Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 475.
Instituted on : 22.12.2014.
Decided on : 08.08.2016.
Surajmal s/o Sh. Bhisham age 52 years, r/o village Bhagwatipur, Teh. & Distt. Rohtak.
………..Complainant.
Vs.
- Tata AIG General Insurance Company Ltd. 501-V Manjil, Building No.4 Din- Doshi Madal(E) Mumbai-400097 through its Manager.
- Tata AIG General Insurance Company Ltd., through its Divisional Manager, Narain Complex, Rohtak.
……….Opposite parties.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
SH. VED PAL, MEMBER.
Present: Sh. Devrat Dalal, Advocate for the complainant.
Sh.Gulshan Chawla, Advocate for the opposite parties.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that the son of the complainant was owner of vehicle no.HR-46D-15679 which was insured with the opposite party vide cover note no.064001/0140125271/00000/000 for the period from 31.07.2013 to 30.07.2014. It is averred that on 07.03.2014 son of complainant had gone to Palwal with his truck as a driver after reaching there he felt some pain in the heart and lastly due to heart failure the son of the complainant had died. It is averred that the matter was reported to the police and after recording the statement of the complainant registered the DD report no.08 dated 08.03.2014 and get conducted the postmortem of the dead body of Sukhbir. It is averred that after the death of Sukhbir Singh, the complainant sent the documents through registered post to the opposite party and requested them for the payment of compensation/claim and benefits of the policy and fulfill all the formalities of the company. It is averred that till today opposite party neither gave any reply to the application for the complainant dated 12.08.2014 nor they released the benefits of the policy in favour of the complainant. It is averred that the act and conduct of the opposite party is illegal and amounts to deficiency in service. It is, therefore, prayed that the complaint may kindly be allowed and opposite party may kindly be directed to pay the claim amount of Rs.200000/- alongwith interest, compensation and litigation expenses to the complainant.
2. On notice, the opposite parties appeared and filed their written reply submitting therein that it is admitted that the vehicle of the complainant was insured with the opposite party for the period from 31.07.2013 to 30.07.2014. It is averred that the son of the complainant namely Sukhbir having gone to Palwal and there he felt heart pain and died by heart failure. It is averred that first intimation with respect to death of Mr.Sukhbir was received by the answering opposite party through the summon from Hon’ble Forum on 31.12.2014 and the action of complainant in delayed reporting of claim stands in violation of policy condition no.1. It is averred that on scrutiny of the documents submitted by the complainant during the pendency of the case, it was noted that the claim of the complainant was not payable as death of Mr.Surajmal had not resulted by accident while driving insured vehicle. Rather, he had died to heart seizure. The police official has also filed “Death report from natural cause” and not from accident. The PMR and DD No.8 also confirms the fact. Hence the answering opposite party is not liable to pay for the present loss and repudiation letter dated 13.08.2015 to the effect was sent to the complainant. All the other contents of the complaint were stated to be wrong and denied. Opposite parties prayed for dismissal of the complaint with costs.
3. Both the parties led evidence in support of their case.
4. Ld. counsel for the complainant in his evidence tendered affidavit Ex.C1/A, documents Ex.C1 to Ex.C8 and has closed his evidence. On the other hand, ld. Counsel for the opposite parties in his evidence tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R4 and has closed his evidence.
5. We have heard learned counsel for the parties and have gone through the material aspects of the case very carefully.
6. In the present case insurance and death of Sukhbir Singh is not disputed. It is also not disputed that after the death complainant filed the claim with the opposite party but the opposite party has repudiated the claim of the complainant vide letter Ex.R4 on the ground that as per Section IV-Personal Accident cover for owner, the company is liable to pay the claim in case the death sustained by owner-driver is caused due to violent accidental external and visible means. But in the instant case Mr. Sukhbir had died due to sudden natural cause and there was no accident to the vehicle insured, thus no liability can be assumed by us for his death.
7. After going through the file and hearing the parties it is observed that the claim of the complainant has been repudiated by the opposite parties on the ground that the insured Sukhbir Singh had not died out of accidental injuries resulting from insured vehicle. In this regard it is observed that as per policy Ex.C5 the owner-driver is also insured under the policy upto Rs.200000/- for which Rs.100/- is voluntary deductible for the policy. It is also observed that as per the documents e.g. Death report Ex.C6 annexed with DD Report, son of the complainant had gone to Palwal on his vehicle and on his way while driving the insured vehicle he had died due to heart failure. But the claim of the complainant has been repudiated by the opposite party on the ground that the insured had not died accidental death and it was a natural death. In this regard reliance has been placed upon the law cited in 2006(1)JRC 47 titled as Deepak Jaiswal Vs. Oriental Insurance Co. whereby Hon’ble National Commission has held that: “Repudiation on the ground that death was due to hypertension which resulted in brain haemorrhage-Deceased fell down while going to bathroom-From this it cannot be presumed that he fell down because he was suffering from hypertension-Cause of death mentioned in copy of death report as accidental fall from the stairs-Repudiation unjustified”, as per 2008(1)CLT 70 titled Rita Devi Vs. National Insurance Co. Ltd. & Ors., Hon’ble National Commission has held that: “When two reasonable interpretations of the terms of the policy are possible, the interpretation which favours the insured is to be accepted and not the interpretation which favours the insurer. It is further held that accident means: “An unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could, not be reasonable anticipated”. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case, it is observed that the death of insured Sukhbir Singh due to heart failure while driving the vehicle was accidental death and hence the opposite parties are liable to pay the claim amount as per policy. As per owner-driver clause of the policy, the deceased was insured for Rs.200000/- under the policy.
8. In view of the facts and circumstances of the case, it is observed that opposite parties shall pay a sum of Rs.200000/-(Rupees two lac only) alongwith interest @ 9% p.a. from the date of filing of present complaint i.e. 22.12.2014 till its realization and shall also pay a sum of Rs.3500/-(Rupees three thousand five hundred only) as litigation expenses to the complainant maximum within one month from the date of decision failing which the opposite parties shall be liable to pay further interest @ 12% p.a. on the awarded amount from the date of decision. Complaint is allowed accordingly.
9. Copy of this order be supplied to both the parties free of costs. File be consigned to the record room after due compliance.
Announced in open court:
08.08.2016.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
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Ved Pal, Member.
