Haryana

Ambala

CC/266/2022

Mrs Anju - Complainant(s)

Versus

The New India Assurance Co Ltd - Opp.Party(s)

D.S. Punia

02 Jan 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, AMBALA.

Complaint case no.	:	266 of 2022
Date of Institution	:	15.07.2022
Date of decision	:	02.01.2024

1. Mrs. Anju widow of Late Sh. Neel Kumar.

2. Rahul Chaudhary S/o Late Sh. Neel Kumar

     Both R/o # 22, New Laxmi Nagar, Jandli, Ambala

          ……. Complainants.

                                                Versus

The New India Assurance Company Limited (Centralized Claim Hub MRO-IV (130001) New India Centre, 13th Floor, 17/A, Cooperage Road, Mumbai 40039

                                                                                   ….…. Opposite Party.

Before:        Smt. Neena Sandhu, President.

                              Smt. Ruby Sharma, Member,

           Shri Vinod Kumar Sharma, Member.           

 

Present:       Shri Daljit Singh Punia, Advocate, counsel for the complainants.

                    Shri S.C.Jaiswal, Advocate, counsel for the OP.

Order:        Smt. Neena Sandhu, President.

1.                Complainant has filed this complaint under Section 35 of the Consumer Protection Act, 2019 (hereinafter referred to as ‘the Act’) against the Opposite Party (hereinafter referred to as ‘OP’) praying for issuance of following directions to it:-

i) To pay the claim amount as per the policy in question to the tune of Rs.25 Lakhs

ii) To pay Rs.2,50,000/- as compensation, damages for suffering, special and general damages, for causing harassment, and mental tension, financial loss etc.

iii) To pay Rs. 33,000/- as litigation expenses

OR

Grant any other relief which this Hon’ble Commission may deems fit.

 

2.             Brief facts of the case are that complainant no 1 is the widow of Neel Kumar S/o Kali Ram where as the complainant no. 2 is the son of the said Neel Kumar from his first wife Maya Wati (since deceased). The complainant no. 1 is the legally married wife of the said Neel Kumar and this marriage took place on 6.07.2014. The complainant no. 1 being the wife of and complainant no. 2 being the son from earlier marriage are legally entitled to file and maintain this complaint against the OP. The deceased husband of the complainant namely Neel Kumar (D.O.B. 6.04.1966) was serving in Haryana Police vide unique ID No 6101 TI. He was in service of Haryana Police Department since 1989 and was member/subscriber of the welfare society constituted by the Haryana Police Department. The Haryana Police has a liaison with HDFC Bank for disbursement of the salary of all its employees under a memorandum of understanding (MOU) dated 6-08-2015. Neel Kumar EHC with Belt & Unit No 1354/AMB was holder of Account Number 50100121184112 in HDFC Bank and he was drawing his salary through that account only. HDFC Bank has further provided an insurance cover to all the employees of Haryana Police under the aforesaid MOU with the Haryana Police through the OP. Under the aforesaid arrangement Neel Kumar was provided an insurance cover by the HDFC Bank through the OP vide policy Number 13030042200100000007 and he was entitled to all the benefits prescribed under the said policy, which provided an insurance cover for a sum of Rs. 25 Lakhs in case of personal accidental death of such employee. Neel Kumar sustained grievous injuries in an accident on the night of 4.11.2020, when he was going for his duty on his motor cycle and he succumbed to those injuries and was declared dead by the Doctors in Civil Hospital Ambala City.  Proceeding under 174 Cr.P.C were conducted by the Police after registration of GD No 14 dated 5.11.2020 at PS Sector-9, Ambala City. The body of the injured Neel Kumar was handed over to his family members after  postmortem conducted by the team of the Doctors of Civil Hospital Ambala City, wherein the final opinion about the cause of death was given as :-

" IN OUR OPINION THE CAUSE OF DEATH IN THIS CASE IS DUE TO SHOCK AND HEMORRHAGE AS A RESULT OF INJURIES SUSTAINED IN ROAD SIDE ACCIDENT, BEING ANTEMORTEM IN NATURE. SUFFICIENT TO CAUSE DEATH IN NORMAL COURSE OF NATURE"

3. The welfare committee of the Police Department submitted a claim file with complete documentation for disbursement of death claim to the complainant, who are the only legal heir of the deceased employee Neel Kumar, which was registered in OP office vide claim Number 13030042200190000185 .But to the utter surprise of the Department as well as the complainant the said claim was repudiated by the OP as conveyed to the HDFC Bank Mumbai vide letter dated Nil. The principal Nodal Officer Sh Vipin Gupta then conveyed the rejection of accidental death claim of Late Sh Neel Kumar EHC 1354/AMB to the DGP Head Quarters, Welfare Branch, Panchkula vide letter dated 19.01.2022 which was further conveyed to the S.P. Office Ambala vide letter Number 5378 dated 27.01.2022 and then through the concerned Welfare Inspector, the complainants were informed about such rejection of their genuine claim. After going through the repudiation/rejection letter it is evident that the reason assigned by the OP for rejection of the claim was totally wrong, illegal and erroneous. As per the postmortem report, the cause of death was the result of injuries sustained in the road side accident, but the reason/ground for repudiation has been stated as the accident happed due to dizziness, which is totally contrary to the reason given in the postmortem report. Legal notice dated 02.06.2022 was also served upon the OP in the matter but was of no use. Hence, the present complaint.
4.           Upon notice, the OP appeared and filed written version wherein it raised preliminary objections to the effect that the complainants have not approached this Commission with clean hands and have suppressed material facts from this Commission; that the complaint is involving complicated questions of facts and law which can be decided by civil court only; the complainants have no locus standi to file this complaint; that the deceased insured had not taken any policy covering the risk of death in an accident etc. On merits, it has been stated that it is wrong that Sh. Neel Kumar sustained injuries in an accident while going for his duty. As per Clause 1 of the insurance policy if any person sustained any bodily injury resulting solely, directly from accident caused by external, violent and visible means only then he was eligible for insured amount. Thus the case of insured does not cover the insurance policy in hand because admittedly he suffered dizziness and allegedly fell down on the road resulting into his death. No accident took place of Sh. Neel Kumar with any vehicle of the third party. As per the Police report lodged by the son of the deceased it is submitted that Sh. Neel Kumar his father suffered the dizziness and fell down on the road resulting into injuries suffered by him and he is succumbed to the injuries. The dizziness was occurred due to pre-existing disease. The complainants have not disclosed the existing disease of Sh.Neel Kumar in claim form. Moreover it is not a case of accident rather it is a case of incident. The death of Sh. Neel Kumar has not occurred in an accident caused by any vehicle, animal or by third party in any manner. The dizziness is neither external, violent or visible cause of accident hence the claim was rightly repudiated. Rest of the averments of the complainant were denied by the OPs and prayed for dismissal of the present complaint with costs.
5.           Learned counsel for the complainants tendered affidavit of complainant No.1 as Annexure CW1/A alongwith documents as Annexure C-1 to C-9 and closed the evidence on behalf of complainants.  On the other hand, learned counsel for the OP tendered affidavit of Mona Bagga, Divisional Manager of the OP-company-New India Assurance Co. Ltd., Ambala Cantt. as Annexure RW-1/A, alongwith documents as Annexure R-1 to R-7 and closed evidence on behalf of the OP.
6.           We have heard the learned counsel for complainants and learned counsel for the OP and have also carefully gone through the case file.
7.           Learned counsel for the complainants submitted that by rejecting the genuine claim of the complainants to the tune of Rs.25 lacs, despite the fact that the insured died in the accident, who was covered under the personal accident policy in question, the OP is deficient in providing service, negligent and adopted unfair trade practice. 
8.           On the contrary, learned counsel for the OP submitted that because the insured died because he fell from his motorcycle while feeling dizziness, which fact has not been disputed by the complainants, meaning thereby that it was not an accident or result of outward, violent and visible means, as such, the claim filed by the complainants/legal heirs of the insured was rightly rejected by the OP.  
9.           Neither the issuance of policy in question in favour of the insured nor the fact that he died during subsistence of the said policy is in dispute. It may be stated here that as per the statement (Annexure E)given by Mr.Rahul Chowdhary, son of Mr.Neel Kumar (insured/deceased) to the Police, it is clearly coming out that the insured was going on his motorcycle and suddenly felt dizzy and fell down from his motorcycle, which resulted into head and nose injury and ultimately he died. Under these circumstances, the only moot question which falls for determination is as to whether the complainants are entitled for any claim under the policy in question or not. It is significant to mention here that once it has been candidly admitted by the OP in their repudiation letter Annexure C-1 that the accident of the insured happened due to dizziness which is the proximate cause of leading injuries. Since, the insured due to dizziness fell down from the motor cycle which resulted into head and nose injury and ultimately he died, therefore, his legal heirs are entitled to get the claim amount of Rs.25 lacs  under clause 3 (b) of the MOU dated 06.08.2015, Annexure C-3, wherein, it was clearly mentioned that Total Personal Accident Death Cover for the account holder is Rs.25 lacs.
10.           However, to writhe  out from the situation, ld. Counsel placed reliance on a clause 1 of one page only, Annexure R-3, which is neither signed by the OP nor by the insured and stated that the insured is entitled to claim if the accident is caused by external, violent and visible means. In our considered opinion this document cannot be relied upon by this Commission as nobody is signatory to this documents. Even this much has not been proved that this page or any other terms and conditions were ever supplied to the HDFC Bank or the insured. Thus, no reliance can be placed on the said document, Annexure R-3 is of no use for the OP and is out rightly discarded.
11.           As far as reliance placed by the OP on Smt.Alka Shukla Versus LIC of India, 2019 (2) Apex  Court Judgments 736 (SC)  is concerned, we have full respect to this judgment and it is submitted that in this case the insured died because of heart attack while driving the motorcycle and it was under those conditions held by the Hon’ble Supreme Court that there is no evidence to show that there was any bodily injury suffered due to fall from motorcycle and that the accident took place as a result of outward, violent and visible means, which was a condition precedent in the insurance policy in that case. Whereas, in the present case, admittedly the insured fell dizziness while plying motorcycle, as a result of which he fell from the motorcycle and sustained head and nose injury which is the proximate cause of his death, as has been admitted by the OP also. 
12.           Apart from it, even in Smt.Alka Shukla Versus LIC of India, 2019 (2) Apex  Court Judgments 736 (SC),  the Hon’ble Supreme Court in para no.12 of its judgment has opined that there is no evidence to show that any bodily injuries were suffered due to the fall from the motorcycle or that they led to the assured suffering a heart attack. But in the present case, it is an admitted case and infact has been the specific case of the OP that bodily injuries were suffered by the insured due to the fall from the motorcycle because of dizziness which led to his death as he sustained head and nose injuries.  Thus, reliance placed by   ld. Counsel for the OP on  Smt.Alka Shukla Versus LIC of India, 2019 (2) Apex  Court Judgments 736 (SC), is misplaced.
13.           Thus, in view of peculiar facts and circumstances of this case, in our considered view the OP is deficient in providing service to the complainants by repudiating their claim on false grounds. 
14.           In view of the aforesaid discussion, we hereby allow the present complaint and direct the OP, in the following manner:-
    1. To pay the amount of Rs.25 lacs (insured amount) to the complainants, alongwith interest @6% p.a. from the date of repudiation of the claim, till its realization.
    2. To pay Rs.5,000/- as compensation for the mental agony and physical harassment suffered by the complainant.
    3. To pay Rs.3,000/- as litigation expenses.    

 

The OP is further directed to comply with the aforesaid directions within the period of 45 days, from the date of receipt of the certified copy of the order, failing which the OP shall pay interest @ 8% per annum on the awarded amount, from the date of default, till realization. Certified copy of this order be supplied to the parties concerned, forthwith, free of cost as permissible under Rules. File be indexed and consigned to the Record Room.

 Announced:- 02.01.2024.

 

(Vinod Kumar Sharma)	(Ruby Sharma)	(Neena Sandhu)
Member	Member	President