DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, U.T. CHANDIGARH

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M/s Suraj Mectech Pvt. Ltd. Office at C-44, Phase-III, Indl. Area, Mohali District Mohali, through its Managing Director Mr. N.Sreedharan.

                   --- Complainant

V E R S U S

[1]     The New India Assurance Co. Limited, Branch Office: Jeevan Parkash Building, 2^nd Floor, Sector 17-B, Chandigarh, through its Branch Manager.

[2]     Manager, Non-Motor Claim Hub, The New India Assurance Co. Limited, Regional Office, SCO No. 36-37, Sector 17-A, Chandigarh. {Deleted vide order dated 05.10.2012}

---- Opposite Parties

BEFORE:      SH. LAKSHMAN SHARMA                    PRESIDENT

MADHU MUTNEJA                               MEMBER

                   SH.JASWINDER SINGH SIDHU             MEMBER

Argued By:             Sh. Baldev K. Behl, Counsel for Complainant.

Sh. Sanjeev K. Arora, Counsel for Opposite Party No.1

Opposite Party No.2 deleted

PER JASWINDER SINGH SIDHU, MEMBER

1.                Briefly stated, the Complainant had taken a “Workmen Compensation (WC) Insurance Policy” from the OP, valid from 17.8.2011 to 16.2.2012, for its 15 employees/workers, who were engaged in shop or yard or in construction of building excluding blasting and tunneling and their monthly wages were upto Rs.4000/-, by paying a premium of Rs.8778/- (Annexure C-1). One of its employee, namely - Rajinder Kumar s/o Sh. Maan Singh, who was covered under the aforesaid Policy, met with an accident on 20.8.2011 at 2.10 PM, while working at the work site of Complainant at M/s Semi Conductor Laboratories, Sector 72, Mohali. He was taken to PGI, Chandigarh, where he last breathed on 25.8.2011. The Complainant claims that it was an accidental death and nobody was responsible for it. Medical certificate of cause of death is at Annexure C-2. A DDR No. 11, dated 26.8.2011 was registered with the Police Station Industrial Area, Phase 8-B, Mohali on the statement of the wife of the deceased. Copies of DDR, Death Certificate and Postmortem are at Annexure C-3 to C-5.  Thereafter, the Complainant has submitted “Report of accident to workman” and filled the claim form, with the OP, for the compensation of death claim of Rajinder Kumar and completed all the formalities. However, vide letter dated 21.05.2012/6.6.2012, the OP rejected the claim, which according to the Complainant tantamounts to gross deficiency in service and unfair trade practice. Hence, the present complaint. 

2.                Notice of the complaint was sent to Opposite Parties seeking their version of the case.  

3.                Opposite Party No.1, its reply admitted the issuance of the policy in question, for 15 employees whose monthly wages were not upto Rs.4,000/-. It is asserted that employees with monthly wages above Rs.4,000/- were not covered under the policy. A claim was reported on the policy in question on 23.8.2011 vide letter dated 20.8.2011 (Annexure R-1) that Sh. Rajinder Kumar, reportedly an employee of the Complainant, met with an accident on 20.8.2011 and died on 25.8.2011. It is pleaded that the case was duly investigated and in the investigation, it was brought to the notice of the answering OP that though the name of the deceased was shown in the salary statement getting Rs.16,000/- p.m. from April 2011 to July 2011 (Annexure R-2 to R-5), however, the closer scrutiny of the salary statement showed that he was neither shown as employee in the summary given at the bottom of the statement nor ESI was deducted every month. This fact was corroborated by the Col.8 of the claim form attached by the Complainant as Annexure C-6 with the complaint, wherein it has been mentioned that the deceased Rajinder Singh was working with the Complainant on contract basis. Further the deceased never signed on any salary statement while receiving salary, rather one Gajender used to sign on the salary statement. It all shows that the deceased Rajinder Kumar was not the employee of the Complainant. It is further brought on record that premium received by the Insurance Company is based on the risk involve. Higher the risk higher is the premium. Had the Complainant intended to cover the employees getting salary of more than Rs.4,000/- p.m., the premium payable to the OP would have been much more. So, the claim was rightly repudiated as the same was not covered under the policy. Denying all other allegations and stating that there is no deficiency in service or unfair trade practice on its part, opposite party No. 2 has prayed for dismissal of the complaint.  

4.                On a separate statement given by the learned counsel for the Complainant to the effect that he do not press this complaint against OP No.2, the name of OP No. 2 was ordered to be deleted from the array of OPs vide order dated 05.10.2012.

5.                We have heard the learned proxy counsel for the Complainant and have perused the record, along with the written arguments filed on behalf of the Complainant.

6.                The present complaint has been moved by the Complainant firm through its Managing Director on the basis of having subscribed for a workmen Compensation Insurance Policy for its employees engaged in work in shop or yard or construction of building of the Complainant. The said policy excluded the acts of blasting & tunneling and also the employees whose wages were more than Rs.4000/- per month. The said policy commenced from 17.8.2011 and was valid up to 16.2.2012. A premium of Rs.8778/- was paid against it. A copy of the policy is annexed at Annexure C-1.

7.                The main grouse of the Complainant is against the Opposite Party No.1 on the ground that one of its employees namely Rajinder Kumar met with an accident on 20.8.2011 while working at the site of the Complainant and was admitted in the PGI Chandigarh where he finally breathed his last on 25.8.2011. The medical report specifically mention the cause of death of Late Rajinder Kumar as accident. The medical certificate to this effect is Annexure C-2.  The Complainant lodged a claim with the Opposite Party No.1 on the basis of the WC Insurance Policy, subscribed by it. But, however, is aggrieved of the non-settlement of the claim of Late Rajinder Kumar, by the Opposite Party No.1. 

8.                The Opposite Party No.1 vide its rejection letter dated 21.5.2012/6.6.2012 repudiated the claim of the Complainant citing the reason that the Late Rajinder Kumar was drawing the monthly wages of Rs.16000/- per month which is higher than the limit of Rs.4000/- for the employees for whom the policy was subscribed for. The Opposite Party No.1 also quoted the contents of salary statement and the summary attached with the claim form, and the reason that the Late Rajinder Kumar’s name did not figure in the wages register with ESIC. Hence, there was no proof of any deduction on his account in monthly statement. Thus, concluding that the claim of the Complainant is not maintainable and was repudiated on aforementioned grounds.

9.                The Complainant while alleging deficiency in service on the part of Opposite Party No.1 and also unfair trade practice though has preferred the present complaint, but at the same time, no new document apart from the ones tendered with Opposite Party No.1 has been brought on record to falsify the stand of Opposite Party No.1, nor there is any document that would fortify the claim of the Complainant, so as to enable this Forum to find reasons for deficiency in service against Opposite Party No.1.  We have perused the document Annexure C-6 which is a report of “Accident to  Workman” tendered with Opposite Party No.1 by the Complainant which is dated 2.9.2011, which also contains the statement of wages and under clause 6, the wages for the month of April to August, 2011, it is clearly found mentioned that Rs.16000/- was being paid by the Complainant to Late Sh. Rajinder Kumar every month as wages. The said document is found stamped and duly signed by the Managing Director of the Complainant. Hence, the Complainant having itself admitted to the fact that Late Rajinder Kumar was being paid wages of Rs.16000/- p.m., could not lodge a claim with Opposite Party No.1 under the aforementioned policy, which was only meant to cover the employees of the Complainant who were earning the wages upto Rs.4,000/- as per the clause of Annex.C-1 policy schedule, subscribed by the Complainant.  Hence, the Complainant was wrong in including the name of Late Sh. Rajinder Kumar in the list of its employees, to be covered under the policy in question, and lodging a claim with the Opposite Party No.1, for the loss suffered by it in his death.  In the present situation, the Complainant has miserably failed to prove its case of deficiency in service against the Opposite Party No.1 by leading a cogent evidence to prove its averments. 

10.              In the light of above observations, we are of the concerted view that the present complaint deserves dismissal. Hence, the present complaint of the Complainant is dismissed. There is no order as to costs.         

11.              Certified copy of this order be communicated to the parties, free of charge. After compliance file be consigned to record room.

Announced

05^th April, 2013.                                           

Sd/-

(LAKSHMAN SHARMA)

PRESIDENT

Sd/-

 (MADHU MUTNEJA)

MEMBER

Sd/-

(JASWINDER SINGH SIDHU)

MEMBER

 “Dutt”