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

==========

Complaint Case No:1489 of 2009

Date  of  Institution :   10.12.2009

Date of   Decision   :   16.05.2011

Nazar Singh Bhullar son of Sh.Mukhvinder Singh, R/o House No.3236, Sector 46-C, Chandigarh.

….…Complainant

                                       V E R S U S

1]       The New India Assurance Company Ltd., Kuthila BLDG, Lower Bazar, Kalka, District Panchkula.

2]       The New India Assurance Company Ltd., SCO No.332-34, Sector 35-A, Chandigarh.

          ..…Opposite Parties

CORAM:          SH.LAKSHMAN SHARMA                         PRESIDENT

SH.ASHOK RAJ BHANDARI            MEMBER

MRS.MADHU MUTNEJA                        MEMBER

Argued by:     Sh.H.S.Chawla, Advocate for the complainant.

                        Sh.D.K.Dogra, Advocate for the OPs.          

PER ASHOK RAJ BHANDARI, MEMBER

­­­­­­­

                The brief facts of the case are as under:-

                That the complainant had purchased one Personal Accidental Policy (Ann.C-1) insuring his wife Harinder Kaur Bhullar against any Accidental Injury/Death, effective from 3.11.2008 to 2.11.2009.  Unfortunately, Mrs.Harinder Kaur Bhullar, expired on 2.3.2009 (Ann.C-2).  The matter was brought to the knowledge of local police as well as OP Insurance Company.  Sh.K.N.S.Sodhi, Investigator, appointed by the OPs, also investigated the matter. The complainant supplied all necessary documents to OPs to settle his claim but it was not done.  Ultimately a legal notice was sent to OPs on 18.11.2009, which too was not replied to.  It is averred that the OPs have failed to settle the claim even after expiry of nine months till the date of filing of the complaint.  Thus this complaint has been filed alleging the above act of OPs as gross deficiency in service.

2]             The OP in their reply have stated that there was no deficiency in service on their part.  Despite repeated letters/reminders by the OPs and Investigator Sh.K.N.S.Sodhi deputed by OP, the complainant never supplied all the documents essential for the settlement of the claim.  There was no F.I.R. and the postmortem report did not show/establish the cause of death as to whether the same was accidental or otherwise/intentional(suicidal).  In fact, the cause of death had not been established till date. No supporting document showing death resulting solely and directly from accident caused by external, violent and visible means were ever supplied by the complainant.  Accordingly, the claim was filed as “Closed/No Claim” vide letter dated 9.7.2009 (Ann.R-4) on account of non-compliance of formalities as required by the OPs.  Denying rest of the allegations, it is prayed that the complaint be dismissed.

3]             Parties led evidence in support of their contentions.

4]             We have heard the ld.Counsel for the parties and have also perused the record.                       

5]             The basic facts of the case have already been incorporated in the foregoing paragraphs.

                The case of the complainant against the OPs is that he had purchased one Individual Personal Accident Policy (Ann.C-1) for a total sum of Rs.9.00 lacs after paying premium including the basic premium and extension fee for medical expenses to the tune of Rs.1011/- in the name of his wife Mrs.Harinder Kaur Bhullar for a period of one year from 3.11.2008 to 2.1.2009.  This policy issued by the OPs covered both the personal accident (Death) as well as medical expenses as a result of injury due to Accident. As per the complainant, his wife expired on 2.3.2009.  Ann.C-2 is the Post Mortem Report, done on the body of life assured, issued by Government Medical College Hospital, Sector 32, Chandigarh.  The opinion given by the doctors in the Post Mortem Report is as under:-

“Definite cause of death in the case cannot be given at the moment of time.  Visra of the deceased is seal & packed in my presence and handed over to the police for the histopathological Analysis.  Definite cause of death can be given after the report will come.”    

6]             The claim of the complainant is that his wife/Life Assured (L.A.). had got electrocuted while washing clothes in the Bathroom due to coming in contact with the live electric heating rod, which was in use.  A DDR was also registered by the Police on the spot. 

                The statements of a few witnesses including Sh.Nazar Singh, Husband of the L.A. were also recorded by the police.  After completing the necessary formalities at the spot of the accident, the Police took the body of Smt.Harinder Kaur in an unconscious state to Govt. Medical College & Hospital, Sector 32, Chandigarh where the doctors declared her brought dead.  The husband of the deceased/LA as well as other witnesses categorically stated before the police that the deceased got electric shock while she was using the electric rod for washing the clothes in the Bathroom and that there was no foul play.  On that basis, the police also recorded in the DDR that no cognizable offence was made out and accordingly, the Inquest Report was sent to the concerned quarter. 

7]             The complainant had accordingly lodged a claim with the OPs and the OPs appointed an Investigator Sh.K.N.S.Sodhi, who after due investigation submitted his report on 10.9.2009 (Ann.R-8).  The report submitted by the investigator was only an interim report stating that since as per the Post Mortem Report, the exact cause of death could not be given at that moment, the final report will be given only after receiving Visra Report from the Pathology Lab. As such, the report of the Investigator remained inconclusive till then. 

                There is one more Report titled as Death Report –Sudden death from natural causes (Ann.C-8) dated 2.3.2009 issued by the Police Department in which same facts as in the DDR have been repeated especially stating that there were several injury marks and signs of bleeding on the various parts of the body of the deceased life assured.  

8]             Finally, Govt. Medical College & Hospital, Chandigarh, Department of Forensic Medicine & Toxicology, has issued the ‘Final opinion regarding Cause of Death’, dated 8.8.2009 which is marked as Ann.A, the relevant portion of which is quoted below:

“Based on the report referred to above and findings of Post Mortem examination conducted by me/us, I/We am/are of the opinion that No definite opinion can be given on the basis of histopatho report.  The cause of death is due to Electrocution”

                Based on the above said final opinion regarding cause of death, the complainant has alleged that although he made a genuine/bonafide claim but the OPs have not paid the claim so far while declaring it as a Closed/No Claim case inspite of his completing all the formalities for processing the same. 

9]             The OPs in their written statement/reply have taken some preliminary objections saying that the case of the complainant was filed as Closed/No Claim on account of non-compliance of required formalities and also due to violation of the terms & conditions of the policy.

                As per the OPs, the contract of insurance was subject to terms & conditions and exclusion clauses of the policy which was effected in utmost good faith, whereas the complainant/life insured concealed and mis-represented the material facts at the time of taking insurance coverage.  But there is no document on record, and not even a shred of any evidence to show what kind of information or documents were called for by the OPs from the complainant/Life Assured at the time of issuance of the insurance policy and that the complainant/Life Assured had failed to give those documents to them.  As a matter of fact, as per sound insurance principles, if the life insured had not supplied the requisite documents in the first instance, the OPs should not have issued the insurance policy at all.  Whereas the company accepted the premium in full without raising any objection whatsoever and also issued an insurance policy in the name of the Life Assured and thereafter when some accident took place and the life assured died, they should not have asked any such question in respect of the information or document allegedly not supplied to them at the time of issuance of the policy.  Therefore, this preliminary objection taken by the OPs is completely invalid & baseless and hence rejected.

10]            In its reply on merits, the OPs have taken the stand that in the Post Mortem Report (Ann.C-2) the exact cause of death was not mentioned and therefore, the claim in question was not admissible as per terms & conditions of the Insurance Policy.  Further, that the Investigation Report of the police does not reveal the mode and manner of the mishap and also the exact cause of death of the Life Assured.  There is already a document on record dated 8.8.2009 (Ann.A), which is the final opinion of Govt. Medical College & Hospital, (Department of Forensic Medicine & Toxicology), Chandigarh in which the exact cause of death has been specifically stated as “Death Due to Electrocution”, since no definite opinion could be given on the basis of Histopath Report.  Therefore, this report has since given a specific and concrete cause of death of the life assured i.e. Mrs.Harinder Kaur Buullar whereas the Accidental Death Claim of the Life Assured was rejected by the OPs on an earlier date i.e. 9.7.2009 without even waiting for the final report in respect of establishing the exact Cause of Death.  Therefore, even the second objection taken by the OPs to declare the claim of the complainant as Closed/No Claim in the absence of ascertaining the exact cause of death also holds no valid ground and hence rejected.  In addition, it is also clearly a case of unfair trade practice on the part of OPs.

11]            Another plea taken by the OPs in their reply/written statement and also during the course of arguments, is that there is no supporting document attached by the complainant showing death of the life assured resulting solely and directly from accident caused by external, violent and visible means and that in the absence of any such document, the claim of the complainant is not admissible for payment.

                In this regard, the meaning of two relevant words i.e. “accident” and “electrocution” as defined by International Standard Dictionaries are as under:-

a)        As per Funk & Wagnall’s Standard Desk Dictionary these words as defined are as under:-

“accident” means

“anything occurring unexpectedly or without known cause, any unpleasant or unfortunate occurrence involving Injury, Loss or Death.”

“Electrocution” means 

“Killing by electricity.”

b)        As per Webster’s New World Dictionary issued by Oxford & IBH Publishing Co. Pvt. Ltd., these words are defined as under:-

“accident”  means

“a happening that is not expected, foreseen, or intended, an unintended happening that results in injury, loss, etc.”

“Electrocution”  means

“to kill with a charge of electricity.”

                    Keeping in view the aforesaid standard meaning of the words “accident” and “electrocution” and in view of the fact that a Government Hospital i.e. Govt. Medical College & Hospital, Sector 32, Chandigarh having a specialized department of Forensic Medicine & Toxicology has given a report pin-pointing and specifying the exact cause of death, which is “electrocution”,  there is not even an iota of doubt that the life assured had died because of electrocution, which is clearly covered under the definition of accident.  Further, the death due to accident is a part & parcel of the terms & conditions of the insurance policy, the fact, which has also been admitted by the OPs themselves.

12]            In view of the above detailed discussion and analysis of entire matter, we are of the considered opinion that the complainant has been fully able to prove and establish his case in respect of his insurance claim of Rs.9.00 lacs against the OPs.  All the objections taken by the OPs have already been countered, replied to and fully rebutted by the complainant with documents and solid arguments whereas the OPs’ have completely failed to establish and prove their case.  As such, there is a lot of merit, weight and substance in the present complaint, which deserves to be accepted.  We therefore allow this complaint in favour of the complainant and against the OPs and pass the following order.

13]            The OPs shall jointly & severally pay the following amounts to the complainant:

i)         To pay Rs.9.00 lakh as the insurance claim being the sum assured in respect of deceased Life Assured Harminder Kaur Bhullar, to the complainant, who is the assignee of the Insurance Policy in the name of deceased/LA, along with interest  at the rate of 9% p.a. from the date of filing this complaint i.e. 10.12.2009 till the date of actual payment.

ii)        To pay Rs.7000/- as cost of litigation.

                The aforesaid order be complied with by the OPs jointly & severally,  within a period of 30 days from the receipt of its certified copy, failing which the OPs shall, jointly and severally, pay the amount of Rs.9.00 lacs along with interest @18% per annum from the date of filing the present complaint i.e. 10.12.2009 till the date of actual payment besides paying Rs.7000/- as cost of litigation.

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

Announced

16.05.2011                                                                                

(LAKSHMAN SHARMA)

PRESIDENT

                                                           (ASHOK RAJ BHANDARI)

MEMBER

(MADHU MUTNEJA)

MEMBER