Haryana

Ambala

CC/329/2011

SMT.URMILA DEVI W/O RAM LAL - Complainant(s)

Versus

THE RELIANCE GENERAL INSURANCE CO. - Opp.Party(s)

K.C.JAIN

28 Nov 2016

ORDER

                       BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AMBALA.

 

              Complaint Case No.    : 329 of 2011

Date of Institution       : 10.10.2011

         Date of Decision         : 28.11.2016

 

 

Smt. Urmila Devi W/o Late Sh. Ram Lal S/o Sheo Ram R/o Khuda Kalan P.O. Ambala Cantt,Tehsil & District Ambala.

……Complainant.

 

Versus

 

1.         The Reliance General Insurance Co.Ltd. through its

(i)        Sales Manager, Branch Office,IInd Floor,SCO No.97, Prem Nagar,Ambala City.

 

(ii)       Regional Manager, Regional Office, Ist Floor, SCO 212-214, Sector 34-A, Chandigarh.

 

2.         Sub Divisional Officer (Civil), Mini Secretariat, Ambala being the Nodal Officer for the District of Ambala under Rajiv Gandhi Pariwar Bima Yojna.

 

3.         District Social Welfare Officer for the District Ambala, Ambala City.

 

                                                                                    ……Opposite Parties.

 

Complaint Under Section 12 of the Consumer Protection Act

 

BEFORE:       SH. D.N. ARORA,  PRESIDENT.

                        SH. PUSHPENDER KUMAR, MEMBER.

                       

Present:          Sh. K.C. Jain, Adv. counsel for complainant.

                        Sh. Mohinder Bindal, Adv. counsel for OP No.1.

Sh. Amitender, Investigator on behalf of OP No.3.

Op No.2 exparte.  

 

ORDER.

 

                        In nutshell, brief facts of the complaint are that husband of complainant died on 27.06.2008  at Govt. Medical College, Chandigarh due to 75 % burn injuries received by him from the domestic stove while he was preparing tea.  It has been submitted that at the time of the incident, a social welfare scheme called ‘Rajiv Gandhi Pariwar Bima Yojana’ (RGPBY) was in force for the period from 28.03.2008 to 27.03.2009 in the State of Haryana for the benefit of the all the families of the State having age 18 to 60 years except the income tax payee, Govt. Servants and employees of Public Sector Undertakings etc. As per the scheme, the legal heir of such person who happen to die in a rail/road/air accident or burn injuries etc. were to be compensated with a sum of Rs.1.00 lac by the insurer Op No.1. OP No.2 & 3 were nominated for implementation of the said scheme. So, the family of the complainant was covered under the scheme and necessary documents for the claim were submitted with OP No.2 being Nodal Officer who forwarded the said claim vide  memo No.58-60/MC dated 15.12.2008  to the Op Insurance Company for making the payment of Rs.1,00,000/- to the complainant but surprisingly enough, no payment has been received till date by the complainant despite visiting several visits.  So, a legal notice  dated 16.03.2011 got served upon the Ops  and OP No.2 issued a reminder to Op No.1  for getting information about the action taken in the matter with a copy of  endorsement  to the complainant but despite that no amount has been released to the complainant.  Hence, the present complaint seeking relief as per prayer clause.

2.                     Upon notice, OP no.1 appeared through counsel and tendered reply raising preliminary objections qua cause of action, jurisdiction and suppression of material facts. On merits, it has been submitted that as per investigation conducted by investigator M/s Royal Associates, the deceased was under the influence of alcohol at the time of alleged accident with stove whereas the answering OP is liable to pay only those claim which falls within the purview of terms and conditions of the insurance policy.  And as per MOU being executed with the Govt. of Haryana wherein it has been specifically mentioned in clause 3(ii)(B)(a)  that the death whilst under the    influence of alcoholic drinks or drugs does not come under the purview of this insurance scheme and thus the legal heirs of such victims are not entitled to any compensation as per the MOU and terms & conditions of the  insurance policy.  It has been submitted that M/s Royal Associates was immediately deputed to investigate the matter and to give fact finding report who submitted his report dated 06.01.2009 and the Ops after going through the report, OP held the claim of complainant not admissible and the same was repudiated since the deceased Ram Lal under the influence of alcohol at the time of suffering injuries and thereby death. As such, the answering OP has submitted that they are not at fault in any manner and prayed for dismissal of complaint with costs.

                        Op No.3 tendered its reply stating that  they have launched the scheme  namely Rajiv Gandhi Parivar BIma Yojna w.e.f 28.03.2008 to 27.03.2009 and paid  a sum of Rs.17.85 crores to the OP No.1 Reliance General Insurance Company Ltd. in lump sum to insure all the families of State of Haryana   except the deceased may not have income tax payee, Govt. Servants and Public Sector Undertaking etc. are  covered under Group Insurance Scheme. As such,  the answering OP is not responsible  for anything  except to appoint an arbitrator, acceptable to both the parties  i.e. Govt. of Haryana & Reliance General Insurance Company Ltd., if some dispute  arises in the implementation of the same.

3.                     To prove their version, counsel for complainant tendered affidavit of complainant Urmila Devi as Annexure CX alongwith documents as Annexures C-1 to C-15 and closed their evidence.  On the other hand, counsel for Op No.1 tendered affidavits Annexure RX & RY alongwith documents Annexures R-1 to R-5 and closed their evidence. OP No.3 tendered affidavit of Sh. Vishal Saini, DSWO, Ambala as Annexure RX and tendered in evidence documents Annexure R-6 and closed their evidence.

4.                     We have heard learned counsel for the parties and gone through the record very carefully.  It is not disputed that on 01.06.2008, the day of receiving burn injuries by husband of complainant Ram Lal, he was covered under a group insurance scheme namely ‘Rajiv Gandhi Pariwar Bima Yojana’ launched by Haryana Govt. to its domiciles. Counsel for the complainant has argued that the Ops have wrongly repudiated the claim of complainant on the ground that on the day of occurrence husband of complainant was under the influence of alcohol.

                        On the other hand,  counsel for Ops to prove the factum that on the day of  incident Ram Lal was under the influence of liquor has placed on record Copy of MLR dated 01.06.2008 conducted at Civil Hospital, Ambala Cantt (Annexure R-2) Report of Investigator M/s Royal Associates (Annexure R-3), statement of Urmila Devi wd/o Ram Lal got recorded by the Investigator as (Annexure R-4) wherein it has been stated that  her husband Ram Lal was a labourer and a drunkard person. On 01.06.2008 at about 6.00 P.M., he was under the influence of liquor and while preparing tea at stove, his clothes caught fire and  he was initially saved by neighbourers and then brought to Civil Hospital, Ambala Cantt and was referred to Govt. Medical College, Chandigarh where he succumbed to the injuries  on 27.06.2008 and his post mortem was done on 28.06.2008.  It has also been stated that  she is having  three children and  the family has no source of income and prayed that she  may be given relief under Rajiv Gandhi Pariwar Bima Yojana.  The statement of complainant has also been supported by the statement of Smt. Mewa Devi, Sarpanch of village of complainant who deposed on the same line as that of complainant. OP No.3 has placed on record terms & conditions of the policy Rajiv Gandhi Parivar Bima Yojna (Annexure R-6) clause 7 & 9 of this document are reproduced as under:-

7. MODE FOR CLAIMING PAYMENT:

(i)        All the documents mentioned above shall be submitted by the insured or legal heir/nominee of the deceased, as the case may be to the Sub-Divisional Officer (Civil)/Nodal Officer who in turn shall refer all the relevant papers alongwith his recommendations to the insurer at the nearest Division/Branch Office of the insurer for releasing the payment as indicated above. The Sub Divisional Officer (Civil)/Nodal Officer shall be assisted by District Social Welfare Officer  and Divisional Manager/Branch manager of the insurance company for completion of required documents for immediate release of compensation.

(ii)       Compensation amount in the form of bank draft or cheque shall be prepared and submitted by the insurer within a period of seventy two hours of the receipt of required documents to the Sub Divisional Officer (Civil)/Nodal Officer who in turn shall disburse the same to the insured or legal heir/nominee of the deceased as the case may be under intimation to the Deputy Commissioner and Director, Department of Social Justice and Empowerment, Haryana, Chandigarh.

                                    9.REJECTION OF CLAIM:

The insurer shall not reject any claim at its own level. In case of any doubt, the claim shall be referred to the Nodal Department i.e. Director, Social Justice and Empowerment, Haryana who shall consider the whole matter and pass a speaking order and his order shall be final.  

5.                     As per document Annexure C-5,   the SDO (C), Ambala sent the case of complainant to the Op No.1 Insurance Company with the recommendations that ‘The claim form alongwith proof of age, ration car, copy of FIR and postmortem report is being enclosed. The report received from Tehsildar enclosed  in original. The applicant is spouse/wife of deceased and is eligible for compensation as per term & conditions of the scheme’.  But the same was repudiated by Op No.1 insurance company on the ground that ‘Deceased was under the influence of alcohol at the time of accident and thus the RGPBY/Policy does not cover  such act’.

6.                     In view of the clause 9 of the term of conditions of the policy, we are of the view that Op insurance company has no power to repudiate any claim  under Rajiv Gandhi Parivar Bima Yojna and thus the act of the Ops is violation of terms & conditions of the policy, hence, the same is illegal and violation of the policy conditions.  As such, repudiation letter of OP No.1 Insurance company is set aside.  Therefore, the case of complainant is sent to the Nodal Department i.e. Director, Social Justice & Empowerment, Haryana for disposal as per the letter bearing memo no.786SW(4) dated 15.04.2008 under Rajiv Gandhi Parivar Bima Yojna (Annexure R-6), as per law.  Complaint is disposed off accordingly.  Copy of the order be sent to the parties concerned, free of costs, as per rules. Assistant of the Forum is directed to send all relevant document alongwith the copy of order to the concerned authority. File after due compliance be consigned to record room.

                                                                                                     Sd/-

ANNOUNCED ON :28.11.2016                                           (D.N. ARORA)

                                                                                                     PRESIDENT 

                                                                                           Sd/-

                                                                              (PUSHPENDER KUMAR)

                                                                                                          MEMBER