Order by:

Smt.Priti Malhotra, President

1.       The complainant has filed the instant complaint under section 35 of the Consumer Protection Act, 2019 stating that Tarsem Singh (now deceased) i.e. husband of the complainant purchased a policy bearing no.2012004222P101305162 named ‘Individual Personal Accident policy’ for the period 13.05.2022 to 12.05.2023 and sum assured under the policy was Rs.5 lakh. Unfortunately on 20.01.2023 at about 7.00 pm when he was coming back to his house on his scooter, when he reached  near school at Godhewala, G.T. Road, Moga his scooter got slipped on road side and he fell down from the scooter and got admitted in Civil Hospital, Moga and where he was declared dead. DDR no.25 dated 21.01.2023 was recorded by P.S. City Moga and proceeding u/s 174 of Cr.P.C. was conducted by the police. After the death of her husband, complainant lodged the claim with Opposite Parties and completed all the formalities, but despite that Opposite Parties did not pay any claim amount to complainant and thereafter vide letter dated 08.08.2023 repudiated the claim on the ground that vehicle was unfit for drive on road or public place as RC of the same expired on 02.06.2018 and at the time of accident Tarsem Singh was not having valid driving license. It is alleged that the complainant approached the Opposite Parties time and again for getting the claim, but the Opposite Parties did not paid any heed to the request of the complainant. Due to such act and conduct of Opposite Parties, the complainant has suffered mental tension and harassment. Hence, this complaint. Vide instant complaint, the complainant has sought the following reliefs:-

a)       Opposite Parties may be directed to pay Rs.5 lakh on account of death claim of her husband alongwith future interest @ 12% p.a. from the date of death till actual realization.

b)      To pay an amount of Rs.2,00,000/- as compensation on account of mental tension and harassement.

c)       To pay Rs.50,000/- as litigation expenses.

d)      And any other relief which this Commission may deem fit and proper be granted to the complainant in the interest of justice and equity.

2.       Opposite Parties appeared through counsel and contested the complaint by filing written reply taking preliminary objections therein inter alia that the complaint of the complainant is not maintainable as per law; the complainant has got no locus standi to file the present complaint; no cause of action ever arose to the complainant against answering Opposite Parties; the complainant has concealed the material facts from this Commission. Further submitted that insured deceased was holder of driving license having no.PB2920090021402 which was issued to the insured by the concerned department for driving Light Motor Vehicles (LMV) & Transport Vehicle (Trans) only. The claim has been lodged by the legal heir of insured on the basis of death of insured that occurred on 21.01.2023 while driving a Bajaj Chetak Scooter having registration no.PB-29D-5419, as the scooter slipped and the insured fell down on the road. As the insured was never permitted to drive two wheelers and thus, he contravened and violated the basic terms and conditions of the policy. As the insured was driving Two Wheeler i.e. Bajaj Chetak Scooter for which he never had due authorization vide the driving license issued to him by concerned Transport Office. As such, claim of the insured is repudiated on the ground that he did not have valid driving license. Further averred that the complaint is also barred by the provisions of Arbitration Act, 1996 as the policy duly contains arbitration clause at serial no.08 of clause ‘Condition”. Further submitted that RC of said vehicle is not even in the name of insured or any of his family members and the complainant has not clarified about it anywhere in the complaint. On merits, all other allegations made in the complaint are denied and a prayer for dismissal of the complaint is made.

3.       Complainant has also filed replication to the written reply of Opposite Parties denying the objections raised by it in its written reply.

4.       In order to prove his case, the complainant has placed on record her affidavit Ex.C1 alongwith copies of documents Ex.C2 to Ex.C9.

5.       On the other hand, Opposite Parties have placed on record affidavit of Sh.Inderjit Ghosh, Divisional Manager, United India Insurance Co. Ltd. Ex.OPs1 alongwith copies of documents Ex.OPs2.

6.         We have heard the ld. counsel for both the parties and also gone through the record.

7.       It is admitted case of the complainant that husband of the complainant namely Tarsem Singh (now deceased) during his life time availed ‘Individual Personal Accident policy’ from the Opposite Parties for the period 13.05.2022 to 12.05.2023. During the policy coverage, unfortunately on 20.01.2023, he met with an accident and got admitted in Civil Hospital, Moga and where he was declared dead. DDR no.25 dated 21.01.2023 was recorded by P.S. City Moga and proceeding u/s 174 of Cr.P.C. was conducted by the police. Thereafter the claim lodged by the complainant with Opposite Parties was rejected by the Opposite Parties vide letter dated 08.08.2023.

8.       The perusal of repudiation letter dated 08.08.2023 reveals that the Opposite Parties repudiated the claim of the complainant on following grounds;

1.       That captioned vehicle no.PB-29-D-5419 was unfit for drive in Road or Public Place, as RC was expired on 02.06.2018.

2.       At the time of accident Tarsem Singh did not have valid Driving Licence. He was having driving license for LMV & Trans only, which was not authorized to drive a Two Wheeler.

From the contents of the repudiation letter and also from the perusal of the record brought forward by the Opposite Parties, it transpires that nowhere Opposite Parties doubted about accidental death of the husband of the complainant who was admittedly covered under the policy i.e. ‘Individual Personal Accident Policy’.

9.       However, the grounds so taken by the Opposite Parties for the repudiation the claim in question are not genuine, as firstly the policy purchased by the insured is accidental policy i.e. Individual Personal Accident policy’, which covers the “death due to accident”. Further it is proved on record vide DDR (Ex.C8) that the alleged accident occurred due to slip of scooter near Godhewala School. Further post mortem report (Ex.C7) is evident of the fact that disease life insured died due to road side accident, as in Post Mortem Report under Column ‘Opinion’ cause of death is mentioned as ‘head injury’. Further the rejection of the claim on the ground that RC of the vehicle has already been expired at the time of accident and that at the time of accident Tarsem Singh did not have valid Driving Licence are not the mandatory requirements of the policy terms and conditions, to settle the claim in question. Moreover, the said violations are not the material violation of the terms and conditions of the policy in question which purely covers the death due to accident.  

10.     The other plea taken by the Opposite Parties is that the present complaint is barred by the provisions of Arbitration Act, 1996 as the policy duly contains arbitration clause at serial no.08 of clause ‘Condition’. But the plea so taken by ld. counsel for the Opposite Parties is unsustainable. As our Hon’ble Supreme Court of India in case titled Emaar MGF Land Ltd. v. Aftab Singh, reported in I, (2015) CPJ 5 (SC), observed that an Arbitration clause on the agreement does not bar the jurisdiction of the Consumer Fora to entertain the complaint. Keeping in view the citations as referred to above the plea taken by ld. counsel for the Opposite Parties is not maintainable.

11.     From the discussion above, we are of the concerted view that Opposite Parties wrongly and illegally repudiated the claim of the complainant and thus the complainant is liable to be compensated for the deficiency in service rendered by the Opposite Parties besides the claim to be paid under the policy in question. 

12.     Now, come to the quantum of amount to be awarded. The perusal of policy document placed on record by the complainant (Ex.C3) reveals that husband of the complainant DLA was insured under the policy for a sum of Rs.4,00,000/- alongwith 15% cumulative bonus i.e. Rs.75,000/-.

13.     Sequel to the above discussion, the present complaint is partly allowed and Opposite Parties are directed to pay to the complainant, the sum assured amount of Rs.4,00,000/- (Rupees Four Lakh only) along with other benefits under the policy in question as discussed above. Further Opposite Party is directed to pay compository cost of Rs.10,000/-(Rupees Ten Thousand only) as compensation and litigation expenses to the complainant. The pending application (s), if any also stands disposed of. The compliance of this order be made by the Opposite Party within 45 days from the date of receipt of copy of this order, failing which, the Opposite Parties are further burdened with additional cost of Rs.10,000/-(Rupees Ten Thousand only) to be paid to the complainant for non compliance of the order. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room.

Announced in Open Commission