Order dictated by:

Sh. Anoop Sharma, Presiding Member

1.       M/s. Brightway Contractors through its Authorized person Dinesh Chand has brought the instant complaint under section  12 & 13 of  the Consumer Protection Act, 1986 on the allegations that complainant firm got Insurance policy from the opposite party covering risk period from 16.6.2015 to 15.6.2016 covering various risks . The said Insurance cover note covers the insurance risk of “personal injury or death to employee of the contractor and or other persons/public”. The said cover covered the risk coverage of Rs. 10 lac and due premium has been paid to the opposite party. Unfortunately in the process of the work of the said project of Qila Gobindgarh, Amritsar , one of the employee of the complainant firm namely Jethu Ram S/o Nana Boota on 23.4.2016 accidently expired. FIR & PMR to the said effect has been made  and the opposite party was duly informed. The claim was made to the opposite party. But the opposite party repudiated the genuine claim of the complainant vide letter dated 26.4.2016 on the ground that the risk of employee is not covered. The cover note issued by the opposite party clearly covers the risk to the death of an employee. No such policy or terms and conditions were made known or delivered to the complainant firm. The act of repudiating the genuine claim of the complainant amounts to deficiency in service.  Complainant vide instant complaint has sought for the following reliefs:-

(a)     Opposite party be directed to pay the claim of Rs. 10 lac alongwith interest @ 12% p.a. from 26.4.2016 till realization ;

(b)     Compensation to the tune of Rs. 5,00,000/- alongwith litigation expenses were also demanded.

Hence, this complaint.

2.       Upon notice, opposite party appeared and filed written version in which it was submitted that  complainant has not come to this Forum with clean hands and has suppressed the material facts. The present complaint has been filed on wrong facts and complainant has not disclosed the actual facts. The true facts are that an officer of the opposite party has issued one cover note to M/s. Punjab Heritage and Tourism Promotion Board  and M/s. Bright Way Contractor & Developer on 15.6.2015. At the time of issuing the said cover note the concerned officer inadvertently mentioned death to employee of the contractor and other people/public in the column of personal injury or death and the risk coverage is Rs. 10,00,000/-. But in the same cover note in the column of special condition, he has mentioned that this cover note is as per policy terms and conditions. It is pertinent to mention that the said cover note was issued on 15.6.2015 and the policy against the said cover note alongwith its terms and conditions has been dispatched to the policy holder on 16.10.2015. As per the complaint, one employee of the company namely Jethu Ram S/o Nana Buta Sahoo was met with an accident  when he was doing his work alongwith other labourers and he suddenly buried under land slide and was died due to this accident. The complainant was well aware of this fact that the employee of the contractor was not covered under this policy because he was taking the said policy from long time and also well aware all the terms and conditions of the said policy. Even otherwise the complainant has mentioned the policy number in his intimation letter dated 25.4.2016 which shows that he has received the policy and was well aware of the terms and conditions of the policy. The concerned officer, who has issued the said policy has also described all the terms and conditions of the policy to the policy holder at the time of issuing the cover note and the policy holder after admitting the same has given his consent to issue the said policy. The risk of death or personal injury to the employee of the policy holder is not covered under the policy . As such after receiving the information regarding the said accidental claim, the opposite party has immediately informed the complainant vide its letter dated 26.4.2016   that the risk of the employee is not covered under the said policy. On merits facts narrated in the complaint have specifically been denied and a prayer for dismissal of complaint was made.

3.       In his bid to prove the case Sh. Deepinder Singh,Adv.counsel for the complainant tendered into evidence affidavit of the complainant Ex.C-1, copy of policy cover note Ex.C-2, copy of claim intimation Ex.C-3, copy of repudiation letter Ex.C-4, copy of death certificate Ex.C-5, copy of joint venture agreement Ex.C-6 and closed the evidence on behalf of the complainant.

4.       To rebut the aforesaid evidence Sh. Rajinder Nayyar,Adv.counsel for the opposite party tendered into evidence affidavit of Sh.Harinder Prinja, Sr.Divisional Manager Ex.OP1, copy of cover note Ex.OP2, copy of letter dated 25.4.2016 Ex,.OP3, copy of repudiation letter Ex.OP4, copy of dispatch register Ex.OP5, copy of policy alongwith terms and conditions Ex.OP6, affidavit of Sh.Sweet Kumar, Development Officer Ex.OP7, copy of Insurance policy alongwith terms and conditions Ex.OP8 and closed the evidence on behalf of opposite party.

5.       We have heard the ld.counsel for the parties and have carefully gone through the record on the file.

6.       Ld.counsel for the complainant has reiterated the facts as detailed  in the complaint and has submitted that complainant firm got Insurance policy from the opposite party covering risk period from 16.6.2015 to 15.6.2016 covering various risks . The said Insurance cover note covers the insurance risk of “personal injury or death to employee of the contractor and or other persons/public”.  The said insurance cover covered the risk coverage of Rs. 10 lac and due premium has been paid to the opposite party. Unfortunately in the process of the work of the said project of Qila Gobindgarh, Amritsar , one of the employee of the complainant firm namely Jethu Ram S/o Nana Boota on 23.4.2016 accidently expired. In this regard FIR as well as Post mortem was conducted on the dead body of Jethu Ram S/o Nana Boota.  The opposite party was also duly informed and the claim was lodged with the  opposite party. But the opposite party repudiated the genuine claim of the complainant vide letter dated 26.4.2016 on the ground that the risk of employee is not covered. The cover note issued by the opposite party clearly covers the risk to the death of an employee. However, no such policy or terms and conditions were made known or delivered to the complainant firm. The aforesaid act of the opposite party of repudiating the genuine claim of the complainant amounts to deficiency in service.

7.       On the other hand, ld.counsel for the opposite party has specifically repelled the aforesaid contentions  of the complainant on the ground that the risk of death or personal injury to the employee of the policy holder is not covered under the policy . It was submitted that an officer of the opposite party has issued one cover note to M/s. Punjab Heritage and Tourism Promotion Board  and M/s. Bright Way Contractor & Developer on 15.6.2015.  However, at the time of issuing the said cover note the concerned officer inadvertently mentioned death to employee of the contractor and other people/public in the column of personal injury or death and the risk coverage is Rs. 10,00,000/-. But in the same cover note in the column of special condition, he has mentioned that this cover note is as per policy terms and conditions. It is pertinent to mention that the said cover note was issued on 15.6.2015 and the policy against the said cover note alongwith its terms and conditions has been dispatched to the policy holder on 16.10.2015. As per the complaint, one employee of the company namely Jethu Ram S/o Nana Buta Sahoo was met with an accident  when he was doing his work alongwith other labourers and he suddenly buried under land slide and was died due to this accident. The complainant was well aware of this fact that the employee of the contractor was not covered under this policy because he was taking the said policy from long time and also well aware all the terms and conditions of the said policy. Even otherwise the complainant has mentioned the policy number in his intimation letter dated 25.4.2016 which shows that he has received the policy and was well aware of the terms and conditions of the policy. The concerned officer, who has issued the said policy has also described all the terms and conditions of the policy to the policy holder at the time of issuing the cover note and the policy holder after admitting the same has given his consent to issue the said policy.

8.       But, however, from the appreciation of the facts and circumstances of the case, it becomes evident that the complainant firm has obtained cover note  from the opposite party   covering various risks in which risk of personal injury or death to employee of the contractor  and other people/public is covered for the sum assured Rs. 10 lacs , copy of cover note is Ex.C-2 on record.  Unfortunately in the process of the work, on 23.4.2016 one employee namely Jethu Ram S/o Nana Boota accidently expired. FIR and Post Mortem on the dead body of employee was got conducted and the opposite party was duly informed. However, the opposite party  repudiated the claim of the complainant  vide letter dated 26.4.2016 on the ground that the risk of employee is not covered. In this regard , opposite party has taken the plea that at the time of issuing the said cover note, the concerned officer inadvertently mentioned death to employee of the contractor and other people/public in the column of personal injury or death  and the risk covered is Rs. 10,00,000/-. But, however, opposite party cannot escape itself from its liability to pay the claim on the ground that the  concerned officer inadvertently issued the policy to the complainant.   The other plea of the opposite party that as per Insurance law cover note is provisional document followed by policy and the liability of the company will remain as per the terms and conditions of the policy. As per the opposite party policy against the said cover note alongwith its terms and conditions has been dispatched to the policy holder on 16.10.2015. But, however, the complainant has stated that  no such policy as well as terms and conditions was ever made known or delivered to the complainant firm. To rebut the aforesaid contention of the complainant, the opposite party has not produced on record any postal receipt/proof regarding the dispatch of the policy as well as terms and conditions  to the complainant. Because the risk of the complainant duly covered from the date of issuance of cover note i.e. w.e.f. 16.6.2015 to 15.6.2016 and  the accident occurred during the subsistence of the policy period. In such a situation, we are of the opinion that the opposite party has wrongly and illegally repudiated the genuine claim of the complainant for no reason. It is generally seen that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. In similar set of facts the Hon’ble Punjab & Haryana High Court in case titled as New India Assurance Company Limited Vs. Smt.Usha Yadav & Others 2008(3) RCR (Civil) Page 111 went on to hold as under:-

“It seams that the insurance companies are only interested in earning the premiums and find ways and means to decline claims. All conditions which generally are hidden, need to be simplified so that these are easily understood by a person at the time of buying any policy.       

The Insurance Companies in such cases rely upon clauses of the agreement, which a person is generally made to sign on dotted lines at the time of obtaining policy. Insurance Company also directed to pay costs of Rs.5000/- for luxury litigation, being rich.

9.       In view of the aforesaid facts and circumstances, the complaint filed by the complainant has merit and the same is hereby allowed and the opposite party is directed to make payment of the insured amount i.e. Rs. 10,00,000/- to the complainant, who would further pay the same to the legal heirs of deceased Jethu Ram s/o Nana Boota. The complainant is also awarded compensation to the tune of Rs. 3000/- as well as litigation expenses to the tune of Rs. 2000/-. Opposite party is directed to make the payment of the awarded amount within 30 days of the receipt of copy of the order ; failing which awarded amount shall carry interest @ 9% p.a. from the date of filing of the claim until full and final recovery. Copies of the order be furnished to the parties free of costs. File is ordered to be consigned to the record room. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Forum.

Announced in Open Forum

Dated : 25.7.2017