Haryana

StateCommission

A/754/2014

Smt. Birma Devi - Complainant(s)

Versus

United India Insurance Company Limited - Opp.Party(s)

19 Jan 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

         

                                                         First Appeal No.754 of 2014  

Date of Institution: 26.08.2014

                                                               Date of Decision: 19.01.2016

 

Smt. Birma Devi W/o Sh. Virender Singh, r/o village and Post Office Dholera,Tehsil Narnaul, District Mahendergarh (Haryana).

…..Appellant

Versus

1.      United India Insurance Company Limited, A-501, Ganesh Plaza Navrangpur, Ahmadabad.

2.      Tulip Global Private Ltd. Registered Office 205, 3^rd Floor, Jaipur Tower, Opposite All India Radio, M.I.Road, Jaipur.

3.      Sada Singh s/oShri Banwari Lal, r/o Dholera, presently residing at Daya Nagar, Narnaul (TG(P) Ltd. I.D. No.2062313).

 

                                      …..Respondents

 

CORAM:             Mr. R.K.Bishnoi, Judicial Member.

                             Mrs. Urvashi Agnihotri, Member.                                                                                                                                        

Present:              Shri Mukesh Yadav, Advocate counsel for the appellant.

Shri Nitin Gupta, Advocate counsel for the respondent No.1.

Mr.H.S.Bhatia, Advocate counsel for the respondent No.2.

                                                   O R D E R

R.K.BISHNOI, JUDICIAL MEMBER:

It was alleged by the complainant that he obtained medi-claim policy from the opposite party No.1 (O.P.) to cover the risk up to 1,25,000/- under different heads.  It was valid from 28.03.2011 to 27.03.2015.  On 22.05.2011 he met with an accident at about 06.30 A.M. at Singhana Road, Narnaul and suffered multiple injuries.  He received treatment at Santokhba Durlabhji Memorial Hospital-cum- Medical Research Institute, Jaipur and spent approximately Rs.32487/- on her treatment.  Claim was submitted with the O.ps., but, to no result.

2.      O.P.No.1 was proceeded ex parte. It was alleged by the O.P.No.2 that complainant purchased policy against payment of Rs.3500/- and it was a business transaction and she was not covered by the definition of consumer. The insurance policy was provided without any charge so there was no relationship of consumer and service provider in between them. As the insurance policy was obtained from Jaipur so District  Consumer Disputes Redressal Forum, Narnaul (In short “District Forum”) was having territorial jurisdiction to try the complaint.  It was also alleged that complainant did not inform it about incident immediately.  The case of the complainant was not covered by the terms and conditions provided in the policy so she was not awarded any compensation.  Other averments were also denied and requested to dismiss the complaint.

3.      After hearing both the parties, District Forum allowed the complaint vide impugned order dated 01.08.2014 and ordered as under:-

“According to the disability certificate Annexure P-34, the complainant had suffered 7% permanent disability, hence under this count we allow Rs.7,000/- to the complainant. The complainant remained hospitalized from 22.05.2011 to 25.05.2011 and she has submitted the bills to the tune of Rs.32,487/-.  According to the personal accident policy, a sum of Rs.25,000/- is payable on account of accidental hospitalization, so we allow Rs.25,000/- to the complainant on this count.  We direct opposite party No.1 to pay a sum of Rs.32,000/- to the complainant.”

4.      Feeling aggrieved therefrom, appellant-complainant has preferred this appeal to enhance the compensation qua permanent disability to the extent of Rs. One lac because she was having 07% permanent disability.

5.      Arguments heard. File perused.

6.      Learned counsel for the appellant-opposite party vehemently argued that as per personal accident policy group only percentage equal to the sum assured is to be given. In the present case the complainant was having only 07% disability, so the learned District Forum granted compensation to the tune of Rs.7000/- for this purpose.  Impugned order is well reasoned and cannot be disturbed.

7.      This argument is of no avail.  From the perusal of policy Ex.P-3 in case of  permanent disability sum assured is to be Rs.One lac.  It is no where mentioned therein that the compensation will be paid as per percentage of disability. As per certificate Annexure P-34 she is having  permanent disability of 07% which is as under:-

“painful movements of neck with deep complication  temporal region.

Hence he/she has the permanent disability to the extent of 07.1% (seven) per cent.”

8.      More so, Annexure.P-2 receipt of Rs.3500/- and Ex.P-3 Tailor made personal accident policy nowhere mentioned that terms and conditions was issued.   So, complainant is not bound by the terms and conditions.

9.      In this era, when there is a competition among the Insurance Companies for developing their business, unhealthy practices are developing to get maximum benefits and profits. It has become a common experience of the Insurance Companies to repudiate genuine claims of the insured on one pretext or the other. A common man is not supposed to know all the niceties and technicalities of law. The insured puts his hard earned money in taking Insurance of his vehicle with a hope and aspiration that in case of any mishap, he or his family shall get some immediate financial assistance but in most of the cases, his/her claim is rejected with just a stroke of pen that he/she did not abide the terms and conditions of the Insurance Policy, which conditions were never supplied by the Insurance Company. The policy entails the liability on both sides. 

10.    Sub-Regulation (2) of the Insurance Regulatory and Development Authority Regulations, 2002 (for short ‘IRDA’) provides that an insurer or its agent or other intermediary shall provide all material information in respect of the proposed cover to the insured.

11.    It is the common experience that an insurer or it’s agent or other intermediary does not provide all material information in respect of a proposed cover to the prospect. When a vehicle is insured, the insurer/it’s agent only provide Insurance Cover Note and not the Insurance Policy, alongwith the terms and conditions, which is violation of Sub-Regulation (2) of the IRDA.

12.    When a Statute or Regulation provides for a manner in which a particular thing must be done, then that thing must be done in that manner only. The Rule of law laid down in Taylor Vs. Taylor 1876 1 Ch.D 426 has been founded on sound principle and well recognized and followed by courts in India for several decades. The principle laid down in Taylor’s case (Supra) is that if a Statute has conferred a power to do an act and has laid down the method in which that power has to be exercised, it necessarily prohibits the doing of the act in any other manner than that which has been prescribed. The principle behind the Rule is that if these were not so, the statutory provision might as well would have not been enacted.

13.    In view of the above it is abundantly clear that if the statute has laid down the method in which the Insurance Company has to exercise its right to issue the policy, then that procedure must be followed by the Insurance Company and it prohibits issuing the policy in any other manner than what has been prescribed. The principle behind the aforesaid Regulations, is that if these were not so, there was no necessity of enacting the said Regulations.  The rider or riders are required to be clearly spelt out.

14.    If the procedure prescribed by the Regulations is not followed by the Insurance Company before issuing insurance policy cover and the premium is recovered with pleasure for earning profit, then the Insurance Company must suffer the consequences as it is to be held that exclusion clauses which are not explained, are to be ignored for the purpose of insurance cover.  It is the duty of the Insurance Company, prima facie, to prove and establish that the Insurance Company has followed the Regulation/procedure of IRDA, which the Insurance Company in the instant case has failed.

15.    Just to get out of the responsibility, sometimes the insurance companies allege that the cover note is a primary document followed by insurance company and the terms and conditions mentioned in the insurance policy are to be followed. In this case they are alleging that the cover note is the basic document and not the insurance policy because, they are feeling the pinch of paying compensation. These terms and conditions are not applicable.  The O.P wrongly repudiated the claim of the complainant. 

16.    From the perusal of above-said arguments, it is clear that complainant is held entitled for Rs.One lac.  Learned District forum did not take into consideration this aspect.  No other point is urged before us.

17.    Keeping in view the facts and circumstances of the case, the complainant is held entitled for Rs.One lac.  With this modification, appeal stands disposed of.

 

January 19th, 2016     Urvashi Agnihotri                                R.K.Bishnoi,                                                               Member                                              Judicial Member                                                         Addl. Bench                                        Addl.Bench