PER:
Sh. Varinderpal Singh Saini, Member
1 The complainant has filed the present complaint against the opposite party by alleging that the complainant is son of deceased Jasbir Singh who was a permanent driver of the opposite party with employee ID No. 39144, as the opposite party is dealing with the business of transport and is one of the most reputed Transport Companies of India. The deceased Jasbir Singh was having valid driving license to operate heavy trucks and as such, the opposite party had been hiring him for operating its vehicle and moreover, the opposite party had also been insuring its employees with some insurance companies in case of happenings involving deaths and injuries to its drivers, so that the family of the drivers and also the drivers could obtain financial assistance in case of these happenings while operating and driving the fleet of the opposite party and also in case during employment any mis-happenings with the drivers in any other way whatsoever resulting in death of the drivers. The opposite party had got deceased Jasbir Singh insured with life insurance policy by receiving Rs. 900/- from him on 2.7.2020 vide receipt No. 110582911 and a cover of Rs. 25 Lakh as life insurance cover was provided by the opposite party through some company to deceased Jasbir Singh being its employee. The deceased Jasbir Singh was on a visit to his house at the above mentioned address i.e. the same as that of the complainant being his son for getting his driving license renewed from Tarn Taran and unfortunately the deceased Jasbir Singh was bitten by some poisonous snake on 18.05.2021 and was taken to one local Hospital namely Dev Raj Joshi Hospital, Main Bazar Chohla Sahib District Tarn Taran but he could not be saved and as such he expired due to the snake bite. At the time of his death he was employee of the opposite party and was just on leave from the opposite party for the purpose mentioned above and as such being insured by the opposite party through some insurance company and a also as the deceased Jasbir Singh had paid premium for getting himself insured with the life insurance policy, the complainant being his son knowing the life insurance policy of the deceased Jasbir Singh procured a necessary documents such as death certificate of Jasbir Singh and the certificate of the doctor and hospital where he was taken for treatment. The complainant also got one Majornama/resolution from the Gram Panchayat of village Rattoke regarding the cause of death of deceased Jasbir Singh as no autopsy was conducted upon the dead body of deceased Jasbir Singh as it was not a case of some road accident but death due to snake bite. Moreover, no police rapat/information was also registered due to the above mentioned reasons and as such this resolution was got issued by the complainant from the village Panchaya, so that no hindrance remains in releasing the insurance claim to the complainant of the deceased Jasbir Singh. The complainant deposited all the above mentioned documents with the opposite party's office at Amritsar and also requested the opposite party through this office to release the insurance claim of Rs.25 Lakh to him immediately so that he could be helped financially after the death of his father as the father is the sole bread earner of the family but inspite of awaiting for long time no insurance claim was release to him by the opposite party so that the complainant sent a letter to the opposite party on 22.07.2021 for requesting the opposite party to release the insurance claim to the complainant immediately but no reply to this letter was ever sent to the complainant by the opposite party and only an amount of Rs.05 Lakh was credited in the account of the complainant vide transfer entry dated 1.09.2021. The complainant approached the opposite party through its Amritsar Office and requested the opposite party to release the full claim of Rs.25 Lakh to him but inspite of several visits the opposite party did not release the insurance claim to the complainant and told the complainant that as the autopsy/post mortem was not got conducted upon the dead body of deceased father Jasbir Singh nor any police rapat was got registered regarding the incident of death of deceased. Jasbir Singh and as such no insurance claim over and above Rs. 05 lakh could be released to the complainant. The complainant requested the opposite party that in cases of deaths due to snake bites etc. there is no requirement of obtaining post mortem report and police rapat copy for getting the insurance claims of the deceased but nothing was done by the opposite party to release the balance insurance claim to the complainant, rather delayed the matter by giving false reasons as above and did not release the balance insurance claim to the complainant. Moreover, the opposite party issued a letter dated 03.08.2021 to the complainant again demanding unnecessary documents from him for getting the insurance claim release to him and as the complainant had already supplied all the available and requisite documents to the opposite party no progress was made by the opposite party to release the claim. The deceased Jasbir Singh had executed one Will in favour of the complainant during his life time vide which he had given all the rights to the complainant in regard to his properties movable and immovable after his death and as such the complainant is having all rights to claim each and everything belonging to deceased Jasbir Singh after his death and prayed the following relieves.
- The opposite party may kindly be directed to release the balance insurance claim of Rs. 20 Lakh to the complainant immediately.
- The opposite party may kindly be directed to pay compensation of Rs. 1 Lakh for causing harassment of complainant.
- The opposite party may kindly be directed to pay litigation expenses of Rs. 50,000/- to the complainant.
Alongwith the complaint, the complainant has placed on record Self attested copy of affidavit of complainant Ex. C-1, Self attested copy of insurance voucher Ex. C-2, Self attested copy of diving license issued on 22.2.1993 Ex. C-3, Self attested copy of driving license renewed by deceased Jasbir Singh before his death Ex. C-4, Self attested copy of certificate of doctor / hospital Ex. C-5, self attested copy of death certificate Ex. C-6, Self attested copy of resolution Ex. C-7, Self attested copy of Adhar Card of deceased Jasbir Singh Ex. C-8, Self attested copy of letter dated 22.7.2021 Ex. C-9, Self attested copy of letter dated 3.8.2021 Ex. C-10, Self attested copy of Bank Statement Ex. C-11, Self attested copy of Will dated 26.10.2015 Ex. C-12, Self attested copy of Adhar Card of the complainant Ex. C-13.
2 Notice of this complaint was sent to the opposite party and opposite party appeared through counsel and filed written version by interalia pleadings that the present complaint is not maintainable and is liable to be dismissed. The complainant has suppressed so many material facts from this commission and not placed true and full facts before this commission. So the complainant is not entitled to any relief from this Commission. The complainant not approached before this Commission with the clean hands and suppressed so many material facts from this Commission, the complainant is not entitled to any relief from this Commission. The insurance claim sought for by the complainant in the case is the amount payable by the insurance company and that such insurance claims are entertained by insurance company only in case of injuries and death arising out of Motor Vehicle Accidents on duty i.e. during the course of employment. On detailed verification the opposite party found that the deceased Jasbir Singh had gone to his native place and that the purpose of his going to native place was to get his driving license renewed from the Transport Authorities of Tarn Taran. The complainant's father is said to have been died due to Snake Bite by a poisonous Snake on 18.05.2021 and is reported to have died. These averments are clear from Paragraph No.4 of the complaint. The deceased driver did not die arising out of any Motor Vehicle Accident during the course of employment. The averments in Paragraph no.3 of the complaint that the deceased was insured with Life Insurance Policy in a Group Life Insurance Scheme taken by us is not disputed and accordingly a sum of Rs.5,00,000/- has been paid. The claim is not entertainable because the death has not taken place during the course of employment and due to any Motor Vehicle Accident. Admittedly the driver died when he was not on duty. The insurance company has its own procedure for admitting any claims under the group Personal Accidents Insurance Scheme and an extract of the claim procedure/ requirements is enclsoed. A copy of letter received from the Insurance Company is also enclosed which is self-explanatory. The procedure details about the submission of certain documents mandatorily for admitting the claims and the important documents i.e. required are a copy of the FIR and the Postmortem Report mentioning the cause of death. On going through the documents that have been produced by the complainant alongwith the complaint only a Medical Certificate of a Private Hospital mentioning that the patient was in a very critical condition (snake bite right arm) and subsequently a death certificate has been issued by the Chief Registrar, Birth & Death, Punjab. As soon as a representation to claim the insurance benefits was received from the complainant. The complainant was duly replied to produce the requirement documents in our letter dated 03.08.2021 which has been duly produced before the Consumer Commission by the complainant. However, question of any relation as a Consumer with us and deficiency of service on part of opposite party does not arise and the complaint is infructuous and vexatious prima- facie. In view of the above, the claim of the complainant under the Group Personal Insurance Scheme not admissible. Another General Insurance Scheme, soon after the intimation of the death of the complainant's father, has received an amount of Rs.5,00,000/- on 01.09.2021 and that the same has been admitted by the complainant in para No.6 of his complaint. So the complainant is not entitled to get any amount from the opposite party and present complaint filed by the complainant is liable to be dismissed. The complainant has got no locus standi and cause of action to file the present compliant. The present complaint is an abuse of the process of court and is liable the dismissed. The complainant has got no cause of action against the opposite party. The complainant is a wrong doer and is not entitled to any relief. The present compliant has been filed by the complainant with malafide intention with ulterior motive with intent to harass the opposite party. The complainant Jasbir Singh was having a valid driving license to operate heavy trucks and as such the opposite party had been hiring him for operating its vehicles and the opposite party had also been insuring its employees with some insurance companies in case of happening involving deaths and injuries to its drivers. The insurance claim sought for by the complainant in the case is the amount payable by the insurance company and that such insurance claims are entertained by insurance company only in case of injuries and death arising out of motor vehicle Accidents on duty i.e. during the course of employment. On detailed verification, the opposite party found that the deceased Jasbir Singh had gone to his native place and that the purpose of his going to native place was to get his driving license renewed from the Transport authorities of Tarn Taran. The opposite party has denied the other contents of the complaint and prayed for dismissal of the same.
3 We have heard the Ld. counsel for the complainant and opposite party and have carefully gone through the record placed on the file.
4 Ld. counsel for the complainant contended that the complainant is son of deceased Jasbir Singh who was a permanent driver of the opposite party with employee ID No. 39144, as the opposite party is dealing with the business of transport and is one of the most reputed Transport Companies of India. The deceased Jasbir Singh was having valid driving license to operate heavy trucks. The opposite party had also been insuring its employees with some insurance companies in case of happenings involving deaths and injuries to its drivers, so that the family of the drivers and also the drivers could obtain financial assistance in case of these happenings while operating and driving the fleet of the opposite party and also in case during employment any mis-happenings with the drivers in any other way whatsoever resulting in death of the drivers. The opposite party had got deceased Jasbir Singh insured with life insurance policy by receiving Rs. 900/- from him on 2.7.2020 vide receipt No. 110582911 and a cover of Rs. 25 Lakh as life insurance cover was provided by the opposite party through some company to deceased Jasbir Singh being its employee. He further contended that the deceased Jasbir Singh was on a visit to his house at the above mentioned address i.e. the same as that of the complainant being his son for getting his driving license renewed from Tarn Taran and unfortunately the deceased Jasbir Singh was bitten by some poisonous snake on 18.05.2021 and was taken to one local Hospital namely Dev Raj Joshi Hospital, Main Bazar Chohla Sahib District Tarn Taran but he could not be saved and as such he expired due to the snake bite. At the time of his death he was employee of the opposite party and was just on leave from the opposite party for the purpose mentioned above and as such being insured by the opposite party through some insurance company and also as the deceased Jasbir Singh had paid premium for getting himself insured with the life insurance policy, the complainant being his son knowing the life insurance policy of the deceased Jasbir Singh procured a necessary documents such as death certificate of Jasbir Singh and the certificate of the doctor and hospital where he was taken for treatment. He further contended that the complainant also got one Majornama/resolution from the Gram Panchayat of village Rattoke regarding the cause of death of deceased Jasbir Singh as no autopsy was conducted upon the dead body of deceased Jasbir Singh as it was not a case of some road accident but death due to snake bite. Moreover, no police rapat/information was also registered due to the above mentioned reasons and as such this resolution was got issued by the complainant from the village Panchaya, so that no hindrance remains in releasing the insurance claim to the complainant of the deceased Jasbir Singh. He further contended that the complainant deposited all the above mentioned documents with the opposite party's office at Amritsar and also requested the opposite party through this office to release the insurance claim of Rs.25 Lakh to him immediately so that he could be helped financially after the death of his father as the father is the sole bread earner of the family but inspite of awaiting for long time no insurance claim was release to him by the opposite party so that the complainant sent a letter to the opposite party on 22.07.2021 for requesting the opposite party to release the insurance claim to the complainant immediately but no reply to this letter was ever sent to the complainant by the opposite party and only an amount of Rs.05 Lakh was credited in the account of the complainant vide transfer entry dated 1.09.2021. The complainant approached the opposite party through its Amritsar Office and requested the opposite party to release the full claim of Rs.25 Lakh to him but inspite of several visits the opposite party did not release the insurance claim to the complainant and told the complainant that as the autopsy/post mortem was not got conducted upon the dead body of deceased father Jasbir Singh nor any police rapat was got registered regarding the incident of death of deceased. Jasbir Singh and as such no insurance claim over and above Rs. 05 lakh could be released to the complainant. He further contended that the complainant requested the opposite party that in cases of deaths due to snake bites etc. there is no requirement of obtaining post mortem report and police rapat copy for getting the insurance claims of the deceased but nothing was done by the opposite party to release the balance insurance claim to the complainant, rather delayed the matter by giving false reasons as above and did not release the balance insurance claim to the complainant. Moreover, the opposite party issued a letter dated 03.08.2021 to the complainant again demanding unnecessary documents from him for getting the insurance claim release to him and as the complainant had already supplied all the available and requisite documents to the opposite party no progress was made by the opposite party to release the claim. The deceased Jasbir Singh had executed one Will in favour of the complainant during his life time vide which he had given all the rights to the complainant in regard to his properties movable and immovable after his death and as such the complainant is having all rights to claim each and everything belonging to deceased Jasbir Singh after his death and prayed that the present complaint may be allowed.
5 Ld. counsel for the opposite party contended that the present complaint is not maintainable and is liable to be dismissed. The insurance claim sought for by the complainant in the case is the amount payable by the insurance company and that such insurance claims are entertained by insurance company only in case of injuries and death arising out of Motor Vehicle Accidents on duty i.e. during the course of employment. On detailed verification the opposite party found that the deceased Jasbir Singh had gone to his native place and that the purpose of his going to native place was to get his driving license renewed from the Transport Authorities of Tarn Taran. The complainant's father is said to have been died due to Snake Bite by a poisonous Snake on 18.05.2021 and is reported to have died. These averments are clear from Paragraph No.4 of the complaint. He further contended that the deceased driver did not die arising out of any Motor Vehicle Accident during the course of employment. The averments in Paragraph no.3 of the complaint that the deceased was insured with Life Insurance Policy in a Group Life Insurance Scheme taken by us is not disputed and accordingly a sum of Rs.5,00,000/- has been paid. The claim is not entertain-able because the death has not taken place during the course of employment and due to any Motor Vehicle Accident. Admittedly the driver died when he was not on duty. The insurance company has its own procedure for admitting any claims under the group Personal Accidents Insurance Scheme and an extract of the claim procedure/ requirements is enclosed. The procedure details about the submission of certain documents mandatorily for admitting the claims and the important documents i.e. required are a copy of the FIR and the Postmortem Report mentioning the cause of death. On going through the documents that have been produced by the complainant alongwith the complaint only a Medical Certificate of a Private Hospital mentioning that the patient was in a very critical condition (snake bite right arm) and subsequently a death certificate has been issued by the Chief Registrar, Birth & Death, Punjab. As soon as a representation to claim the insurance benefits was received from the complainant. The complainant was duly replied to produce the requirement documents in our letter dated 03.08.2021 which has been duly produced before the Consumer Commission by the complainant. However, question of any relation as a Consumer with us and deficiency of service on part of opposite party does not arise and the complaint is infructuous and vexatious prima- facie. In view of the above, the claim of the complainant under the Group Personal Insurance Scheme not admissible. Another General Insurance Scheme, soon after the intimation of the death of the complainant's father, has received an amount of Rs.5,00,000/- on 01.09.2021 and that the same has been admitted by the complainant in para No.6 of his complaint. So the complainant is not entitled to get any amount from the opposite party and present complaint filed by the complainant is liable to be dismissed. The complainant has got no locus standi and cause of action to file the present compliant. The present complaint is an abuse of the process of court and is liable the dismissed. The complainant Jasbir Singh was having a valid driving license to operate heavy trucks and as such the opposite party had been hiring him for operating its vehicles and the opposite party had also been insuring its employees with some insurance companies in case of happening involving deaths and injuries to its drivers and prayed that the present complaint may be dismissed.
6 We have carefully gone through the rival contentions of Ld. counsels for the parties.
7 In the present case, according to complainant, her husband Jasbir Singh died on 15.5.2021 and he is entitled to the death claim from the opposite party. But according to the opposite party, the complainant is not to the claim as per terms and conditions of the policy as he has not died on duty and at the time of death / alleged snake bite he was not driving the vehicle of the company. As such as per terms and conditions of the policy the complainant is not entitled to the death claim of the complainant.
8 Both the parties are bound by the terms and conditions of the policy. The terms and conditions of the Insurance Policy have to be strictly construed. Hon’ble Supreme Court in the case of Export Credit Guarantee Corporation of India vs. Garg Sons International 2013 (1) SCALE 410 (SC) held in Para Nos.8 to 11 as under:
“8. It is a settled legal proposition that while construing the terms of a contract of insurance, the words used therein must be given paramount importance, and it is not open for the Court to add, delete or substitute any words. It is also well settled, that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risks covered by the policy, its terms have to be strictly construed in order to determine the extent of the liability of the insurer. Therefore, the endeavour of the Court should always be to interpret the words used in the contract in the manner that will best express the intention of the parties. (Vide: M/s. Suraj Mal Ram Niwas Oil Mills (P) Ltd. v. United India Insurance Co. Ltd., (2010) 10 SCC 567).
9. The insured cannot claim anything more than what is covered by the insurance policy. The terms of the contract have to be construed strictly, without altering the nature of the contract as the same may affect the interests of the parties adversely. The clauses of an insurance policy have to be read as they are consequently, the terms of the insurance policy, that fix the responsibility of the Insurance Company must also be read strictly. The contract must be read as a whole and every attempt should be made to harmonize the terms thereof, keeping in mind that the rule of contra proferentem does not apply in case of commercial contract, for the reason that a clause in a commercial contract is bilateral and has mutually been agreed upon. (Vide : Oriental Insurance Co. Ltd. v. Sony Cheriyan AIR 1999 SC 3252; Polymat India P. Ltd. v. National Insurance Co. Ltd., AIR 2005 SC 286; M/s. Sumitomo Heavy Industries Ltd. v. Oil & Natural Gas Company, AIR 2010 SC 3400; and Rashtriya Ispat Nigam Ltd. v. M/s. Dewan Chand Ram Saran AIR 2012 SC 2829).
10. In Vikram Greentech (I) Ltd. & Anr. v. New India Assurance Co. Ltd. AIR 2009 SC 2493, it was held: “An insurance contract, is a species of commercial transactions and must be construed like any other contract to its own terms and by itself. The endeavour of the court must always be to interpret the words in which the contract is expressed by the parties. The court while construing the terms of policy is not expected to venture into extra liberalism that may result in rewriting the contract or substituting the terms which were not intended by the parties. (See also: Sikka Papers Limited v. National Insurance Company Ltd & Ors. AIR 2009 SC 2834).”
11. Thus, it is not permissible for the court to substitute the terms of the contract itself, under the garb of construing terms incorporated in the agreement of insurance. No exceptions can be made on the ground of equity. The liberal attitude adopted by the court, by way of which it interferes in the terms of an insurance agreement, is not permitted. The same must certainly not be extended to the extent of substituting words that were never intended to form a part of the agreement.”
9 While repudiating the claim of the complainant of remaining amount the opposite party has not committed any deficiency in service and unfair trade practice and the claim has been validly repudiated by the opposite party.
10 In view of the above discussion, we do not find any merit in the present complaint and the same is hereby dismissed with no order as to costs. Case could not be disposed of within the stipulated period due to heavy pendency of the cases in this Commission. Copies of the order be furnished to the parties as per rules. File is ordered to be consigned to the record room.
Announced in Open Commission.
24.07.2024
