State Consumer Disputes Redressal Commission
Renu Gupta vs Future General India Insurance Co. on 22 February, 2023
C. NO./644/2013 D.O.D.:22.02.2023
MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
IN THE DELHI STATE CONSUMER DISPUTES REDRESSAL
COMMISSION
Date of Institution: 10.12.2013
Date of hearing: 05.08.2022
Date of Decision: 22.02.2023
COMPLAINT NO.- 644/2013
IN THE MATTER OF
MS. RENU GUPTA,
W/O MR. PRADEEP KUMAR GUPTA,
R/O 32, KUNWAR COLONY,
KHANDARI ROAD, AGRA,
UTTAR PRADESH - 282 005.
(Through: LAWYERS INC)
...Complainant
VERSUS
1. M/S FUTURE GENERAL INDIA INSURANCE CO. LTD.
303-301, 3RD FLOOR, KAILASH BUILDING,
26, K.G. MARG, NEW DELHI - 110 001.
(Through: Mr. Navneet Kaur, Advocate)
Opposite Party No.1
2. M/S PRIDENT INSURANCE BROKERS PVT. LTD.
462, UDYOG VIHAR, PHASE - V,
GURGAON, HARYANA - 122 016.
(Through: Mr. Navneet Kaur, Advocate)
Opposite Party no. 2
3. M/S BSR & CO., 8TH FLOOR, TOWER B,
BUILDING NO. 10, CYBER CITY, PHASE -11,
GURGAON, HARYANA - 122 001.
...Opposite Party No.3
DISMISSED PAGE 1 OF 8
C. NO./644/2013 D.O.D.:22.02.2023
MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
CORAM:
HON'BLE JUSTICE SANGITA DHINGRA SEHGAL
(PRESIDENT)
HON'BLE MS. PINKI, MEMBER (JUDICIAL)
Present: None for Complainant.
Mr. Saurabh Tiwari, proxy counsel for Mr. Navneet
Kumar, Counsel for the Opposite Party No. 1.
None for Opposite Party no. 2 & 3.
PER: HON'BLE JUSTICE SANGITA DHINGRA SEHGAL PRESIDENT
JUDGMENT
1. The present complaint has been filed by the Complainant before this commission alleging deficiency of service and unfair trade practice by the Opposite Parties and has prayed the following reliefs:
a) Pass the orders that there is a clear deficiency in the services, negligence of duty and unfair trade practices by the respondent nos. 1 & 2;
b) Pass orders/directions for the release of payment of Rs.60,00,000/- (Rupees Sixty Lakhs Only) (claim amount of the complainant as per the Insurance Policy) by the respondent nos. 1 & 2;
c) Pass orders/directions for the payment of the aforesaid insurance claim amount of Rs.60,00,000/-
alongwith interest @ 24% from the date of filing of the claim by the respondent nos. 1 & 2;
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MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
d) Pass orders/directions orders for the payment of Rs.2,00,000/-(Rupees Two Lakhs Only) as damages for causing undue harassment and mental agony against the respondent nos. 1 & 2;
e) Pass orders/directions for the payment of Rs.75,000/- (Rupees Twenty-Five Thousand Only) towards the cost of the present litigation against the respondent nos. 1 & 2; Commission deems just, fair and expedient.
f) Pass any other and further orders/directions as this Hon'ble Commission.
2. Brief facts necessary for the adjudication of the present complaint are that the Complainant is the legal heir of Late Mr. Puneet Gupta who expired on 08.03.2012 alongwith his wife Ms. Varsha Gupta. The Opposite Party No. 3 has taken a group personal accident insurance policy bearing no. A0070164 for all its employees. As per Clause 1 of the aforesaid policy, it is provided that the payment of sum assured shall be made in case of accidental death.
3. On the occasion of Holi i.e., on 08.03.2012, Late. Puneet Gupta and Late. Ms. Varsha after playing Holi went for bathing and did not turn up for long time. Thereafter, when family members checked for them, both were lying unconscious in the bathroom. They were immediately taken to Pushpanjali Hospital and Research Centre, DISMISSED PAGE 3 OF 8 C. NO./644/2013 D.O.D.:22.02.2023 MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
Agra, U.P by the family members but were declared dead on arrival by the hospital. Accordingly, the said incident was reported to the police and Post Mortem was conducted by the authorities. However, the post mortem report failed to provide any conclusive reason for the death of deceased. The police authorities after investigation submitted its report dated 26.11.2012 and observed that there was no malafide in the said incident and the death had occurred accidentally.
4. Since Late. Mr. Puneet Gupta was insured by the Opposite Party no.3, the complainant lodged a claim with the Opposite Party no. 1 for an amount of Rs. 60,00,000/- but the Opposite Party no.1 repudiated the claim vide letter dated 20.02.2013 by observing that "As per the information provide the couple had froth in their mouths, when they were discovered in the bathroom. The post mortem report could not confirm the cause of the death. However, the viscera analysis carried out subsequently confirmed the present of organic chloro insecticide poison in the viscera... under these circumstances, we regret our inability to consider for the settlement."
5. The Opposite Party no. 3 again requested the Opposite Party no.1 and 2 to reconsider the claim but till date the claim has not been released by the Opposite Party no.1 and 2. The Complainant obtained a detailed viscera report from Sarojini Naidu Medical College Agra, U.P., vide letter dated 17.06.2013 and also taken an expert opinion which confirmed that the cause of the death is not due to Organochlorine Poisoning but due to Gas poisoning from the geyser. The Complainant submitted that the repudiation of the claim by the Opposite Party no.1 and 2 was arbitrary and illegal.
DISMISSED PAGE 4 OF 8 C. NO./644/2013 D.O.D.:22.02.2023
MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
6. The Opposite Party no.1 has contested the present case and has raised preliminary objections as to the maintainability of the complaint case. The counsel of the Opposite Party no.1 submitted that the Complainant is not consumer under the Consumer Protection Act, 1986. The counsel for the Opposite Party no.1 further submitted that that the present complaint involves complicated question of facts and law, which cannot be adjudicated in a summary procedure.
7. The counsel for the Opposite Party no.1 further submitted that the complainant has not discharged her onus to prove that the death of the deceased had occurred due to the peril which is covered under the policy in question. He also submitted that Late Mr. Puneet Gupta died due to oral poisoning as there was presence of frothing from mouth and nose and therefore, the possibility of gas poisoning by bathroom geyser was not correct. Pressing the aforesaid contention, the counsel for the Opposite Party no. 1 submitted that the repudiation of the claim was rightly done and prayed for dismissal of the complaint with exemplary cost.
8. The Complainant has filed the Rejoinder rebutting the written statement filed by the Opposite Party no.1. Both the parties have filed their Evidence by way of Affidavit in order to prove their averments on record. The written arguments of both the parties also on the record.
9. We have perused the material available on record and heard the counsel for the parties.
10.The first question for consideration before us is whether the present complaint involves complicated question of facts and law, which cannot be adjudicated in a summary procedure.
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MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
11. At the outmost we deem it appropriate to refer "Punjab Lloyd Ltd.
Vs. Corporate Risk India Pvt. Ltd.", (2009) 2 SCC 301, it was held that the complicated question of law should be decided by the regular court. It further held that the decisive test is not the complicated nature of question of fact and law arising for decision. In another case titled as "LIC & Ors. Vs. Surinder Kaur & Ors., arising out of SLP (c) No.17866 of 2005, decided by the Hon'ble Supreme Court , wherein it held that complex question of facts cannot be decided by the Consumer Forum under the Consumer Protection Act and such issues can be subject matter of regular civil court.
12. It is not disputed between the parties that the Opposite Party no. 3 had taken a group personal accident insurance policy for all its employees including the son of the Complainant bearing Group Accident Policy No. A0070164 (Annexure C/3). It is also clear from Clause No. 1 of the insurance policy in question that the sum assured shall be made in case of accidental death. It is also evident from the death certificate (Annexure c/1 Colly) that Mr. Puneet Gupta and Ms. Varsha Gupta expired on 08.03.2012.
13. A perusal of the Post Mortem Report (Annexure C/6) shows that the cause of death of the deceased could not be ascertained in the present case and therefore, viscera was preserved by the authorities. Thereafter, in the viscera report dated 11.10.2012 (Annexure-F), it was observed that 'Organochlorine Insecticide Poison' was present in the body of the deceased.
14. However, the Complainant filed an expert opinion dated 18.05.2013 of the Forensic Expert namely Dr. Ajay Agarwal, wherein it was observed that the cause of death of Mr. Puneet Gupta and Varsha DISMISSED PAGE 6 OF 8 C. NO./644/2013 D.O.D.:22.02.2023 MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
Gupta, most likely, cannot be organochlorine poisoning. There is possibility of accidental carbon monoxide (CO) poisoning in view of circumstantial evidence. More so, it is also noted in the said report that Organochlorine may be found in the body in healthy living state due to presence in the plastic lining of canned or microwaveable foods, fruits, vegetables as they are deliberately used for agricultural purposes as pesticides. The complainant also relied upon the report of the concerned investigation officer, who sought the permission from the senior officer for the closure of the case as there was no evidence/proofs had been found by him which suggest that the deaths was caused due to some wrongdoing by any person.
15. On the other hand, the Opposite Party no.1 also filed a Medico Legal Report dated 28.06.2013 (Annexure H) of Mr. Puneet Gupta, which observed that the 'Organochloro Insecticide Poison' was the cause for the death of the insured. The Opposite Party no. 1 also repudiated the claim of the Complainant vide letter dated 20.02.2013 by holding that the death of the insured was not accidental and therefore, was not covered under the terms and conditions of the policy in question.
16. In view of the aforesaid facts and circumstances, it is not clear that 'Organochloro Insecticide Poison' found in the body of the insured was whether due to oral poisoning or due to leakage from the geyser. Due to contrary opinion in the medical reports filed by the parties and lack of evidence, we are of the opinion that the present complaint involves complicated questions of facts which require elaborate oral and documentary evidence and the examination of the witnesses for proper disposal of the matter.
DISMISSED PAGE 7 OF 8 C. NO./644/2013 D.O.D.:22.02.2023
MS. RENU GUPTA VS. M/S FUTURE GENERAL INDIA INSURANCE COMPANY LIMITED & ORS.
17. Consequently, the present complaint stands dismissed as the present case cannot be adjudicated in the summary procedure adopted by this commission and the Complainant is at liberty to take appropriate remedy as per law for proper adjudication of the present case.
18. Application(s) pending, if any, stand disposed of in terms of the aforesaid judgment.
19. A copy of this judgment be provided to all the parties free of cost as mandated by the Consumer Protection Regulation, 2005. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
20. File be consigned to record room along with a copy of this Judgment.
(JUSTICE SANGITA DHINGRA SEHGAL) PRESIDENT (PINKI) MEMBER (JUDICIAL) Pronounced On:
22.02.2022 DISMISSED PAGE 8 OF 8