State Consumer Disputes Redressal Commission
Surinder Kaur vs National Insurance Company Ltd on 29 November, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, DAKSHIN MARG, SECTOR-37A, CHANDIGARH
2nd Bench
FIRST APPEAL NO. 1243 OF 2008
Date of Institution: 27.11.2008
Date of Decision: 29.11.2012
Surinder Kaur W/o Late Avtar Singh, Ward No. 10, Durlabh Nagar,
255, Behind Gurdwara Vishavkarma, Tehsil Samrala, District
Ludhiana.
.....Appellant
VERSUS
National Insurance Company Ltd, B.O., Samrala, District Ludhiana
through Branch Manager.
.....Respondent
First Appeal under Section 15 of
the Consumer Protection Act,
1986 against the order dated
19.9.2008 passed by the District
Consumer Disputes Redressal
Forum, Ludhiana.
Before:
Sh. Inderjit Kaushik, Presiding Member
Sh. B.S. Sekhon, Member Present:
For the appellant : Sh. Parminder Singh, Advocate For the respondent : Sh. B.S. Taunque, Advocate BALDEV SINGH SEKHON, MEMBER This is an appeal against the order dated 19.9.2008 passed by the District Consumer Disputes Redressal Forum, Ludhiana (hereinafter called as "District Forum") vide which the complaint of the complainant-appellant (hereinafter called as "appellant") was ordered to be decided by the Civil Court if deemed proper by the appellant.
2. Briefly stated, the facts of the case are that Sh. Avtar Singh, husband of the appellant, obtained a Janta Personal Accident Insurance Policy for Rs. 5,00,000/- vide policy No. CHRO400000/0152913 dated 6.4.1997 by paying a premium of Rs. 1,650/-. This policy was valid for First Appeal No. 1243 of 2008 Page 2 of 9 the period 8.4.1997 to 7.4.2009. Unfortunately, on 22.7.2006, Sh. Avtar Singh, while driving his scooter PJI-5561B collided with a motorcycle at Samrala on Chandigarh Highway near hospital of Dr. Sohan Lal Blaggan. Nearby shopkeepers took the injured Sh. Avtar Singh to Dr. Sohan Lal, who referred him to J.P. Scan Centre, Khanna where he was taken for scanning. After getting CT Scan done, on way back to Samrala, Sh. Avtar Singh breathed his last. The death was intimated to the respondent vide letter dated 18.10.2006. The respondent vide letter dated 18.11.2006 asked for reasons for delay in intimation of the accident and for non-lodging of FIR and non- conducting of the post mortem. The appellant replied vide letter dated 2.11.2006 explaining the reasons of delay in lodging the claim and not lodging of FIR or not getting the post mortem done. It was pleaded that FIR was not lodged and post mortem could not be got conducted as the appellant lost her mental stability after knowing about the sudden death of her husband and she was not aware that lodging of FIR was necessary. Regarding the delay in intimating the respondent insurance company, it was explained that the appellant was not aware about the said policy but after some time, when she was searching the papers in the house, she suddenly found the insurance papers relating to the policy and it was only then she came to know about the said policy and hence the delay. Still the respondent repudiated the claim filed by the appellant vide letter dated 30.3.2007 on the ground of delay and non- conducting of post mortem.
3. Hence, the complaint before the District Forum seeking directions to the respondent to pay sum assured i.e. Rs. 5,00,000/- as First Appeal No. 1243 of 2008 Page 3 of 9 per the terms and conditions of the policy alongwith interest @ 18% till realization. Litigation charges of Rs. 15,000/- were also parayed.
4. Upon notice, the respondent insurance company filed written statement in which it was pleaded that on receipt of intimation regarding the death of Sh. Avtar Singh, the matter was thoroughly got investigated from Sh. R.S. Ahluwalia. On going through the said investigation report and documents placed in the claim file, the claim of the appellant was repudiated as "no claim" vide letter dated 30.3.2007 on the ground that the claim pertaining to death of Sh. Avtar Singh was not covered under the Janta Personal Accident Insurance Policy and that the appellant had violated the condition No. 1 of the insurance policy and further that the death of Sh. Avtar Singh had not occurred due to accident. It was further pleaded that the respondent company vide its letter dated 18.10.2006 called upon the appellant to explain reasons for late lodging of the claim on 11.10.2006 while the death had occurred on 22.7.2006. The appellant had failed to give the reply to the said letter. Investigator Sh. R.S. Ahluwalia made thorough enquiries and prepared his report on 2.3.2007 alongwith documents. The repudiation of the claim was conveyed vide letter dated 30.3.2007 in which the reasons were explained as under:-.
"i) Our policy covers the death caused by solely and directly from accident caused by external violent and visible means. In this case you failed to prove that insured (deceased) died due to accident causing external violent and visible injuries. You have failed to submit the FIR and post mortem report which are essential to confirm the accidental death. Thus death caused is not covered under policy coverage.First Appeal No. 1243 of 2008 Page 4 of 9
ii) You have violated condition No. 1 of the policy which states that company will be informed about the happening of accident immediately. In case of death written notice must be so given before interment cremations and in any case within one calendar month after death. But you intimated the company about after three months.
iii) Our investigator Mr. R.S. Ahluwalia has investigated and concluded that death of the deceased has not occurred due to accident."
5. All other allegations were denied. Dismissal of the complaint was prayed.
6. The parties led their evidence by way of affidavits and documents.
7. The learned District Forum, after going through the pleadings of the parties and evidence on record, passed the impugned order in following terms:-
"Consequently, in the interest of justice, we refrain ourselves to decide the fate of the complainant and let it to be decided by the civil court of competent jurisdiction for the reasons that detailed enquiry and investigation is required to know the truth especially when FIR qua accident was not lodged, nor post mortem was got conducted. Hence, matter is ordered to be decided by the Civil Court, if deemed proper by the complainant."
8. Aggrieved by this order, the appellant has come up in appeal.
9. The learned counsel for the appellant submitted that the District Forum has illegally relegated the matter to Civil Court without First Appeal No. 1243 of 2008 Page 5 of 9 appreciating the fact that the insured died due to the accident. The District Forum did not take into consideration that Dr. Sohan Lal Blaggan gave certificate and affidavit to the effect that late Sh. Avtar Singh met with an accident and was brought to his clinic and he referred him for scanning. Dr. Sohan Lal Blaggan had further stated in his affidavit that Sh. Avtar Singh died on way back after getting the scanning done. Sh. Avtar Singh has died due to accident and, therefore, the respondent was liable to compensate the appellant as per insurance policy. It was further submitted that the appellant had filed sufficient evidence on record to show that Sh. Avtar Singh died due to accident. Apart from certificate of Dr. Sohan Lal Blaggan, scan report dated 22.7.2006, affidavits of Sukhwinder Singh, Gurwinder Singh, Subhash Chander, Vinod Kumar, Mohinder Singh have been proved on record and all of them had stated that Sh. Avtar Singh had die due to accident. Acceptance of the appeal and setting aside of the impugned order was prayed.
10. Learned counsel for the respondent submitted that there was no merit in the appeal and the same be dismissed.
11. Submissions have been considered. Record has been perused.
12. The admitted facts of the case are that Sh. Avtar Singh husband, of the appellant, obtained a Janta Personal Accident Insurance Policy for Rs. 5,00,000/- which was valid for the period 8.4.1997 to 7.4.2009. It is also not disputed that Sh. Avtar Singh died during the validity of the said policy. The death certificate (Ex. C-1) shows that Sh. Avtar Singh had died on 22.7.2006. The version of the appellant is that on 22.7.2006 when Sh. Avtar Singh was driving his scooter, he collided with a motorcycle at Samrala at Chandigarh Highway near hospital of First Appeal No. 1243 of 2008 Page 6 of 9 Dr. Sohan Lal Blaggan and nearby shopkeepers took the injured Sh. Avtar Singh to Dr. Sohan Lal Blaggan. Evidently, when an accident takes place and the driver of the vehicle gets injured he is taken to the nearest possible hospital. Since, the shop of Dr. Sohan Lal Blaggan was just nearby he was taken by the shopkeepers for first-aid/treatment. Evidently, Sh. Avtar Singh suffered from some head injury, therefore, he was rightly referred by Dr. Sohan Lal Blaggan for getting scan of his head done. Certificate of Dr. Sohan Lal Blaggan (Ex. C-2) states that late Sh. Avtar Singh was brought to his clinic on 22.7.2006 at 2:00 PM and he had head injury and after investigation he was referred to J.P. Scan Centre, Khanna. This certificate is further supported by an affidavit of Dr. Sohan Lal Blaggan (Ex. C-14), in which it was confirmed that Sh. Avtar Singh was seriously injured in the accident on 22.7.2006 and two persons namely Sukhwinder Singh and Vinod Kumar took him to Khanna for getting scanning done. This fact is further substantiated by the affidavits given by Sh. Sukhwinder Singh as well as by Sh. Vinod Kumar (Ex. C-4 and Ex. C-7 respectively). Both Sh. Sukhwinder Singh and Sh. Vinod Kumar were working in the shop of the deceased Sh. Avtar Singh called Universal Auto Store situated at Chandigarh Road. One Sh. Gurwinder Singh had also filed his affidavit, who was doing business in the shop called Bhatia General Store near the shop of Dr. Sohan Lal Blaggan, in which it has been deposed that his workers namely Sukhdev Singh, Sukhwinder Singh and Vinod Kumar came to the spot and took Sh. Avtar Singh to Dr. Sohan Lal Blaggan who suggested to get the scan reports as Sh. Avtar Singh had serious head injury. The most important document, the report of J.P. Scan Centre, Khann (Ex. C-3) confirms that Sh. Avtar First Appeal No. 1243 of 2008 Page 7 of 9 Singh was taken to the centre for scanning on 22.7.2006 and the report regarding NCCT Brain clearly reveals that Sh. Avtar Singh was having "SDH right fronto-temporo-parietal region with gross midline shift", clearly implying that Sh. Avtar Singh actually suffered severe head injury which resulted from a road accident.
13. The respondent insurance company had repudiated the claim on the ground that the intimation was given late. Evidently, when a person gets injured in a road accident, the family members specially wife is in a state of shock and the first and foremost priority is to get the patient treated and not to rush to the insurance company to inform about the said accident. Even though the claim has been filed late about 3 months but the queries raised by the respondent insurance company had been duly replied by the appellant vide letter (Ex. C-11) in which the reasons of the delay has been duly explained. Firstly, she was not aware of the fact that the deceased Sh. Avtar Singh was having any accidental policy and she came across the papers about the policy after the death of Sh. Avtar Singh. Evidently, when the appellant was under
severe shock due to the sudden death of her husband, she was not expected to know that the matter was to be reported to the police or the post mortem was to be got carried out before cremation specially when she was not even aware about the accidental policy purchased by her husband. Even though there is a clause in the policy terms and conditions to inform about the accidental death immediately before cremation but this fact was only in the knowledge of the deceased Sh. Avtar Singh and after his death no one else was aware of this condition of the policy. Therefore, this condition could not be fulfilled. First Appeal No. 1243 of 2008 Page 8 of 9
14. The respondent insurance company had primarily relied upon the investigation report of Sh. R.S. Ahluwalia (Ex. R-2) in which he concluded that he had not been able to get any solid proof to determine whether Sh. Avtar Singh really met with an accident. He has raised doubt that had it been so, Sh. Avtar Singh should have been taken to some hospital or at least Civil Hospital Samrala. Police was also not informed regarding the accident. He has further opined that it is mandatory that in case of an accident, police has to be informed and in case of death police get the post mortem conducted. In the present case, neither the police was informed nor the post mortem was done and under the circumstances, it could not be determined whether Sh. Avtar Singh had died due to rod accident or due to some other problem.
15. Careful perusal of this investigation report shows that Sh. R.S. Ahluwalia, investigator had not placed on record any document to show that Sh. Avtar Singh died due to any reason other than the road accident. He has only expressed his doubt that had Sh. Avtar Singh met with an accident, he would have been taken to some hospital in Ludhiana or Civil Hospital, Samrala. This argument of investigator is not only untenable but very ridiculous. In case of a sudden accident, how the patient is taken to a particular hospital, depends upon the wisdom of the persons who immediately rush to his rescue or the availability of a hospital nearby. Since Dr. Sohan Lal Blaggan's hospital was the nearest, therefore, there is nothing suspicious about taking the injured to the hospital of Dr. Sohan Lal Blaggan's Clinic. Mere expression of doubt does not substantiate the case of the respondent when there is sufficient evidence on record to show that Sh. Avtar Singh suffered serious head injury in a road accident which First Appeal No. 1243 of 2008 Page 9 of 9 caused his death. When there is no reason to show that the deceased Sh. Avtar Singh had died due to any other reason than in accident, denying the appellant of her legal right definitely is an unfair trade practice.
16. The learned District Forum has wrongly relegated the case to the Civil Court only on the basis of minor discrepancy about whether Sh. Avtar Singh went to or was brought to the clinic of Dr. Sohan Lal Blaggan specially when there is sufficient evidence on record to decide the case on merits.
17. In view of the above discussion and findings, the appeal of the appellant is allowed and the impugned order of the District Forum is set aside. The complaint is allowed and the respondent insurance company is directed to pay the appellant the sum assured i.e. Rs. 5,00,000/- alongwith interest @ 6% per annum from the date of filing of the claim i.e. 18.10.2006 till its realization within two months from the date of receipt of the copy of this order.
18. The arguments were heard on 19.11.2012 and the order was reserved. Now, the order be communicated to the parties.
19. The appeal could not be decided within the statutory period because of the heavy pendency of the court cases.
(Inderjit Kaushik) Presiding Member (Baldev Singh Sekhon) Member November 29, 2012 VINAY