State Consumer Disputes Redressal Commission
B.M. Shriram General Insurance Co. Ltd. vs Smt Neelam Devi Alias Neelam Kunwar on 21 December, 2023
Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023
Smt. Neelam Devi alias Neelam Kunwar
AFR / NAFR
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
Date of Institution: 09/10/2023
Date of Final Hearing: 21/12/2023
Date of Pronouncement: 21/12/2023
APPEAL No.- FA/23/209
IN THE MATTER OF :
Branch Manager, Shriram General Insurance Co. Ltd.,
Fourth Floor, Maruti Heights, Near R.K. Mall,
G.E. Road, Raipur,
Dist. RAIPUR (C.G.) ... Appellant
Through: Shri Deepesh Kumar Thawait, Advocate
Vs.
Smt. Neelam Devi alias Neelam Kunwar,
W/o. Late Shri Jitendra Kumar Mehta,
R/o. Rawabhatha Banjari, P.S. - Khamtarai, Raipur (C.G.)
Permanent Address: Vill. Oriya Kalan, P.O. Gurua, Lesliganj,
Dist. PALAMU (JHARKHAND) ... Respondent
Through : Shri Sudipto Gupta, Advocate
CORAM: -
HON'BLE SHRI JUSTICE GAUTAM CHOURDIYA, PRESIDENT
HON'BLE SHRI PRAMOD KUMAR VARMA, MEMBER
PRESENT: -
Shri Deepesh Kumar Thawait, Advocate for the appellant. Shri Sudipto Gupta, Advocate for the respondent.
O R A L O R DE R PER: - JUSTICE GAUTAM CHOURDIYA, PRESIDENT This appeal, filed under Section 41 of the Consumer Protection Act 2019 (hereinafter called "the Act" for short) is directed against order dated 23/08/2023 passed by District Consumer Disputes Redressal Commission, Raipur (C.G.) (hereinafter referred to as "District Commission" for short), in Complaint Case No.CC/2017/156, whereby the complaint of the respondent herein alleging deficiency in service against the opposite party / appellant herein by not settling her insurance claim in time, is partly allowed and the opposite party / appellant is directed to pay the complainant/ respondent within 45 days the amount of insurance claim Rs.2,00,000/- (Two Lacs) with interest @ 6% p.a. from the date of filing complaint i.e. 27.02.2017 till realization, Rs.5,000/- (Five Dismissed Page 1 of 6 Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023 Smt. Neelam Devi alias Neelam Kunwar Thousand) as compensation for mental agony and Rs.5,000/- (Five Thousand) as cost of litigation. Feeling aggrieved the opposite party has approached this Commission by way of this appeal.
2. In nutshell the facts of the case are that the deceased husband of the complainant / respondent was registered owner of vehicle bearing registration No.CG-04-JC-9936 for which insurance cover under a package policy was obtained from the opposite party / appellant for the period between 14.08.2012 to 13.08.2013. On 16.12.2012, during subsistence of the insurance policy, when the vehicle was being driven by the deceased Jitendra Kumar Mehta, it met with an accident in which he sustained serious injuries in his head. He was brought to the hospital in unconscious condition. Subsequently he was referred to higher center Ram Manohar Lohia Hosptal New Delhi, where he remained admitted from 21.04.2013 to 13.05.2013, when he could not gain his consciousness, he was referred to Christian Medical College Vellore. In that hospital deceased Jitendra Kumar Mehta remained admitted from 22.05.2013 to 11.06.2013, where his exercises and physiotherapy was also done and was discharged. But he could not recover from the traumatic injuries and ultimately died on 23.05.2014. Claim case was filed before the Motor Accident Claims Tribunal but the same was dismissed holding the claim as P.A. Claim as the deceased was the owner and driver of the vehicle himself and he did not come in the category of a third person. As per averment of the complainant/ respondent the non-applicant impleaded in the claim case who is the opposite party / appellant insurance company in this case was fully aware of the entire facts regarding accidental death of the insured Jitendra Kumar Mehta, but they did not take any step for settlement of the claim, which amounted to deficiency in service on their Dismissed Page 2 of 6 Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023 Smt. Neelam Devi alias Neelam Kunwar part. Hence, complaint was filed before the District Commission seeking direction to the opposite party / insurance company for payment of personal accident death claim of Rs.2,00,000/- with interest @ 12% p.a., compensation for mental agony Rs.20,000/- along with cost of litigation and any other relief which the District Commission deems fit to award.
3. The opposite party / appellant in its written version except the admitted facts has denied all the adverse allegations leveled against. It was specifically denied that the deceased insured died as a result of accident. It was averred that the insured did not die as a result of accident, therefore neither information of his death was given nor any claim form was submitted before the insurance company by the complainant/ respondent, which was a mandatory condition as per the insurance policy but was not followed by the complainant / respondent. It was also averred that as no document and claim form was submitted before the insurance company within the proper and prescribed time, no cause of action arose to file the complaint, hence for the above reasons the complaint is liable to be dismissed with cost.
4. Learned District Commission after going through the record and considering the rival contentions of both parties observed that as a claim case under section 163 A of the Motor Vehicles Act before the Motor Accident Claims Tribunal was filed, the opposite party / insurance company was aware of the insurance claim regarding accidental death of the insured but the claim amount was not given, whereas the deceased insured was the owner driver of vehicle who was having a valid and effective driving licence and died as a result of the traumatic injuries suffered in the accident in question. Hence, the opposite party / insurance company was found guilty of committing deficiency in service and was Dismissed Page 3 of 6 Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023 Smt. Neelam Devi alias Neelam Kunwar directed to pay amount of personal accident cover with interest and compensation as aforesaid in paragraph No.1.
5. We have heard final arguments of both parties, perused the record and the written arguments submitted by both parties.
6. So far as the question of not giving any intimation of the incident and not filing insurance claim before the insurance company is concerned, in the record of the District Commission a copy of certified copy of order dated 29.11.2016 passed in Claim Case No.191/2015, which was instituted on 25.02.2015, Annexure-C1 has been brought on record by the respondent/ complainant. That claim case was filed against the insurance company who is appellant / opposite party in this case, they were represented by the same learned counsel who appeared before the District Commission as well as before us also. In view of all these facts it is not justified on the part of the insurance company to say that intimation of incident and death of the insured owner driver was not given in proper and prescribed time. At the same time it is also true that at least since February - March 2015 the insurance company is being represented with regard to the same insurance claim, which is under consideration. Therefore, this defence taken by the insurance company that insurance claim along with documents was never submitted before the insurance company is not sustainable and if the facts being so, the insurance company ought to have asked the respondent / complainant to file documents and claim form for its consideration even during pendency of the complaint before District Commission, but nothing of that sort was done, hence we are of the considered view that at this stage in the interest of justice this plea cannot be permitted to prevail and we are agree with the observations made by learned District Commission in this regard. Dismissed Page 4 of 6 Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023 Smt. Neelam Devi alias Neelam Kunwar
7. The next question which arises for consideration is whether the death of the insured owner-driver was accidental in nature ? In this regard learned counsel for the appellant insurance company has argued that the insured died on 23.05.2014 after a long period from the date of incident 16.12.2012. The respondent / complainant has not filed any certificate of the treating doctor or any other doctor to the effect that the death of the insured was accidental in nature, hence it cannot be termed as accidental death. We have considered these arguments and gone through the treatment papers and death summary, death certificate etc. of the deceased. From all these documents it clearly appears that the deceased remained hospitalized right from the date of accident itself and from time to time as and when required was referred to different Hospitals for further care. He was discharged on 11.06.2013 with the comment that : -
"Relatives were taught about patient care including skin care, dressing for the sacral ulcer, giving NG feeds and ROM exercises for all joints. He was discharged on request."
Medicines were recommended with the recommendation that : -
"Please follow measures to prevent pressure ulcers- position changes every 2 hours in bed".
This recommendation clearly shows that the patient was discharged in bed ridden position and in every two hours his position was needed to be changed to prevent pressure and ulcer for which patient care including skin care was explained to his relatives. Obviously when the patient was discharged from the Hospital he was in need of care and he was on continuous treatment, medicines, physiotherapy and exercises as prescribed by the Hospital and ultimately died on 23.05.2014, hence this contention of the insurance company that the death of the insured was not accidental in nature is not acceptable and the insurance company is liable to pay compensation to the legal representative of the deceased insured as Dismissed Page 5 of 6 Appeal Nos.: Branch Manager, Shriram General Insurance Co. Ltd. Date of Pronouncement:
FA/23/209 Vs. 21/12/2023 Smt. Neelam Devi alias Neelam Kunwar per terms and conditions of the policy considering his death as an accidental death.
8. The appellant / opposite party insurance company has only filed one page Certificate cum Policy Schedule without any detailed policy terms and conditions, which is necessary to ascertain the definition or terms and conditions with regard to the term „accidental death‟ applicable as per the policy in question. Otherwise also in the Claim Case No.191/2015 before the Motor Accident Claims Tribunal Raipur, this issue has already been decided and the death of the insured Jitendra Kumar Mehta died due to the traumatic injuries suffered by him in the accident. Admittedly that order is nowhere challenged by the insurance company and has attained its finality. Therefore, award of amount of personal accident cover as per „P.A. Cover under Section III for owner-driver by learned District Commission in the impugned order appears to be just and proper.
9. In view of the foregoing discussion, we are of the considered view that this appeal being devoid of any merit is not sustainable, hence the same is dismissed and the impugned order passed by learned District Commission, which is in considered view just and proper in the facts and circumstances of the case is affirmed. Accordingly, all the interlocutory applications, whatever is pending shall also stand disposed off. No order as to cost of this appeal.
(Justice Gautam Chourdiya) (Pramod Kumar Varma)
President Member
/12/2023 /12/2023
Pronounced On: 21st December 2023
Dismissed Page 6 of 6