State Consumer Disputes Redressal Commission
Icici Lombard Gic Ltd. vs Shiv Prasad Tiwari on 22 September, 2023
Daily Order M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PLOT NO.76, ARERA HILLS, BHOPAL FIRST APPEAL NO. 317 OF 2018 (Arising out of order dated 08.08.2018 passed in C.C.No.242/2015 by District Commission, Rewa) ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED, 3RD FLOOR, ALANKAR PALACE, COMMERCIAL PALACE, ZONE-II, M. P. NAGAR, BHOPAL (M.P.) .... APPELLANT. Versus 1. SHIV PRASAD TIWARI, S/O LATE SHRI VIBHISHAN TIWARI, 2. PRATIMA TIWARI, D/O SHRI SHIV PRASAD TIWARI, 3. PRAMILA TIWARI, D/O SHRI SHIV PRASAD TIWARI, 4. BRAHMANAND TIWARI, S/O SHRI SHIV PRASAD TIWARI, 5. RAHAS TIWARI, D/O SHRI SHIV PRASAD TIWARI, 6. VIVEKANAND TIWARI, S/O SHRI SHIV PRASAD TIWARI, RESPONDNE NO.4 TO 6 ARE MINOR THROUGH GUARDIAN THEIR FATHER SHRI SHIV PRASAD TIWARI, ALL R/O VILLAGE-BAIRATHPUR, POST-SENGAR, POLICE STATION-LOUR, DISTRICT-REWA (M.P.) 7. BLOCH MEDICAL OFFICER, C.H.G. MAUGANJ, DISTRICT-REWA (M.P.) 8. CMO, KUSHABHAU THAKRE DISTRICT HOSPITAL, BICHIYA, DISTRICT-REWA (M.P.) 9. GOVERNMENT OF M.P. THROUGH COLLECTOR, DISTRICT-REWA (M.P.) .... RESPONDENTS. BEFORE : HON'BLE SHRI JUSTICE SHANTANU S. KEMKAR : PRESIDENT HON'BLE DR. (MRS) MONIKA MALIK : MEMBER
COUNSEL FOR PARTIES :
Shri Amit Tiwari, learned counsel for the appellant.
Ms. Kalpana Verma, learned counsel for the respondent 1 to 6.
None for the respondent no. 7 to 9.-2-
O R D E R (Passed on 22.09.2023) The following order of the Commission was delivered by Dr.(Mrs) Monika Malik, Member:
This appeal by the opposite party no.4/appellant the ICICI Lombard General Insurance Company Limited (hereinafter referred to as 'insurance company') is directed against the order dated 08.08.2018 passed by the District Consumer Disputes Redressal Commission, Rewa (for short 'District Commission') in C.C.No.242/2015, whereby the District Commission has partly allowed the complainant filed by the complainants/respondent no.1 to 6 (hereinafter referred to as 'complainants').
2. Briefly put, facts of the case are that the complainant no.1 and his late wife Smt. Shrutikirti Tiwari (hereinafter referred to as 'deceased') who were already parents of five children, had approached the opposite party no. 1 on 29.01.2012 regarding sterilization operation to be performed on the deceased. It is alleged that after two and half years of the said operation, the deceased conceived and was admitted in the hospital of opposite party no.1 for child birth. On 08.05.2015, the deceased delivered a son and few hours later, she died. Later, after few days, newly born child also died. It is alleged by the complainant no.1 that due to negligence and -3- deficiency in service on part of the opposite party no.1, the deceased conceived even after undergoing the sterilization operation and died while delivering a child. The aforesaid conduct of the opposite parties caused harassment and pain to the complainants. Alleging deficiency in service against the opposite parties, the complainants approached the District Commission, seeking relief.
3. The opposite party no.1 to 3 despite service of notice remained absent before the District Commission and were proceeded ex-parte.
4. The opposite party no.4-insurance company resisted the complaint on the ground that it was not intimated regarding death of the deceased. Also, it is not proved that the claim form with respect to the deceased was sent to the insurance company and the same was received by it. The complainants are thus not entitled to any relief, which has been claimed by them.
5. The District Commission partly allowed the complaint and directed the opposite parties jointly or severally to pay Rs.30,000/- to the complainants. In addition, compensation of Rs.10,000/- with another sum of Rs.2,000/- as costs is also awarded. Entire aforesaid amount is directed -4- to be paid within one month failing which the amount shall be paid with interest @ 6% p.a. from the date of order, till payment.
6. Heard.
7. Learned counsel for the appellant-insurance company argued that the complainants had not filed any claim before the concerned authority or the insurance company regarding failure of sterilization operation. The deceased was insured for a period from 01.03.2013 to 31.03.2013 and the claim which was made later does not come under the policy period. He also argued that limit to make liable for payment of claim by the insurance company had already exhausted. The operation was conducted on 29.01.2012 and as per Health Ministry, Union of India, last date to accept the claim was 30.06.2013. On 08.05.2015, when the cause of action arose, the insurance company did not have any policy in existence. The policy had expired and no renewal was made to this policy. There has been no deficiency in service or unfair trade practice committed by the insurance company and therefore, the impugned order deserves to be set-aside.
8. We find that the District Commission while partly allowing the complaint has made an observation that when the insurance company had insured the deceased for the year 2012-2013 and the deceased delivered a child on 08.05.2015, the complainants deserve to be given claim amount but while holding it, the District Commission has not discussed the basis for holding the same. The policy schedule which is filed in the record of the District Commission and condition for payment of claim have also not been discussed in the impugned order.
9. In this view of the matter, we are of a considered opinion that the case deserves to be remanded back to the District Commission.
10. Accordingly, the impugned order is set-aside and the matter is remanded back to the District Commission for decision afresh.
11. Parties are directed to appear before the District Commission on 06.11.2023.
12. Record of the District Commission be sent at the earliest.
13. The District Commission is directed to proceed with the matter in accordance with law and to pass a well reasoned order and also to decide the matter as expeditiously as possible, but not later than three months of the appearance of the parties.
14. With the aforesaid observations and directions, this appeal stands disposed of, with no order as to costs.
(JUSTICE SHANTANU S. KEMKAR) (DR. MONIKA MALIK) PRESIDENT MEMBER