State Consumer Disputes Redressal Commission
The Oriental Insurance Company Limited vs Smt. Kanta Devi And Others on 7 November, 2012
BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM SOLAN, H
H.P. STATE CONSUMER
DISPUTES REDRESSAL COMMISSION, SHIMLA.
First Appeal No.17/2012
Date
of Decision: 07.11.2012
The Oriental
Insurance Company Limited,
Through its Senior
Divisional Manager,
Divisional Office,
Mythe Estate,
Shimla, H.P.-171 003.
..
Appellant
Versus
1. Smt. Kanta Devi widow
of late Shri Raj Pal;
2. Naresh Kumar son of late Shri Raj Pal;
3. Dinesh Kumar son of late Shri Raj Pal;
4. Monika Kumari daughter of late Shri Raj
Pal;
(Respondents No.3 and
4 are minors, through their mother and natural guardian Smt. Kanta Devi,
respondent No.1)
All residents of Village Jejhwin,
Pargana Geharwin,
Tehsil Jhandutta, District Bilaspur,
H.P.
Respondents
Coram
Honble Mr. Justice (Retd.) Surjit Singh, President
Honble Mr. Chander Shekhar Sharma, Member
Honble Mrs. Prem Chauhan, Member
Whether
approved for reporting?[1]
Yes.
For
the Appellant: Mr.
P.S. Chandel, Advocate
For the Respondents: Mr.
Rajesh Verma, Advocate
O R D E R:
Justice (Retd.) Surjit Singh, President (Oral) The present appeal, under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 19th October, 2011, of learned District Consumer Disputes Redressal Forum, Bilaspur, Camp at Ghumarwin, whereby a complaint, under Section 12 of the Consumer Protection Act, 1986, filed against the appellant by the respondents, who are the wife and children of late Shri Raj Pal, has been allowed and the appellant ordered to pay a sum of `4.00 lacs, on account of insurance money, with interest at the rate of 9% per annum and also to pay `5,000/- as compensation and litigation expenses.
2. In the complaint filed by the respondents, it was alleged that deceased Raj Pal was the husband of respondent Kanta Devi and father of rest of the respondents, two of whom were minors at the time of filing of the complaint, had purchased a life insurance policy from the appellant and in terms of the said policy, in the event of Raj Pal dying an accidental death, a sum of `4.00 lacs was to be paid and in addition to that, a sum upto `1.00 lac was to be paid, by way of reimbursement of medical expenses.
3. It was alleged that said Raj Pal died on 04.11.2003, due to fall, which resulted in head injury. Respondents filed a complaint, under Section 12 of the Consumer Protection Act, 1986, in the year, 2006, which was decided on 08.04.2008, vide order Annexure C-9. The order said that the respondents shall lodge a claim with the appellant, who will consider and decide the same, on merits, within 90 days. In terms of the aforesaid order, respondents submitted claim to the appellant, which was rejected, vide letter dated 26.08.2008, copy Annexure R-9. Upon that respondents filed a fresh complaint, under Section 12 of the Consumer Protection Act, 1986, seeking direction to the appellant to pay insurance money and also to pay compensation.
4. Appellant contested the complaint and pleaded that the same was barred by time. It was also stated that the respondents-complainants were guilty of suppression of material facts, with regard to cause of death of insured Raj Pal and so the complaint was not competent and maintainable. On merits, it was denied that Raj Pal had died as a result of accidental fall, as alleged in the complaint.
5. Learned District Forum, vide impugned order has held that plea of limitation, cannot be allowed to be raised, in view of the order passed in the earlier complaint, i.e. order dated 08.04.2008, copy Annexure C-9.
Also, it has been held that respondent- complainant Kanta Devi is bed ridden, on account of her having 99% permanent disability, while two of the respondents-complainants were minors when the complaint was filed.
6. As regards merits of the case, learned District Forum concluded that though post-mortem report was not there, nor had any report been lodged with the police, yet from a document collected by an Investigator, appointed by the Life Insurance Corporation of India, in-connection with investigation of a claim, which was lodged with the said Corporation, as the deceased had purchased one policy from that Corporation also, it was made out that deceased had sustained head injury, due to fall and that was the cause of his death. With this finding, the complaint was allowed and impugned order passed.
7. Learned counsel representing the appellant wants to adduce in evidence a letter dated 21.06.2012 received from the Life Insurance Corporation of India, per which the counsel for the appellant has been intimated that claim which the respondents lodged with the said Corporation, in respect of death of Raj Pal, has been repudiated.
8. Learned counsel representing the respondents submits that the letter may be permitted to be placed on record, to avoid delay in the disposal of case.
9. The document, i.e. the aforesaid letter dated 21.06.2012 in no way indicates that cause of death of deceased was different from the head injury. Learned counsel for the appellant submits that he inspected the register maintained by the Life Insurance Corporation of India and there is an entry in the register that deceased had been suffering from chronic cancer of throat, when he purchased the policy from the Life Insurance Corporation of India and that was why the claim had been repudiated.
10. The Letter dated 21.06.2012 does not say that deceased was suffering from cancer. In any case, even if we assume that he was suffering from cancer, that would not mean that cause of death was not the head injury sustained by the deceased. Also, it is not made out from the letter as to when was the policy purchased from the Life Insurance Corporation of India. May be that when the policy was purchased from the Life Insurance Corporation of India, deceased was suffering from cancer, but not at the time, when he purchased the policy from the present appellant, because it is not made out from the record that the policy was purchased from the appellant subsequent to purchase of the policy from the Life Insurance Corporation of India.
11. Above stated position apart, it is not the pleaded case of the appellant that deceased was suffering from cancer or for that matter, any other disease, at the time when he purchased the policy, from it.
12. Now, when it is not the case of the appellant that deceased was suffering from any ailment, when the policy was purchased, leave alone cancer, no amount of evidence which the appellant might produce would be relevant, in view of the basic principle of law that evidence of a fact which is not pleaded, cannot be taken into consideration.
13. Next submission made on behalf of the appellant is that claim was barred by time, when the complaint was filed. This plea cannot be accepted for the reason that order, copy Annexure C-9, passed in earlier complaint of the respondents, attained finality, as it was not challenged in appeal by the appellant and the said order directed the appellant to decide the claim of the respondents, if made, within 90 days of the passing of the said order. Respondents lodged the claim with the appellant, who rejected the same. That gave a fresh cause of action to the respondents. Apart from this, respondent Kanta Devi is admittedly confined to bed as she is having 99% permanent disability. Two of other four respondents were minors, even at the time of filing of second complaint and limitation against the minors does not begin to run, so long as they remain minors, per Section 6 (1) of Limitation Act, 1963.
14. Coming to the merits of the case, plea of the appellant is that an Investigator appointed by it reported that claim of the respondents that deceased had been taken to Apna Hospital at Ghagus, after he sustained head injury, is not correct, as no record was found with the said hospital, indicating that deceased had been taken there for treatment of head injury.
15. Respondents placed on record, Annexure C-8, copy of report of the Investigator, engaged by the Life Insurance Corporation of India, to investigate the cause of death of Raj Pal deceased, because one policy had been purchased by deceased from the Life Insurance Corporation of India also and claim for insurance money based on that policy had been lodged with the said Corporation. As per Annexure C-8, Investigator engaged by the Life Insurance Corporation of India, was told by the doctors of Apna Hospital that the patient was brought in a vehicle and that the condition of that patient was seen in the vehicle itself and he being unconscious, his attendants were advised to rush him to I.G.M.C., instead of getting him admitted to/treated at their hospital. Now, when the deceased was examined by the doctors in the vehicle itself and was not taken inside the hospital, question of any record having been maintained by the hospital, with regard to his admission/treatment did not arise. The aforesaid report, Annexure C-8, shows that the deceased was having head injury and was unconscious.
16. As a result of the above stated position, we see no merit in the present appeal and the same is, therefore, dismissed.
17. One copy of this order be sent to each of the parties, free of cost, as per Rules.
(Justice Surjit Singh) President (Chander Shekhar Sharma) Member (Prem Chauhan) Member November 07, 2012 *dinesh* [1] Whether Reporters of the local papers may be allowed to see the order?