State Consumer Disputes Redressal Commission
The New India Assurance Co. Ltd. ... vs 1.Smt. Simarjeet Kaur Wife Of Late Shri ... on 13 January, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA First Appeal No.509 of 2006 Date of Institution: 01.03.2006 Date of Decision: 13.01.2012 The New India Assurance Co. Ltd. Regional Office, S.C.O. No.36-37, Sector 17-A, Chandigarh through its duly constituted attorney. Appellant (OPs) Versus 1. Smt. Simarjeet Kaur wife of late Shri Mewa Singh, 2. Amrik Singh minor son of Shri Mewa Singh through Simarjeet Kaur, complainant No.1 real mother and natural Guardian. 3. Harbans Kaur wife of Shri Sukhdarshan Singh @ Mahla Singh All Residents of Village Ghukianwali Tehsil Dabwali District Sirsa. 4. National Federation of Blind, 2721 Chowk Sangtrashan, 2nd Floor, Pahar, Ganj, Delhi-110055, through its General Secretary. Respondents BEFORE: Honble Mr. Justice R.S. Madan, President. Mr. B.M. Bedi, Judicial Member. For the Parties: Shri D.K. Dogra, Advocate for appellant. None for respondents. O R D E R
Justice R.S. Madan, President:
Case called several times since morning but none put in appearance on behalf of the respondents-complainants though the case is fixed for arguments. It is already 1.00 P.M. This appeal relates to the year 2006. Heavy pendency of appeals/complaints as well as non-cooperative attitude of the parties/their counsel is the reason for heavy cause list. Under these circumstances we do not think it appropriate to adjourn this appeal indefinitely and therefore we proceed to decide the same after hearing the learned counsel for the appellant-opposite party and going through the case file.
This appeal has been preferred against the order dated 27.01.2006 passed by District Consumer Forum, Sirsa whereby complaint bearing No.395/2004 filed by complainants (respondents therein) seeking direction to the appellant-opposite party to pay the insurable benefits in respect of Janta Personal Policy obtained by Mewa Singh (now deceased-hereinafter referred to as the Life Assured).
The brief facts of the present case as can be gathered from the record are that Mewa Singh son of Mahla Singh husband of complainant-Smt. Simarjeet Kaur, father of complainant No.2 Amrik Singh and son of complainant No.3-Harbans Kaur (herein respondents) had obtained an Insurance Policy known as Janta Personal Policy for rupees one lac for the period 5.6.002 to 4.6.2003. According to the complainants the life assured died in a road side accident on 25.03.2003. Complainants submitted claim with the opposite parties but their claim was repudiated on the ground that the complainant had not furnished the copy of Postmortem Report and F.I.R. alongwith the claim papers. Challenging the repudiation of her claim, the complainants filed complaint before the District Consumer Forum. Complainants claim was resisted by the opposite parties on the above stated ground.
District Consumer Forum while disposing of the complaint observed that the F.I.R. and the Postmortem report, is not the conclusive proof with respect to the accident and thus accepted complaint and granted relief to the complainants as under:-
we direct the respondents to make payment of Rs.one lac of the insured amount within a period of one month and deposited the same within stipulated time. We further made it clear that the complainant Simarjeet Kaur wife of Mewa Singh is entitled to get Rs.50,000/- from the total amount of Rs.one lac and complainant No.2 Amrik Singh minor son of the deceased Mewa Singh is entitled to get Rs.25000/- being the real son and L.R. and remaining Rs.25000/- to be paid to his mother Smt. Harbans Kaur. We further made it clear that amount of minor be deposited in some nationalized bank and released the same after his attaining maturity. The aforesaid relief granted by us is sufficient to meet the ends of justice. Hence, the demand of compensation as well as costs of proceedings is hereby declined. We further direct the officials of the respondent-company to deposit the insured amount i.e. Rs.one lac within stipulated period failing which the complainant entitled to compensation of Rs.5000/- on account of physical and mental harassment paid and agony with costs of proceedings to the tune of Rs.2000/-. The amount of compensation and costs of proceeding shall be recovered from the pocket of erring officer/official. We order accordingly. The parties are left to bear their own costs. Copies of the order be supplied to both the parties as per rules.
Aggrieved against the order of the District Consumer Forum, the opposite parties No.1 and 2 have come up in appeal.
We have heard learned counsel for the appellants and perused the case file.
According to the complainants Mewa Singh died in an accident. However, no F.I.R., no Postmortem Report in order to prove that Mewa Singh died in an accident has been furnished by the complainant. It has also come on the record that the complainant had not informed the Insurance Company about the death of the life assured within the prescribed period of one month from the date of death as per condition No.1 of the Policy given in Annexure A-1. Conditions No.1 and 2 of the Insurance Policy are reproduced as under:-
CONDITIONS
1. Upon the happening of any event which may give rise to a claim under this policy the insured shall forthwith give notice to the company. Unless reasonable cause is shown, the insured should within one calendar month after the event which may give rise to a claim under the policy, give written notice to the company with full particulars of the claim.
2.
Proof satisfactory to the company shall be furnished of all matters upon which a claim is based. Any medical or other agent of the company shall be allowed to examine the person of the insured on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the company and in the event of death, to make a post-mortem examination of the body of the insured, and such evidence as the company may from time to time require (including a post-mortem examination, if necessary), shall be furnished within the space of fourteen days after demand in writing, and in the event of a claim in respect of loss of sight the insured shall undergo at the insurers expenses such operation or treatment as the Company may reasonably deem desirable. Provided that in the case of a claim by death or permanent total disablement all sums payable only on the delivery of this Policy cancelled and discharged.
It is evident from the record that for the first time the complainants had informed the Insurance Company in writing on 24.10.2003 when notice was sent by them. Though the complainants have taken the plea that they were requesting the opposite parties to pay the insured benefits, but no cogent and convincing evidence has been produced by them in this regard. The other relevant aspect of the case is that after receiving the information from the complainants, the opposite parties had demanded the copy of the F.I.R. and Postmortem report of the deceased but the complainants failed to furnish the same though the same were necessary for settling complainants claim in view of the terms and conditions of the Insurance Policy. This fact has been clearly mentioned in Annexure A-2 under the heading of SCOPE OF TABLE OF BENEFITS, reproduced as under:-
CLAIM DOCUMENTS:-
In case of Death Claim:-
1.
Claim Form
2. F.I.R. and Final Investigation Report
3. Death Certificate
4. Post-Mortem Report
5. Any other documents desired by the Company.
Thus, the complainants failed to adhere to the aforesaid terms and conditions of the Insurance Policy for settling their claim.
It is well settled law that for settling insurance claims, the terms and conditions of the Insurance policy have to be construed strictly. Reference in this regard may be made to case law cited as UNITED India INSURANCE CO. LTD. versus HARCHAND RAI CHANDAN LAL, (2004) 8 Supreme Court Cases 644, wherein Honble Supreme Court has observed as under:-
Held, the terms of the policy shall govern the contract between the parties and they have to abide by the definition given therein, and all those expressions appearing in the policy have to be construed as it is and something cannot be added, subtracted or substituted Honble Apex Court in case cited as Suraj Mal Ram Niwas Oil Mills (P) Ltd. Versus United India Insurance Co. Ltd and another, 2011 CTJ 11 (Supreme Court) (CP) has observed as under:-
22. Before embarking on an examination of the correctness of the grounds of repudiation of the policy, it would be apposite to examine the nature of a contract of insurance. It is trite that in a contract of insurance, the rights and obligations are governed by the terms of the said contract. Therefore, the terms of a contract of insurance have to be strictly construed, and no exception can be made on the ground of equity.
24. Thus, it needs little emphasis that in construing the terms of a contract of insurance, the words used therein must be given paramount important, and it is not open for the Court to add, delete or substitute any words. It is also well settled that since upon issuance of an insurance policy, the insurer undertakes to indemnify the loss suffered by the insured on account of risk covered by the policy, its terms have to be strictly construed to determine the extent of liability of the insurer. Therefore, the endeavour of the court should always be to interpret the words in which the contract is expressed by the parties.
The facts and circumstances of the instant case are fully attracted to HARCHAND RAI CHANDAN LALs case (Supra) and Suraj Mal Ram Niwas Oil Mills (P) Ltd case (Supra).
In view of the aforesaid discussions it has been sufficiently proved that the complainants failed to furnish the copy of the F.I.R. and the Postmortem report. In other words, the complainants failed to prove that the deceased Mewa Singh had died in any accident. Thus, the Insurance Company cannot be held liable to pay the insurable benefits to the complainants. District Consumer Forum has failed to appreciate all these legal aspects of the case, hence, the impugned order cannot be allowed to sustain.
For the reasons recorded above, this appeal is accepted, impugned order is set aside and the complaint is dismissed.
Announced: Justice R.S. Madan 13.01.2012 President B.M. Bedi Judicial Member