National consumer disputes redressal commission
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REVISION PETITION NO. 1660 OF 2011(From the order dated 13.04.2011 in Appeal No.610/08 of the Rajasthan State Consumer Disputes Redressal Commission, Jaipur) Abhikram, Through its Partner Mr. Nimish Patel, Amrit-Lila Bungalow, Off Nagari Hospital Road, Near Gujarat College, Ahmedabad – 380 006 … Petitioner/OP
Versus Hotel Himmatgarh Palace, through Col. Mansingh Managing Director, Thar Hotel (P) Ltd., Jaisalmer – 345 001 … Respondent/Complainant
HON’BLE MR. JUSTICE K.S. CHAUDHARI, MEMBER
PRONOUNCED ON 8th January, 2013 O R D E RPER JUSTICE K.S. CHAUDHARI, MEMBER This revision petition has been filed against the order dated 13.4.2011 passed by the Rajasthan State Consumer Disputes Redressal Commission, Jaipur (in short, ‘the State Commission’) in Appeal No. 610/08 – Hotel Himmatgarh Palace Vs. Abhikram by which order of District Forum dismissing complaint was set aside and appeal was partly allowed and respondent/petitioner was directed to pay Rs.2,65,300/- along with 9% p.a. interest to the complainant. 2. Brief facts of the case are that respondent/complainant hired architectural and structural consultancy of the petitioner/OP for renovation and extension of the Himmatgarh Palace Hotel complex at Jaisalmer. This service was to be provided in two stages, namely; conceptual stage and schematic stage. Complainant paid a sum of Rs.5,30,600/- as consultancy fee to the opposite party but as conceptual design was not complete, complainant filed complaint for refund of fee along with compensation and cost of litigation. OP/respondent filed written statement and submitted that complainant is not a consumer as defined in the Consumer Protection Act, hence, complaint may be dismissed. Further, it was alleged that complaint has been filed with the illegal motive to get the work completed without paying fees and took many other objections regarding jurisdiction, etc. Learned District Forum vide its order dated 4.3.2008 dismissed the complaint holding that complaint does not fall within the purview of consumer against which State Commission vide impugned order partly allowed the complaint. Hence, this revision petition has been filed. 3. Heard learned Counsel for the parties and perused record. 4. Learned Counsel for the petitioner submitted that complainant/respondent does not fall within the purview of consumer and learned State Commission has committed error in allowing complaint partly as the purpose of availing services of the petitioner was for commercial purposes, hence, petition may be allowed and order of the State Commission may be set aside. On the other hand, learned Counsel for the respondent submitted that order passed by the learned State Commission is in accordance with law as complainant after retirement from military services tried to develop his palace for his livelihood, hence, the petition may be dismissed. 5. As per averment of the complaint, complainant is Hotel Himmatgarh Palace. Nowhere it has been mentioned in the complaint that its Director, Man Singh is running this Palace for earning his livelihood by means of self-employment. Perusal of paragraph 10 of the District Forum order reveals that about 80 rooms were to be developed in complainant’s hotel. Memo of appeal filed before the learned State Commission also reveals that complainant, Himmatgarh Palace is branch of Thar Hotels (P) Ltd. which is registered under Company’s Act. Thus, it becomes very clear that complainant, Himmatgarh Palace is branch of Thar Hotels (P) Ltd. and about 80 rooms were to be developed in this hotel and for this purpose architectural services were taken from the petitioner/OP. 6. Learned Counsel for the petitioner has rightly argued that developing 80 rooms for hotel purposes cannot come within the purview of earning livelihood by means of self-employment. Learned Counsel for the respondent has simply argued that hotel was to be developed for self-employment which argument cannot be accepted because, firstly, no averment has been made in the complaint that services were availed for earning livelihood by means of self-employment and secondly complainant being branch of Thar Hotels (P) Ltd.,Jaisalmer, this business cannot come within the purview of business for earning livelihood by means of self-employment. In such circumstances, complainant/respondent does not fall within the purview of consumer under Section 2 (d) of the C.P. Act. Complaint was not maintainable before District Forum and learned District Forum has not committed any error in dismissing complaint, though, on other grounds and learned State Commission has committed error in partly allowing the complaint and petition is liable to be accepted. 7. Consequently, the revision petition filed by the petitioner against the respondent is allowed and impugned order dated 13.4.2011 passed by the learned State Commission is set aside and complaint is dismissed. Complainant/respondent may initiate appropriate proceedings for recovery of fees, etc. before any other Forum/Civil Court. Parties to bear their own cost. ..……………Sd/-…………… ( V.B. GUPTA, J) PRESIDING MEMBER
( K.S. CHAUDHARI, J) MEMBERk NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI
[Against the order dated 01.04.2011 in Appeal No. 389/2010 of the State Consumer Disputes Redressal Commission, U.T. Chandigarh] M/s Worldwide Immigration Consultancy Services Ltd. Through its Authorized Representative Shri Rajiv Bajaj SCO No. 2415-16, Sector 22-C Chandigarh
Versus 1. M/s Reliance General Insurance Co. Ltd. (Anil Dhirubhai Ambani Group) Through its Chairman SCO No. 212-213, First Floor, Sector-34 Chandigarh
2. M/s Reliance General Insurance Co. Ltd. (Anil Dhirubhai Ambani Group) Through its General Manager SCO No. 212-213, First Floor, Sector-34 Chandigarh 3. M/s Reliance General Insurance Co. Ltd.Through Rajesh Sharma, Sr. Manager SCO No. 212-213, First Floor, Sector-34 Chandigarh … Respondents
For the Petitioner : Mr. Sunil Goyal, Advocate Mr. Sujit K. Singh, Advocate
For the Respondents : Mr. Navneet Kumar, Advocate Pronounced on : 9th JANUARY, 2013 O R D E R PER SURESH CHANDRA, MEMBER This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1986 against the order dated 01.04.2011 passed by the State Consumer Disputes Redressal Commission, U.T. Chandigarh (‘State Commission’ for short), by which the State Commission dismissed the appeal filed by the petitioner. The petitioner had through his appeal before the State Commission challenged the order dated 31.08.2010 passed by the District Consumer Disputes Redressal Forum-II, U.T. Chandigarh (‘District Forum’ for short) in Complaint Case No. 1456 of 2009, by which the District Forum had dismissed the complaint of the petitioner. The orders of the District Forum and the State Commission are placed on record. 2. Briefly stated, the facts of the case are that the petitioner/complainant had purchased a vehicle BMW X Series X5 3.0 D from M/s Krishna Automobiles, Chandigarh vide invoice dated 29.07.2008 for an amount of Rs.57,95,000/-. This vehicle was insured with M/s Reliance General Insurance Co. Ltd., who are the respondents/opposite parties, vide Private Car Policy valid for the period 27.07.2008 till midnight 28.07.2009. The Insured Declared Value (IDV) of the vehicle was Rs.55,05,250/-. On 18.12.2008, the vehicle met with an accident at Chandigarh and suffered extensive damage, about which an FIR was lodged with the police station and accident was also reported to the office of the respondents/opposite parties. On 30.12.2008, the said vehicle was inspected by one Shri Kailash Chandra, Surveyor and Loss Assessor, who assessed the loss and prepared an estimate for repairs. As per the report of the surveyor, the damage to the vehicle was assessed at Rs.41,95,457/-. According to the petitioner/complainant, the repairs of the said vehicle had crossed 75% of the IDV and hence the vehicle was to be declared as total loss as per terms of the policy. However, the respondents/opposite parties refused to declare the said vehicle as total loss case and insisted on getting the repairs of the vehicle done. Later on, it appears that another surveyor, namely, Engineer Vinod Kumar Sharma, independently surveyed the vehicle on 12.02.2009 and vide his report dated 12.02.2009 assessed the loss at Rs.41,56,839/-. This surveyor also remarked that it would not be much economical to get the vehicle repaired as after the major repairs, the vehicle would not come to its original position. It is the case of the petitioner/complainant that despite the later survey report and his repeated requests, the respondents/opposite parties kept on delaying the settlement of the claim and paid only Rs.22,99,000/- to the petitioner/complainant as claim amount and additional sum of Rs.20,00,000/- was received on sale of the salvage to a third party with the help of the respondents/opposite parties. As such, according to the petitioner/complainant, the total amount paid to the petitioner/complainant was Rs.42,99,000/- i.e. 78.08% of the IDV, which is more than 75% of the IDV and, hence, it should have been treated as the case of total loss but since the respondents/opposite parties declined to do so, alleging deficiency in service on their part, the petitioner lodged a complaint before the District Forum, which, as stated above, the District Forum dismissed. The appeal filed against this order also came to be dismissed by the State Commission vide its impugned order and in these circumstances the petitioner/complainant has come to the National Commission through the present revision petition. 3. We have heard Mr. Sunil Goyal, Advocate for the petitioner/complainant and Mr. Navneet Kumar, Advocate for the respondents/opposite parties and perused the record. 4. The broad facts of the case are more or less not under dispute. The only question, which has arisen for our consideration in this case, is as to whether the plea of the petitioner/complainant to treat the claim of the petitioner/complainant as a total loss in the light of the report of the second surveyor, Engineer Vinod Kumar Sharma, who was not appointed by the Insurance Company, should be accepted in spite of the petitioner/complainant having accepted the payment of Rs.22,99,000/- as full and final settlement from the respondents/opposite parties. Both the Fora below have rejected the case of the petitioner/complainant while dismissing the complaint. The State Commission while dismissing the appeal of the petitioner/complainant and upholding the order of the District Forum has recorded the following observations in support of the impugned order :- “10. The learned counsel for the OPs i.e. M/s Reliance General Insurance Company Limited has argued that the complainant has been compensated fully by the OPs. As per the terms and conditions, an IRDA approved surveyor was deputed to assess the loss. As per the report of the surveyor (Annexure R-2), the cash loss value was assessed at Rs.22,99,000/-. As per this report, the vehicle was very much repairable and was not a case of total loss within the meaning of the policy and for this reason, the OPs requested the complainant to get the vehicle repaired. Since the complainant was no(t) interested to get his vehicle repaired, therefore, the complainant has opted to settle the claim at cash loss basis and the OPs have settled the claim of the complainant after receiving the unconditional and free consent of the complainant for opting the cash loss and not choosing it to get the vehicle repaired. Hence, as per the request and consent of the complainant, the cash loss settlement was agreed upon, and the value of the claim was assessed at Rs.22,99,000/-. This was less than 75% of the IDV, which was duly accepted by the complainant in full and final settlement of the claim. Further the complainant has also received a sum of Rs.20 lacs as a salvage value, hence the complainant in total has received a sum of Rs.42,99,000/-. It is further argued that the report of Vinod Kumar Sharma, Surveyor is not admissible as this surveyor is not authorized surveyor of the OPs. It is next argued that the complainant has been fully compensated, hence prayed that the appeal filed by the complainant may kindly be dismissed with the heavy costs.
5. We agree with the view taken by the State Commission in the matter. Besides the fact that the second surveyor was not appointed by the Insurance Company, admittedly the petitioner/complainant had accepted the net claim amount of Rs.22,99,000/- in full and final settlement of his claim and issued a consent letter dated 03.07.2009. In the absence of any fraud, misrepresentation, undue influence or coercion being used by the Insurance Company to make the petitioner/complainant to sign the discharge voucher, the claim now made by the petitioner/complainant cannot be accepted. In the given facts and circumstances, the three cases, namely, United India Insurance v. Ajmer Singh Cotton & General Mills & Ors. [II (1999) CPJ 10 (SC)]; Amir Ali A. Mukadam v. United India Insurance Co. Ltd. [IV (2007) CPJ 234 (NC)]; and National Insurance Co. Ltd. v. Boghara Polyfab Private Limited [(2009) 1 SCC 267] cited and relied on by learned counsel for the petitioner/complainant would not provide any comfort to the petitioner/complainant since each case has to be decided on its own merits in the light of the given circumstances. 6. Keeping in view the facts and circumstances of this case, we do not see any reason which would justify our interference with the impugned order. The revision petition, therefore, stands dismissed but with no order as to costs.
……………Sd/-………………. (K.S. CHAUDHARI, J.) PRESIDING MEMBER
…………Sd/-………………… (SURESH CHANDRA) MEMBER
Mukesh
NEW DELHI
REVISION PETITION NO.4073 OF 2012(From the order dated 16.07.2012 in First Appeal No.166/2012 of the Kerala State Consumer Disputes Redressal Commission, Thiruvananthapuram)
MR. SANKARANKUTTY P. PORAKKATT HOUSE, THALAVANIKKARA P.O. THALORE-680 306, THRISSUR DISTRICT, KERALA STATE. ...... PETITIONER Versus THE DEVELOPMENT OFFICER RUBBER BOARD REGIONAL OFFICE ANAPPARA, RAMAVARMAPURAM P.O., THRISSUR DISTRICT, KERALA STATE PINCODE: 680 631, ....... RESPONDENT
HON’BLE MR. JUSTICE AJIT BHARIHOKE,PRESIDING MEMBERHON'BLE MR.SURESH CHANDRA, MEMBERFor the Petitioner : In person PRONOUNCED ON: January, 2013ORDER PER SURESH CHANDRA, MEMBER This revision petition challenges order dated 16.07.2012 passed by the Kerala State Consumer Disputes Redressal Commission, Thiruvananthapuram (‘the State Commission’ for short) by which the State Commission dismissed the appeal filed by the petitioner. 2. The factual matrix of this case are that the petitioner-complainant purchased 190 rubber stems from the respondent-opposite party on 31.07.1991 for Rs.617.50 on a subsidized rate. According to the petitioner, the stems did not grow and the petitioner lost everything in the process. Since the petitioner was not familiar with the rubber plantation, he could not understand the quality of the rubber stems supplied to him by the respondent. Out of the 190 stems, very few had sprouted but those few also did not grow. This was brought to the notice of the Field Officer as well as the Development Officer of the Rubber Board. However, in spite of information of the damage suffered by the petitioner, the respondent Board did not return the expenses incurred by the petitioner for the rubber stems in question and hence the petitioner filed a complaint claiming the cost of the rubber stems with interest @ 15% and Rs.500/- as compensation. 3. On notice, the respondent-OP contested the complaint. It was submitted by the OP that as per his own admission, the petitioner was not familiar with the cultivation of the rubber and was ignorant about it. It was submitted that except the petitioner, the other 27 rubber farmers who had taken the rubber stems, there was no complaint from them. Regarding the allegation that the rubber stems were not of good quality, it was contended that the complaint in question was lodged only after one year and no expert inspected his cultivation or any report was filed by him regarding cultivation. It was also submitted by the OP that the petitioner being ignorant about the rubber plantation, he did not take proper care of the purchased stems and they were not planted in the pits having necessary depth and size. It was also stated by the OP that the pits were waterlogged and hence the stems did not sprout. Denying any deficiency on its part, the respondent prayed for dismissal of the complaint. The District Forum vide its order dated 02.11.2011 in Complaint No.247/1993 partly allowed the complaint by directing the respondent to return Rs.617.50 to the petitioner and to pay Rs.2,000/- as compensation along with costs of Rs.300/- within one month from the date of the order. Not satisfied with the order of the District Forum, the petitioner carried the matter to the State Commission by filing an appeal for additional compensation. As stated above, First Appeal of the petitioner was dismissed by the State Commission vide its impugned order which is now under challenge through the present revision petition. 4. We have heard the petitioner who has appeared in person. 5. It is to be noted that initially the complaint was filed by the petitioner on 19.04.1993 before the District Forum claiming the cost of rubber stems (which was Rs.617.50) with interest @ 15% and Rs.500/- as compensation. However, later on when in the first round of litigation before the State Commission the matter was remanded by the State Commission for fresh disposal after giving opportunity to both the parties to adduce evidence on the disputed issue whether the stems supplied were defective, the petitioner filed an amendment application dated 07.08.2008 for amending the complaint for loss of production of Rs.49,549.50. On remand, though the amendment application was allowed by the District Forum, a compensation only of Rs.2,000/- besides the return of the cost of the rubber stems amounting to Rs.617.50 along with litigation cost of Rs.300/- were allowed by the order dated 02.11.2011 by the District Forum (as indicated above). We find that the State Commission while upholding the said order of the District Forum and dismissing the appeal of the petitioner has recorded the following reasons in support of the impugned order:- “7. The counsel for the respondent submitted that the rubber stems were given to the farmers at Government subsidized rate by the Rubber Board. The plants were of good quality and it does not carry any warranty for the plants as the growth of the plants differ due to the cultivation and climatic conditions. He also submitted that the growth of the plants depends on natural situation and also based on the proper nursing of the plant. The facts being so, it is not proper for the Forum below to fasten any liability on the opposite party, who are only a mediator. It is also argued that the Forum below ought to have dismissed the complaint in limine as the complaint is not sustainable. Submitting that there is absolutely no deficiency in service on the part of the opposite parties, the learned counsel argued that the complainant was not a traditional rubber planter and in his complaint itself he conceded that he was unaware of the plantation of the rubber stems. It is also pointed out that he approached the opposite party 3 months after planting the stems and by that time the sprouts were damaged. Further the respondent was provided with 190 plants in subsidized rate again in the next year. The additional claim made by the complainant was only after the case was remanded from the State Commission to adduce evidence for the opposite party. The amendment petition was filed only after 7 years. The counsel submitted that the additional claim has no legal stand at the stage of remand as the claim was barred by limitation and there cannot be any claim on the ground that the petitioner planted Koodathai in the same place. The additional claim is only an imaginary loss of production which is not supported with any substantiating evidence. There is no case for the appellant that he had produced any expert opinion regarding the loss of rubber stems.
8. On an appreciation of the arguments advanced by the appellant and the learned counsel for the respondent and also on going through the records we are of the view that the appellant/complainant could not substantiate proper evidence to show the loss of production that would have incurred in the rubber plantation for the 1 year. Merely giving the details in the publication and the market value could not be considered as the criteria for the assessment of loss of production of the rubber stems that would have grown and had assured yield in the future. The absence of any scientific criteria for the assessment of loss of production, we are not in a position to consider the claim of the compensation to the complainant. As there is no appeal preferred by the opposite party/respondent we are not disturbing the order passed by the Forum below and uphold the order. In the result, appeal is dismissed. Parties are to suffer their respective costs.”
6. We agree with the view taken by the State Commission and in the given facts and circumstances, we do not see any reason to interfere with the order of the State Commission. Consequently, the revision petition stands dismissed at the threshold with no order as to costs. Sd/- ……………….…………… (AJIT BHARIHOKE J.) PRESIDING MEMBER Sd/- ……………….…………… (SURESH CHANDRA)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI
FIRST APPEAL NO. 665 OF 2007 (Against the order dated 13.09.2007 in Complaint Case No. 80/2000(Hry)/RBT No. 121/2007 of the State Consumer Disputes Redressal Commission, U.T. Chandigarh)
1. Branch Manager Life Insurance Corporation of India Branch 11U, Plot No. 8, Sector-11 Mathura Road, Faridabad 2. Senior Divisional Manager Life Insurance Corporation of India Divisional Office-II Jeevan Pragati, Plot No.6 District Centre, Laxmi Nagar Delhi Through Assistant Secretary Life Insurance Corporation of India Northern Zonal Office Jeevan Bharti, Connaught Circus New Delhi … Appellants Versus Laxman Swaroop S/o Raja Ram C/o M/s Goel Electronics Main Bazaar Old Faridabad … Respondent
HON'BLE MR. JUSTICE ASHOK BHAN, PRESIDENT
For Appellants : Mr. Ashok Kashyap, Advocate For Respondent : Mr. Narender S. Yadav, Advocate with Mr. A. Anandan, Advocate
1. This appeal has been filed by Life Insurance Corporation of India and another (hereinafter referred to as appellants) being aggrieved by the order of the State Consumer Disputes Redressal Commission, U.T. Chandigarh (hereinafter referred to as State Commission), which had allowed the complaint of Shri Laxman Swaroop (respondent-complainant herein). FACTS :- 2. In his complaint before the State Commission respondent-complainant had contended that his wife Smt. Sunita Devi (hereinafter referred to as the life assured) had taken a life insurance policy for an assured sum of Rs.3 Lakhs with the maturity date of 07.11.2027. It was a double benefit accident policy and, therefore, as per the terms of the policy in case of death of the life assured, respondent/complainant was to be paid an additional sum equivalent to the sum assured under the policy, if the death was caused solely and directly as a result of an accident. It was further contended that before issuing the insurance policy, thorough enquiries about the health of the life assured had been made by the appellant/Insurance Company and she was also examined by its doctors and found to be in good health. On 15.01.1998 the life assured fell down from the staircase in her own house and sustained serious and multiple injuries, including head injuries. She was immediately taken to City Hospital and Maternity Home, Fariabad, where from she was referred to Dr. Puneet Mittal, Orthopedic Surgeon, Faridabad on the same day. She, however, died three days later i.e. on 18.01.1998 due to the above serious injuries received by her as a result of her falling down from the staircase. After the death of his wife, respondent/complainant visited the office of the appellant-Insurance Company and informed it about the same and being a nominee of the life assured filed the necessary claim supported by relevant documents. However, even though all the required formalities were completed, the appellant-Insurance Company repudiated the claim vide its letter dated 02.11.1998 by leveling false allegations that the life assured was suffering from Koch’s Chest (Tuberculosis) for over one year and she had consulted a medical practitioner for treatment and this important material information was suppressed while taking the insurance policy and, therefore, the appellant-Insurance Company was fully justified in repudiating the claim. Being aggrieved by the repudiation of the claim both on account of the death of his wife as also non-payment of the additional sum as per the double benefit accident clause, respondent-complainant filed a complaint before the State Commission alleging deficiency in service and requested that the appellant-Insurance Company be directed to pay the claim amount of Rs.6 Lakhs under the life insurance policy taken by the life assured Smt. Sunita Devi since it was a double benefit accident policy along with interest @ 18% per annum from the date of her death till the date of actual payment to the respondent-complainant and also Rs.1 Lakh as damages and Rs.11,000/- as litigation cost. 3. Appellant-Insurance Company on being served filed written statement refuting these charges. It was contended that the contract of insurance being one of ‘uberrima fides’ i.e. contract of utmost good faith, the life assured was legally bound to disclose all material facts, including the status of her health, which she failed to do. On the other hand, as per information available from the City Hospital And Maternity Home, Faridabad dated 29.04.1997, it was clearly established that the life assured had been admitted in that hospital for medical complaints, which included Koch’s Chest i.e. Tuberculosis. Therefore, appellant-Insurance Company was fully justified in repudiating this claim as per conditions of the insurance policy. Apart from this, it was further submitted that her death was not caused because of any injuries that she sustained when she fell down from the staircase, as contended by respondent-complainant, because as per the medical records these injuries were of minor nature and could not have caused her death. Therefore, the claim was rightly repudiated. 4. The State Commission after hearing both the parties and on the basis of evidence filed before it allowed the complaint by concluding that the appellants-Insurance Company has not been able to conclusively prove that the life assured was suffering from Koch’s Chest (Tuberculosis) and that she had suppressed this material fact. The State Commission also concluded that the terms and conditions of the policy were not brought to the notice of the life assured and in the absence of doing so it cannot be held that the policy was void and that the life assured had withheld certain material information regarding her health. The State Commission, therefore, directed the appellant-Insurance Company to pay the respondent-complainant Rs.6 Lakhs under the insurance policy with interest @ 9% per annum after three months of the death of the life assured i.e. 18.04.1998 till payment. Sum of Rs.5000/- was also awarded as compensation. Being aggrieved by this order, this first appeal has been filed. 5. Learned counsel for both the parties made oral submissions. 6. Learned counsel for the appellant-Insurance Company stated that the State Commission erred in not taking cognizance of the important documentary evidence filed before it, namely, the admission file of the City Hospital and Maternity Home, Faridabad dated 29.04.1997, wherein it was clearly stated that the life assured had been suffering from Koch’s Chest (Tuberculosis) and was on ATT for over one year. This amounted to suppression of material facts and by withholding this information, the contract based on utmost good faith was clearly breached. Apart from this, from the medical report of Dr. Puneet Mittal, the orthopedic surgeon, who treated the life assured after her fall, it is clear that the injuries caused were to the phalanx, little finger and shoulder. There was no mention of any serious injury, including head injury. She was given syrup Crilinctus and was advised review after one week. Clearly, these injuries were not serious enough to have caused her death. Under the circumstances, the claim under the double benefit accident policy was justifiably repudiated. 7. Learned counsel for the respondent-complainant on the other hand stated that the State Commission has rightly concluded that there was no credible evidence to confirm that the life assured suffered from Tuberculosis and the admission file from the City Hospital and Maternity Home, Faridabad could not be relied on since it did not have any signatures and was not supported by any evidence or affidavit, in this respect. It was again contended that admittedly the life assured had fallen accidentally on 15.01.1998 and died within three days of the same. Thus, there was clearly a nexus between her accidental fall and her death and, therefore, there was no justification in the repudiation of the claim under the double benefit accident policy. 8. We have heard learned counsel for the parties. We agree with the view taken by the State Commission that the appellants-Insurance Company was not able to produce any credible evidence to prove that the life assured was suffering from Koch’s Chest disease prior to her having taken the insurance policy. Production of a document to this effect does not amount to proving the same and in this case mere production of an admission file, whose authenticity has not been verified/confirmed, is not adequate proof of any pre-existing disease. However, we find force in the contention of the appellant-Insurance Company that from the documentary evidence produced by the respondent-complainant i.e. the medical report from Dr. Puneet Mittal, the orthopedic surgeon, who treated the life assured after her fall, does not indicate any serious injury which could have caused her death. There was no mention whatsoever of any head injury nor was she advised hospitalization which could have been necessary had she sustained any major injury. Only minor injuries to the phalanx, little finger and shoulder were mentioned in the report and respondent-complainant has not been able to produce any evidence including the post mortem report to support his statement that his wife died because of a serious head injury. 9. Keeping in view the above facts, we are unable to uphold the order of the State Commission directing the appellant-Insurance Company to pay the respondent-complainant the entire amount of Rs.6 Lakhs under the double benefit accident policy and set aside the same. However, since the life assured had admittedly died during the validity of the policy, the respondent-complainant is entitled to Rs.3 Lakhs being the amount for which the life was insured. 10. In view of these facts, appellant-Insurance Company is directed to pay the respondent-complainant Rs.3 Lakhs with interest @ 9% per annum from the date of repudiation of the claim till its payment as also litigation cost of Rs.5000/-. 11. The appeal stands disposed of in the above terms. Sd/- (ASHOK BHAN, J.) PRESIDENT
Sd/- (VINEETA RAI) MEMBERMukesh
NEW DELHI |