Rewari District Commission Holds United India Insurance Co Liable For Deficiency In Service, Orders To Disburse Amount And Pay Compensation

Brief Facts:

Late Dinesh Kumar held a Kisan Credit Card (KCC) account with the Primary Agriculture Cooperative Society (“PACS”). The accidental death claim insurance premium was transferred from PACS Bank to United India Insurance Company Ltd. (“Insurance Company”) to cover the potential accidental death of the deceased. Tragically, the deceased suffered severe injuries in a roadside accident and succumbed to these injuries during an ongoing treatment at Park Hospital, Gurugram (“Hospital”). An autopsy was conducted on the deceased's body and an FIR was filed against the driver of the unknown vehicle responsible for the accident. Meanwhile, the family members (“Complainants”) made several communications with PACS and the Insurance Company but received no satisfactory response for the settlement of claims. Feeling aggrieved, the Complainants filed a consumer complaint in the District Consumer Disputes Redressal Commission, Rewari, Haryana (“District Commission”).

In response, the Insurance Company asserted that an investigation was initiated upon receiving notification of the accident. An Auto Investigator was appointed to verify the facts, and the report dated February 26, 2021, recommended repudiating the claim. The basis for this recommendation was the alleged non-cooperation of the deceased's relatives, who refused to disclose the accident spot and provide medical treatment documents for verification. This was considered a violation of condition no.2 of the insurance policy. Additionally, the Insurance Company stated that there was a delay in reporting the accident. PACS didn't appear before the District Commission. Therefore, it was proceeded against ex-parte.

Observations by the Commission:

The District Commission acknowledged the emotional distress experienced by the Complainants, who lost a 29-year-old breadwinner. Despite one of the Complainants being the nominee in the deceased's account, the District Commission held that the responsibility to honour the T&C of the policy fell on the Insurance Company. The contention of the Insurance Company regarding the late reporting and alleged non-cooperation on the part of the Complainants was dismissed by the District Commission as baseless. Therefore, the District Commission held the Insurance Company liable for deficiency in services.

The District Commission directed the Insurance Company to pay Rs. 50,000/- as the accidental death claim to those Complainants who were the first-class heirs of the deceased. Another Complainant, as the father and nominee, was also instructed to disburse the claim amount to the first-class legal heirs. The District Commission awarded an additional compensation of Rs. 30,000/- for mental agony and harassment, along with Rs. 11,000/- as litigation expenses, to be shared equally among the Complainants.

Case Title: Ram Kanwar vs Max Life Insurance Co. Ltd.

Case Number: CC/405 of 2019

Advocate for the Complainant: Complainant in person

Advocate for the Respondent: Nitesh Singhi

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