The onus of proving accidental death lies with the insurance company, and the need for sufficient and cogent proof to establish accidental death.

JUDGMENT

Paramjeet Singh Dhaliwal, President - The instant appeal has been filed by the appellant/complainant against the order dated 01.03.2016 passed by District Consumer Disputes Redressal Forum, Moga (in short, "the District Forum"), whereby the complaint filed by her, under section 12 of the Consumer Protection Act, 1986, against the respondents/opposite parties was dismissed.

2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.

3. Brief facts, as averred in the complaint, are that Sh. Amrik Singh, husband of the complainant, was working as a Mandi Supervisor in Market Committee, Dharamkot. He opened account No. 50100062801386 with opposite party no. 3-Bank and obtained a loan of Rs. 3,50,000/- from it, which was repayable in monthly instalment of Rs. 17,263/- from 07.01.2015 to 07.12.2016. The loan amount was disbursed to him on 24.11.2014. In order to secure the loan, opposite party no. 3 got insured the husband of the complainant with HDFC Ergo General Insurance Company Ltd., which is its sister concern, by deducting Rs. 1,863/- from his account on 24.11.2014 and sending the same to opposite party no. 1 & 2, who issued a policy 'Sarv Suraksha Policy' bearing no. 2950 2009 1452 3900 000 in the name of Amrik Singh. The complainant was appointed as nominee in the said policy. Under the said policy, the coverage was given regarding the 'Credit Shield Insurance' (to secure the loan amount of Rs. 3,50,000/-) for an amount of Rs. 3,50,000/-, accidental death for an amount of Rs. 4,00,000/- and accidental hospitalization for an amount of Rs. 1,00,000/-. The premium deducted by opposite party no. 3 from his account was acknowledged by opposite party No. 1, vide letter dated 25.11.2014. On 08.02.2015, husband of the complainant suddenly fell down from his motorcycle and got injured. He was diagnosed as suffering from 'Cervical Spine Injury' and ultimately he died on 10.02.2015 due to said accidental injury and cardiac arrest in Guru Nanak Dev Super Speciality Hospital Tarn Taran. The complainant spent an amount of Rs. 25,000/- on his treatment. She lodged the claim, alongwith the requisite documents as required by opposite party no. 3, and the same were acknowledged/accepted by opposite parties no. 1 & 2. They also sent a message on 27.04.2015 on the mobile of the complainant, stating that her claim (No.C295014006689) was processed and the same would be decided, as soon as possible. She specifically explained the opposite parties No. 1 & 2, through emails, that there was no post-mortem and FIR regarding the said accident. However, the opposite parties failed to settle the claim of the complainant. Due to non-payment of claim amount under the policy, opposite party no. 3 started harassing the complainant to make payment of the loan amount, having full knowledge that they had already insured her husband, through the policy in question. Opposite parties No. 1 & 2 issued a letter dated 01.07.2015 demanding FIR, Post-mortem report etc. Ultimately, the complainant sent legal notice dated 04.09.2015 to the opposite parties, who neither gave any reply nor decided the claim. Accordingly, the complainant approached the District Forum, seeking the following directions to them:

(i) to pay Rs. 7,75,000/- being the sum assured and coverage (Credit Shield Insurance Rs. 3,50,000/-, accidental death Rs. 4,00,000/- and accidental hospitalization expenses Rs. 25,000/- under the policy in question), alongwith interest @ 12 % per annum;

(ii) to pay Rs. 1,00,000/-, as compensation for mental tension, harassment and agony suffered by the complainant; and

(iii) to pay Rs. 22,000/- as litigation expenses.

4. Upon notice, opposite parties No. 1 & 2 appeared before the District Forum and filed joint reply, whereas opposite party No. 3 did not appear despite its service and was proceeded against ex parte.

5. Opposite parties No. 1 & 2, in their reply, raised preliminary objections