IMPORTANT POINT
Accident – An accident is an occurrence or an event, which is unforeseen and startles one when it takes place but does not startle one when it does not take place. It is not the happening of the expected but the happening of the unexpected, which is called as an accident.

JUDGMENT

Kiran Sibal, Member.—The complainant has filed this complaint under Section 17 of the Consumer Protection Act, 1986 (in short “the Act”), against the opposite parties (in short “OPs”) seeking following directions:-

i) The OPs be directed to release the amount insurance claim of Rs.25 lacs on account of death of her husband, along with interest @ 18% p.a. till the date of payment;

ii) The OPs be further directed to pay compensation to the tune of Rs.50,000/- on account of harassment;

iii) To pay Rs.11000/- as litigation expenses.

2. Brief facts, as set out in the complaint, are that the husband of the complainant; namely, Gursahib Singh (DLA) had purchased a ‘Personal Accident Cover Policy’ i.e. ‘Activ Secure’ bearing No.12-18-0039430-00 for a sum assured of Rs.25 lacs from OP No.1. The policy was valid w.e.f 05.09.2018 till 04.09.2020. The DLA purchased the said policy of OP No.1 through OP No.3 by paying an amount of Rs.6,684/- as single premium (Rs.3,240/- as Basic Premium, Rs.2,884/- as premium for Optional Covers and Rs.1,019/- as IGST) through Net Banking. Unfortunately, on 18.09.2018, the DLA died on the spot due to an accident with a Truck and an FIR No.0125 dated 18.09.2018 was registered under Section 304-A, 279, 427 of IPC in P.S. Sirhali, District Tarn Taran. The complainant intimated the OP No.1 & 2 through claim information No.12-18-0039430/612180000205 for receiving the claim amount on account of death of her husband. But the Insurance Company repudiated the claim of the complainant on the ground that the DLA had a previous history of hospitalization from 02.12.2017 to 21.12.2017 for Retroperitoneal Tumor and the same was not disclosed to the insurance company at the time of inception of the policy. The DLA had purchased a ‘Personal Accident Cover Policy’ under the product name “Activ Secure” and the page No.7 of the insurance policy provides description of the product name ‘Activ Secure’ and further provides the facilities covered by this product name wherein under Section IA clause 1.1: ‘Accidental Death Cover (AD): Lump Sum payment in the event of Accidental Death’ has been mentioned. It is apparent from the description of the product name that the claim of the complainant is duly covered by the insurance policy and the alleged misrepresentation/non-disclosure has no nexus with the cause of death of the DLA. The complainant has made various efforts to get release the claim amount but all in vain. The act and conduct of the OPs amounts to unfair trade practice and deficiency in service on their part. Hence, this complaint.

3. Notice of the complaint was issued to the OPs and OPs No.1 & 2 were appeared through counsel. But OP No.3 refused to accept the notice and he was proceeded against exparte, vide order dated 04.03.2020.

4. OPs No.1 & 2 filed written reply raising preliminary objections that the present complaint is false, frivolous, vexatious and abuse of the process of this Commission since no cause of action arises against answering OPs. This commission has no jurisdiction to entertain the present complaint and the present complaint is not maintainable as the complainant has not approached this Commission with clean hands. On merits, OPs No. 1 & 2 stated that the DLA approached the OPs for availing insurance policy and upon receipt of duly signed proposal form, the policy in question was issued on 05.09.2018. In case the policyholder is not satisfied with the features or the terms and conditions of the policy, he could withdraw/return the policy within 15 days of the receipt of the policy documents i.e. under the “Free Look” option. The Provision of free look is also explicitly stated in policy terms and conditions and a copy of the policy documents along with the signed copy of the proposal form was duly sent to the insured. The DLA had an opportunity to read the contents filled by him in the proposal form and intimate the company if he had missed to state about his past medical condition. Th