In the absence of direct evidence, mere hearsay regarding negligence in driving does not validate an insurance claim denial.

1. Instant appeal is arising out of the order dated 20/11/2021 passed by learned District Consumer Commission, Mandi, in Consumer Complaint No. 72/2021, titled Smt. Mathura Devi v. Religare Health Insurance Company Limited & Another

2. Brief facts of Case:
Briefly, the case of the complainant is that son of the complainant Shri Dev Raj (since deceased) had purchased a single premium health insurance policy on 18/05/2018 from the opposite party No.1 / Insurance Company through the opposite party No.2 / Bank. The complainant being the mother and legal heir was appointed as a nominee. The sum assured was Rs.15,00,000. On 7th August, 2020, Shri Dev Raj (deceased) met with an accident at Pau - Nulla - Mohni, Banjar, District Kullu and sustained the injuries and later on died in IGMC, Shimla on 09/08/2020. FIR No. 77/2020, dated 07/08/2020 relating to the incident was registered in Police Station, Banjar (Seraj), District Kullu, Himachal Pradesh. Information regarding the accident was given to the opposite parties and relevant documents were supplied for payment of claimed amount. vide letter dated 13/03/2021, the claim was repudiated by the opposite party No.1 / Insurance Company.

3. Opposite party No.1 (Insurance Company) has filed reply to the complaint and submitted that at the time of accident, the deceased / life assured Dev Raj was driving the vehicle rashly and negligently in high speed. Consequently, the vehicle in question went off the road. The deceased / life assured Dev Raj had violated the terms and conditions of the policy while driving the vehicle rashly and negligently in high speed. Therefore, the complainant is not entitled to any relief.

4. The opposite party No.2 / Bank in its reply has pleaded that the policy in question was purchased by the deceased / life assured from the opposite party No.1 / Insurance Company. The opposite party No.2 / Bank at no point of stage remained involved in any kind of dispute. If at all any dispute is there, it is between the complainant and the Insurance Company.

5. In rejoinders, the complainant has reiterated the contents of complaint and refuted the objections put forth by the opposite parties.

6. Thereafter parties led evidence in support of their respective pleadings.

7. After hearing parties, learned District Commission partly allowed the complaint in favour of the complainant.

8. Feeling aggrieved by the order of learned District Commission, the appellant / Insurance Company has preferred the instant appeal before this Commission.

9. We have heard learned Counsel appearing on behalf of the parties and have also gone through the record carefully.

10. Learned Counsel of the appellant / Insurance Company has submitted that at the time of accident, vehicle in question was driven by deceased / life assured Dev Raj rashly and negligently in high speed and as such violated the terms and conditions of the Insurance policy. The police filed final report, i.e. closer report under S.173, CrPC, which was accepted by the Competent Court of jurisdiction.

11. On the other hand learned Counsel for the respondent No.1 / complainant has submitted that deceased / life assured died in the accident. Since the deceased / life assured died in the accident, intention of deceased / life assured before accident cannot be attributed against him. Learned Counsel for the respondent No.1 / complainant further submitted that the impugned order does not require any interference and the appeal of the appellant be dismissed and relied upon order passed by learned Hon'ble National Commission in case titled Mala Sahni Seth v. New India Assurance Co. Ltd. , 2020 (IV) CPJ 206 (NC), decided on 08/10/2020.

12. Fi