Sham Sunder (Retd.), President:
1. This appeal is directed against the order dated 26.11.2013, rendered by the District Consumer Disputes Redressal Forum-I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which, it dismissed the complaint, filed by the complainant (now appellant).
2. The facts, in brief, are that the complainant obtained a Personal Accident Insurance Policy, from the Opposite Party, valid for the period from 18.03.2011 to midnight of 17.03.2012, for the capital sum risk, to the tune of Rs.5 lacs, on payment of premium, to the tune of Rs.993/-. During the currency of the said Insurance Policy, the complainant met with an accident, on 19.03.2011, while walking, whereafter he was taken to Apollo Clinic, Chandigarh. The Doctors of the said Hospital, advised the complainant, complete bed rest. Thereafter, the complainant filed a claim, with the Opposite Party, alongwith all the requisite documents, vide Annexure C-3, followed by reminders dated 28.07.2011 Annexure C-4 and 31.08.2011, Annexure C-5. However, the Opposite Party, disowned its liability, on the ground, that no such claim was reported to its office. It was stated that the claim was duly intimated to the office of the Opposite Party and the same was acknowledged by it. It was further stated that the complainant spent approximately, a sum of Rs.15,000/-, for treatment of the injuries suffered by him, in the said accident. It was further stated that the Opposite Party, was requested to pay the amount of claim, but to no avail. It was further stated that the aforesaid acts of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence into unfair trade practice. When the grievance of the complainant, was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter to be called as the Act only), was filed, directing the Opposite Party, to reimburse, the amount of Rs.15,000/-, spent by him, on his treatment; pay compensation to the tune of Rs.20,000/-, for mental agony and physical harassment; cost of litigation, to the tune of Rs.10,000/-; and interest on the aforesaid amounts @12% P.A., till realization.
3. The Opposite Party, in its written version, admitted the issuance of Personal Accident Insurance (Individual) Policy, to the complainant. According to the Opposite Party, the said Policy was valid, for the period from 18.03.2010 to 17.03.2011. It was stated that the complainant met with an accident, on 19.03.2011, and, on the said date, the Policy was not in force. It was further stated that the details of accident were not mentioned by the complainant, in the complaint. It was further stated that according to the Personal Accident Insurance Policy, the claim was payable only if the insured sustained any bodily injury, resulting solely and directly, from the accident caused by external violent and visible means, and if the injury resulted into disability of any part of the body. It was further stated that though the alleged accident, which took place on 19.03.2011, was not covered under the said Insurance Policy, and no liability was admitted, yet the medical certificate dated 19.03.2011, submitted by the complainant, did not show that he was totally and permanently disabled, in any way, and, as such, his case did not fall, under the provisions of the same (Insurance Policy), even if the same was in force. It was denied that the complainant had submitted any letter dated 02.04.2011, to the office of the Opposite Party, or it acknowledged the same. It was further stated that the complainant did not intimate the Opposite Party, about any such accident, immediately, as required under Condition No.1 of the Insurance Policy. It was further stated that neither there was any deficiency, in rendering service, on the part of the Opposite Party, nor it indulged into unfair trade practice. The remaining averments, were denied, being wrong.
4. The Parties led evidence, in support of their case.
5. After hearing the Counsel for the parties, and, on going through the evidence, and record of the case, the District Forum, dismissed the complaint, as stated above.
6. Feeling aggrieved, the instant appeal, has been filed by the appellant/complainant.
7. We have heard the Counsel for the appellant, at the preliminary stage, and, have gone through the evidence, and record of the case, carefully.
8. The Counsel for the appellant, submitted that a wrong stand was taken by the Opposite Party, in its written version, that the Policy, on the date, the accident took place, was not in force. He further submitted that Annexure C-10 is a copy of the cover note, which clearly showed that the Personal Accidental Insurance Policy, was issued, in favour of the complainant, for the period from 18.03.2011 to the midnight of 17.03.2012, for the capital sum risk, to the tune of Rs.5 lacs, for which premium, to the tune of Rs.993/-, was paid. He further submitted that even the incident was intimated to the Opposite Party, vide Annexure C-3, dated 02.04.2011, which was duly acknowledged by it, as photo-impression of stamp of the said Office, is in existence thereon. He further submitted that the complainant submitted the bills, in the sum of Rs.15,000/-, spent by him, on his treatment, and he was also advised bed rest, as is evident from the medical certificate Annexure C-2 dated 19.03.2011 of the Hospital aforesaid, yet, his claim was not settled, but, on the other hand, it was repudiated. He further submitted that repudiation of claim of the complainant was illegal and arbitrary. He further submitted that the act of repudiation of claim of the complainant, on the part of the Opposite Party, amounted to deficiency, in rendering service, as also indulgence, into unfair trade practice. He further submitted that the order of the District Forum, being illegal, and invalid, is liable to be set aside.
9. The first question, that falls for consideration, is, as to whether, on the date of the alleged accident, on 19.03.2011, the complainant had a valid Personal Accidental Insurance Policy or not. Annexure C-10, is a copy of the Personal Accidental Policy, issued in favour of the complainant, which shows that the same was valid, for the period from 18.03.2011 to the midnight of 17.03.2012, for the capital sum risk, to the tune of Rs.5 lacs, for which premium, to the tune of Rs.993/-, was paid by him. Under these circumstances, the stand taken by the Opposite Party, in its written version, that the complainant was not having effective and valid Insurance Policy, on the alleged date of accident, is totally false. It is, therefore, held that the complainant was having a Personal Accidental Policy, valid for the period from 18.03.2011 to midnight of 17.03.2012, when the accident took place.
10. The next question, that falls for consideration, is, as to whether, the complainant intimated with regard to the alleged accident, to the Opposite Party, immediately, after the same or not. Annexure C-3 is a copy of the letter dated 02.04.2011, addressed to the Branch Manager, National Insurance Company Limited, SCO No.85-86, Sector 17-D, Chandigarh, vide which intimation was given by the complainant, that he met with an accident and the Doctor advised him complete bed rest. Vide this letter, the complainant further stated to register his claim and complete the requisite formalities. The alleged accident, took place on 19.03.2011, and for the first time, intimation with regard to the same, was given to the Opposite Party, on 02.04.2011 i.e. after a period of about more than 13 days. It is to be seen, as to what are the consequences of delay, in intimation of the alleged accident, to the Opposite Party, by the complainant. For this purpose, we have to refer to the terms and conditions of the Policy, Annexure R-1. Condition No.1 of the terms and conditions of the Policy, at page 41 of the District Forum file reads as under:-
œUpon the happening of any event which may give rise to a claim under this policy, written notice with full particulars must be given to the Company immediately. In case of death, written notice also of the death must unless reasonable cause is shown, be given before Interment/ cremation and in any case, within one calendar month after the death and in the event of loss of sight or amputation of limbs, written notice thereof must also be given within one calendar month after such loss of sight or amputation?.
11. It is evident, from the afore-extracted condition, that the complainant was required to intimate the Opposite Party, with regard to the alleged accident, immediately, after the same had taken place. Since, in the instant case, the complainant intimated the Opposite Party, after about 13 days, he was not entitled to the amount of claim and repudiation of the same could be said to be legal and valid. In New India Assurance Company Ltd. Vs Trilochan Jane, First Appeal No.321 of 2005 decided on 9.12.2009 by the National Consumer Disputes Redressal Commission, the question that fell for decision, as to what was meant the word œimmediately?. In that case also, there was condition No.1 in the Policy, which prescribed that intimation with regard to the incident, which may lead to any claim was required to be given immediately. While accepting the appeal, holding the repudiation of claim, by the Insurance Company, as valid, and setting aside the order of the Fora below, the National Consumer Disputes Redressal Commission, New Delhi, held as under;
œWord immediately has not been defined under the Act. Resort has to be made to the dictionary meaning assigned to it.
As per Oxford Advanced Learners Dictionary, the word immediately means at once.
As per Strouds Judicial Dictionary, Fifth Edition, word immediately is defined as under:
(1). œThe word œimmediately?, although in strictness it excludes mean times, yet to make good the deeds and intents of parties it shall be construed such convenient time as is reasonable requisite for doing the thing?.
As per Blacks Law Dictionary, Sixth Edition, word immediately means: -
œImmediately. Without interval of time, without delay, straightway, or without any delay or lapse of time. When used in contract is usually construed to mean œwithin a reasonable time having due regard to the nature of the circumstances of the case?, although strictly, it means, œnot deferred by any period of time. The words œimmediately? and œforthwith? have generally the same meaning. They are stronger than the expression œwithin a reasonable time? and imply prompt, vigorous action without any delay.?
According to Mitras Legal and Commercial Dictionary, Fifth Edition, word immediately is defined as under: -
œImmediately. œImmediately? is to be construed as meaning with all reasonable speed, considering the circumstances of the case. Halsburys Laws of England, 4th Ed. Vol. 23, para 1618, p. 1178.
The word immediately is stronger than the expression within a reasonable time, and imply prompt, vigorous action, without any delay. It means all convenient speed. The word immediately should not be construed so as to require doing something which is impossible.?
As per Oxford Advanced Learners Dictionary, the word immediately means at once whereas Strouds Judicial Dictionary, Fifth Edition, word immediately in the context of contract has to be taken as reasonable requisite time for doing the thing. As per Blacks Law Dictionary, Sixth Edition, word immediately means doing of a thing straightway or forthwith but when used in the context of contract, it is usually construed to mean œwithin a reasonable time having due regard to the nature of circumstances of the case?. More or less to the effect, is the same meaning assigned in Mitras Legal and Commercial Dictionary, Fifth Edition. Since, in the present case, there was a contract between the insured and the insurer and, the word immediately, under the circumstances, has to be construed within a reasonable time having due regard to the nature of circumstances of the case.
12. Similar principle of law, was laid down in Silversons Vs Oriental Insurance Company Ltd. and Anr. IV(2011)CPJ 9(SC). In the instant case, intimation with regard to the accident was not given immediately, but after 13 days, as stated above. As such, repudiation of claim of the complainant, on this ground, could be said to be legal and valid.
13. Even otherwise, the claim of the complainant did not fall within the ambit of the terms and conditions of the Insurance Policy. According to the complainant, as per the averments, made by him, in the complaint, which were supported by him, by way of affidavit, on 19.03.2011, when he was walking, he met with an accident. He did not state even a single word, as to whether, any vehicle struck against him. He also did not state, in his affidavit, as to whether, any cattle struck against him, resulting into his fall, leading to injuries on his person. It was required of the complainant, to give complete details, with regard to the alleged accident. If the complainant, while walking, on account of certain reasons, which did not have any connection with the external factors, fell down, then certainly his case did not fall within the purview of the terms and conditions of the Insurance Policy, in question. The relevant terms and conditions of the Policy Annexure R-1, however stipulate as under:-
œNow this Policy witnessed that subject to the terms exclusions definitions and conditions contained herein or endorsed or otherwise expressed hereon the Company will pay to the insured as hereinafter mentioned if at any time during the currency of this Policy, the insured shall sustain any bodily injury, resulting into solely and directly from accident, caused by external violent and visible means, then the Company shall be liable to pay to the insured or his legal personal representative, as the case may be the sum or sums hereinafter set fourth that is to say-
(A) If such injury shall within twelve (12) calendar months of its occurrence be the sole and direct cause of the death of the insured, the capital sum insured stated in the Schedule hereto.
(B) If such injury shall within twelve (12) calendar months of its occurrence be the sole and/or direct cause of the total and irrecoverable loss of
(ii). Sight of both eyes or of the actual loss by physical separation of the two entire hands or two entire feet or one entire hand and one entire foot or of such loss of sight of one eye and such loss of one entire foot or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the capital insured stated in the Schedule hereto.
(iii). Use of two hands, or tow feet, or of one hand and one foot or of such loss of sight of one eye and such loss of use of one hand or one foot, the capital insured stated in the Schedule hereto.
(C) If such injury shall within twelve (12) calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of:-
(i). the sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot, fifty percent (50%) of the capital sum insured stated in the Schedule hereto.
(ii). total and irrecoverable loss of use of a hand or a foot without physical separation, fifty percent (50%) of the capital sum insured stated in the Schedule hereto.
(d) If such injury shall as a direct consequence thereof immediately permanently totally and absolutely disable the insured from engaging in any employment or occupation of any description whatsoever, then a lumpsum equal to hundred percent (100%) of the capital sum insured stated in the Schedule hereto:.
14. In the instant case, no cogent and convincing evidence was produced by the complainant, as stated above, that the accident took place, on account of external violent and visible means, and if the injury resulted into permanent disability of any part of the body. No evidence was also produced, on the record, to the effect that, on account of the alleged accident, there was a loss of eyesight, or tow feet. The complainant also did not produce any evidence, to prove that the injury suffered by him, permanently, totally and absolutely disabled him, from engaging in any employment or occupation of any description. Copy of the medical certificate Annexure C-2 produced by the complainant, did not, in any way, prove this factum. The mere fact that, in the medical certificate, it was written that the complainant was advised bed rest, for one week, did not mean that he was permanently disabled, on account of the alleged injury, depriving him, from engaging in his occupation. Even the case of the complainant did not fall within the ambit of the terms and conditions of Policy Annexure R-1. The District Forum was, thus, right in holding that the repudiation of claim of the complainant was legal and valid. The District Forum, was also right, in holding that the Opposite Party was neither deficient, in rendering service, nor indulged into unfair trade practice. The order of the District Forum, being legal and valid, is liable to be upheld.
15. No other point, was urged, by the Counsel for the appellant.
16. In view of the above discussion, it is held that the order passed by the District Forum, being based on the correct appreciation of evidence, and law, on the point, does not suffer from any illegality or perversity, warranting the interference of this Commission.
17. For the reasons recorded above, the appeal, being devoid of merit, must fail, and the same is dismissed, at the preliminary stage, with no order as to costs. The order of the District Forum is upheld.
18. Certified copies of this order, be sent to the parties, free of charge.
19. The file be consigned to Record Room, after completion.