BEFORE THE HON’BLE NATIONAL CONSUMER DISPUTES

REDRESSAL COMMISSION, NEW DELHI

FIRST APPEAL NO. 1525 OF 2018

IN RE:
UNITED INDIA INSURANCE CO. LTD. … PETITIONER

VERSUS

SH. OM PRAKASH KHOSLA … RESPONDENT

N.D.O.H. 16.02.21
INDEX

S. No. Particulars Pages

1. WRITTEN ARGUMENTS/BRIEF SYNOPSIS

ON BEHALF OF THE PETITIONER (UNITED 01……09
INDIA INSURANCE CO. LTD

NEW DELHI APPELLANT

THROUGH

DATED:- 05.02.2021 (PRADEEP GAUR & ASSOCIATES)

ADVOCATES & LEGAL CONSULTANTS,
CHAMBER NO. 322,
PATIALA HOUSE COURTS
NEW DELHI-110001
MOB: 9810081811, 9350890202
 BEFORE THE HON’BLE NATIONAL CONSUMER DISPUTES
REDRESSAL COMMISSION, NEW DELHI

FIRST APPEAL NO.1525 OF 2018

IN RE:
UNITED INDIA INSURANCE CO. LTD. … PETITIONER

VERSUS

SH. OM PRAKASH KHOSLA … RESPONDENT

WRITTEN ARGUMENTS/BRIEF SYNOPSIS ON BEHALF OF THE

PETITIONER (UNITED INDIA INSURANCE CO. LTD)

1. That the respondent is assignee in personal accident claim of his wife Chanchal

Rani Khosla and he and his wife have been taking medi-claim and personal

policies from the appellant insurance company since 1997 against premium.

The wife of the respondent obtained personal accident policy from the

appellant insurance company which was valid for the period 24/05/2013 to

23/05/2014. On 07.12.2013, the insured Smt. Chanchal Rani Khosla i.e. wife of

respondent fell down in her home and suffered hip fracture and she remained

under treatment at Prabh Simran Hospital from 07.12.2013 to 13.12.2013.

Thereafter, she was again admitted in the hospital on 17.02.2014 to 20.02.2014

for right side weakness and aphaisa. She was 70 years old at the time of alleged

accident. The insured i.e. wife of the deceased died on 04.09.2014.

2. That the respondent i.e. husband of the deceased insured lodged the claim

before the appellant insurance company under the PA claim. The appellant

company demanded certain documents from the respondent on 29.01.2016 and

they were supplied accordingly by respondent /complainant.

3. That the appellant insurance company thereafter, appointed Royal Associates

as investigator to investigate the claim. After investigation it came to notice

that the deceased insured i.e. the wife of the deceased was suffering from

multiple medical problems due to which she died at her home and the time gap

between her injury and death is ten months and no post mortem was conducted

and disability pertains to medical problems. The appellant insurance company

on the basis of the investigation report and the report of the panel doctors

repudiated the claim of the respondent vide their repudiation letter dated

09.08.2016.

4. That the said repudiation of the claim the respondent complainant filed the

complaint before the Hon’ble State Commission, Punjab on 12.04.2017.

5. That the receipt of notice of complaint, the appellant insurance company

entered appearance and filed its written reply stating therein that the complaint

is without any cause of action. The complainant i.e. respondent herein has

concealed the material facts from the Forum. The insured Chanchal Rani

Khosla has not died due to injury sustained by her on 07.12.2013. She was 70

years old and suffered from multiple diseases like diabetes, hypertension,

parkinson’s disease, heart disease and was under treatment at K.D. hospital

from 07.12.2014 to 20.02.2014, where she was diagnosed as a case of right side
 weakness with Aphasia (loss of voice). The insured died after more than six

months from the date of discharge from K.D. Hospital and she had not taken

any treatment for injury at K.D. Hospital proving that she was fully recovered

from the injury suffered on 07.12.2013. She was hospitalized at K.D. Hospital

for diseases which have no nexus with her injury. The respondent complainant

has not obtained post mortem report of the deceased insured for revealing the

precise cause of her death. There is no substance on the record that the

deceased insured died due to injury suffered on 07.12.2013. she died on

account of multiple diseases and not on account of injury as asserted by

complainant i.e. respondent herein. The Ld. State Commission after hearing

arguments from both sides, reserved the order.

6. The Ld. State Commission vide its order dated 09.04.2018 allowed the

complaint of the respondent /complainant and directed the opposite party i.e.

appellant insurance company herein to pay insurance claim as per policy terms

and conditions, as complainant has been designated as assignee by life assured

in the policy. The appellant insurance company was also directed to pay

interest @ 8% p.a. to the complainant from the date of repudiation of the

insurance claim till actual payment. It was also stated therein that the

complainant is also entitled to Rs. 50,000/- as compensation for mental

harassment and Rs. 20,000/- as cost of litigation. It was also stated therein that

the compliance of this order shall be made within 45 days after receipt of

certified copy of order.

 7. That therefore, the present revision petition was filed to set aside the

order dt. 09.04.2018.

8. That the impugned order passed by the Hon’ble State Commission is

perverse and devoid of merits and as such is not maintainable on the basis

of the facts and law applicable.

9. That the Ld. Fora below failed to appreciate the fact that the

complainant/respondent despite being given so many opportunities failed

to prove by cogent evidence that what was the stock at the time of loss.

Further as per the claim form and the intimation the estimated loss was

made for Rs. 1,45,000/- whereas the Ld. For a below has awarded Rs.

1,92,000/- under the head of loss to the stock without any basis in view of

the fact that the complainant/respondent has stated that on the date of loss

there was stock of 3000 kgs mustard oil and 5000 kgs mustard. The

respondent himself vide letter dated 21.11.2000 has quantify the value of

the mustard oil and raw mustard as Rs. 1,70,000/-. This makes it clear

that the assessment of compensation by the Ld. For a below is wrong.

10. That the Ld. Fora below erred in not taking into consideration the fact

that it was established by the survey report that at the time of loss there

was no oil in the tank and the said aspect was also confirmed by the

complainant/respondent in his evidence as he has stated in reply to

question no. 26 that the tank was totally empty. The Ld. Fora below

without any basis allowed the compensation in toto as claimed by the

 complainant/respondent despite having the evidence on record to prove

otherwise. It is also submitted here that the survey report cannot be

brushed aside unless it has been proved that the said report was prepared

with malafide intention and the complainant/respondent has produced

sufficient material to prove the loss otherwise then assessed by the

surveyor.

11. That the Ld. Fora below erred in not taking into consideration the fact

that no expert assessment was on record except the report of the surveyor

appointed by the petitioner insurance company and no malafide was

raised in the pleadings against the surveyor.

12. That the Ld. For a below erred in reaching to the conclusion that when

the fire took place in the factory, oil in tanker burnt then it was natural to

look empty whereas it was stated by the petitioner insurance company

that in sales tax it has not been declared that what was the stock at the

time of taking fire. When the surveyor investigated the matter, the tanker

was empty the said aspect was also confirmed by the

complainant/respondent in his evidence as he has stated in reply to

question no. 26 that the tank was totally empty.

13. That the Ld. Fora below erred in confirming the order of the Ld. District

Forum and relying on the judgment of the Hon’ble Supreme Court in the

matter of New India Assurance Co. Ltd. Vs. Pradeep Kumar, IV (2009)

CPJ 46 (SC), wherein it was decided that the survey report is not final
 and any party is not bound to it. In this case, so less assessment by the

surveyor is like a drop in the ocean. Hence, the compensation of Rs.

2,92,000/- allowed by the forum for stock, filter, pump and machinery is

not arbitrary. Whereas no expert assessment was on record except the

report of the surveyor appointed by the petitioner insurance company and

no malafide was raised in the pleadings against the surveyor by the

complainant/respondent.

14. That the petition is not being filed within the period of limitation. The

certified copy of the order of the Hon’ble State Commission was received

by the petitioner insurance company on 11/05/2018 and thereafter, after

obtaining opinion of the counsel of the petitioner insurance company, the

file was sent to the Head office of the petitioner insurance company for

taking permission to file the present revision petition before this Hon’ble

Commission and the revision petition is being filed thereafter. It is,

therefore, respectfully prayed that this Hon’ble National Commission be

pleased to:

i) Call for the record of the C. Case NO. 222/2017 titled as Mr. Om Prakash

Khosla VS UIIC from the Hon’ble State Commission, Chandigarh

Punjab.
ii) Accept the present revision and set aside/recall impugned order dated

09/04/2018 passed by the Hon’ble State Commission, Chandigarh

Punjab.

iii) Allow the cost throughout in favour of the petitioner and against the

respondent

15. Pass such other or further order(s) as may be deemed fit and proper is

passed in favour of the petitioner insurance company and against the

respondent in the interest of justice. The deposited amount in terms of the

directions of this Hon’ble Commission vide order dated 09.04.2018 if

released to the respondent may kindly be ordered to be refunded.

The revision petition be allowed in favour of the petitioner and against

the respondent.

NEW DELHI APPELLANT

THROUGH

DATED:- 05.02.2021 (PRADEEP GAUR & ASSOCIATES)

ADVOCATES & LEGAL CONSULTANTS,
CHAMBER NO. 322,
PATIALA HOUSE COURTS
NEW DELHI-110001
MOB: 9810081811, 9350890202