State Consumer Disputes Redressal Commission
Sh. Hari Singh. vs State Bank Of India. Gen. Insurance Co. ... on 28 February, 2019
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA
First Appeal No. : 21/2018
Date of Presentation: 22.01.2018
Order Reserved on : 25.10.2018
Date of Order : 28.02.2019
......
Hari Singh son of Shri Gandhi Ram resident of Village Harwani
Post Office Upper Behli Tehsil Sundernagar District Mandi H.P.
...... Appellant/Complainant
Versus
1. State Bank of India General Insurance Company Ltd. 101
Junction of Western Express Highway & Andheri-Kurla
Road Andheri (East) Mumbai-400069 through Senior Vice
President and National Head Agency Digital and alternate
channel.
2. State Bank of India General Insurance Company Ltd. 101,
201, 301 Natraj Junction of Western Express Highway &
Andheri-Kurla Road Andheri (East) Mumbai-400069
through Health Claim Team Deputy Vice President
Claims-Health
3. State Bank of India General Insurance Company Ltd. 101,
201, 301 Natraj Junction of Western Express Highway &
Andheri-Kurla Road Andheri (East) Mumbai-400069
through Grievance Redressal Officer
4. State Bank of India Branch Office Bhojpur Tehsil
Sundernagar District Mandi H.P. through Manager.
......Respondents/Opposite parties
Coram
Hon'ble Justice P.S. Rana (R) President
Hon'ble Mr. Vijay Pal Khachi Member
Hon'ble Ms. Sunita Sharma Member.
Whether approved for reporting?1 Yes.
1
Whether reporters of the local papers may be allowed to see the order? Yes.
Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018)
For Appellant : Mr. Jai Dev Thakur Advocate.
For Respondents No.1to3 : Mr. Harsh Vardhan Advocate vice
Mr. Chandan Goel Advocate.
For Respondent No.4 : Ex-parte.
JUSTICE P.S. RANA (R) PRESIDENT:
O R D E R :-
1. Present appeal is filed under section 15 of Consumer Protection Act 1986 against order dated 22.12.2017 passed by Learned District Forum in consumer complaint No.241/2016 titled Hari Singh Versus State Bank of India General Insurance Company Ltd. & Ors. Brief facts of Consumer Complaint:
2. Complainant Hari Singh filed consumer complaint under Section 12 of Consumer Protection Act 1986 pleaded therein that complainant is father of Jagat Raj Arya who expired on dated 14.04.2016 at about 8:47PM at Chandi Mandir Galma Tehsil Balh District Mandi H.P. It is pleaded that deceased was duly insured with the opposite parties. It is further pleaded that on dated 14.04.2016 deceased Jagat Raj Arya was offering prayers in the evening time at Chandi Mandir Galma Tehsil Balh District Mandi H.P. and it is further pleaded that there was huge rush of devotees and the Priest of said Temple was offering prayers to the goddess by dancing and was beating himself with steel chain and due to that devotees were running here and there and there was 2 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) hustle and bustle between the devotees and due to hustle and bustle the deceased Jagat Raj Arya fell down on stairs and rolled down on retaining wall at about 7:00PM. It is further pleaded that deceased was brought to Civil Hospital Ratti where deceased died on dated 14.04.2016 at about 8:47 PM.
It is further pleaded that complainant is nominee of deceased being father of deceased. It is further pleaded that postmortem of deceased was also conducted. It is further pleaded that deceased died due to accidental death and claim was submitted before the opposite parties but opposite parties did not settle the claim and committed deficiency in service. Complainant sought relief of payment of Rs.400000/- (Four lac). In addition complainant sought litigation costs. Prayer for acceptance of consumer complaint sought.
3. Per contra version filed on behalf of opposite parties No.1 to 3 pleaded therein that consumer complaint is not maintainable. It is pleaded that claim of complainant was repudiated vide letter dated 31.08.2016. It is further pleaded that deceased died due to natural death and did not die due to accidental death. It is further pleaded that Myocardial Infarction is natural cause of death and not accidental cause of death. It is further pleaded that opposite parties No.1 to 3 did not commit any deficiency in service. Prayer for dismissal of consumer complaint sought.
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Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018)
4. Per contra separate version filed on behalf of opposite party No.4 pleaded therein that consumer complaint is not maintainable and complainant is estopped to file the complaint due to his own acts, deeds, and conduct. It is admitted that Jagat Raj Arya was duly insured with the opposite parties. It is further pleaded that deceased died due to Myocardial Infarction as per postmortem report. It is further pleaded that complainant is not legally entitled to claim as the legal heirs of deceased i.e. Wife and daughter of deceased are alive. It is pleaded that opposite party No.4 is only referring agency and has no concern with the Insurance policy. Prayer for dismissal of consumer complaint sought.
5. Complainant filed rejoinders and reasserted the allegations mentioned in the complaint.
6. Learned District Forum dismissed the complaint and held that Myocardial Infarction is natural death. Feeling aggrieved against the order passed by learned District Forum complainant filed present appeal before State Commission.
7. We have heard learned Advocates appearing on behalf of appellant and co-respondents No.1 to 3 and we have also perused entire record carefully. Co-respondent No.4 was proceeded ex-parte by State Commission.
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Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018)
8. Following points arise for determination in present appeal.
1. Whether appeal filed by appellant is liable to be accepted as mentioned in memorandum of grounds of appeal?
2. Final order.
Findings upon point No.1 with reasons:
9. Complainant filed affidavit in evidence. There is recital in affidavit that deponent is father of Jagat Raj Arya who expired on dated 14.04.2016 at about 8:47PM at Chandi Mandir Galma Tehsil Balh District Mandi H.P. There is further recital in affidavit that life of deceased was duly insured with the opposite parties to the tune of Rs.400000/-
(Four lac). There is further recital in affidavit that on dated 14.04.2016 deceased Jagat Raj Arya was offering prayers in the evening time at Chandi Mandir Galma Tehsil Balh District Mandi H.P. and there is further recital in affidavit that there was huge rush of devotees and the Priest of the said Temple was offering prayer to the goddess by dancing and beating himself with steel chain and due to that devotees were running here and there and there was hustle and bustle between the devotees and due to hustle and bustle the deceased Jagat Raj Arya fell down on stairs and rolled down on retaining wall at about 7:00PM. There is further recital in 5 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) affidavit that deceased was brought to Civil Hospital Ratti where deceased died on dated 14.04.2016 at about 8:47 PM. There is further recital in affidavit that deponent is nominee of deceased being father of deceased. There is further recital in affidavit that deceased was 31 years old. There is further recital in affidavit that date of birth of deceased has been wrongly mentioned in the postmortem report. There is further recital in affidavit that deceased was medically fit as per medical fitness certificate issued by Medical Officer PHC Dhanotu Tehsil Sunder Nagar District Mandi on dated 05.03.2016. There is further recital in affidavit that deceased had also donated blood in the years 2006-2007 and 2007- 2008 at Govt. Polytechnic College Hamirpur H.P. and was physically fit and was not suffering from any internal disease in his body. State Commission has carefully perused all the annexures filed by complainant carefully.
10. Opposite parties filed affidavit of Miss. Madhavi Uttam Patil. There is recital in the affidavit that claim of complainant was repudiated by opposite parties vide letter dated 31.08.2016. There is further recital in affidavit that death of deceased occurred due to Myocardial Infarction i.e. Due to natural cause and not by any accident. There is further recital in affidavit that Insurance Company is not 6 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) liable to indemnify the complainant. State Commission has carefully perused all the annexures filed by opposite parties.
11. Submission of learned advocate appearing on behalf of complainant that deceased died due to accidental death and on this ground appeal filed by complainant be allowed is decided accordingly. It is proved on record that deceased Jagat Raj Arya died on dated 14.04.2016 when he had gone to Chandi Mandir Galma Tehsil Balh District Mandi H.P. as devotee. It is proved on record that deceased fell on the stairs and rolled down from the stairs and thereafter was brought to Civil Hospital Ratti where he died due to injuries.
12. State Commission has carefully perused postmortem report No.37 dated 15.04.2016 signed by two Medical Officers and as per postmortem report deceased died due to Massive Myocardial Infarction. As per legal definition Massive Myocardial Infarction means heart attack. As per law heart attack is life threatening condition which occurs when blood flow to heart muscles is blocked. As per law accident means unfortunate incident that happened unexpectedly and unintentionally. As per Medical Fitness Certificate placed on recorded deceased Jagat Raj Arya was not suffering from any infectious, contagious disease. There is no evidence on recorded in order to prove that deceased was suffering from any internal or external prior disease of body. It is held that 7 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) learned District Forum has wrongly interpreted words Myocardial Infarction as natural death. It is held that heart attack is not natural death but is unexpected and unintentional accidental death. See 2004 (1) CPJ 288 SCDRC Chhattisgarh titled Life Insurance Corporation of India Versus Nirmala Jaiswal & Anr. There is recital in the police report that deceased Jagat Raj Arya married one year back with Anita Devi and one daughter was also born from the marriage of Anita Devi and deceased Jagat Raj Arya.
13. Submission of learned advocate appearing on behalf of Insurance Company that deceased died due to natural death and on this ground appeal filed by complainant be dismissed is decided accordingly. There is no evidence on record in order to prove that deceased died due to natural death. As per postmortem report signed by two Medical Officers deceased died due to Massive Myocardial Infarction. State Commission is of the opinion that Massive Myocardial Infarction falls within the definition of massive heart attack which is admittedly accidental death and not natural death. Point No.1 is decided accordingly.
Point No.2: Final Order
14. In view of findings upon point No.1 above appeal is allowed. Order of learned District Forum dated 22.12.2017 passed in consumer complaint No. 241/2016 is set aside. It is 8 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) ordered that opposite parties No.1 to 3 jointly and severally shall pay amount of Rs.400000/- (Four lac) alongwith interest at the rate of 9% per annum from the date of filing complaint till realization to the legal-heirs of deceased who falls within Class-I legal-heirs of deceased namely Anita Devi widow of deceased and her minor daughter in equal shares within one month after receipt of file.
15. It is proved on record that complainant was nominee in the Insurance policy and nominee is only trustee and as per Hindu Succession Act 1956 father falls within Class-II schedule mentioned under Hindu Succession Act 1956 and does not fall within Class-I legal heir and as per Hindu Succession Act 1956 widow of deceased and minor daughter of deceased fall within Class-I legal-heirs of deceased.
16. It is further ordered that opposite parties No.1 to 3 jointly and severally shall pay compensation to the tune of Rs.20000/- (Twenty thousand) to the legal heirs of deceased mentioned supra. It is further ordered that opposite parties No.1 to 3 jointly and severally shall pay litigation costs to the tune of Rs.10000/- (Ten thousand) to the legal heirs of deceased mentioned supra. It is further ordered that amount shall be divided equally between the widow of deceased and minor daughter of deceased. Share of minor daughter of 9 Hari Singh Versus State Bank of India General Insurance Co. Ltd. & Ors. (F.A. No.21/2018) deceased shall be deposited in the FDR till the minor attained the age of majority. Postmortem report of deceased No.37 dated 15.04.2016 and Medical Fitness Certificate of deceased dated 05.03.2016 shall form part and parcel of order. File of learned District Forum alongwith certified copy of order be sent back forthwith and file of State Commission be consigned to record room after due completion forthwith. Certified copy of order be transmitted to parties forthwith free of costs strictly as per rules. Appeal is disposed of. Pending application(s) if any also disposed of.
Justice P.S. Rana (R) President Vijay Pal Khachi Member Sunita Sharma Member 28.02.2019.
*GUPTA* 10