State Consumer Disputes Redressal Commission
Bal Shah Yadav vs United India Insu.Co. on 5 January, 2019
M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PLOT NO. 76, ARERA HILLS, BHOPAL (M.P.)
FIRST APPEAL No. 622 /2013.
Balshah Yadav,
R/o Gram Duvriya Tola Khati,
Tehsil Pushparajgarh,
District Shahdol (M.P.). .... Appellant.
Versus
1. Branch Manager,
United India Insurance Co. Ltd.,
Division Office 2A, 203, Zone -I,
M.P. Nagar, Bhopal (M.P.).
2. Chief Medical & Health Officer,
Anuppur, District Anuppur (M.P.). .... Respondents.
BEFORE:
HON'BLE SHRI JUSTICE SHANTANU S. KEMKAR, PRESIDENT
HON'BLE SHRI S. D. AGARWAL, MEMBER
HON'BLE DR. (SMT) MONIKA MALIK, MEMBER
COUNSEL APPEARING FOR THE PARTIES :
Ms. Mona Paliwal, learned counsel for the appellant.
Shri Pradeep Nighojkar, learned counsel for the respondent no.1.
None for the respondent no.2.
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ORDER
(Passed on 5 /1/2019) The following order of the Commission was delivered by Shantanu S. Kemkar, J :
This appeal at the instance of the complainant has been filed under Section 15 of the Consumer Protection Act, 1986 (for short the "Act") challenging the order dated 21.12.2012 passed by District Consumer Disputes Redressal Forum, Shahdol (for short the "Forum") in Complaint Case No.28/2011.
2. Briefly stated the appellant - complainant had filed a complaint case under Section 12 of the Act before the Forum stating therein that his wife Smt. Durgawati during her pregnancy was registered at Govt. Primary Health Centre (for short "Primary Health Centre"). She was regularly examined by the Doctors at Primary Health Centre. On 26.6.2006 when she was admitted in the said hospital she delivered a female child. However, immediately after delivery she became unconscious and ultimate died on 27.6.2006 due to "cardiac respiratory failure because of severe anemia with PPH". It is further stated in the complaint that the complainant being BPL card holder was covered under 'Vijaya Raje Janani Kalyan Insurance Scheme' floated by the respondent no.2 State Govt. which provided that in case a woman dies during pregnancy on account of the complications arising out of pregnancy including being anaemic, excessive bleeding, shock etc. within 42 days of the delivery, her legal representatives -3- would be entitled for compensation of Rs.50,000/- and medical expenses of Rs.1,000/- from the respondent no.1 - United India Insurance Company Ltd. In order to get the benefit of the Scheme the complainant had submitted Claim Form dated 27.6.2006 (Ex. C - 3) to the respondent no.2 being Nodal Agency. The respondent no.2 - Nodal Agency forwarded the claim form to respondent no.1 - Insurance Company with covering letter dated 28.8.2006 (Ex. R -3). However, as the claim was neither allowed nor rejected the appellant sent legal notice on 21.10.2011 seeking compensation amount of Rs.50,000/- and Rs.20,000/- towards deficiency in service and for mental agony caused to him. However, no heed was paid by the respondents to pay the amount as claimed by the appellant - claimant, he had filed the aforesaid complaint.
3. On being noticed the respondent no.1 has filed reply and denied the claim. It is stated by the respondent no.1 that the respondent no.2 never forwarded the claim to it and as such there was no question of rejecting or accepting it.
4. The Forum after considering the pleadings and the evidence led by the parties dismissed the claim on the ground that the complainant has failed to establish that the second respondent had forwarded the claim form to respondent no.1 along with necessary documents. Challenging the said order the present appeal has been filed.
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5. We have heard learned counsel for the parties and perused the record.
6. Having gone through the record we find that a letter No.7228 dated 28.8.2006 (Ex. R-3) signed by the second respondent - Chief Medical & Health Officer, Anuppur was forwarded to the respondent no.1. Through the said letter not only the claim form in prescribed format of appellant - claimant's wife, but also of one Smt. Sukvariya Bai was also forwarded to the first respondent -- Branch Manager of United India Insurance Company, Shahdol. The forwarding of the said letter Ex. R--3 also finds corroboration by the affidavit dated 17.10.2012 of R. P. Shrivastava, Chief Medical and Health Officer, Anuppur. In the said affidavit a categorical statement is made by Shri R. P. Shrivastava, Chief Medical and Health Officer which reads as under :-
ß¼1½ ;g fd e0iz0 'kklu yksd LokLF; ifjokj dY;k.k foHkkx ea=ky; ds ifji= Øa-@1274@2006@17@esfN&2 Hkksiky fnuakd 19-05-2006 ds vuqlkj e`R;q nj de djus o laLFkkxr izlo dks c<+kok nsus ds fy;s fot;k jkts tuuh dY;k.k chek ;kstuk fnuakd 16-05-2006 ls e/; izn's k esa ykxw dh xbZ gS mDr ;kstuk ds vuqlkj izlo ds nkSjku e`R;q gksus ij 50000@& :i;s dk Hkqxrku fd;k tkuk FkkA mDr ;kstuk dk vof/k 12 ebZ 2006 ls izkjaHk gksdj 01 o"kZ ds fy;s FkhA &5& ¼2½ ;g fd ifjoknh dh iRuh Jherh nqxkZorh ifr Jh cky'kkg ;kno xzke [kkvh fodkl[k.M iq"ijktx<+] ftyk vuwiiqj dks izlo ihM+k gksus ij lkeqnkf;d LokLF; dsUnz] vejdaVd esa HkrhZ djk;k x;k Fkk ,oa mipkj ds nkSjku mldh e`R;q gks xbZ FkhA ¼3½ ;g fd 'kiFkdrkZ ds dk;kZy; eq[; fpfdRlk ,oa LokLF; vf/kdkjh ds i= Øa- @2006@7288 fnuakd 20-08-2006 dks e`frdk nqxkZorh dk nkok izdj.k vukosnd Øa- 1 dk;kZy; dh vksj ls vko';d dk;Zokgh gsrq Hkst fn;k FkkAÞ
7. Although we find on record affidavit dated 9.11.2012 of Mr. A. K. Pal, Branch Manager of respondent no.1, but in the said affidavit there is no specific denial of receipt of the covering letter Ex. R--3 No.7288 dated 28.8.2006 of respondent no.2 along with which the claim form in prescribed format was forwarded to the respondent no.1. There is also no denial of the affidavit of R. P. Shrivastava dated 17.10.2012. In the circumstances, in our considered view the finding recorded by the Forum that the appellant - claimant and the respondent no.2 had failed to prove that the claim form with necessary documents was forwarded to respondent no.1 to be based on misreading of evidence. On the other hand from the affidavit and documents available on record it is very clear that the appellant - claimant as also respondent no.2 had discharged their burden to establish that the claim form along with necessary documents was sent to respondent no.1 for consideration and necessary action. Thus it is clear that -6- the respondent no.1 by not acting upon it has certainly committed deficiency in service.
8. The appellant being insured under the said scheme and as it is clear from the evidence on record that during her pregnancy his wife was regularly getting treatment in the second respondent's hospital. It is also evident from the evidence available on record that she had died immediately next day after the delivery due to "cardiac respiratory failure because of severe anemia with PPH". In these background facts in our considered view the appellant is entitled for getting the benefit of the Scheme and his claim for compensation deserves to be allowed.
9. In the result, the appeal is allowed. The impugned order is hereby set-
aside. The respondent no.1 is directed to pay the amount of Rs.50,000/- with interest at the rate of 9% per annum from the date of filing of the complaint till realization to the appellant and also Rs.10,000/- towards compensation for physical and mental agony.
10. No order as to the costs.
(JusticeShantanu S. Kemkar) (S.D.Agarwal) (Dr.Monika Malik)
PRESIDENT MEMBER MEMBER
Phadke