State Consumer Disputes Redressal Commission
Smt.Bhanupriya Patel vs Samiti Prabandhak Seva Sahkari Samiti ... on 13 July, 2018
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G).
Appeal No.FA/2018/448
Instituted on : 30.05.2018
Smt. Bhanupriya Patel, W/o Late Shrawan Kumar Patel,
Aged 34 years, R/o : Ward No.8, Risama,
Tehsil and District Durg (C.G.) ... Appellant (Complainant)
Vs.
1. Samiti Prabandhak,
Seva Sahkari Samiti Maryadit, Risama,
Tehsil and District Durg (C.G.)
2. Branch Manager,
Jila Sahkari Kendriya Bank Maryadit, Durg,
Branch - Anda, Tehsil & District Durg (C.G.)
3. Iffco Tokio General Insurance Company Ltd.,
205, 2nd Floor, MM Silver Plaza, In Front of Udyog Bhawan,
Near Mining Office, Mahaveer Nagar, Ring Road No.1,
Raipur (C.G.) 492006, India. .... Respondents (OPs)
PRESENT :
HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE SHRI D.K. PODDAR, MEMBER
HON'BLE SHRI NARENDRA GUPTA, MEMBER
HON'BLE SMT. RUCHI GOEL, MEMBER
COUNSEL FOR THE PARTIES :
Shri Hitendra Kumar Tamrakar, Advocate for the appellant (complainant).
Shri Sudhir Tiwari, Advocate for the respondent No.1 (O.P. No.1) &
Respondent No.2 (O.P. No.2).
Shri P.K. Paul, Advocate for the respondent No.3 (O.P. No.3).
ORDER
DATED : 13/JULY/2018 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT.
This appeal is directed against the order dated 10th April, 2018, passed by District Consumer Disputes Redressal Forum, Durg (C.G.) (henceforth "District Forum") in Complaint Case No.C.C./2017/721. By the impugned order, learned District Forum, has dismissed the complaint of the complainant.
// 2 // 2 Briefly stated the facts of the complaint of the complainant are that the husband of the complainant, Late Shrwan Kumar Patel was Kisan Credit Card Holder / Member of the O.P. No.1 Seva Sahkari Samiti Maryadit, Risama. The Head Office, Jila Sahkari Kendriya Bank Maryadit, Durg paid a sum of Rs.40/- towards premium to the O.P. No.3 in respect of each Kisan Credit Card Holder / Members of O.P. No.1 and they were insured under Janata Personal Accident Policy for sum assured Rs.5,00,000/- for the period of one year from 29.02.2016 to 28.02.2017. The husband of the complainant was also insured under Janata Personal Accident Policy for the sum insured Rs.5,00,000/- , by the O.P. No.3 through O.P. No.2 under Insurance Policy No.51626177, 51626342, 51626353, 51626359 and 51626365. On 01.06.2016, in the night, after taking dinner, the husband of the complainant along with his other family member went to roof of his house for sleeping. In night at about 10.30 to 11.00, the husband of the complainant was going to bathroom for urination, due to darkness, suddenly he fell down from the roof to the ground, due to which he sustained grievous injuries. The husband of the complainant was got admitted in Sparsh Multispecialty Hospital, Bhilai for treatment from where after being referred, he was got admitted in Medical College Hospital, Raipur for further treatment where he died during treatment 14.06.2016. The intimation regarding the incident was given to Police Station Anda, where Merg Intimation No.16/2016, was recorded. After death of her husband Shrawan Kumar Patel, the complainant gave intimation regarding his death to the O.P. No.1 and O.P. No.2. The complainant also submitted claim form along with Police Investigation Report, Merg Intimation, Inquest, Post Mortem Report, Death // 3 // Certificate and other documents before the O.P. No.1and O.P. No.2. The Claim No. is 51071714, 51071713, 51071712, 51071711 and 51071710. The O.P. No.2 informed the complainant that it received a letter from O.P. No.3 to the effect that the insurance claim is not payable. The O.P. No.2 also provided copy of the letter dated 02.06.2017 sent by the O.P. No.3. The complainant also received letter dated 02.06.2017 from the O.P. No.3 by registered post regarding repudiation of the claim. Vide letter dated 02.06.2017, the O.P. No.3 repudiated the claim of the complainant on the ground that "As per Admission Ticket of Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.) H/o fall from height on 1/6/2016 10.30 PM, height 15-18 ft (first floor) Village Rishma, District Durg. Patient fall under Alcoholic influence from 1st floor case, head injury. After accident when the husband of the complainant was admitted in the hospital, the doctors have not conducted any test regarding the consumption of alcohol and its quantity and did not give his opinion. Therefore, it is clearly established that the deceased Shrawan Kumar was not under Alcoholic influence at the time of the accident. The doctor of Medical College Hospital, Raipur who conducted the post mortem report opined that the death of Shrawan Kumar Patel was due to cardio respiratory failure as a result of Head Injury. In the post mortem report, it is not mentioned that the deceased Shrawan Kumar Patel had consumed alcohol. In the post mortem report, the quantity of the alcohol consumed by the deceased, is also not mentioned. The Doctor, also did not preserve the Viscra of the deceased. The O.P. No.3 in spite of receiving premium amount from O.P. No.2 in respect of husband of the complainant for Janata Personal Accident Policy, did not want to pay the // 4 // insurance claim amount to the complainant, therefore, to escape from its liability, the O.P. No.3 is denying to pay a sum of Rs.5,00,000/- to the complainant. The complainant several time contacted the O.P. No.2 for getting information regarding the payment of claim amount by the O.P. No.3, and she suffered mental agony and financial loss. The act of the O.P. No.3 comes in the category of deficiency in service and unfair trade practice. Hence, the complainant has filed the instant complaint before the District Forum and prayed for granting reliefs, as mentioned in the relief clause of the complaint.
3. The O.P. No.1 & O.P. No.2 have filed their joint written statement and averred that the husband of the complainant, Shrawan Kumar Patel was Kisan Credit Card Holder of the O.P. No.1 Seva Sahkari Samiti Maryadit, Risama and after his death, the O.P. No.1 & 2 have discharged their duty properly. The O.P. No.1 & 2 are not liable to pay any amount to th complainant. The complainant is not having any complaint with the O.P. No.1 & O.P. No.2. From the perusal of the complaint of the complainant, it is clear that the O.P. No.1 and O.P. No.2 have discharged their duties. The amount of insurance premium has been sent to O.P. No.3 and entire documents have been submitted. The O.P. No.1 and O.P. No.2 have not committed any deficiency in service or unfair trade practice.
4. The O.P. No.3 filed its written statement and averred that according to the medical slip/ admission card, indoor patient summary sheet, admission ticket of deceased Shrawan Kumar Patel, issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur during his treatment and according to LAMA // 5 // summary Report issued by Sparsh Multispecialty Hospital, the deceased was under influence of alcohol. It means he was under the influence of alcohol, due to which he had fallen from first floor to the ground, which is clearly mentioned in the above documents. The Janata Personal Accident Policy was issued by the O.P. No.3 in the name of the O.P. No.2 for its account holder /members under the terms and condition with exclusions. In case of violation of terms and conditions and under exclusions, the Insurance Company is not liable to pay compensation. The complainant submitted claim Nos.51071710, 51071711, 51071712, 51071717, 51071714 before the Insurance Company through O.P. No.2. On submitted claim by the complainant before the Insurance Company through O.P. No.2, the Insurance Company considered on the claim and from perusal of the investigation report of Investigator Sanat and medical slip/admission card, indoor patient summary sheet, admission ticket and LAMA Summary Report of Sparsh Multi Specialty Hospital, it was found that at the time of incident, the deceased Shrawan Kumar Patel was under influence of alcohol and it is also mentioned that he fell down from the first floor to the ground. If the deceased would not have consumed alcohol, he would not have fell down from the first floor to the ground. The one and only reason of death of deceased Shrawan Kumar Patel is that at the time of incident he was under
influence of the liquor. The O.P. No.3 vide letter dated 02.06.2017 repudiated the claim submitted by complainant through O.P. No.2 on the ground that at the time of accident, the deceased Shrawan Kumar Patel was under the influence of alcohol, it means he was in intoxicating condition. By not paying the sum assured and by repudiating the claim of the complainant, the O.P. // 6 // No.3 did not commit any deficiency in service and unfair trade practice. The one and only reason of death of the deceased Shrawan Kumar Patel is that he was under the influence of alcohol at the time of incident. The claim of the complainant was repudiated by the O.P. No.3 on 02.06.2017 according to the Exclusion Clause that the insurer is not liable to pay if the loss is due to - The insured being under the influence of intoxicating liquor or drug. The repudiation of the claim of the complainant by the O.P. No.3 is just and proper. The O.P. No.3 repudiated the claim of the complainant because the same was not payable as per Exclusions of the insurance policy. The Insurance Company has not acted any work, which comes in the category of deficiency in service. The complaint is liable to be dismissed against the O.P. No.3.
5. The complainant has filed documents Annexure A-1 is Kisan Credit Sah. Pass Book (Kisan Credit Car) of Shrawan Kumar, Annexure A-2 to A-6 are Janata Personal Accident Policy Schedule, Annexure A-7 is prescription slip issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, Annexure A-7 (A) is Admission Card issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, Annexure A-7 (B) is Indoor Patient Summary Sheet, issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, Annexure A-7 (C) to (F) is Admission ticket, Annexure A-7 (G) is LAMA Summary, issued by Sparsh Multispecialty Hospital, Bhilai (C.G.), Annexure A-7(H) is CPR Notes, Annexure A-7(I) is Discharge Slip issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur (C.G.), Annexure A-7 (J) is medical record, Annexure A-7(K) is letter sent to The CMO, Department of Casuality, Dr. B.R.A.M. Hospital, Raipur, Annexure A-8 is Police Investigation Report , Annexure A-9 is Merg // 7 // Intimation, Annexure A-10 is Inquest, Annexure 11 is Post Mortem Examination Report, Annexure A-12 is Death Certificate of Shrawan Kumar Patel, Annexure A-13 is letter dated 14.06.2017 sent by the O.P. No.2 to Branch Manager, Branch Anda, Annexure A-14 is letter dated 02.06.2017 sent by the O.P. No.3 to the complainant.
6. The O.P. No.1 and O.P. No.2 have not filed any documents.
7. The O.P. No.3 has filed documents. Annexure NA-3/01 is Sales Literature of Janata Personal Accident Insurance, Annexure NA-3/02 is the statement give by Mahadev Patel, Annexure NA-3/3 is Certificate, issued by Shri Keshawram Chauhan, Kotwar of Risama.
8. Learned District Forum after having considered the material placed before it by the parties, has dismissed the complaint of the complainant by the impugned order.
9. Shri Hitendra Kumar Tamrakar, learned counsel appearing for the appellant (complainant) has argued that Late Shrawan Kumar Patel, who was husband of the complainant was Kisan Credit Card Holder / Member of the O.P. No.1 Seva Sahkari Samiti Maryadit, Risama. A sum of Rs.40/- towards premium was deducted from his account and the same was sent to O.P. No.3. The deceased Shrawan Kumar Patel, was duly insured with the O.P. No.3 under Janata Personal Accident Policy for the sum insured Rs.5,00,000/- for the period of one year from 29.02.2016 to 28.02.2017. On 01.06.2016, in the night after taking dinner, the husband of the complainant, Shrawan Kumar Patel // 8 // along with his other family members went to roof of his house for sleeping. In the night at about 10.30 to 11.00, the husband of complainant, Shrawan Kumar Patel was going to bathroom for urination, due to darkness, suddenly he fell down from the roof to the ground, due to which he sustained grievous injuries. The husband of the complainant Shrawan Kumar Patel was got admitted in Sparsh Multispecialty Hospital, Bhilai for treatment and thereafter he was referred to Medical College Hospital, Raipur for treatment where during treatment he died on 14.06.2016. The matter was reported to Police Station, Anda where Merg No.16/2016 was recorded and post mortem was conducted on the dead body of the deceased Shrawan Kumar Patel. The complainant submitted claim before the O.P. No.3 but the O.P. No.3 repudiated the claim of the complainant on the ground that at the time of incident, the deceased Shrawan Kumar Patel had consumed alcohol and he was under influence of the alcohol. The ground taken by the O.P. No.3 for rejection of the claim of the complainant is erroneous. The deceased Shrawan Kumar Patel did not consume alcohol at the time of incident. In the Post Mortem Report, there is no mention regarding consumption of alcohol by the deceased Shrawan Kumar Patel. Merely the statement of the brother of the deceased recorded by the Investigator, in which he stated that the deceased was intoxicated, is not sufficient to repudiate the claim of the complainant. The O.P. No.3 has not proved the quantity of the alcohol. Merely presence of alcohol or smell of alcohol, is not sufficient to repudiate the claim of the complainant. In the instant case, the O.P. No.3 has utterly failed to prove that at the time of incident, the deceased was under alcoholic influence, therefore, the O.P. No.3 has // 9 // wrongly repudiated the claim of the complainant. Learned District Forum has also dismissed the complaint of the complainant erroneously. Therefore, the appeal filed by the appellant (complainant) may be allowed. The complainant is entitled to get the reliefs, as mentioned in the relief clause of the complaint, from the O.P. No.3 (Insurance Company).
10. Shri P.K. Paul, learned counsel appearing for the respondent No.3 (O.P. No.3) (Insurance Company) has argued that at the time of accident, the deceased Shrawan Kumar Patel was under influence of liquor and due to influence of liquor, he fell down from the roof of his house to the ground and sustained injuries, which is proved on the basis of the medical record. The deceased Shrawan Kumar Patel died on 14.06.2016 after 12-13 days of the incident occurred on 01.06.2016 and thereafter post mortem was conducted on 15.06.2016. The deceased died after near about 14 days of the incident and the post mortem was conducted after 15 days, therefore, in the post mortem, it is not possible to ascertain the presence of alcohol, hence, the respondent No.3 (O.P. No.3) has rightly repudiated the claim of the appellant (complainant). The impugned order passed by the District Forum, is just and proper and does not suffer from any infirmity, irregularity or illegality, hence does not call for any interference by this Commission. The appeal filed by the appellant (complainant) may be dismissed.
11. Shri Sudhir Tiwari, learned counsel appearing for the respondent No.1 & 2 (O.P. No.1 & 2) has argued that the husband of the appellant (complainant), deceased Shrawan Kumar Patel, was an account holder of the O.P. No.1 Seva // 10 // Sahkari Samiti Maryadit, Risama and he was having Kisan Crdit Card with O.P. No.1 Seva Sahkari Samiti Maradit. The deceased Shrawan Kumar Patel was insured under Janata Personal Accident Policy with the O.P. No.3. After receiving intimation regarding death of the deceased Shrawan Kumar Patel, the O.P. No.1 & O.P. No.2 sent intimation regarding his death to the O.P. No.3. The O.P. No.1 and O.P. No.2 done their job property and did not commit any deficiency in service. Learned District Forum has rightly dismissed the complaint against the O.P. No.1 & 2. The appeal filed by the appellant (complainant) is liable to be dismissed.
12. We have heard learned counsels appearing for both the parties and have also perused the record of the District Forum a well as the impugned order.
13. It is admitted fact that the husband of the complainant, Late Shrawan Kumar Patel, was Kisan Credit Card Holder/Member of the respondent No.1 (O.P. No.1) Seva Sahkari Samiti Maryadit, Risama. It is also admitted fact that amount of Rs.40/- towards premium amount was deducted by the respondent No.2 (O.P. No.2) from the account of the deceased Shrawan Kumar Patel and the same was sent to the respondent No.3 (O.P. No.3). The deceased Shrawan Kumar Patel was insured with the O.P. No.3 under Janata Personal Accident Policy for the period from 29.02.2016 to 28.02.2017 and the sum insured under the above policy is Rs.5,00,000/-. It is also admitted fact that on 01.01.2016, the deceased Shrawan Kumar Patel fell down from roof of his house and he died during treatment on 14.06.2016.
// 11 //
14. The appellant (complainant) has filed Annexure A-7, which is prescription slip dated 13.06.2016 issued by Dr. Bhimrao Ambedkar Memorial Hospital, Raipur (C.G.) in which it is mentioned "C/o fall from height 15-18 ft severe head injury diffuse SAH with COMA. Referred to Neurosurgery." In Annexure A-7 (C) , which is Admission Ticket dated 13.06.2016 issued by Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.), under the head Complaints, it is mentioned "H/o fall from height on 1/6/2016, 10.30 PM height 15-18 fit (first floor) Village Risama, District Durg." Patient fall under alcoholic influence from 1st floor. Case Head Injury. H/o Vomiting on the same days. H/o Bleeding from Nose and Ear. No H/o loss of consciousness. No H/o vision loss.". Annexure A-7 (G) is LAMA Summary issued by Sparsh Multi Specialty Hospital, Bhilai (C.G.). In the above documents under the head Diagnosis, it is mentioned that "Severe Head Injury with Diffuse SAH with Diffuse Brain Injury with Left Sided FT Contusion with SDH with COMA." Under the head History, it is mentioned that "Alleged H/O - Fall From height. Date 01.06.2016 height 10:30 PM height 15-18 Fit (1st floor), Village Rishma Dist. Durg. Patient fall under alcoholic Influence from 1st floor case. Head Injury. Left side Complete Hamiplasia. GCS - E2M5V1. "
15. Shri Hitendra Kumar Tamrakar, drew our attention towards the Merg Intimation (Annexure A-9) and Inquest Report (Annexure A-10) and has argued that in both the documents, there is no mention regarding the consumption of alcohol by the deceased Shrawan Kumar Patel. The above contention of the learned counsel for the complainant, is not acceptable. The incident took place on 01.06.2016 and the deceased died on 14.06.2016 i.e. after near about 14 days // 12 // of the incident, therefore, it is not possible to find the alcoholic contents in the abdomen of the deceased. The inquest was also prepared at that time the presence of alcohol or alcoholic smell, was not found, therefore, on the basis of merg intimation and inquest report, it cannot be held that the deceased was not under influence of alcohol at the time of incident. The deceased Shrawan Kumar Patel was firstly admitted in Sparsh Multispecialty Hospital, Bhilai, on 02.06.2016. In LAMA Summary issued by Sparsh Multispecialty Hospital, it is specifically mentioned that the Patient fall under alcoholic Influence from 1st floor. The same thing is also mentioned in the Admission ticket of Dr. B.R. Ambedkar Memorial Hospital, Raipur (C.G.). The incident took place in the night of 01.06.2016 and the deceased Shrawan Kumar Patel died on 14.06.2015. The post mortem examination on dead body of the deceased was conducted on 15.06.2016, therefore, it is not possible that at the time of conducting post mortem, the alcohol was present in the abdomen of the deceased or alcoholic smell was found in the dead body.
16. The respondent No.3 (O.P. No.3) appointed Shri Sanat as Investigator, who recorded statement of brother of the deceased, Mahadev Patel. O.P. No.3 has filed Annexure NA-3-2, which is statement of Mahadev Patel, who is brother of the deceased Shrawan Kumar Patel, in which it is specifically mentioned that his brother Shrawan Kumar Patel was under intoxication and had gone to toilet and he fell down from the roof of his house to the ground. The Village Kotwar of Village Risama Keshavram Chauhan, gave Certificate (Annexure NA-3-3) in which it is mentioned that due to intoxication, Shrawan Kumar Patel fell down from the roof to the ground.
// 13 //
17. Looking to the above documents, it appears that at the time of incident, the deceased Shrawan Kumar Patel was under intoxication and under influence of alcohol. Under the Exclusion Clause of the insurance policy, the insurer (O.P. No.3), is not liable to pay sum insured to the complainant under Janata Personal Accident Policy, because at the time of incident, the deceased Shrawan Kumar Patel was under the influence of intoxicating liquor.
18. Therefore, the impugned order dated 10.04.2018, passed by learned District Forum, is just and proper and does not suffer from any irregularity or illegality, hence, does not call for any interference.
19. Hence, the appeal filed by the appellant (complainant) being devoid of any merits, deserves to be and is hereby dismissed. No order as to the cost of this appeal.
(Justice R.S. Sharma) (D.K. Poddar) (Narendra Gupta) (Smt. Ruchi Goel)
President Member Member Member
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