State Consumer Disputes Redressal Commission
The Orintal Insurance Co. Ltd. vs Dali Bai on 10 May, 2007
BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BEFORE THE STATE CONSUMER DISPUTES REDRESSALCOMMISSION, RAJASTHAN, JAIPUR Appeal No.74/2007 The Oriental Insurance Co.Ltd. V/s Dali Bai Date of Judgment:- .5.2007 PRESENT Honble Mr.Justice Sunil Kumar Garg, President Shri T.P.Gupta, Member Smt.Vimla Sethia, Member Mr.Jitendra Mitruka for the appellant. Mr.Vinod Sharma for the respondent. JUDGMENT
BY THE STATE COMMISSION (Per Honble Mr.Justice Sunil Kumar Garg,President) This appeal under section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as the Act of 1986) has been filed by the appellant-opposite party against the order dated 27.11.2006 passed by the learned District Forum, Bhilwara in case no.205/2005 by which the complaint filed by the complainant-respondent under section 12 of the Act of 1986 was allowed in the manner that the appellant was directed to pay to the complainant respondent a sum Rs.one lac as insurance claim amount under the individual personal accident policy of the deceased-Sohan Lal alongwith interest at the rate of 9% p.a. with effect from 25.11.2004 till payment was made and the appellant was further directed to pay to the complainant respondent a sum of Rs.1000/- as cost of litigation.
2. It may be stated here that the complainant respondent had filed a complaint before the District Forum, Bhilwara on 12.9.2005 stating inter-alia that on 2.12.2002, her husband Sohan Lal (hereinafter referred to as the deceased) had taken individual personal accident policy bearing no.242400/42/003/00628 from the appellant covering the risk upto Rs.one lac in case of death in accident and the same was valid for the period from 2.12.2002 to 1.12.2003. It was further stated in the complaint that on 14.3.2003 when the deceased was coming to his house on cycle, he fell down from the cycle in the pit and since there were some stones, therefore, he received injuries as a result of which he was taken to M.G. Hospital, Bhilwara for treatment and since no recovery was made in that hospital, therefore, deceased was taken to Ramsnehi Sewa Sansthan, Bhilwara for treatment and ultimately, deceased had died on 30.3.2003. After the death of the deceased, a claim was preferred by the complainant respondent being wife and nominee of the deceased, but that claim was repudiated by the appellant through letter dated 25.11.2004 stating inter-alia that death of the deceased had taken place not in an accident, but it was a natural death and therefore, as per terms of the policy in question, the claim was not payable as no report of the accident was lodged by the complainant respondent in the police station nor any FIR was registered by the police and no post mortem of the dead body of the deceased was got conducted and furthermore, information was given by the complainant respondent after one year from the date of death of the deceased.
Thereafter, the present complaint was filed.
3. A reply was filed by the appellant in which the appellant took the same pleas, which were taken by it in the repudiation letter dated 25.11.2004. It was further replied that as per the report of Shri Pradeep Lakhotia, Insurance Investigator dated 16.11.2004 appointed by the appellant, the death of the deceased was not accidental one and the disease CVA which was found in the bed head ticket of M.G. Hospital means a brain haemorrhage in common language and therefore, it could not be said that the death of the deceased was accidental one and rather it was a case of natural death and in view of this, claim was not payable under the policy in question and the same was rightly repudiated by the appellant through letter dated 25.11.2004 and the present complaint deserves to be dismissed.
4. After hearing the parties, the learned District Forum, Bhilwara through impugned order dated 27.11.2006 allowed the complaint of the complainant respondent in the manner as indicated above holding inter-alia:-
(i) That so far as the report of Shri Pradeep Lakhotiya, Investigator is concerned, that could not be considered in absence of affidavit and furthermore, that report could not be considered because the statements, which were recorded by the Investigator, have not been produced.
(ii) That no enquiry was made by the appellant from two hospitals, namely, M.G. Hospital, Bhilwara and Ramsnehi Sewa Sansthan, Bhilwara where the deceased was got admitted.
(iii) That on 14.3.2003 when the deceased was got admitted in the M.G. Hospital, Bhilwara, the disease which was found and mentioned in the bed head ticket was C.V.A. (Cerebro Vascular Accident) and thus, the deceased had died because of brain haemorrhage and for that the cause assigned by the complainant respondent was accepted by the learned District Forum.
(iv) That in the condolence message published in the news paper dated 31.3.2003, it was specifically stated that the deceased had died due to falling from cycle and therefore, the death of the deceased was accidental one.
(v) That so far as the delay in filing the complaint is concerned, that was condoned by the learned District Forum looking to the entire facts and circumstances of the case and looking to the fact that the complainant respondent was widow.
(vi) That repudiation of claim of the complainant respondent was not justified and it amounted to deficiency in service on the part of the appellant.
5. Aggrieved from the said order dated 27.11.2006 passed by the learned District Forum, Bhilwara, the appellant-Insurance Company has preferred this appeal.
6. In this appeal, the main contention of the learned counsel for the appellant is that the death of deceased in the present case was not an accidental one, but it was a natural death and if the death of deceased would have been accidental one, at least report in the police station would have been lodged and post mortem of the dead body of deceased would have been got conducted and information would have been given to the appellant Insurance Company in time and in absence of that, death of deceased could not be regarded as accidental death and rather it was a natural death and in view of this, claim was not payable under the terms of the policy in question and the same was rightly repudiated by the appellant and the learned District Forum has committed serious error and illegality in decreeing the claim of the complainant respondent. The findings of learned District Forum are wholly erroneous, illegal and perverse one and therefore, the same cannot be sustained and liable to be set aside and this appeal deserves to be allowed.
7. On the other hand, the learned counsel appearing for the complainant respondent has supported the impugned order of the learned District Forum.
8. We have heard the learned counsel appearing for the appellant and the learned counsel appearing for the respondent and gone through the entire materials available on record.
9. There is no dispute on the point that on 2.12.2002, the deceased had taken individual personal accident policy bearing no.242400/42/003/00628 from the appellant covering the risk upto Rs.one lac in case of death in accident and the same was valid for the period from 2.12.2002 to 1.12.2003.
10. From the bed head ticket of Mahatma Gandhi Hospital, Bhilwara, it is very much clear that the deceased was got admitted in that hospital on 14.3.2003 and he was discharged on 22.3.2003 and in that bed head ticket, it was also mentioned:-
(i) That deceased was suffering from C.V.A. (Cerebro Vascular Accident).
(ii) That there was large intra-cranial haemorrhage in left fronto temporal parietal lobes.
(iii) That deceased was having loss of speech.
(iv) That in the past history, there was no illness. 11. There is also
no dispute on the point that deceased had died on 30.3.2003.
12. On record, there is a condolence message which was published in the news paper on 31.3.2003 in which it was specifically stated that about 15-16 days earlier deceased had fallen from the cycle and thereafter, he died on 30.3.2003.
13. There is a report of Shri Pradeep Lakhotia, Investigator dated 16.11.2004 in which he came to the conclusion that the deceased was admitted in the hospital on 14.3.2003 and he was discharged on 22.3.2003 and he died on 30.3.2003 at his residence and the cause of death was CVA Cerebro Vascular Accident, which means brain haemorrhage in common language. He further came to the conclusion that death of the deceased was not an accidental one.
14. There is also no dispute on the point that the claim was preferred by the complainant respondent before the appellant with some delay and that delay was explained by the complainant respondent in the manner that no doubt her husband-deceased had fallen from cycle as a result of which he received injuries and thereafter, he was got admitted in the hospital and died on 30.3.2003, but claim could not be preferred by her earlier as she was not aware of the fact that her husband-deceased had taken the policy in question and as soon as she came to know about the policy in question, she preferred the claim.
15. There is also no dispute on the point that the claim of the complainant respondent was repudiated by the appellant through letter dated 25.11.2004 stating inter-alia that death of the deceased had taken place not in an accident, but it was a natural death and therefore, as per terms of the policy in question, the claim was not payable as no report of the accident was lodged by the complainant respondent in the police station nor any FIR was registered by the police and no post mortem of the dead body of the deceased was got conducted and furthermore, information was given by the complainant respondent after one year from the date of death of the deceased.
16. Thus, the question for consideration is whether in the facts and circumstances just narrated above, the repudiation of claim of the complainant respondent by the appellant was justified or not or whether the findings of the learned District Forum decreeing the claim of the complainant respondent could be sustained or not.
17. In our considered opinion, when the deceased was not having any illness prior to 14.3.2003 and when he was admitted in the hospital on 14.3.2003 with CVA Cerebro Vasuclar Accident (Brain Haemorrhage), therefore, the possibility that he would have received that injury because of falling from cycle could not be ruled out. The fact that he was not in a position to speak further reveals that the injury was serious one otherwise if he would have been in a position to speak, the things would have been made more clear.
18. Furthermore, in the condolence message which was published in the news paper on 31.3.2003, it was specifically stated that about 15-16 earlier, the deceased had fallen from the cycle and thereafter, he was taken to hospital and died on 30.3.2003 and thus, when the fact of falling of deceased from the cycle was specifically mentioned in the condolence message published in the news paper on 31.3.2003 and when the complainant respondent was not aware of the fact at that time that deceased was having policy in question, therefore, it could not be said that the fact of falling of deceased from cycle was wrongly mentioned in the condolence message. Thus, the fact that deceased had fallen from the cycle as a result of which he received injury and thereafter, he was taken to hospital and he died on 30.3.2003 should be found established and for that, this is the best evidence.
19. So far as the report of Shri Pradeep Lakhotia, Investigator dated 16.11.2004 is concerned, in view of the facts and circumstances just narrated above, the same could not be considered and accepted on point of non-accidental death.
20. So far as the delay in preferring the claim by the complainant respondent is concerned, the same has been satisfactorily explained by the complainant respondent and looking to the entire facts and circumstances of the case, it cannot be said that the claim made by the complainant respondent was false or concocted one.
21. So far as the point of non lodging of first information report and non-conducting of post mortem of the dead body of deceased is concerned, it may be stated that that non furnishing of first information report and post mortem examination report will not mean that no accident had taken place. In cases where there was no collusion between the two vehicles or in an accident of the present nature where another person was not involved in the accident, it was not necessary for the complainant respondent or anybody else to have lodged a report. Furthermore, since the death of the deceased had taken place after about 15-16 days of the alleged accident, therefore, in such circumstances, post mortem examination was also not necessary, especially when no offence was committed under the provisions of the Indian Penal Code or any other enactment. Therefore, this State Commission is of the view that there was no necessity of lodging any FIR and getting post mortem examination done.
22. For the reasons stated above, repudiation of claim of the complainant respondent was not justified and it amounted to deficiency in service on the part of the appellant and the learned District Forum has rightly held so. The findings of the learned District Forum decreeing the claim of the complainant respondent are based on correct appreciation of entire materials and evidence available on record and they do not suffer from any basic infirmity or illegality or perversity and hence, no interference is called for with the same and this appeal deserves to be dismissed.
Accordingly, this appeal filed by the appellant is dismissed.
(Smt.Vimla Sethia)(T.P.Gupta)(Justice Sunil Kumar Garg) Member Member President