State Consumer Disputes Redressal Commission
Tejendra Kumar vs National Insurance Co. Ltd. & Anr on 21 June, 2024
Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024
National Insurance Co. Ltd. & Anr.
AFR / NAFR
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
Date of Institution: 29/01/2024
Date of Final Hearing: 11/06/2024
Date of Pronouncement: 21/06/2024
APPEAL No.- FA/24/51
IN THE MATTER OF :
Tejendra Kumar S/o. Late Shri Santram Janbandhu,
R/o. Job, Tah. Chhuriya,
Dist. RAJNANDGAON (C.G.) ... Complainant/Appellant
Through: Shri Harish Kumar, Advocate
Vs.
1. National Insurance Company Limited,
Through: Divisional Manager, Divisional Office,
Govind Mahal, G.E. Road, Raipur,
Tah. & Dist. RAIPUR (C.G.) ... O.P. No.1/Respondent No.1
Through: Shri Deepesh Thawait, Advocate
2. Manager, C.G. Rajya Gramin Bank,
Branch: Chhuriya, Town/P.O. & Tah. Chhuriya,
Tah. & Dist. RAJNANDGAON (C.G.) ... O.P. No.2/Respondent No.2
Through: Ex-parte
CORAM: -
HON'BLE SHRI JUSTICE GAUTAM CHOURDIYA, PRESIDENT
HON'BLE SHRI PRAMOD KUMAR VARMA, MEMBER
PRESENT: -
Shri Harish Kumar, Advocate for the appellant
Shri Deepesh Thawait, Advocate for the respondent No.1.
Proceeded ex-parte against respondent No.2 vide order dated 10.05.2024.
ORDER
PER: - JUSTICE GAUTAM CHOURDIYA, PRESIDENT This appeal, filed under Section 41 of the Consumer Protection Act 2019 (hereinafter called "the Act" for short) is directed against order dated 27.12.2023 passed by District Consumer Disputes Redressal Commission, Rajnandgaon (hereinafter called "District Commission" for short) in complaint case No.CC/2020/96 whereby the complaint filed by the appellant herein was dismissed observing the death of the insured as not proved to be an accidental death.
2. In nutshell the facts of the case are that father of the complainant being an account-holder of the opposite party No.2/respondent No.2 Allowed. Page 1 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024 National Insurance Co. Ltd. & Anr.
Bank was insured under the Pradhanmantri Suraksha Bima Yojana (hereinafter „PMSBY‟ for short) and premium of Rs.12/- was paid through his Bank Account to the opposite party No.1/ respondent No.1 insurance company. The father of the complainant/ appellant Santram was bitten by dog on 01.10.2017 and died on 01.11.2017 during treatment for dog bite. Uncle of the complainant/ appellant Toman Lal gave intimation to the opposite party No.1/ respondent No.1 through the opposite party No.2/ respondent No.2 Bank and as complainant/ appellant was minor at that time hence the claim was also submitted before the insurance company through his uncle Toman Lal. But the claim was repudiated by the insurance company on the ground that copy of merg intimation or FIR was not received by them hence for want of copy of merg intimation or FIR the claim was closed as „No Claim‟, alleging which as deficiency in service, after giving advocate notice dated 01.11.2019 which was not replied, complaint was filed before the District Commission seeking insured sum of Rs.2,00,000/- along with compensation for mental agony Rs.50,000/- and cost of litigation etc.
3. The opposite party No.1/ respondent No.1 in their written version except the admitted facts denied all the allegations leveled against them and averred that deceased Santram Janbandhu was covered under the PMSBY, but as the benefit of scheme is only provided in case of accidental death and as per statement of the complainant himself the insured person died of dog bite, hence the benefit of the PMSBY was not provided. As per terms and conditions of the insurance scheme copy of FIR or postmortem report was also not submitted, hence the claim was liable to be rejected. It was prayed that accordingly the compliant is also liable to be dismissed with cost.
Allowed. Page 2 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024 National Insurance Co. Ltd. & Anr.
4. The opposite party No.2/ respondent No.2 also in their written version except the admitted facts denied all the allegations leveled against them and averred that on intimation of death of the insured Santram duly filled claim form was sent to the insurance company but due to non- submission of copy of FIR the claim was closed as „No Claim‟, in which the Bank has not committed any deficiency in service, hence the complaint be dismissed with cost against the opposite party No.2/ respondent No.2.
5. Learned District Commission in the impugned order observed that as per averments of the complainant/ appellant himself the deceased died after one month from the date of dog bite and in such situation he is not entitled to get compensation under PMSBY. It was also observed that as per the averments made in the complaint being the complainant minor the claim was submitted by his uncle Toman Lal, whereas in the cause title the complainant‟s age has been written as 18 years and as stated in paragraph no. 02 of the complaint, the claim was submitted by the uncle of the complainant, Toman Lal, but the complaint does not bear his signature. The complaint was dismissed by the District Commission with the above observations.
6. Final arguments heard and perused the record. We have also gone through the written arguments submitted by learned counsel for the appellant as well as the respondent No.1. We proceeded ex-parte against the respondent No.2 vide order dated 10.05.2024.
7. Learned counsel for the appellant/ complainant reiterated the averments made in the complaint and argued that learned District Commission has passed the impugned order overlooking the facts and documents available on record i.e. treatment slip Exhibit C-8 to Exhibit C- 21, Exhibit C-22 Gram Panchayat meeting proposal and Panchnama, Exhibit Allowed. Page 3 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
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C-23 in which treatment for dog bite is mentioned. He has further argued that only for want of FIR or postmortem report the accidental death of Santram cannot be disputed. He has placed reliance upon judgement of Hon‟ble National Commission in Mrs. Ajmeri Khatun Vs. General Manager, National Insurance Company Ltd. & Ors., 2015 1 CPR (NC) 162 and argued that it was not possible to register FIR against a street dog and likewise postmortem of the dead body was also not conducted as he died due to dog bite. In the years 2018 at the time of filing claim form the complainant was minor hence the same was submitted through Toman Lal but since the complainant had attained majority in the year 2020, the complaint was filed with his signature. With the above arguments learned counsel for the appellant prayed that the appeal be allowed setting aside the impugned order and the opposite parties/ respondents be directed to pay the reliefs sought in the complaint.
8. Learned counsel for the respondent No.1/ opposite party No.1 has also reiterated the defence taken in their written version before District Commission and supporting the impugned order has prayed that this appeal be dismissed. In paragraph No.09 of the written arguments the respondent No.1 has mentioned the important dates of the case as the date of dog bite 31.10.2017, death of the Santram on 01.11.2017 and claim repudiation date as 16.05.2019.
9. We have considered the above arguments. In the record of the District Commission the Indoor Patient Discharge Slip of the deceased Santram issued by Government Medical College Hospital Rajnandgaon is available as Exhibit C-9 attested by Medical Officer of District Hospital, Rajnandgaon (C.G.). In the said document the date of admission is mentioned as 31.10.2017, date of discharge as 01.11.2017 and the category is mentioned as „Dog Bite‟.
Allowed. Page 4 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024 National Insurance Co. Ltd. & Anr.
10. Exhibit C-8 is medical certificate filled by the treating doctor Dr. B.L. Kumre, MBBS of Medical College. In the said document it is mentioned that the patient was admitted on 30.10.2017. The cause of accident/incident is mentioned as Dog Bite and the disease is detailed as hydrophobia. The treatment record and Medicine Chart are also available on record in which at the end the DoA - 31.10.2017 and LAMA 01.11.2017 is mentioned. It is also mentioned that the patient was referred to MCHR, Raipur. Death certificate of the deceased Santram has been brought on record as Exhibit C-22. The respondent No.1/ opposite party No.1 has mentioned in the written argument the date of dog bite of Santram as 31.10.2017 and his date of death as 01.11.2017. The above documents and the entries made therein conclusively prove that the deceased Santram was admitted in the Hospital on 31.10.2017 and died next day on 01.11.2017. However, the incident of dog bite occurred on 01.10.2017 but due such incident of dog bite the deceased insured developed hydrophobia and died to during treatment. Thus it is apparent that the cause of death of the insured was dog bite resulted into hydrophobia.
11. So far as the observation of the District Commission to the effect that the complaint does not bear signature of Toman Lal is concerned, in the paragraph No.02 of the complaint the averment made by the complainant was to the effect that the claim from was submitted to the insurance company through the opposite party No.2/ respondent No.2 Bank. It was nowhere stated that the complaint was filed through the uncle of the complainant as he was minor. In fact in the cause title itself the complainant mentioned his age as approx. 18 years and he himself had signed the same. In the record of the District Commission copy of death certificate of mother of the appellant / complainant is also available who died on 14.06.2014. At the time of submission of claim form the appellant Allowed. Page 5 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024 National Insurance Co. Ltd. & Anr.
/ complainant was minor that is why the claim form submitted through his uncle Toman Lal. Therefore, looking to the facts and circumstances of the case we are of the view that it was not necessary that the complaint bears signature of Toman Lal and observation of learned District Commission in this regard is also not correct
12. So far as the nature of death is concerned, in the record of the District Commission the terms and conditions, rules and specific definition of words for the purpose of insurance cover in question under PMSBY has not been filed and in such situation it would be appropriate to refer to the general definition/meaning of words given in an authentic law dictionary. In Black‟s Law Dictionary the meaning of accident has been given as under : -
"1. An unintended and unforeseen injurious occurrence; something that does not occur in the usual course of events or that could not be reasonably anticipated
2. An unforeseen and injurious occurrence not attributable to mistake, negligence, neglect, or misconduct."
The meaning of accidental death is given as under : -
"Accidental death. A death that results from an unusual event, one that was not voluntarily, intended, expected, or foreseeable.
From the above definition of accident and accidental death it clearly appears that something that does not occur in the usual course of events or that could not be reasonably anticipated, such occurrence comes under the category of accident and a death resulted from an unusual, involuntarily, unexpected and unforeseeable event is an accidental death.
13. With no stretch of imagination it can be said in the facts and circumstances of the case that the incident of dog bite was an involuntarily, unexpected and unforeseeable event which resulted into death of insured person, as it clearly appears from the treatment papers that the deceased insured Santram was admitted with complaint of dog Allowed. Page 6 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
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bite and during treatment he developed hydrophobia and ultimately died on the next day of admission in the hospital.
14. As per the medical literature of World Health Organization, submitted by learned counsel for the appellant/ complainant, hydrophobia is one of the symptoms of rabies caused by furious rabies which results in hyperactivity, excitable behavior, hallucinations, lack of coordination, hydrophobia (fear of water) and aerophobia (fear of drafts or of fresh air) and death occurs after a few days due to cardio-respiratory arrest. In the instant case the incident of dog bite occurred with the deceased insured on 01.10.2017 after few days he developed hydrophobia. In the treatment record dated 01.11.2017, Exhibit C-17, the diagnosis is mentioned as Rabies and history of CAD with hydrophobia (Dog bite) (+). Looking to the above documents, treatment history and medical literature, we have no doubt in our mind that the incident of dog bite comes under the category of accident and the death resulted by such dog bite is accidental in nature. The death of the deceased insured was very well covered under the PMSBY.
15. Learned counsel for the appellant has cited judgement of Hon‟ble National Commission in Mrs. Ajmeri Khatun (supra). In that case Hon‟ble National Commission provided emphasis to its earlier judgement in Dharmisetty Srinivas Rao Vs. New India Assurance Co. Ltd., I (2006) CPJ 11 (NC) and discussed paragraph No.4 of that case in its paragraph No.06 of Mrs. Ajmeri Khatun (supra) as under : -
"4. In our view, as stated by Dr. N. Prasad Rao, Civil Assistant Surgeon, Govt. Hospital, Anakapalli, post-mortem was not conducted on the dead body, because usually, in snake bite cases postmortem examination is not conducted. Further, there is a certificate on record issued by him on 27.7.1996 that the deceased was admitted in the Community Hospital, Anakapalli on 23.7.1996 at 11 a.m. for snake-bite and the patient expired on the same day at 4 p.m. The certificate is signed by the Civil Assistant Surgeon, Community Hospital. Thereafter, there is a certificate issued by the Village Administrative Officer of Anakapalli Mandal to the effect that Gorli Appala Narasamma, widow of late Nookaraju, died because of snake Allowed. Page 7 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
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bite on 23.7.1996 at about 10 a.m., while she was cutting grass. This information was conveyed to him by the neighbouring farmers. In our view, there is no justifiable ground to disbelieve the Village Administrative Officer and the doctor who treated the deceased".
From the above judgement of Hon‟ble National Commission it clearly appears that in case of snake bite when postmortem of dead body was not conducted, the other documents, certificate of civil assistant surgeon and certificate issued by village administrative officer were believed holding that there was no justifiable ground to disbelieve the village administrative officer and the doctor who treated the deceased.
16. In the facts of the present case also treatment record, certificate issued by treating doctor, death certificate of the deceased and proposal passed in Gram Panchayat meetings have been brought on record which are sufficient to prove the authenticity of occurrence of incident, treatment taken and the death of the insured person. The insurance company was not justified in treating the insurance claim of the deceased insured as „No Claim‟ for want of merg intimation or FIR as in the event of Dog bite it is not expected from the family members of insured to give intimation to the police or to compulsorily let the postmortem of the dead body conducted. Thus, in our considered view the appellant/ complainant being nominee of the deceased insured is entitled to get compensation under the PMSBNY in question and learned District Commission has erred in dismissing the complaint, hence the impugned order is liable to be set aside.
17. We are of the considered view that the respondent No.1/ opposite party No.1 has committed deficiency in service in not allowing the insurance claim of the complainant and is liable to pay the amount of insurance claim of the deceased insured to his nominee. So far as liability of the respondent No.2/ opposite party No.2 is concerned we do not find Allowed. Page 8 of 9 Appeal Nos.: Tejendra Kumar Date of Pronouncement:
FA/24/51 Vs. 21/06/2024 National Insurance Co. Ltd. & Anr.
any lack of duties on their part as being the Bank, as an account-holder of which the insurance cover was obtained, it does not appear that they were negligent in discharging their duties in sending the insurance claim to the insurance company in time.
18. With the foregoing discussion, we allow this appeal and set aside the impugned order. The complaint filed by the appellant herein before District Commission is partly allowed. The respondent No.1/ opposite party No.1 is directed to pay the appellant / complainant within 45 days the insurance amount under PMSBY Rs.2,00,000/- (Two Lacs) along with interest @ 6% p.a. from the date of filing complaint i.e. 03.07.2020 till realization. The respondent No.1/ opposite party No.1 is also directed to pay Rs.20,000/- (Twenty Thousand) to the appellant / complainant towards compensation for mental agony suffered by him along with cost of litigation Rs.5,000/- (Five Thousand).
(Justice Gautam Chourdiya) (Pramod Kumar Varma)
President Member
/06/2024 /06/2024
Pronounced on: 21st June 2024
Allowed. Page 9 of 9