State Consumer Disputes Redressal Commission
National Insurance Co. Ltd. vs Aparna Kahar & Others on 19 July, 2013
State Consumer Disputes Redressal Commission State Consumer Disputes Redressal Commission West Bengal BHABANI BHAVAN (GROUND FLOOR) 31, BELVEDERE ROAD, ALIPORE KOLKATA 700 027 S.C. CASE NO. : FA/107/2012 (Arisen out of judgement dt. 6.1.12 of DCDRF, Birbhum in C.F.Case No. CC/39/O/2011) DATE OF FILING : 16.03.2012 DATE OF FINAL ORDER: 19.07.2013 APPELLANT National Insurance Co. Ltd. Division-III, National Insurance Building, Ground Floor, 8, India Exchange Place, Kolkata-700 001. RESPONDENTS 1. Aparna Kahar Wife of Late Tinku Kahar Benepukurpara P.O. & P.S. Circle - Suri, Birbhum. 2. Manager, G.T.F.S., 16, R.N.Mukherjee Road Kolkata-700 001. 3. Branch Manager, G.T.F.S., Suri Branch, Suri, Rabindrapally, P.O. & P.S. Circle Suri, Birbhum. 4. Chatterjee Engineering Flat No. 301, Crystal Rinance 19, Kirikung Society Near Jivan Bharati School Karclibug Vadodara-15, Gujarat. 5. Officer-in-Charge Ichhapore Police Station P.O. Ichhapore, Dist. Surat, Gujarat. BEFORE : MEMBER : MR. S.COARI MEMBER : MR. D.BHATTACHARYA FOR THE APPELLANT : Mr. Gopal Basu, Ld. Advocate FOR THE RESPONDENT : Mr. Anjan Kr. Dutta, Ms. Bisakha Sribastab, Ld. Advocates Mr. Abhik Kr. Das, Ld. Advocate : O R D E R :
MR. S.COARI, LD. MEMBER The present Appeal has been directed against the judgement and order dt. 6.1.2012 passed by the Ld. District Consumer Disputes Redressal Forum, Birbhum (Suri) in C.F.Case No. CC/39/O/2011, wherein the Ld. District Forum allowed the petition of complaint on contest against the OP No. 1 and dismissed the same against the other Ops thereby awarding a sum of Rs. 5,00,000/- in favour of the complainant directing the OP No. 1 to pay the same along with a further direction upon the OP No. 1 to pay interest @ 10% per annum on the aforesaid amount from the date of filing of claim petition till the date of actual payment, within one month from the date of the order.
The case of the complainant/Respondent before the Ld. District Forum, in brief, was that the complainant is the wife of the insured, Tinku Kahar (since deceased), who obtained a Goup Janata Personal Accident Insurance Policy for Rs. 5,00,000/- from the Insurance Company after observing all the formalities. According to the complainant, during the subsistence of the insurance coverage the said Tinku Kahar on 17.9.2008 fell down while dancing on the occasion of Viswakarma Puja. Due to such accidental fall Tinku Kahar got seriously injured and ultimately succumbed to his injuries. Initially, the Insurance Co. was informed about the accident death and thereafter the complainant submitted the claim before the Insurance Co. along with all related and connected documents. The Insurance Co. repudiated the claim on the plea that the death was not an accidental one and that the insured having died due to coronary heart disease the claim could not be entertained. According to the complainant, such refusal on the part of the Insurance Co. tantamounted to deficiency in service and hence, the petition of complaint for proper redressal.
The Insurance Co. contested the case by filing a written version thereby denying and disputing all the material averments mentioned in the petition of complaint contending, inter alia, that the death of the insured being not an accidental one and that the insured died due to coronary heart disease, the claim was not entertainable. According to the OP No. 1, in the absence of any deficiency in service at the instance of the Insurance Co., as claimed by the complainant, the petition of complaint was liable to be dismissed.
Ld. District Forum while disposing of the petition of complaint has observed that during the subsistence of the insurance coverage the insured died out of an accidental fall and the claim having been filed after observing all the requisite formalities the Insurance Co. ought to have considered the claim of the complainant, who happens to be the wife of the deceased insured, and by not allowing the claim of the complainant the Insurance Co. has committed gross negligence and deficiency in service and accordingly, disposed of the petition of complaint in the manner as discussed above.
The only moot question that revolves round the present Appeal is as to whether the Ld. District Forum was justified enough in disposing of the petition of complaint in the manner as mentioned above.
Case laws referred to on behalf of the Appellant/Insurance Co.
1. 2012 (2) CPR 31 (NC)
2. 2012 (2) CPR 78 (NC) Case laws referred to on behalf of the Respondent/G.T.F.S. Rita Devi @ Rita Gupta Vs. National Insurance Co. Ltd.
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2008BusLR 77 NCDRC DECISION WITH REASONS At the time of hearing the Ld. Advocate for the Appellant has submitted before us that the Ld. District Forum having utterly failed to appreciate the actual state of affairs has arrived at a wrong and improper decision, which is not at all sustainable under the law. According to the Ld. Advocate, when it is an admitted position that the insured died while dancing on the occasion of Viswakarma Puja, was attacked with coronary heart disease and ultimately died, question of designating the death to be an accidental one does not arise at all and on this score alone the impugned judgement is liable to be set aside.
While elaborating on this point, the Ld. Advocate for the Appellant/Insurance Co. has submitted before us that the insurance policy does not permit a claim when the diseased dies a natural death.
When it is a clear case of death by coronary heart disease, the Ld. District Forum ought to have rejected the petition of complaint and having not done so the Ld. District Forum has committed gross error and miscarriage of justice and the impugned judgement is liable to be set aside.
We have duly considered the submissions so put forward on behalf of the Appellant and have also gone through the materials on record including the impugned judgment and find that in this case the complainant has put forward a case to the effect that during subsistence of the insurance coverage the insured died an accidental death and upon furnishing a claim the same was repudiated by the Insurance Co. without any rhyme and reason and hence, the petition of complaint for proper redressal. The Insurance Co., on the other hand, has come up with a case to the effect that the present case does not fall under the clause of Accidental Death and as such, in repudiating the claim of the complainant the Insurance Co. has not committed any error and/or deficiency in service, as claimed by the complainant and the petition of complaint was liable to be dismissed.
We have carefully gone through the impugned judgement and find that the Ld. District Forum has really traversed the pros and cons of respective partys case and in arriving at a just and proper decision has practically left no stone unturned. We find much substance in the observation made by the Ld. District Forum, namely, when there is no case of the Insurance Co. about any pre-existing disease and/or that at the time of granting the insurance policy any such factor and/or data came to light, question of presumption that the insured died due to coronary heart disease does not arise at all. From the facts and circumstances of the case and the materials on record we are of the considered view that the Ld. District Forum was quite justified in upholding the case of the complainant and question of holding a contrary view, as claimed by the Appellant/Insurance Co., does not arise at all. We have also considered the decisions relied upon by the Insurance Co. But the facts and circumstances of those decisions being quite different from the instant case the principles laid down in those decisions are not applicable to this case. Having considered the present Appeal in the light of above discussion we find no reason to interfere with the finding of the Ld. District Forum, which, in our opinion, should be confirmed. In the result, the Appeal fails.
Hence, it is ORDERED that the Appeal stands dismissed on contest but without any order as to costs. The impugned judgement stands confirmed.
MEMBER MEMBER