State Consumer Disputes Redressal Commission
Smt. Farida Begum vs B.M.Golden Multi Services & Ors. on 4 April, 2016
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR (C.G.)
Appeal No.FA/2015/86
Instituted on : 26.03.2015
Smt. Farida Begum, W/o Late Mohammad Sirajuddin,
R/o : Maszid Para, Kargi Road, Kota.
Police Station Kota, District Bilaspur (C.G.) ... Appellant
Vs.
1. The Manager,
Golden Multi Services Club Limited,
S.B. Mansion, 16, R.N. Mukharjee Road,
Kolkata 700-001
2. Divisional Manager,
National Insurance Company Limited,
Shakespeare Sarani, 6th Floor,
Kolkata 700-001
3. Divisional Manager,
National Insurance Company Limited,
B-1 Taha Complex, Vyapar Vihar Road,
Bilaspur, District (C.G.) 495001 .... Respondents
PRESENT: -
HON'BLE JUSTICE SHRI R.S. SHARMA, PRESIDENT
HON'BLE MISS HEENA THAKKAR, MEMBER
HON'BLE SHRI D.K. PODDAR, MEMBER
HON'BLE SHRI NARENDRA GUPTA, MEMBER
COUNSEL FOR THE PARTIES :-
Shri R.R. Sahu, for the appellant.
Shri P.K. Paul, for the respondents.
ORDER
Dated : 04 /04/2016 PER: - HON'BLE JUSTICE SHRI R.S. SHARMA, PRESIDENT This appeal is directed against the order dated 13.01.2015, passed by the District Consumer Disputes Redressal Forum, Bilaspur (C.G). (henceforth "District Forum" for short), in Complaint Case // 2 // No.CC/30/2013. By the impugned order, learned District Forum, has dismissed the complaint of the appellant (complainant).
2. Briefly stated the facts of the complaint of the appellant (complainant) are that the Late Mohammad Sirajuddin, who was husband of the appellant (complainant) had purchased Group Personal Accident Policy from the respondent No.3 (O.P.No.3). The Control No. of the Insurance Policy is C.M.S.C./G.P.F./04-05/A.A-0371884 dated 23.09.2004 and Policy No. is 100300/42/04/8200012, which was effective for the period from 23.09.2004 to 22.09.2014 In the policy there was a condition that if the insured dies in an accident,100% compensation would be paid. On 12.12.2009, Mohammad Sirajuddin had gone to bath room and due to slipping in the bath room he sustained injuries and became unconscious . Mohammad Sirajuddin was taken to Community Health Centre, Kota. The condition of the injured was serious and critical, therefore, he was referred to C.I.M.S. Bilaspur. The deceased was being taken to C.I.M.S. Bilaspur and on the way he died. When the deceased was reached to C.I.M.S., the doctors declared him dead and funeral was performed according to Muslim rites. The claim form was submitted by the appellant (complainant) before the respondent No.2 (O.P.No.2) and respondent No.3 (O.P. No.3), but till 23.08.2012 the Insurance Company did not settle the claim of the appellant (complainant). The appellant (complainant) filed consumer complaint before the District Forum, Bilaspur (C.G.), which was // 3 // registered as Complaint Case No.197/2010. Vide order dated 12.03.2012, the District Forum directed as under :-
(a) the complainant will submit claim form along with relevant documents before the Insurance Company within a period of two months from the date of order of the District Forum and the Insurance Company will co-operate the complainant.
(b) The O.P. Insurance Company will settle the claim form submitted by the complainant within two months from submitting claim form and will intimate the complainant.
(c) If the complainant is not satisfied with the decision of the Insurance Company, then she will be at liberty to file fresh complaint.
(d) Both the parties shall bear their own cost. On being direction given by the District Forum, the appellant (complainant submitted claim form along with relevant documents before the Insurance Company, but the Insurance Company did not settle her claim till 23.08.2012 and committed deficiency in service. Hence, the appellant (complainant) filed present complaint.
3. The respondent No.1 (O.P.No.1) Multi Services Club Limited filed its written statement and averred that a Memorandum of Understanding had been entered into between National Insurance Company Limited and // 4 // Golden Multi Services Club Limited for the purpose of effective operation of Group Personal Accident Policy effective from 02.04.2004. Unfortunately, the mast policy document i.e. Group Personal Accident Policy has not been issued at all by National Insurance Company Limited, even though as per the arrangement the relevant "Certificates of Insurance"
was issued by Golden Multi Services Limited in the form of an information slip mentioning the details of the name of the Insured Person Sum Insured, Period of Insurance, Name of the Nominee etc., as per the following wordings "This is to certify that the Following Persons(s) is are covered under the Group Personal Accident Policy of National Insurance Company Limited, Divisional Office No.III, 1, Shakespeare Sarani, 6th Floor, Kolkata
- 700 001 subject to the terms, conditions and exclusions of the policy. On the basis of arrangement, Golden Multi Services Club Limited had issued the certificate with specific mention that National Insurance Company Limited had provided insurance coverage to Md. Sirajuddin (since deceased) a member of Golden Multi Services Club Limited under National Insurance Company Limited's policy No.100300/42/04/8200012, endorsement No.100300/42/04/82/30087 for the period 23.09.2004 to 22.09.2014 for the sum insured of Rs.5,00,000/-. Farida Begum being wife was made nominee under the policy. The respondent No.2 (O.P.No.2) was intimated the claim on 06.05.2010 and the said intimation was forwarded to National Insurance Company Limited on 07.05.2010 vide letter dated 07.05.2010, therefore, the respondent No.1 (O.P.No.1) did not commit any // 5 // deficiency in service and the appellant (complainant) is not entitled to get any compensation from the respondent No.1 (O.P.No.1).
4. The respondent No.2 (O.P. No.2) and respondent No.3 (O.P.No.3) have filed their joint written statement and averred that the death of the deceased Mohammad Sirajuddin was not accidental and the appellant (complainant) did not file any document regarding death of the deceased. The appellant (complainant) did not file Post Mortem Report. The Insurance Company asked the appellant (complainant) to file Post Mortem Report, Final Report and First Information Report, but the appellant (complainant) did not submit the above documents before the Insurance Company, therefore, the claim of the appellant (complainant) could not be decided for want of above documents. The appellant (complainant) is not entitled to get any compensation from the respondent No.2 (O.P.No.2) and respondent No.3 (O.P.No.3), hence the complaint is liable to be dismissed.
5. Initially, The appellant (complainant) filed consumer complaint before the District Forum, Bilaspur (C.G.), which was registered as Complaint Case No.197/2010. Vide order dated 12.03.2012, the District Forum decided the complaint, as mentioned in para 2 of this order.
6. The appellant (complainant) has filed documents. The documents are copy of order dated 12.03.2012 passed by the District Forum in // 6 // Complaint Case No.197/2010, letter dated 04.06.2012 sent by the appellant (complainant) to the respondents (OPs), letter dated 28.06.2012 sent by Golden Multi Services Club Limited, Kolkata to the appellant (complainant), letter dated 23.08.2012 sent by the appellant (complainant) to the Manager, Golden Multi Service Club Limited, Calcutta, Janta Personal Accident Insurance Claim Form, voter ID card of the appellant (complainant), death certificate of Mohammad Sirajuddin issued by Registrar, Birth Death, Insurance Certificate, acknowledgement, postal receipt
7. The appellant (complainant) again filed Complaint Case No.CC/30/2013 on 02.02.2013 and vide order dated 13.01.2015, learned District Forum, after having considered the material placed before it by the parties, has dismissed the complaint. Hence this appeal
8. Shri D. Dutta, learned counsel appearing for the appellant (complainant) has argued that the insured Mohammad Sirajuddin had gone to bath room and due to slipping in the bath room, he sustained injuries and he was taken to Community Health Centre, Kota where he was treated as outdoor patient. Looking to the seriousness of the injuries sustained by Mohammad Sirajuddin, he was referred to C.I.M.S. Bilaspur, In the outdoor patient slip, the doctor of Community Health Centre, Bilaspur specifically mentioned that the deceased Mohammad Sirajuddin sustained accidental injuries in his head, therefore, his death was // 7 // accidental in nature and was covered under the insurance policy. The appellant (complainant) is widow of deceased Mohammad Sirajuddin and she was made nominee under the insurance policy, therefore, she is entitled to get sum assured under the insurance policy from the respondents (OPs) and merely non-submission of the post mortem report, is not sufficient to disallow the genuine claim of the appellant (complainant). Shri D. Dutta, has placed reliance on Narendra Singh Bhasin Vs. National Insurance Co. Ltd., I (2005) CPJ 523.
9. Shri Kamlesh Kaushik, learned counsel appearing for the respondent No.1 (O.P.No.1) has argued that the appellant (complainant) has not been able to prove that the death of the deceased Mohammad Sirajuddin was accidental in nature. The appellant (complainant) has not adduced any medical evidence to prove the nature of death of the deceased. The appellant (complainant) has filed photocopy of the outdoor patient slip, but the appellant (complainant) did file original outdoor patient slip and the affidavit of the concerned doctor has not been filed by the appellant (complainant). If the deceased Mohammad Sirajuddin sustained injuries due to accident and the doctor mentioned in his patient history, the matter would have been reported to the Police Station, but no such report has been filed by the appellant (complainant) and the post mortem was not conducted, therefore, for want of medical negligence, it cannot be held that the death of deceased was accidental in // 8 // nature. The appeal of the appellant (complainant) is liable to be dismissed.
10. None appeared for the respondent No.2 (O.P.No.2) and respondent No.3 (O.P. No.3) on 17.03.2016 when the case is fixed for final hearing.
11. We have heard learned counsel for the parties and have also perused the record of the District Forum.
12. The appellant (complainant) filed photocopy of outdoor patient slip of Community Health Centre, Kota. In the said document, it is mentioned "Accidental Injury", but the concerned doctor did not mention in the said slip that due to slipping in the bath room, the deceased sustained injuries . In the said document, in left side, it is mentioned thus :-
"ckFk:e esa fxjus ls flj esa pksV vkbZ gS Qjhnk csxe iRuh"
But the above endorsement, which is mentioned in Hindi, is not certified/attested by the concerned doctor. According to the outdoor patient slip, the annual No. is mentioned 16023, therefore, it was proper for the appellant (complainant) to call register of the said hospital or to file affidavit of the concerned doctor. According to the appellant (complainant) the deceased Mohammad Sirajuddin was referred to // 9 // C.I.M.S. Bilaspur for treatment. It appears that the case was accidental, therefore, it was obligatory for the concerned hospital to intimate the concerned Police Station, but no such intimation or Police Report has been filed by the appellant (complainant).
13. The burden lies on the appellant (complainant) to prove that death of the deceased insured was accidental in nature, but the appellant (complainant) did not adduce any medical evidence to prove that the death of the deceased was accidental in nature.
14. In United India Insurance Co. Ltd. Vs. Canara Bank & Anr. I (2016) CPJ 699 (NC), Hon'ble National Commission has observed thus :-
"14. The Fora below have ignored the fact that onus of proving that the insured died as a result of accidental fall was on the respondent complainant which respondent has failed to discharge. Therefore, the impugned order cannot be sustained. We accordingly allow the revision petition, set aside the impugned order and dismissed the complaint."
15. In Oriental Insurance Co. Ltd. Vs. Tara, II (2015) CPJ 661 (NC), Hon'ble National Commission has observed that "Complainant was under
obligation to prove that cause of death of insured was the injuries sustained in unfortunate accident."
16. The concerned doctor has simply mentioned in the outdoor patient slip that "accidental injury" but kinds and number of injuries have not // 10 // been mentioned in the said document, therefore, the said document is highly doubtful, otherwise in order to succeed in her claim, onus to prove that deceased die due to injuries suffered in the accident, is on the appellant (complainant), but the appellant (complainant) did not adduce cogent evident to prove that the death of the deceased occurred due to slipping in the bath room.
17. We are of the view that the impugned order dated 13.01.2015, 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.
18. Therefore, 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) (Ms. Heena Thakkar) (D.K. Poddar) (Narendra Gupta) President Member Member Member 04 /04/2016 04 /04/2016 04/04/2016 04 /04/2016 // 11 //