State Consumer Disputes Redressal Commission
National Insurance Ltd. vs Jaswinder Kaur on 9 August, 2017
FIRST ADDITIONAL BENCH
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, SECTOR 37-A, DAKSHIN MARG, CHANDIGARH.
First Appeal No.323 of 2017
Date of Institution : 02.05.2017
Order reserved on: 08.08.2017
Date of Decision : 09.08.2017
National Insurance Company Ltd., Regional Office, SCO No.332-
334, Sector 34-A Chandigarh through its Authorized Signatory.
.....Appellant/Opposite party No.2
Versus
1. Jaswinder Kaur Wife of Late Sh. Buta Singh R/o Patti
Dhaliwalwas, Village Jakhepal, Tehsil Sunam, District
Sangrur.
2. Sewak Singh son of Late Sh. Buta Singh R/o Patti
Dhaliwalwas, Village Jakhepal, Tehsil Sunam, District
Sangrur.
.........Respondents/complainants
3. State Bank of Patiala, New Grain Market, Branch Sunam,
Tehsil Sunam, District Sangrur, through its Branch Manager.
.....Respondent No.3/opposite party No.1
Appeal against order dated
21.03.2017 passed by the District
Consumer Disputes Redressal
Forum, Sangrur.
Quorum:-
Shri J. S. Klar, Presiding Judicial Member.
Smt. Surinder Pal Kaur, Member Present:-
For the appellant : Sh. Nitin Gupta, Advocate For respondent No.1&2 : Sh. Sanjeev Goyal, Advocate For respondent No.3 : Ex-parte ............................................ F.A. No. 323 of 2017 2 J.S. KLAR, PRESIDING JUDICIAL MEMBER :-
Challenge in this appeal by appellant is to order dated 21.03.2017 of District Consumer Disputes Redressal Forum Sangrur, directing the appellant to pay the insured amount of Rs.2,00,000/- along with interest @ 9% per annum from the date of filing the complaint till realization to the respondents No.1&2 of this appeal with further amount of Rs.10,000/- as compensation for mental harassment and Rs.5,000/- as cost of litigation.
Respondents No.1 and 2 of this appeal are the complainants in the complaint before the District Forum Sangrur and appellant of this appeal is OP No.2 therein and respondent No.3 of this appeal is OP No.1 in the complaint therein and they be referred, as such, hereinafter for the sake of convenience.
2. Complainants filed complaint under Section 12 of Consumer Protection Act 1986 (in short 'Act') against OPs on the averments that Buta Singh husband of complainant No.1 and father of complainant No.2 was having account with OP No.1 State Bank of Patiala bearing account No.65071882203. OP No.1 deducted Rs.12/- on 02.06.2016 under PMSBY Insurance Scheme and Buta Singh above account holder was thus insured for Rs.2,00,000/- in the event of his accidental death. Buta Singh met with an accident on 08.10.2015, when he fell from his bicycle and sustained injuries therein, necessitating his admission to Sibia Health Care Private Limited Sangrur on 08.10.2015. He remained admitted their till 12.10.2015 and ultimately succumbed F.A. No. 323 of 2017 3 to his injuries on 14.10.2015. Since Buta Singh suddenly fell from his bicycle and in this accident, he sustained injuries, hence no police report was lodged nor any autopsy on his dead body was conducted. Complainants lodged claim with OP No.1, duly supported by all relevant documents for the release of the claim, but to no effect. They wrote letter dated 04.02.2016 to OP No.1 submitting all documents, as required by OP No.1 for release of the claim amount. OPs repudiated the claim of the complainants on false and baseless grounds. The repudiation of insurance claim of complainant caused mental harassment to them. Previously, complainants also filed a complaint before the Consumer Fora, which was dismissed in default, vide order dated 29.10.2016 on account of non-appearance of their counsel. Present complaint is, thus, maintainable as per order of Supreme Court in Civil Appeal No.577 of 2016. Complainants have prayed that OPs be directed to release the insured amount of Rs.2,00,000/-along with interest @ 18% per annum from the date of death of Buta Singh (DLA), besides compensation of Rs.50,000/- for mental harassment and Rs.11,000/- as cost of litigation.
3. Upon notice, OP No.1 State Bank of Patiala put in appearance and filed its separate written reply contesting the complaint of the complainants. Preliminary objections were raised by OP No.1 that complaint has no locus standi or cause of action to file the complaint and hence complaint is not maintainable. F.A. No. 323 of 2017 4 Complainants have not come to the Forum with clean hands and concealed the material facts from the Fora. Complainants are alleged to be estopped by their acts and conducts from filing the complaint. No notice was issued by complainants to OPs before filing this complaint. It was denied by OP No.1 that complainants are consumers, hence the complaint filed by them is not maintainable. The complaint is alleged to be based on false and wrong facts, being vexatious in nature. On merits, this fact was admitted that Buta Singh since deceased held an account with OP No.1 bank and was insured for accidental death. OP No.2 denied claim petition on 05.11.2015 with regard to death of Buta Singh on the allegations of injuries by his sudden fall from bicycle and his treatment therefor at Sibia Hosptial Sangrur. The said application was forwarded to National Insurance Company with death certificate of Buta Singh, medical certificate given by Dr. Prabjot Singh Sibia dated 05.1.2015 and bill invoice for the settlement of the claim. OP No.2 demanded copy of FIR and postmortem report regarding death of Buta Singh, but no such documents were supplied by complainants. OP No.1 again forwarded the application to OP No.2 National Insurance company, informing that FIR and postmortem report were not provided by complainants, which were mandatory as per memorandum of understanding arrived at between the parties. Sewak Singh complainant again moved an application to OP No.1 bank on the same facts on 04.02.2016, which was forwarded to OP No.2 F.A. No. 323 of 2017 5 National Insurance Company on 18.02.2016 by OP No.1. It was returned by OP No.2 on the same comments, vide letter dated 25.02.2016, that postmortem report and FIR were mandatory to be supplied by complainants in this case. OP No.1 controverted other averments of complainants for their any entitlement to claim amount and, thus, prayed for dismissal of the complaint.
4. OP No.2 filed its separate written reply and contested the complaint of the complainants by raising preliminary objections that complaint is not maintainable. Complainants have not come to the Forum with clean hands and suppressed the material facts from the Forum. Complainants have not complied with the terms and conditions of the policy and hence, they have no locus standi to file the complaint. The fact of falling from bicycle is not an accidental death. On merits, it was denied by OP No.2 that Buta Singh met with an accident on 08.10.2015 by falling from bicycle. This fact was denied by OP No.2 that Buta Singh sustained injuries and was admitted to Sibia Health Care Private Limited Sangrur for his treatment. This fact was also denied that FIR was not registered with the Police. Complainants have not got the autopsy on the dead body of insured Buta Singh purposely, so as to suppress the real truth of his death being a natural one. It is mandatory that claim should be supported by original FIR, panchnama, postmortem report and death certificate in case of accidental death. OP No.2 reiterated the valid repudiation of the insurance claim by it for absence of postmortem F.A. No. 323 of 2017 6 report, police report, panchnama and death certificate of accidental death of Buta Singh-insured.
5. The complainants tendered in evidence documents as Ex.C-1 to Ex.C-10 along with affidavit as Ex.C-11 and closed the evidence. As against it, OP No.1 tendered in evidence affidavit of Sh. Chanchal, Branch Manager of OP No.1 as Ex.OP1/1, along with documents annexure A to Annexure D and closed the evidence. OP No.2 tendered in evidence affidavit of Randhir Singh, Assistant Manager of OP No.2 as Ex.OP2/1 along with documents Ex.OP2/2 to Ex.OP2/7. On conclusion of evidence and arguments, District Forum Sangrur, accepted the complaint of complainant by directing OP No.2 to pay amount of Rs.2,00,000/- to complainants with interest @ 9% per annum from date of filing the complaint till its actual payment and further compensation of Rs.10,000/- for mental harassment and Rs.5,000/- as cost of litigation. Aggrieved by above order dated 21.03.2017 of District Forum opposite party No.2 now appellant preferred this appeal against the same.
6. We have heard learned counsel for parties and also appraised the evidence on record with their able assistance. There is no dispute of this fact that Government of India launched a personal accident insurance claim known as Pradhanmantri Surksha Bima Yojna. OP No.1 State Bank of Patiala entered with agreement with OP No.2 National Insurance Claim with regard to F.A. No. 323 of 2017 7 this insurance scheme of its account holder. Buta Singh (DLA) held an account with OP No.1 State Bank of Patiala, vide account No.65071882203. He was insured under the above scheme for his accidental death. The above-referred facts are not in controversy in this case. The bone of contention arose between the parties only on the premise that complainants failed to submit the copy of police report, copy of postmortem report and so on to the insurance company through OP No.1-Bank. Evidence on record of both side has also been examined by us with the able assistance of counsel for parties. The submission of counsel for appellant is that as per memorandum of understanding entered into between OP No.1-Bank and OP No.2-National Insurance Company, it is obligatory to produce the copy of police report and postmortem report, panchnama and death certificate in case of accidental death for claiming the insured amount by them. The entire controversy hinges upon this point between the parties. OP No.2 the present appellant repudiated the insurance claim of complainants being legal representatives of deceased insured- Buta Singh primarily on the ground that complainant failed to prove copy of FIR and postmortem report of dead body of insured, which is mandatory as per memorandum of understanding between them. National Commission has held in New India Insurance Company Limited Vs. State of Haryana and Ors. reported in 2008(2) CPJ 371 that Consumer Protection Act, 1986 Section 21(b) Insurance claim, motor accident, accidental death. F.A. No. 323 of 2017 8 Denial of the benefit under Government Scheme on account of non-production of FIR and postmortem report. Treatment of deceased carried on in Government Medical College and Hospital. Non production of document in support - insurance cannot discount and reject reports and statement of Government Hospital authorities, Gram Panchayat and other Government authorities, without evidence to contrary. Fraud, misrepresentation of material facts with regard to death of insured not established. Repudiation of claim not proper, revision petition dismissed. Similarly, National Commission has also held in 15, TPD Gram Sewa Sahakari Samiti Ltd. Vs. Charnjit Kaur reported in 2011 (4) CPJ 390 that Consumer Protection Act, 1986 Sections 2(1)(g), 14(1)(d) and 21(b) - failure of payment of - agricultural loan - death of 'AS', wife claimed for Rs.1 lakh under Agricultural Securitization Scheme after deduction of loan amount. Complaint allowed. Revision petition against - contention raised that death of 'AS' not accidental - not tenable. Decisions of Forum based on certificate given by Sarpanch which was supported by series of affidavits filed on behalf of complainants justifying manner in which 'AS' died which conclusively proved that it was an accidental death. Technical objections such as not filing an FIR, absence of postmortem report and not filing claim within thirty day will not make much a difference to case of the complaints. No interference warranted - revision petition dismissed. National Commission has also examined the F.A. No. 323 of 2017 9 controversy like the case in hand and held in United India Insurance Company Ltd. Vs. Pallamreddy Aruna reported in 2007(4) CPJ 389 that Consumer Protection Act, 1986 Section 21(b), insurance claim, death due to snake bite, postmortem, claim was repudiated on the ground that proof of death by snake bite was not established without conducting postmortem. Contention cannot be accepted. Death was duly proved by certificate of police official, village Administrative officer and the doctor. In a small village, villagers cannot wait for postmortem in cases of snake bite. A doctor in such cases can certify that person concerned had died because of poison due to snake bite. Order passed by authorities below upheld.
7. So it is evident from the tenor of the plethora of law laid down by National Commission (supra) that postmortem report and police report are not sine qua non requisites for claiming the insurance amount. The facts controverted can be proved by evidence aliunde as well. On the basis of law laid down by National Commission in the above authorities, we reject the contention of the appellant insurance company that the insurance claim cannot be processed without postmortem report and police report, panchnama and death certificate of insured. This fact can also be proved by other evidence.
8. Now we take up the crux of the matter as to whether death of Buta Singh-insured was accidental or natural. Undoubtedly, witnesses of complainants stated that it was F.A. No. 323 of 2017 10 accidental death, which fact has been equally controverted by the witnesses of the OPs on the record. We have to search for independent evidence on the record to determine this point. Ex.C-3 is discharge summary of Buta Singh issued by Dr. Prabjot Sibia Healthcare Pvt. Ltd. at Sangrur. It is evident by this document that Buta Singh was a case of Right Pneumothorax (post trauma) who was given the treatment therefor. His death certificate issued by Registrar of Birth & Death is Ex.C- 4 on the record proving his death on 14.10.2015, but the cause of death is not specifically recorded in it. The sole evidence relied upon by complainants is the discharge summary Ex.C-3 issued by Sibia Healthcare Private Limited for treatment of Buta Singh-insured. In addition to that, certificate issued by Dr. Prabjot Singh, Sibia Healthcare Private Limited is Ex.C-7 dated 05.11.2015 certifying that Buta Singh insured was admitted in Sibia Healthcare Private Limited Sangrur on 08.10.2015 to 12.10.2015 under registration No.5246. He was a case of right pheumothorax post trauma from road traffic accident (fall from bicycle on road-non MLC case). He expired on 14.10.2015 due to trauma caused by Road Traffic Accident. Ex.C-3 and Ex.C-7 are the documents of Sibia Healthcare Private Limited issued by Dr. Prabjot Singh, treating doctor of Buta Singh. The above-referred documents have gone unrebutted on the F.A. No. 323 of 2017 11 record by OPs in this case. The OPs have not led any contrary cogent evidence to refute above medical evidence on the record. Cause of death of Buta Singh is, thus, proved to be right pneumothorax post trauma from road traffic accident (fall from bicycle on road-non MLC case) as depicted in Ex.C-7 certificate on the record. The pneumothorax is usually caused by an injury to the chest, such as broken rib or puncture wound. It may also occur suddenly without an injury. A pneumothorax can result from damage to the lungs caused by conditions such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. This condition occurs when air leaks into the space between the lungs and chest wall. A blunt or penetrating chest injury, certain medical procedures or lung disease can cause a pneumothorax as well.
9. It is thus evident from perusal medical record of Sibia Healthcare Private Limited Sangrur that death of Buta Singh was on account of road side accident, having fallen from bicycle, which was a non-MLC case. As per the drift of law laid down by National Commission (supra), postmortem report and police report are not obligatory components before releasing the insurance claim by insurance company. Consequently, District Forum rightly appreciated the F.A. No. 323 of 2017 12 controversy in this case and awarded the claim amount to complainants being LRs of insured.
10. With regard to maintainability of second complaint, there is plea of complainant that previous complaint was dismissed in default only without its adjudication on merits. Subsequently, complaint is, thus, maintainable, when previous complaint is dismissed in default for non- appearance alone. The counsel for appellant has also not controverted this proposition of law during arguments before us. Consequently, we hold the instant complaint to be maintainable, as put in by the complainants.
11. As a sequitur of our above discussion, we have not come across any perversity or illegality in the order of the District Forum calling for any interference therein in this appeal. The order of District Forum is affirmed in this appeal. Finding no merit in the appeal, the same is hereby dismissed.
12. The appellant had deposited an amount of Rs.25,000/- with this Commission at the time of filing the appeal and another amount of Rs.1,25,000/- on 12.05.2017 in compliance with order dated 04.05.2017 of this Commission. Both these amounts with interest, which accrued thereupon, if any, be remitted by the registry to the respondent/complainant by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay order, if any. F.A. No. 323 of 2017 13
13. Arguments in this case were heard on 08.08.2017 and the order was reserved. The certified copies of order be communicated to the parties, as per rules.
14. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (Surinder Pal Kaur) MEMBER August 09, 2017 DB