State Consumer Disputes Redressal Commission
Smt. Rukmani Devi vs National Insurance Company Ltd. & Anr. on 1 January, 2010
H H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA. Appeal No. 298/2009. Date of Decision 1.1.2010. In the matter of: Smt. Rukmani Devi Wd/o Sh. Durga Nand Verma, R/o Village Fanal, PO Kuhinal, Tehsil Kotkhai, Distt. Shimla, HP. Appellant. Versus 1. National Insurance Company through its Divisional Manager, Divisional Office, Himland Hotel, Tehsil & District Shimla, HP; 2. The State of Himachal Pradesh through Secretary (Education) to the government of Himachal Pradesh, Shimla 171 002, HP; 3. The Director, Primary Education, Himachal Pradesh, Shimla 171 003, HP; 4. The Block Primary Education, Officer, Block Deha, Tehsil Theog, Distt. Shimla, HP. Respondents. Honble Mr. Justice Arun Kumar Goel (Retd.), President. Honble Mrs. Saroj Sharma, Member. Honble Mr. Chander Shekhar Sharma, Member. Whether approved for reporting? Yes. For the Appellant.: Mr. Raman Jamalta, Advocate vice counsel Mr. Ranvir Chauhan, Advocate. For the Respondent No.1. Dr. Lalit K. Sharma, Advocate. For the Respondents 2 to 4 Mr. L.S. Negi, ADA. O R D E R
Justice Arun Kumar Goel (Retd.), President (Oral).
Appellant is aggrieved from the order dated 20.7.2009, passed by District Forum Shimla, in Consumer Complaint No. 244/2003. By means of impugned order, complaint filed by the appellant has been dismissed, hence this appeal.
2. Late husband of the appellant, Shri Durga Nand was working as Headmaster in Government Primary School, Chawai, (Deha Block), Tehsil Theog, District Shimla. According to the appellant, respondents No. 2 to 4 with a view to provide insurance cover to its staff had got the deceased alongwith other persons insured with respondent No.1 to the extent of Rs. 2 lacs in case of accidental death.
3. Deceased died as a result of accident according to the appellant, and daily diary report to that effect was lodged. This fact is mentioned by respondent No.4 in his communication dated 16.4.2002, Annexure C-7. This is a letter addressed to the Divisional Manager of respondent No.1. Accident had taken place on 2.2.2001 as a result of which the deceased sustained grievous injuries and ultimately he died on 5.5.2001. Premium had been deducted out of his salary is clear from the certificates issued by Block Primary Education Officer. Documents to this effect are at pages 47 and 49 of the complaint file. Appellant had submitted copy of FIR, discharge slip issued by IGMC Shimla, MLC, and certificate of first aid issued by Civil Hospital Kotkhai, certificate from Tehsildar regarding amount disbursed through Sub Divisional Officer and death certificate, to the Block Primary Education Officer, vide Annexure C-6.
4. Since claim was not settled appellant got legal notice issued vide Annexure C-10, but without any consequence. Alleging deficiency in service, Complaint No. 244/2003 was filed by her. Stand of the respondent No.1 while contesting this complaint was, that it was not maintainable as the appellant was not a consumer under Consumer Protection Act, 1986 and after the claim was examined under the policy, deficiency of service was not there, and repudiation of claim was justified. According to it since post mortem report was not furnished after he died on 5.5.2001, complaint was liable to be dismissed. Further according to respondent No.1 it was for the legal heirs to justify the stand that deceased had died as a result of accident. This is the pith and substance of the reply filed by the respondent.
5. On the other hand respondents 2 to 4 did not dispute the death of the deceased, Sh. Durga Nand Verma as a result of accident and also premium having deposited qua the deceased. Circumstances whereunder delay occurred in submission of claim were also explained in their reply by them. District Forum below after hearing the parties dismissed the complaint on the sole ground that in terms of the policy death certificate was required to be furnished by the appellant, that having not been submitted, plea raised by learned counsel for respondent No.1 was upheld, and consequently complaint of the appellant was turned down.
6. Mr. Jamalta learned counsel for the appellant submitted that the District Forum below fell into error by dismissing the complaint solely on the ground, that the post mortem certificate had not been submitted. According to him death is not in dispute. What is disputed according to him was that there is nothing on record to suggest that as a result of accident on 2.2.2001 near Gumma, and after he had been admitted in IGMC at Shimla, the injuries proved to be fatal. This ground is wholly untenable in law, as well as in the facts and circumstances of this case.
7. With a view to advance the case of the appellant, learned counsel for the appellant drew our attention to the copy of the order passed by MACT-II, Shimla in MAC No. 136-S/2 of 2001, decided on 30.8.2005, titled as Rumkmani and others Vs. Managing Director, Himachal Road Transport Corporation (HRTC) and another. This case had arisen out of the accident that was there on 2.2.2001, wherein Durga Nand deceased had sustained injuries which according to claimants in this case proved fatal. It is further case set out by the claimants before the MACT, that injured was taken to Civil Hospital Kotkhai, and from there he was referred to IGMC, Shimla.
He was operated upon and subsequently discharged in a critical condition on 12.2.2001. He ultimately died on account of said injuries on 5.5.2001. In this background complaint was allowed by the MACT-II, Shimla. HRTC challenged the order of the MACT-II, Shimla in FAO No. 472/2005 before the Honble High Court of Himachal Pradesh. This matter was compromised in Lok Adalat. Copy of the order passed by Honble High Court is at pages 125 to 129, and of the MACT-II, Shimla at pages 131 to 145.
8. For the reasons to be recorded hereinafter, we are of the view that mere non submission of the post mortem report of deceased-insured could not have been made the ground to reject the insurance claim of the appellant in the facts and circumstances of the case, particularly keeping in view the order of the MACT-II, Shimla as well as of the Honble High Court passed in Lok Adalat referred to hereinabove.
9. In this behalf we specifically called upon Dr. Sharma, learned counsel for the respondent No.1 as to what difference it would made even if post mortem report had been submitted. Per him this is the requirement of the insurance policy subject to which risk was covered. In respect of the documents attached with the complaint, referred to hereinabove we again asked him as to what he has to say regarding certificate particularly Annexure C-7, dated 16.4.2002 issued by the Block Primary Education Officer wherein the death of Shri Durga Nand Verma is stated to be due to accident and certificate to that effect issued by Tehsildar confirming the factum of accident having been also submitted. Dr. Sharma persisted with vehemence that his client could only processed the case after receipt of documents as mentioned in the insurance policy.
10. This approach, we feel too pedantic besides being too technical. This according to us negates the purpose of obtaining insurance policy. In case of the present nature as also keeping in view the stand of respondents 2 to 4 in our opinion this appeal deserves to be allowed.
11. Accident having taken place on 2.2.2001 and to this effect there is overwhelming evidence on record which has remained uncontested, as well as uncontroverted. Likewise the deceased having been shifted to IGMC, Shimla with grievous injuries where he was attended upon and discharged, is again established from the evidence on the complaint. Suffice it to say that no doubt post mortem should have been filed by the authorities concerned, we have no doubt in our mind in this behalf that if the appellant was aware that for want of the post mortem report she would be dragged to litigation by respondent No.1, and its non filing would be fatal to her claim, she would have certainly done the needful. We may mention here that respondent No.1 ought to have explained to respondents 2 to 4, that the policy conditions subject to which insurance was undertaken should have been explained to all the beneficiaries who were covered under the insurance policy. Therefore this is an additional ground to reject the plea of Dr. Sharma that until post mortem report was produced his client was not bound to pay the sum insured.
12. On an overall examination of the whole case we are of the view that impugned order passed by District Forum below deserves to be set aside. Ordered accordingly.
13. No other point was urged.
In view of the aforesaid discussion this appeal is allowed while setting aside the order passed by District Forum Shimla, in Consumer Complaint No. 244/2003, dated 20.7.2009 and consequently allowing the said complaint. As a result of it, we hold respondent No1 liable for payment of Rs. 2 lacs, alongwith interest @ 9% per annum from the date of filing of the complaint, i.e. 28.5.2003 till the date of payment/deposit whichever is earlier alongwith Rs. 5000/- as cost of this appeal as well as of complaint.
Learned counsel for the parties have undertaken to collect copy of this from the Court Secretary free of cost as per rules.
Shimla, January 1, 2010. ( Justice Arun Kumar Goel ) (Retd.) President.
(Saroj Sharma) Member.
( Chander Shekher Sharma ) /Karan/ Member.