State Consumer Disputes Redressal Commission
Smt. Eliamma Vargees vs The Oriental Insurance Co.Ltd on 6 June, 2011
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
(A/11/2327)
Appeal No.46/2011
Instituted on : 27/01/2011
Smt. Eliamma Vargees,
W/o Late Shri K.S. Vergees,
R/o : Village & Post. Chichola,
Tehsil & District : Rajanandgaon (C.G.) .... Appellant
Vs.
The Oriental Insurance Company Limited,
Through : Branch Manager,
In Front of L.I.C. Office, Railway Station Road,
Rajnandgaon, Teh. & Dist. Rajnandgaon (C.G.) .... Respondent
PRESENT :
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SMT. VEENA MISRA, MEMBER
HON'BLE SHRI V.K. PATIL, MEMBER
COUNSEL FOR THE PARTIES :
Shri R.K. Bhawnani, for appellant.
Shri L.K. Joshi, for respondent.
ORDER (ORAL)
DATED : 06/06/2011 PER :- HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT This is an appeal of the complainant, who is widow of deceased Late Mr. K.S. Vargees, who was insured by the respondent No.1/Insurance Company under Group Janta Personal Accident Policy for sum of Rs.5,00,000/- in case of accidental death. The District Consumer Disputes Redressal Forum, Rajnandgaon (C.G.) (hereinafter called "District Forum" for short) has dismissed the Complaint Case // 2 // No.55/2010 filed by the appellant herein, vide order dated 30.12.2010, on the finding that age of the deceased, was more than 80 years and, therefore, the complainant/appellant, was not entitled of getting any benefit of the insurance policy.
2. In nutshell, the facts of the case are that Late Mr. K.S. Vargees, was account holder in Durg-Rajnandgaon Gramin Bank, Branch Chichola, District Rajnandgaon (hereinafter called "the Bank" for short) having Saving Account No.2582. As per agreement between the respondent No.1/Insurance Company and the Bank, all account holders of the Bank, were insured by the respondent No.1/Insurance Company under Group Janta Personal Accident Policy for a sum of Rs.5,00,000/- against the accidental death. The deceased Mr. K.S. Vargees died on 07.09.2009 in a road accident, therefore, complainant preferred a claim before the Insurance Company for getting benefit of the insurance policy. The said claim was repudiated by the Insurance Company, on the ground that under the terms of the policy, benefit is only payable when the person is of the age between 5 to 80 years. The deceased was aged 84 years and therefore, no claim was payable in case of his accidental death.
3. District Forum agreed with the contentions of the Insurance Company and dismissed the complaint.
// 3 //
4. We have heard arguments advanced by both parties and perused record of the District Forum.
5. The respondent No.1/Insurance Company upon whom burden of proof was lying to show that deceased insured was of more than 80 years of age, has claimed to have discharged this burden by relying upon on the copy of Merg Intimation, copy of First Information Report recorded on the basis of such Merg Intimation, copy of Final Report of the Police and application moved by the Police for conducting Postmortem of the dead body of the deceased insured.
6. Counsel for the complainant/appellant has drawn our attention towards the affidavit of the complainant/appellant filed before District Forum, and copy of the complainant's affidavit filed by the Insurer, as well as copy of Postmortem Report and submitted that in her affidavit filed before insurer , the complainant/appellant, has clearly stated that the age of the deceased insured Mr. K.S.Vargees was 70 years and his date of birth was 27.02.1940 and, so, he was below 80 years of age. It has also been argued by him that the Doctor, who conducted Postmortem of dead body of the deceased insured, has also estimated age of the deceased as 77 years. Whereas counsel for the respondent No.1/Insurance Company submitted that in all the aforesaid documents of Police investigation, age of deceased insured was mentioned as 84 years. He submitted that as deceased insured had // 4 // already crossed the outer limit of 80 years of age, therefore, benefits under the insurance policy, could not be granted to the wife of the deceased insured Mr. K.S. Vargees.
7. We have considered the aforesaid arguments.
8. We find that all documents, which have been relied by counsel for the respondent No.1/Insurance Company, were basing on Merg Intimation recorded by Head Constable, copy of which is available in the record of the District Forum as annexure N.A.-5. From this document, it appears that one Mr. Rajiv, S/o Shri N.I. Koris, aged about 42 years, had given informations to the Head Constable, Gusti of Police Station Basantpur, District Rajnandgaon (C.G.) who recorded this Merg Intimation, on telephonic call of Mr. Rajiv that in a road accident occurred in front of Durg-Rajnandgaon Gramin Bank, someone has sustained injuries. Then, he proceeded to the spot and referred the injured person to the Hospital. In that accident, Mr.K.S. Vergees, S/o Late Mr. S. Vargees, had died and his age has been recorded by the said Head Constable as 84 years, which was his estimation or may be the estimation of a third person Rajiv of age of deceased insured Mr. K.S. Vargees. On the basis of this document, First Information Report was recorded by the S.H.O. and then Investigation was conducted and ultimately Final Report was prepared. As all these documents were basing on the Merg // 5 // Intimation, therefore, age of the deceased insured was mentioned everywhere as 84 years, which was estimation of the Head Constable and no-one told him that the age of the deceased insured was 84 years. When dead body of the deceased insured was sent by Police to Doctor for Postmortem, then in that application, age of deceased insured was mentioned firstly something else, but later on it was overwritten as 77 years. The Doctor, who conducted Postmortem, in his Report annexure N.A.7, has recorded the estimated age of the deceased and opined that deceased was of about 77 years of age. That was opinion of a Medico person, who has got experience, as well as knowledge of determining age of human beings. Apart from it, complainant/appellant herself has filed her affidavit annexure N.A.10 before the Insurance Company much prior to the date of filing of complaint before District Forum and in that affidavit, it was stated by her that the date of birth of her deceased husband was 27.02.1940 and his age was 70 years. That affidavit was available with the Insurance Company and it appears that respondent no.1/Insurance Company had not made any efforts to verify the facts stated by the complainant/appellant in her affidavit, in respect of age of her deceased husband and in respect of his date of birth. It has been argued by counsel for the respondent No.1 that deceased was a literate person, who was having account with the Bank and was also practicing in Medicine in some Pathy. It appears that even then the // 6 // respondent No.1 had never tried to procure any document by which date of birth and correct age of the deceased insured, could be determined. The respondent no.1 has simply proceeded on the estimation of the age made by Head Constable, which was not worth- relying in view of specific statement on oath by the complainant/appellant made before the Insurance Company and later on made before the District Forum and was duly corroborated by the Postmortem Report, where Doctor has estimated age of the deceased insured as 77 years.
9. Thus, we find that the Merg Intimation, First Information Report, Letter of Police to Doctor for conducting Postmortem of the dead body of the deceased insured and Final Report, were of not much reliance regarding age of deceased, in comparison to the statement on oath by the complainant/appellant and the estimation of the Doctor regarding age of the deceased insured.
10. We further find that District Forum, has committed a mistake in relying upon the Merg Intimation, in comparison to specific statement of the complainant/appellant on oath and in dismissing the complaint of the appellant herein.
11. Therefore, the appeal succeeds and is allowed. The impugned order of the District Forum, is set aside. The respondent // 7 // No.1/Insurance Company, is directed to pay sum assured Rs.5,00,000/-, along with interest @ 6% p.a. from the date of filing of the complaint till date of payment to the complainant/appellant. Apart from it, cost of litigation, which is quantified as Rs.1,000/-, will also be payable by the respondent No.1/Insurance Company to the complainant/appellant.
(Justice S.C.Vyas) (Smt. Veena Misra) (V.K. Patil)
President Member Member
/06/2011 /06/2011 /06/2011