ORDER BY HON’BLE PRESIDENT- MR. P.K. PADHI:

                                                                                            JUDGMENT

            Complainant has filed this consumer complaint U/s.35 of C.P. Act, 2019 seeking following reliefs;

            “Direct the opposite parties to settle the death claim of the complainant and other benefits in respect of the insurance policy and pay @ 18% per annum over the entire award amount”.

            The brief fact of the case is that, the husband of complainant Rabindra Kumar Sahoo was working as a Mazdoor bearing G.P. No.B/27 Group No.63 and the income derived from his service and was maintaining his family providing better sanitary facilities to his family members. On 25.4.2021 in the second shift, the husband of complainant deployed to work in unloading the wagon under the control and supervision of the employer where he met with an accident and sustained severe external and internal bleeding injuries. And he was immediately carried out to P.P.T. Hospital, Paradeep and admitted there, but when his condition was so serious, the P.P.T. Hospital referred him to Relax Medical-cum-Hospital for better treatment where he declared as dead. On 07.5.2021, in this connection Mangalabag P.S. U.D. Case No.932/21 was registered and post mortem and inquest conducted over the dead body. Soon after the death of her husband the complainant intimated this fact to the opposite party No.2, but the opposite parties remained silent over the matter in spite of repeated request of the complainant. Finding no other way out the complainant submitted a representation on 11.4.2022 to the opposite party No.1 thereby narrating entire grievance relating to dissatisfaction, mental agony towards the inaction thereby to settle the death claim in favour of the family of the deceased insured as per condition is going to be worst day by day. But the opposite parties without justifiable reason delayed the matter for which the complainant approached to the opposite parties in several time, which reveals that the deficiency of service on the part of the opposite parties.

            The opposite parties have filed their written statement stating as under;

            The complainant has suppressed the material fact, as such has not come to this Hon’ble Commission with clean hands. The opposite party No.1 has issued the individual personal accident policy bearing No.2603034220P111666417 for the period from 11.12.2020 to 10.12.2021 in the name of the deceased, Late Rabindra Kumar Sahoo. The company shall not be liable to make any payment under this policy in respect of any claim of such claim be in any manner fraudulent or supported by any fraudulent statement or device, whether by the insured or by any person on behalf of the insured persons. This is a case of preexisting disease for which the deceased expired due to his own negligence as he was not care to consult with any doctor for his treatment. Hence this opposite party is not liable to pay any compensation.

            We have gone through the records, evidence affidavit more particularly the post mortem report in which the doctor conducted autopsy has stated as under;

            “VI- More detailed description of injury or disease – Under surface of scalp contused over right hemisphere, a piece of skull bone under external injury 1 is incised and placed under external injury 2. Underlying duramater is repaired with gel foma. Brain is intact, softened. An area of yellowish discolouration of brain parenchyma of size 7cm diameter present over right parietotemporal lobe (contusion necrosis). Brainstem hemorrhage over midbrain, Lungs are intact and paleand edematous. Heart is intact and right chamber contains fluid blood. Stomach is intact and contains about 150mg of semidigested food material. Small intestine and large intestine are intact. Liver, Spleen and Kidneys are intact and pale. Bladder is intact and empty. Organ of generation is intact. All other internal organs are intact.

            VII- Opinion of Sub-Assistant Surgeon as to cause of death – 1) The above mentioned external injuries and the internal effects are ante mortem in nature and could have been caused by application of hard, rough or blunt impact. 2) Death is due to craniocerebral injuries and its complications. 3) The time since death is within 6-12 hours at the time of autopsy.”

            Since the death has been caused due to external injury and happened in course of duty hour, we held that complainant is a consumer as defined under section 2(1) (g) of Consumer Protection Act, 2019 and entitled to get the insured amount. We therefore allow this consumer complaint directing the opposite party No.1 to pay the insured amount within 45 days of passing of the order failing which it will carry interest @ 6% per annum from the date of order till date of payment on the insured amount. With the aforesaid observation and direction consumer complaint is disposed of. No cost.