Delhi

West Delhi

CC/15/278

NIKHIL BATRA - Complainant(s)

Versus

BAJAJ ALLIANZ GEN INS. - Opp.Party(s)

24 Jul 2018

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM (WEST)

150-151; COMMUNINTY CENTER ; C-BLOCK; JANAK PURI; NEW DELHI

CASE NO. 278-2015

Sh. Nikhil Batra

S/o Late Sh. Rajinder Kumar Batra  

R/o G-9/199, Sector-16, Rohini

Delhi.                                                           …….. Complainant   

 

VERSUS

M/s Bajaj Allianz General Insurance Co.ltd, Regd.  Office. GE Plaza,  Airport road   Yewda-Pune-411006

Also At:-

M/s Bajaj Allianz General  4Insurance  Co. Ltd.  Block No. -4, 7^th Floor, DLF Towers,  15,                                                                     Shivaji Marg.(Moti Nagar)                        ……..  Opposite Party

 

  

 

O R D E R

 

K.S. MOHI, PRESIDENT

Complainant is the nominee of his deceased brother Mr. Anish Batra  who had  obtained  one policy  bearing No. OG-14-1104-6402- 00000894 effective  from 07.01.2014 to 06.01.2015 covering  risk of personal accident to the sum insured                     of Rs. 2,00,000/- and for accidental Hospitalization  to the sum  insured of Rs.1,00,000/-.  It is further averred  that the beneficiary  of the policy  namely  late Sh.  Aninsh Batra  was found   unconscious  in an  auto Rikshaw  Near C-Block, DDA  market   Sector  15 Rohini, Delhi on09.02.2014 at 9.00 a.m.  and accordingly  was taken to Baba Sahib Ambedkar Hospital  where  he was  declared brought  dead.  The mother of  the complainant reached  the hospital  and believed  the version of the police  reported that  it was a natural  death, therefore no FIR  was lodged.  However, M.L.C was conducted.  But  viscera report was awaited.  Thereafter the complainant  being nominee  of deceased  lodged  a claim  under  the policy  with OP stating the cause of  death  as normal  heart attack  without knowing  that report of viscera taken around six to twelve  months.  It has been further stated  in the complaint that  perusal of para 9 of post mortem report dated  10.01.2014 indicated following external injuries.

1. Abrasion, 2cm X 1cm  present over the light side  of face, 2cm  below  lateral angle of right eyebrow.
2. Abrasion, 0.5 cm X 0.5cm present over the right eyebrow.
3. Abrasion, 0.5cm X 0.5cm  present over the left side of face. 11 cm. lateral to midline.
4. Abrasion, 3cm X1.5cm present over the medical aspect of left  limb, 4cm below let  knee joint.                                            Complainant  stated  that  while travelling  in  auto rickshaw  the deceased  sustained  the aforesaid external  injuries  on account of sudden  application of  breaks by auto rickshaw  driver which resulted in his death , therefore, complainant was entitled to the sum of Rs. 2,00,000/-towards accidental death.

3. The OP, however, did not pay the aforesaid amount therefore committed deficiency in service.

4. The OP filed written statement that insurance policy in question  did not cover  death  or injuries  due to  natural causes  and that  policy extended  its coverage  in respect of accidental  death and injuries. The document on record  shows  that brother of complainant  died due to heart attack whereas  the policy  provides that it will indemnify the insured only  in event of accidental  death.  It  has been further stated that injuries  described  in postmortem  report  are of such nature  that they cannot,  at its own,  lead to death of  young individual. On merit the OP admitted the policy in favour of the deceased  but denied  contents of claim. 

    

    

5.                                                                                                                                                                                                                Complainant has filed his affidavit with documents  Ex. CW1/A to CW 1/H. On the other hand  Sh. Dushyant Meena  has filed affidavit in evidence testifying all the facts as stated in the written statement.  Parties have also filed their respective written submissions.

6.         We have heard Learned Counsel for the parties and perused the record.

7.           In the present case the policy  is  not  in dispute.  The question that arises for consideration  is  as to whether  the injuries  allegedly  sustained by deceased  Mr. Anish Batra  infact  resulted of accident the  answer  is negative.  The bare perusal of contents of insurance policy would show that the liability of the OP was to compensate the insured  in case of accidental death.  The accidental death occurs where the  impact of accident is such that insured  succumbed  to the injuries  sustained  in the course of accident. Now the contents of postmortem report are relevant to be discussed.  The postmortem report  nowhere suggested  that death  was  the result  of injuries received  by the insured  in fact the carved look  on the injuries mentioned  in the postmortem would explicitly   demonstrate that the said injuries   cannot be by any stretch imagination be said to be sufficient  to cause the death of  young individual .  It is also the case of the complainant  that death  is the result  of natural consequences. 

Keeping in view the discussion I am of the opinion that the complainant is miserably failed to make out the case to be entitled to sum  insured. 

       Therefore the complaint being without any merit dismissed.

Copy of this order be sent to the parties as per rules.

  Announced this__26____ day of ___July______ 2018.

 

( K.S. MOHI )               (PUNEET LAMBA)                                                                                                                                                                                                                                                                PRESIDENT                  MEMBER