STATE CONSUMER DISPUTE REDRESSAL COMMISSION

BIHAR, PATNA

Appeal No. 239 of 2017

National Insurance Company Ltd. Madhubani and Kolkata through their Regional Manager, Regional Office, Sone Bhawan, Birchand Patel Marg, Patna-1

                                                                                                                                                      … O.P. No. 2 & 3/ Appellant

Versus

1.  Chandra Bhushan Panjiar, Son of Prahlad Panjiar, the resident of Village & PS- Babubarahi, District- Madhubani

                                                                                                                                             …. Complainant/Respondent no. 1

2.  Golden Trust Finance Services, 3^rd Floor, Sadaiy Bhawan, Near Marwari Niwas, Frazer Road, Patna-1

                                                                                                                                                    …. O.P. no. 1/Respondent no. 2

Counsel for the Appellant: Adv. Abhay Kumar Sinha

Counsel for the Respondent: None

Before,

Hon’ble Mr. Justice Sanjay Kumar, President

Md. Shamim Akhtar, Member

Mr. Ram Prawesh Das, Member

Dated 11.07.2023

As per Md. Shamim Akhtar, Member.

O r d e r

1. The appellants have filed the appeal against the order dated 06.07.2017 passed by Ld. District Consumer Forum, Madhubani in Consumer Case no. 42 of 2013 whereby and whereunder they are directed to make payment of Rs. 1,00,000/- (One lac)  to the complainant (Respondent no. 1) towards accidental death of his deceased mother, the policy holder and further directed to make payment of Rs. 5,000/- as compensation and Rs. 3,000/- as litigation cost.
2. The case of the appellant /O.P in brief is that the complainant /respondent no. 1 cum nominee’s mother deceased Rekha Panjiar had taken a Janta Personal accident policy of Rs. 1,00,000/- from O.P. no. 1/appellant through Golden Trust Finance Services, Kolkata for the period 31.03.2004 to 30.03.2019 vide policy no. 100300/47/04/9600022/03/96/30451. Further case is that on 18.06.2011 the insured Rekha Panjiar died in course of treatment at Ruban Hospital, Patna due to accident, when on 16.06.2011 the complainant-Chandra Bhushan Panjiar alonwith mother Rekha Panjiar was going to Babubarhi from Darbhanga by motorcycle and met with an accident near Sati Asthan and as a result thereof Rekha Panjiar received head injury and was brought to Madhubani Hospital from where she was referred to DMCH, Darbhanga and from there she was referred to PMCH, Patna, but was admitted in Ruban Hospital, Patna where she died. Further, case is that no FIR was lodged and no postmortem was done and the respondent no. 2 was intimated on 30.08.2011 and on 27.01.2012 the O.P. no. 1/respondent no. 2 the GTFS after receiving claim form along with policy certificate and other papers frm the complainant/respondent submitted it to the appellant/Insurance company who repudiated the claim on 03.03.2015 and for which complaint case no. 42 of 2013 was filed and the impugned order was passed.
3. Ld. Counsel for the appellant submitted that impugned order is against the provisions of the insurance Act and order has been passed in violation of the terms and conditions of the policy. It was also submitted that the complainant has not filed copy of FIR and the postmortem report and the death certificate issued by the Ruban Hospital shows that death of the insured caused by cardio respiratory failure and prayer is made to set aside the impugned order.
4. The complainant/respondent has not appeared for hearing.
5. Heard, perused the record. It is not the case of the complainant that FIR was made and postmortem was done. Simple case is that on the fateful day the insured met with an accident while going on a bike and was firstly admitted at Madhubani, Hospital from where she was referred to DMCH, Darbhanga and thereafter to PMCH, Patna but was admitted to Ruban Hospital, Patna where she died. The Xerox copy of the referral slip attached with the records which appears to be of DMCH shows that the patient was admitted on 15.06.2011 at 8:50 AM with complain of vomiting with blood mixed and unconsciousness and was also impression that the patient also suffered fracture in RT temporal bone. The medical certification of death issued by Ruban Hospital, Patna in its column case of death at para (b) also mentions cerebral contusion- This is a head injury which is common in case of accident.
6. The only issue involved in this appeal is whether in absence of FIR, Postmortem report, final police report the accidental claim can be settled /or not.
7. The issue raised in this appeal stands decided by the National Commission in case of Geeta Devi Vs. United India Insurance Co. Ltd. since reported in 2015 (III) CPR (NC) 223 in which in paragraph no. 8, 10 & 11 it has been held as follows:

                      8. The learned counsel for the insurance Company submitted that the petitioner did not submit copy of police report, Panchnama, Postmortem report and the original policy and thereafter, the claim was rejected as ‘No Claim’.

10. A brief perusal of the patient’s history shows that at the time of admission in the hospital, the insured had a fall in the bathroom, vomited blood and was in semi-conscious state. The treatment record shows that the insured was taken to the hospital at 5:00 A.M immediately preceding the fall in the bathroom and he died at 6:30 A.M on the very same day. It can be safely construed that any internal injury suffered by him on account of fall in the bathroom has a direct nexus to his death. In fact, the hospital record clearly states that the insured did not suffer from any ‘chest pain’. The onus to prove that the death of the insured is a natural one and not an accidental death, shifts on the Insurance Company and they did not place any cogent or substantial evidence on record to establish their case that the death was no account of cardiac arrest and should, therefore, be inferred as a natural death.

11. when a death is caused by accidental fall, the question of reporting to the police and conducting a panchnama does not arise. Admittedly, the postmortem was not done as the death of the insured was not construed to be a suspicious one. Therefore, repudiating the claim on the ground that the claimant had not sent the documents, which were not relevant to the nature of death, is totally unjustifiable.

8. In present case death of insured from accidental fall is well established by oral, documentary, medical evidence placed before the District Consumer Forum. The accidental claim was denied for want of FIR, Postmortem report and final police report which has been held to be not mandatory and repudiation of claim on said basis is not justified.
9. For the reasons as stated above this Commission does not find any error or infirmity in the judgment and order passed by the District Consumer Forum, accordingly this appeal is dismissed.

(Md. Shamim Akhtar)                            (Ram Prawesh Das)                                                       (Sanjay Kumar,J)

             Member                                                   Member                                                                       President

Md. Fariduzzama