Sri A.K. Bhattacharyya, President

The fact of the present case as per complainant in short are that the complainant’s wife (Smt. Sadhana Samanta) since deceased had a SBI General’s Personal Accident Insurance Policy being no. 137300000000 with certificate no. 44184078 for the sum of Rs.400000/- for a period of one year from 10.05.2013 to 09.05.2014 with the OPs. The policy holder died on 30.04.2013 due to accident (fallen in bathroom) at home (Kalaberia) under P.S. at Bhagwanpur, Dist.- Purba Medinipur, even after removing her at Command Hospital, Alipore, Kolkata.

The complainant, being the nominee of the policy holder, made a death claim before the OPs on 20.12.2013 in respect of the said policy and then sent all documents on 23.12.2013 to the OPs.

Inspite of receiving the claim from duly filled in amalgamated with the necessary documents, the OPs repudiated the said claim vide letter dtd. 17.02.2014 on flimsy ground, hence the instant case is filed on 14.07.2014 for relief as stated in the petition of complaint.

The record goes to show that all the OPs received the notices and appeared in this Forum through their respective Lawyers, but ultimately they did not contest the case by not filing any written version for which this case was heard exparte against all the OPs.

Point for consideration

Whether the complainant is entitled to any relief as sought for?

Decision with reason

We have heard the argument of the ld. Advocate of the complainant over the exparte hearing of the instant case and have carefully gone through the pleading of the complainant as well as all the photocopies documents filed by the complainant on record as per list.

Materials on record show that Sadhana Samanta since deceased being the wife of the complainant was a policy holder being no. 137300000000 for a period of one year from 10.05.2013 to 09.05.2014 under Personal Accident Policy issued by SBI General Insurance (OP 2). The letter dtd. 23.12.2012, 17.02.2014, 10.04.2014 and 19.05.2014 of SBI General Insurance Co. Ltd. also support that deceased Sadhana Samanta was insured for an amount of Rs.400000/- under Personal Accident Policy, subject to exclusions, provisions and other terms as specified in the said policy under SBI General Insurance Co. Ltd.

The grievance of the complainant, who is the nominee of the said policy, is that the OPs repudiated the claim vide letter dtd. 17.02.2014 on flimsy ground.

It appears from the letters dtd. 17.02.2014 and 19.05.2014 of SBI General Insurance Co. Ltd.( Senior Vice President of Claims) and (Chairman, Grievance Redressal Committee) addressed to the complainant that the claim of the complainant over the said policy was repudiated due to left parietal intra cerebral haemorrhage – anticident cause being primary hypertension and Type 2 Diabetes of policy holder because it was come to their knowledge as per details mentioned in the copy of cause of death of Mrs. Sadhana Samanta received from Command Hospital, Alipore, Kolkata and that the death was due to medical causes, so it does not fall within the purview of policy terms and conditions.

The photocopies of medical case sheet dtd. 13.11.2013, 30.11.2013 of Command Hospital (E.C.), Alipore, Kolkata filed on record by the complainant supports the causes of death of said policy holder as mentioned by the OPs in their aforesaid letters. Conditions in respect of Exclusions of the said policy has been made in overleaf of SBI General Insurance (certified).

From the terms and conditions of the S. B. General Insurance Certificate of the said policy stood in the name of Sadhana Samanta mentioned on the overleaf of the same disclose that the coverage of the same is limited to death on account of accident only and that the company shall not be liable for any claim or claims under this policy arising from the term Exclusions including loss caused directly or indirectly by any other kind of deceases.

The medical certificate(photocopy) of cause of death on record and and medical case sheet issued by Command Hospital (E.C.) Kolkata in the name of Sadhana Samanta, wife of the complainant, indicates that the patient (Sadhana Samanta) was admitted there on 13.11.2013 and died on 30.11.2013 at 10.30 in the said hospital due to deceases or condition directly leading to death 1) Left Parietal Intra Cerebral Haemorrhage (OPTD) and anticident cause of death were a)primary hypertension and b)Type 2 Diabetes Mellitus.

The OPs in writing by their letters dtd. 17.02.2014 and 19.05.2014 informed the complainant that the claim was repudiated due to medical causes which does not come as coverage within the purview of the said policy.

Having considered the discussions made above and the materials on record, we are of the view that the complainant is not entitled to any relief as sought for since cause of death does not fall within the purview of the coverage of the policy in question.

As such, the instant complaint is liable to be dismissed.

Hence, it is,

Ordered

that the C.C. case being no. 50 of 2014 be and the same is dismissed on exparte without any cost.