The complainant Aminul Haque filed a petition against SBI Gen. Ins. Co. stating that his wife, Nazmunnesa Begam took an Insurance policy from O.P No.2. Nazmunnesa nominated her husband in the policy. On 13.08.2013 at about 4P.M. the insured slept from the staircase leading to 2nd floor of her house and got serious injury on her head. She was immediately taken to Rampurhat Sub Divsional Hospital and was admitted under attending doctor. But the insured died at 6.55 P.M. on the same day. According to the attending doctor she died in cerebrovascular accident.
The complainant informed O.P No.2 and also informed P.S. Rampurhat. He also submitted claim form along with the relevant documents. The O.Ps repudiated the claim. Then the complainant sent an application before the grievance redressal officer for considering the decision but the same was also repudiated by the GRO.
On behalf of the O.Ps Ld. Advocate appeared in this case but neither filed written version nor moved the case.
The case was heard ex parte. Upon pleading of the party following points are to be considered for discussion.
Points
- Whether the O.Ps have deficiency in service or not?
- Is complainant entitled to get reliefs?
Decision with reasons
The points being interlinked each other are taken together for discussion.
Having gone through the papers submitted by the complainant the Forum noticed that the insured died on cerebrovascular accident on 13.08.2013. After death the nominee of the policy filed claimed form along with papers. The O.Ps in their letter dated 28.02.2014 requested the complainant to file attested copies of FIR, final police report and postmortem report. The complainant did not lodge FIR before or immediate after death of insured. The letter dated 12.03.2014 written by the complainant to the O.Ps reveals that the complainant lodged FIR to the Police Station on 10.01.2014 on advice of State Bank of India Life Insurance Officer. The complainant lodged FIR after 5months of incidence. That means there was no necessity of lodging FIR. It was admitted by the complainant. Attending doctor of Sub-Divisional Hospital, Rampurhat felt no need of postmortem. So, there was no question of filing the attested copy of postmortem report. The complainant stated in his letter dated 12.03.2014 to the O.P that “no police report has been filed as the hospital Authority did not feel any necessity of reporting the matter to the police.” However, complainant lodged GOB being No. 516 to the Police Station for the interest of getting insurance claim from the O.Ps. The Forum surprisingly notices that the complainant did not mention the accident in his FIR. On the contrary he stated that his wife was suffering from respiratory problem.
Cerebrovascular accident does not indicate the cause of death by accident. It is the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. Cerebrovascular accident is also referred to as a stroke……………. There are two main types of cerebrovascular accident or stroke. An ischemic stroke is caused by a blockage and a hemorrhagic stroke is caused by a breakage in a blood vessel. In both cases, part of the brain is deprived of blood and oxygen causing the brain’s cells to die.
The doctor nowhere mentioned the said death due to external hit. According to the definition mentioned on policy accident means a sudden, unforeseen and unexpected event caused by external, violent and visible means and resulting in physical bodily injury. Cerebrovascular accident does not arise out of bodily injury.
The complainant has not filed the policy certificate. So, the terms and condition is not clear though the O.Ps letter to complainant filed by later reveals that it was personal accident policy covering only accidental death.
In case of accidental death it always requires final report of Police enquiry and postmortem report for the purpose of insurance claim. Both of its are absent in this case. Neither final report of police inquiry nor postmortem report are present for supporting to the statement of the complainant. Even belated FIR says the death caused by respiratory problem. The complainant nowhere mentioned the incident of falling on the stair case. Thus the complainant fails to prove his case. The O.P has no deficiency in service.
Proper fees have been paid.
Hence,
O R D E R E D
that C.F case No. 111/2015 be and the same is dismissed in ex parte against the O.Ps without cost.
Copy of this order be supplied to the parties each free of cost.
