FINAL ORDER / JUDGEMENT

Sri. Apurba Kr. Ghosh          ……….President

The Complainant has filed this case against the O.Ps. u/s 12 of the Consumer Protection Act 1986 and praying for the following order / reliefs:-

1. Directions against the O.Ps. to pay a sum of Rs. 5,00,000/- to the complainant towards compensation.
2. Directions against the O.Ps. to pay a sum of Rs. 1,00,000/- to the complainant for causing mental pain.
3. Any other order/orders to which the complainant is entitled.

BRIEF FACT OF THE COMPLAINT

1. That the complainant is permanently residing within the jurisdiction of this Commission.
2. That, the husband of the complainant  was a police personnel his rank was Assistant Sub-Inspector of police, Government of West Bengal and he died on 31.08.2012 at Balurghat Hospital/ he was deputed at R 1 Balurghat Police Line for law and order duty vide order No. 3150/RO dt. 27.08.2012/command certificate was given vide GDE No. 28/08/2012 G.E. No. 716/12 by the officer in-charge of Sukna I.C.
3. That, the Reserved Inspector of police Balurghat issued another command certificate in favour of Denesh Pandey who is husband of the complainant/that command certificate was being in CC No. SP dt. 29.08.2012  and Denesh Pandey was on duty on 31.08.2012 and continued till the visit of the CM of W.B./ on the said date when he was performing in the stadium of Balurghat at about 6.30 pm he was feeling uneasy he suffered his health setback and went to the bath room, take water in his mouth but his condition was unchanged and then his colleagues took him in the Balurghat Hospital, he was admitted there but he died due to cardio vascular failure on 31.08.2012/ post  mortem was done on 01.09.2012.
4. That, the husband of the petitioner died due to stress & train while he was performing his duty as ASI of Police over the period of time and that’s why his death occurred accidentally due to cardio vascular failure and it was an accidental death.
5. That, at the time of death Denesh Pandey was under the  coverage of the National Insurance Company in a scheme of group Insurance policy/identity card was issued in the name of Denesh Pandey being car No GINI0603491212 and another card NO. GINI060403491213 which was valid from 01.08.2012.
6. That, the husband of the petitioner was the only earning member of his family and due to such death  the petitioner sustained mental and financial loss.
7. That, the death of husband of the petitioner was due to heart attack which has been reflected in the post mortem report and the petitioner is entitled to get compensation for the death of her husband under the Insurance Policy.
8. That, the OP Insurance company has refused to pay any compensation under the mediclaim policy by violating the natural justice and husband of the complainant was a consumer and the complainant being the legal heir of her deceased husband she is entitled to get the relief as prayed for.

In support of the complaint the complainant has filed the following documents:-

1. Letter dated 03.06.2013, Memo No. 115/RO from S.P. Darjeeling.
2. Letter dated 23.05.2013, Memo no. 888 wel/MI

      Wel/MI 179-12 (Pt-i)

3. Letter of office National Insurance Company Ltd. dt. 20.05.2013 Ref. No. 100701/WBP/PNC
4. Letter dt. 01.09.2012 Super of District Hospital Dakshin Dinajpur, Balurghat (P.M. Report doctor)
5. V.I.P duty pass card attested Xerox Denesh Pandey.
6. Spl. Command Certificate OP dt. 29.08.2012
7. Sukna I.C. GDE No. 28.08.2012 dt. 28.08.2012
8. Death certificate of Denesh Pandey
9. Voter I.D. Xerox Denesh Pandey
10. SPL CC dt. 29.08.2012. Balurghat
11. P.M. Report.
12. Salary Statement of Denesh Pandey
13. Insurance Policy(Meidiclaim) no. of card 4 in number issued National Insurance Co. Ltd.
14. Advertisement paper of Mediclaim Policy.

Notice was sent from this commission for serving the same on the OP’s. On receipt of notice the OP appears before this commission through vokalatnama, filed written version, denied all the material allegation of the complainant. In the written version the OP Insurance Company has stated that the statements made in Para No. 1, 2 & 8 of the complaint are not admitted by the OP and the statements of Para No. 3 to 6  of the complaint petition are not know to the OP & denied by them. The OP Insurance company has further stated in the written version that, the statements made in Para No. 7 of the complaint petition are denied as the death of the husband of the complainant occurred due to natural caused and not covered under the policy and thereby the claim was repudiated. The OP has further stated corresponding to Para No. 9 of the complaint that, as the death was caused due to cardio Vascular failure the same is not covered under the policy and the OP denied the death was accidental in nature. The OP Insurance Company has denied the statements made in Para No. 10 to remaining paragraphs of the complaint. By filing the written version the OP praying for dismissal of the case.

List of documents filed on behalf of the OP:-

1. Photocopy of letter dated 01.08.2024, by the Sr. DM, Kolkata, to the Sr. DM, Siliguri Divisional Office,
2. Photocopy of letter dated 20^th May, 2013, written by the Sr. Branch Manager, Shakespeare Sarani, Kolkata, to the Director General & I.G. Police, Writer’s Building.
3. Photocopy of Memo No. 290/RO, dated 14.02.2013, written by the Supdt. of police, Darjeeling, to the DIG of Police, Writer’s Building, Kolkata.
4. Photocopy of Memo No. 289/RO, dated 14.02.2013, written by the Supdt. of Police, Darjeeling, to the DIG of Police, Writer’s Building, Kolkata.
5. Photocopy of letter dated nil, of Smt. Shakuntala Pandey, addressed to the DIG of Police, Writer’s Building, Kolkata
6. Photocopy of post-mortem report of Denesh Pandey, dated 01.09.2012.

Having heard the Ld. Advocate of both the parties and on perusal of the complaint, written version of the following points are to be considered by this Commission.

POINTS FOR CONSIDERARTION 

1. Whether the Complainant is a consumer?
2. Whether the case is maintainable under the C.P. Act 1986?
3. Whether there is any deficiency in service on the part of the O.P. as alleged by the Complainant?
4. Is the Complainant entitled to get any award and relief as prayed for as per the prayer of her Complaint?

                   Decision with Reasons

All the points are taken up together for discussion to avoid unnecessary repetition and for sake of convenience and brevity of this case.

The complainant was given opportunity to produce her evidence. In order to prove the case the complainant has adduced evidence by filing written evidence in the form of an affidavit. In the written evidence the complainant has corroborated the contents of the complaint.

At the time of argument Ld. Advocate of the complainant submits that, the complainant has filed the written notes of argument. He argued that, the complainant has been able to prove the case against the OP’s and  she is entitled to get the relief as prayed for. He also argued that, the husband of the complainant has died on 31.08.2012 when he was on duty as ASI of Police and at the time of death he was under coverage of mediclaim policy of the National Insurance Company Ltd. and his policy card No. GINI0603491212 and another number GINI0603491213 the said policy was effected from 1^st August 2012 for one year. It is further argued that, the death was accidental in nature and condition of the policy was that, if any person died in accident then a sum of Rs. 5 lakhs will be given towards compensation. It is also argued that, the husband of the complainant died due to sun-stroke which is accidental in nature as stated in the medical Journal. Ld. Advocate of the complainant referred decisions of (i) Param Pal Singh through father – versus- National Insurance Company 2013 AIR SE 233 in Para 27 & 28. (ii) 2015 Aci.CR67 (iii) 2014 Acci.CR 218.

Ld. Advocate of the OP during argument has stated that, they have stated everything in their written notes of argument and the complainant has failed to prove its case against the OP. He further argued that, the death of Denesh Pandey occurred due to natural cause which has been admitted by the complainant in affidavit Paragraphs of the complaint petition. He also  argued that, the medical officer in the P.M. report opined that the death of the husband of the complainant occurred due to cerebro vascular accident and a natural cause of death. It is further argument of the OP is that, the policy availed by the late Denesh Pandey being a Group Mediclaim policy of the west Bengal police forces where personal accident cover was inbuilt and only  covers death by accident and that’s why if death occurred due to natural causes no compensation can be payable. He further argued that, the complainant is not entitled to get compensation under the purview of the existing policy as the sun stroke followed by heat attack is not an accident, it was a natural cause of death which was explained by the Deputy Inspector General of Police, Planning & Welfare, West Bengal in his letter address to the S.P. Darjeeling on 28.05.2013 and thereafter rightly repudiated the claim. It is further argument of the op that there was no negligent or deficiency in service on their part and the op’s are not in any way for causing mental pain, agony to the complainant. Ld. Advocate of the OP praying for dismissal of this case.

Having heard the Ld. Advocate of both the parties and on perusal of the evidence as well as documents filed by the parties it is admitted fact that, the husband of the complainant was a police personnel. It is also admitted fact that, the husband of the complainant was having group Mediclaim policy covering the West Bengal Forces, wherein personal Accident(PA) cover was inbuilt.

Now let us see how far the complainant has been able to prove the case against the OP and  whether the complainant is entitled to get relief as prayed for?

 From careful perusal of the complainant and evidence of the complainant  it reveals  that , the complainant has stated that, her husband has died due to cardio-vascular failure(para-7 of the complainant).

The complainant in Para no. 12 of her complainant has specially stated that during the duty hours her husband sustained heart attack and due to sunstroke followed by heart attack he died and the same has been reflected from the opinion of the P.M. Report. From the said specific admission of the complainant it can safely presumed that death of Denesh Pandey was caused which was  natural one.

There is no doubt that, death of any family member is an accident to that family. But it does not mean that all natural death will be treated as an accidental death in the eye of law.

 In the case in hand the Autopsy surgeon after holding post mortem examination of the body of Denesh Pandey opined in the P.M. Report that the death occurred due to “cardio vascular accident” and a “ natural cause of death” and the same has also been admitted by the  complainant. But how the complainant is claiming death benefit for the existing Mediclaim policy of her husband has not been proved or explained in this case. It is very much hard to swallow a natural death as accidental one.

It is needless to mentioned here that, if any death is occurred due to natural causes no death benefit/ compensation can be payable because as per terms of a group Mediclaim policy of West Bengal police Forces it only covers death by an accident.

 The decisions referred on the side of the complainant are not applicable to the facts and circumstances of this case.

 Considering all we are of the view that, the complainant has not been able to prove the case against the OP.

 Hence,

 It is therefore,

O R D E R E D

That, the instant consumer case being in No 60/2014 is hereby dismissed on contest but without any cost.

 Let a copy of this judgment be given to the parties free of cost.