BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
CACHAR :: SILCHAR
Con. Case No. 33 of 2013
Smti. Bijoy Laskshmi Nath, ……………………….………… Complainant.
-V/S-
1. Bajaj Allianz General Insurance Company Ltd.,
Represented by the Manager,
DGP House, Ground Floor, 88C Old Prabhadevi Road
Prabhadevi, Mumbai. O.P No.1.
2. The Manager, Bajaj Allianz General Insurance Company Ltd.
2nd Floor, Bajaj Finsevu Building, Behind-Weikfield IT Park,
Nagar Road, Viman Nagar, Pune-411014 O.P No.2.
3. The Manager, Bajaj Allianz General Insurance Company Ltd.
G.E Plaza, Airport Road, Yerwada, Pune – 411014. O.P.No.3
4. The Manager, Bajaj Allianz General Insurance Company Ltd.,
2B, 2nd Floor, N.H. Centre Point, Opp. Bora Services Station,
G.S. Road, Ulubari, Guwahati-781007. O.P No.4.
5. The Branch Manager,
Bajaj Allianz General Insurance Company Ltd.,
Jagannath Travels Building Complex, Hospital Road,
P.O. & P.S. Silchar-1, Dist. Cachar. O.P No.5.
6. The Manager, Bajaj Allianz General Insurance Company Ltd.
3rd floor, Block-‘B’, Eco Space, Plot No.11/F/11, New Town,
Rajarhat, Kolkata-700156. O.P.No.6.
Present: - Sri Bishnu Debnath, President,
District Consumer Forum,
Cachar, Silchar.
Mrs. Chandana Purkayastha, Member,
District Consumer Forum,
Cachar, Silchar.
Shri Kamal Kumar Sarda, Member,
District Consumer Forum,
Cachar, Silchar.
Appeared :- Sri Dhrubajyoti Nath, Advocate for the complainant.
Sri A.S. Mitra, Advocate for the O.Ps.
Date of Evidence……………………….. 25-03-2014, 11-08-2015, 02-05-2017
Date of written argument……………… 31-08-2017
Date of oral argument ……………….... 09-10-2017, 27-11-2017
Date of judgment………………………. 22-12-2017
JUDGMENT AND ORDER
Sri Bishnu Debnath,
- Smti. Bijoy Lakshmi Nath brought the instant case under the provision of the Consumer Protection Act,1986 against Bajaj Allianz General Insurance Company Ltd., for award of compensation for accidental death of her son Ashrujit Nath and realization of sum assured of Rs.7,05,000/- under Insurance Policy No.OG-09-1901-6401-00197217.
- Brief facts as under :-
Late Ashrujit Nath purchased the life insurance policy No.OG-09-1901-6401-00197217 for his personal accident/credit shield coverage during the period from 20-11-2008 to 19-11-2010. But unfortunately after 10 months 23 days of the commencement of the policy he died due to accident on 14-10-2009 during traveling by North East Express from Guwahati to New Delhi
- His dead body was recovered from the seat No. 70 of Coach No.S-12 on 14-10-2009 at New Delhi by G.R.P and brought to Aruna Asaf Ali Government Hospital, Sobzi Mandi, New Delhi for post-mortem examination. Accordingly, Post-Mortem examination was done vide P.M No.1918/2009 dated 17-10-2009. Of course, G.R.P, New Delhi Railway Station investigated the case by registering a vide D.D. No.10B, dated 14-10-2009.
- On the following day of the accidental death of the life assured, the Complainant informed the matter to the Bajaj Allianz General Insurance Co. and its officers. They are referred here as ‘O.Ps’. Subsequently, younger brother of the deceased submitted claim Form on 22-10-2009 to the O.Ps but the O.Ps repudiated on 24-12-2011 on the plea that as per documents submitted by the claimants death of insured was not conclusively proved or established to be due to accidental bodily injures.
- On being aggrieved with the repudiated letter dated 14-12-2011 the instant complaint lodged against the Bajaj Allianz General Insurance Co. Ltd. represented by 6 (Six) officers including the Manager, Bajaj Allianz General Insurance Co. Ltd., Hospital Road, (Near Jagannath Travels Building Complex), Silchar, Cachar, Assam.
- The O.Ps submitted their joint W/S. In the W/S denied the allegation of negligence or disservice etc. But the plea of the O.P are that it was a natural cause of death of the insured due to cardio failure as per claim Form which is outside the coverage of the insurance policy.
- During hearing, the complainant deposed as P.W-1 and exhibited 18 number of documents and also annexure 5 (five) other documents to establish the fact but late Ashrujit Nath died due to accident. The O.Ps also examined Sri Sibaji Thakur, the legal Executive Officer and exhibited 4 (four) number of documents including claim Form vide Ext-A, Post-mortem Report vide Ext-B, Forensic Test vide Ext-C letter of repudiation vide Ext-D. At the end of evidence both side’s counsels submitted written arguments.
- We have heard oral argument, perused the written argument, also perused the evidence on record and Medical Expert Opinion dated 06-11-2017 vide letter of the Principal SMCH No. SMCH/11683 dated 13-11-2017 and opinion of HOD of Surgery Department, SMCH vide No. SMCH/SUR/17/3018, dated 06-11-2017.
- In this case the complainant exhibited relevant document i.e. statement of witness in connection with investigation of the aforesaid case by the GRP, New Delhi Railway Station vide D.D.No.10B, dated 14-10-2009 vide Ext-9 to Ext-16 and judgment of the Railway Claims Tribunal, Guwahati dated 14-01-2015 vide Ext-18 to establish the fact that the Life Assured late Ashrujit Nath died due to accident during travelling from Guwahati to New Delhi by N.E. Express.
- As per the police investigation record vide Ext-9 to Ext-16, it is not clear that Ashrujit died due to accident but as per Ext-18 the Technical Member of the Railway Claim Tribunal the death of Life Assured was not natural, rather deceased died due to untoward incident as defined U/S 123(C) of the Railway Act,1989. Of course, the Railway Claim Tribunal awarded compensation of Rs.4,00,000/- and directed the Railway Authority to pay the same.
- Anyhow without giving any comment to the finding of the Railway Claims Tribunal regarding untoward incidence for the sake of keeping decorum of justice delivery system, we are to look into evidence on record to conclude whether Life Assured died due to accident because the insurance policy was taken for risk coverage for accidental injury and accidental death only.
- The complainant by adducing evidence exhibited Post-mortem Report and Viscera Analysis Report to establish the plea that the Life Assured died due to accident. The cause of death are not clearly mentioned in those reports. Accordingly, the documents vide Ext-3, Xet-3(i) and Ext-4 sent to Silchar Medical College and Hospital for study by Medical Expert and to opine the cause of death. The Medical Expert reported vide letter referred hereinabove that the injuries described in the Post-mortem Report are not sufficient to cause of death and Viscera analysis report gave negative result. As such the said Medical Expert could not form opinion due to inconclusive Post-mortem Report. The record cause of inconclusiveness of PM Report is not known to us.
- As the Medical papers are not sufficient to opine that the Life Assured died due to accident, so it is required to establish the alleged fact of accidental death otherwise by adducing oral evidence. But in the record no iota of oral evidence is available from any independent reliable witness to conclude that some incidence was occurred in the Train at the relevant time, which resulted death of Life Assured Ashrujit Nath. Rather the O.P by adducing evidence of D.W exhibited Claim Form vide Ext-A. In the Claim Form very clearly written cause of death was Cardio respiratory failure. The Claim Form was submitted on 22-10-2009 i.e. after 7 (Seven) days of the date of death of the deceased by the younger brother of the deceased and same Claim Form was not yet withdrawn by submitting a fresh one with ground of accidental death of Life Assured.
- Anyhow, it is not necessary to discuss and decides as when or from which date the complainant is raising the allegation that death of Ashrujit Nath was not caused due to Cardio respiratory failure but caused of accident. The pertinent matter regarding accidental death is required to establish by the complainant or in other word, it is the burden of the complainant to establish the plea that Life Assured died due to accident inside the Train. The burden is not discharged by adducing believable and reliable evidence. Hence, onus of the O.P that Life Assured died due to Cardio Attack is not necessary to discharged. In this case it is admitted fact that Life Assured died during the travelling by Train on 14-10-2009 but the insurance Company is not liable to pay the sum assured to the legal heir of the Life Assured in view of the term and condition of the above mentioned insurance policy because alleged accidental death of Life Assured Ashrujit Nath was no been established.
- Therefore, in this case we are of opinion that the complainant is not entitled any relief or reliefs as prayed for or any relief as per law and equity. Thus, the case is dismissed on contest. Supply free certified copy of judgment to the parties. Given under hand and seal of this District Forum on this the 22nd day of December, 2017.
