Jharkhand

Bokaro

CC/18/77

Meena Devi - Complainant(s)

Versus

M/s Reliance General Insurance Co. ltd. - Opp.Party(s)

R.P. Singh

08 Jun 2022

ORDER

District Consumer Commission, Bokaro.

Case No. 77/2018

Date of Filing-02-07-2018

 Date of Order-08-06-2022

Meena Devi W/o Late Jagdish Chandra Rajwar

R/o Qr. No. 497, Sector-3/A, Bokaro Steel City,

District- Boakro, Jharkhand.

                                      Vr.

1. M/s Reliance General Insurance Co. Ltd. M-5, Chandrakali Bhawan, 3^rd Floor, City Centre, Sector-4, Bokaro Steel City, District- Bokaro, Jharkhand

 2. M/s- Reliance General Insurance Co. Ltd. Flat No. 301, 3^rd Floor, Krishe Block, Krishe Sapphire, Madhapur, Hyderabad, PIN-500081

 3. Secretary, Bokaro Steel Samuhik Durghatna Bima Samittee, Room No 45, Old Admn. Building, Bokaro Steel City, Bokaro- 827001, Jharkhand

Present:-

          Shri Jai Prakash Narayan Pandey, President

          Smt. Baby Kumari, Member

                                                -Order-

1. Complainant has filed this case with prayer for direction to O.Ps. to make payment of Rs. 5,00,000/- as insurance claim with interest @ 12% per annum and to pay Rs. 15,000/- & Rs. 25,000/- respectively as compensation and litigation cost to her.
2. Complainant’s case in brief is that her husband namely Late Jagdish Chandra Rajwar was an employee of SAIL, Bokaro Steel Plant (in short BSL) vide staff No. 666844 who was covered under group insurance policy No. 241031729140000001 valid for the year 2017-18 for the sum insured Rs. 5,00,000/- with Reliance General Insurance Co. Ltd. (here in after referred as insurance co.). Further case is that said Jagdish Chandra Rajwar was on duty on 16.07.2017 but he was not feeling well hence while he was going to BGH for treatment he met with an accident  and thereafter he was shifted to BGH where he died on 18.07.2017 for which information to the Police was given. Postmortem on the dead body was conducted according to it death was due to injuries. Complainant being wife of the deceased has filed claim before the O.P. No.1 &2 but it was turned down on the ground that intimation regarding death was not given within 60 days from the date of the death rather it was received on 99^th  day of the death. Inspite of issuance of legal notice grievance was not settled hence case has been filed with above mentioned prayer.
3.  O.P. No.1&2 have filed W.S. mentioning therein that case is time barred, there is no cause of action for the case and hence claim is not maintainable. Further reply is that as per terms and conditions of the policy intimation of accident was to be made within 60 days from the day of the death which was not done hence it has been denied.
4.  O.P. No.3 being BSL Authority has filed W.S. mentioning therein that statement made in para 1,2,3 of the complaint petition are correct. Further there is no comment on para 5,6,7,8,9,10,11,14, 15,16,17&18 of the complaint petition. It has been admitted that deceased was employee of BSL and he died due to accident as it was intimated by the complainant and its intimation was given to the O.P. No.1 &2.
5.  Inspite of due service of notice O.P. No.1 &2 (Insurance Co.) has not filed W.S. hence vide order dt. 25.05.2019 both have been debarred from filing W.S.
6.   On perusal of the pleadings of the parties it appears that only point for consideration is whether death of the deceased was due to accident or otherwise ? Whether complainant is entitled to get any relief as claimed or not?
7. Following facts are admitted facts of the parties :-

1. That deceased Late Jagdish Chandra Rajwar was an employee of SAIL/BSL Bokaro.
2. That deceased was insured with O.P. No.1 &2 with the insurance policy covering accidental death.
3.  That deceased died on 18.07.2017.
4. That the complainant is wife of the deceased.

8. Point No. 1 &2:- Since both points are interlinked  with each other hence they are being taken up for decision together. Main argument is that death was due to heart attack hence complainant is not entitled to get benefit of insurance policy covering accidental death. Further it is argued that there was late intimation to the O.P. No.1&2 regarding death of the deceased hence due to it claim has been repudiated.
9. Therefore, we have to see whether it was accidental death or death due to heart attack. Photo copy of the postmortem report is on record and accordingly postmortem on the body of deceased was conducted on 18.07.2017. As per postmortem report a lacerated wound with clotted blood present on Occipital area. On further dissection blood and blood clot also found in trachea and larynx. There is fracture of occipital bone.  As per opinion of the doctor injuries were of ante-mortem in nature. Cause of death is crenio-cerebellor injury leads to shock, hemorrhage, cardio respiratory failure.
10.  On careful perusal of the report submitted by the Police officer in connection with Sector IV P.S. case No. 79/2017 case and postmortem report of the deceased it is very much clear that death of the deceased was caused due to shock and cardio respiratory failure as a result of injuries sustained during accident and there was no any other cause of the death.
11. So far the ground related to repudiation of the claim in respect to late intimation to the O.P. No.1 and 2 is concerned it is not acceptable in this case because separation order No. 42836 dt. 20.07.2017 was issued by the BSL Authority in respect to death of the deceased hence said BSL Authority was under obligation to intimate the O.Ps. regarding the death of the deceased about which complainant cannot be held responsible. However, there are several Judicial pronouncements on which basis it can be safely said that mere on the ground that there was few days delay in intimation regarding death to the Insurance Co. claim cannot be rejected specially in this case in which widow of the deceased who is only literate to put her signature is not expected to do all prudent acts of a well educated person.
12.  In light of above discussion we are of the opinion that complainant is entitled to get relief as claimed and death of the deceased was due to accident , accordingly both points are being decided in favour of the complainant and against the O.P. No.1&2.
13. Thus we find and hold that the claim of the complainant is being   

allowed in the manner indicated here in below:-

O.P. No. 1 & 2(Reliance General Insurance Co. Ltd.)are directed to pay Rs. 5,00,000/- (Rs five lac) only to the complainant within 60 days from today otherwise they will pay interest thereon @ 10% per annum from 02.07.2018 (the date of filing of the case). Further O.P. No. 1 & 2 are directed to pay Rs. 10,000/- as compensation related to various type of harassment and Rs. 5,000/- as litigation cost within 60 days from today.