| Final Order / Judgement | STATE CONSUMER DISPUTE REDRESSAL COMMISSION BIHAR, PATNA Appeal No. 210 of 2018 Reliance Life Insurance Company Limited, H, Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai- 400710 through Authorized Signatory Mr. Rajesh Kumar at present posted as Branch Manager … Appellant Versus 1. Nibha Devi, W/o- Mr. Dinesh Kumar Ray, at Ramchandrapur, Dushahara, PO- Mohiuddin Nagar, District- Samastipur, Bihar 2. Branch Manager, Height Insurance Services Limited, Kanhauli Complex, Hospital Road, Hajipur, District- Vaishali- 833101 …. Respondents Counsel for the Appellant: Adv. Anil Kumar Counsel for the Respondent: Adv. Pritam Kumar Before, Hon’ble Mr. Justice Sanjay Kumar, President Mr. Ram Prawesh Das, Member Dated 28.03.2023 As per Sanjay Kumar, President. O r d e r - Present appeal has been filed for setting aside the judgment and order dated 10.03.2018 passed by the Ld. District Consumer Forum, Vaishali at Hajipur in Consumer Complaint no. 61 of 2014 whereby and whereunder the Ld. District Consumer Forum has allowed the complaint case and directed appellant to pay the accidental benefit claim of Rs. 1,00,000/- with sum assured amount of Rs. 1,00,000/- along with interest @7% p.a from the date of death i.e 26.07.2011 within 30 days from the date of receipt of the order failing which interest @10% p.a shall become payable.
- Briefly stated the facts of the case is that husband of complainant had opted for accidental benefit insurance policy from Reliance Life Insurance Company Limited for sum assured amount of Rs. 1,00,000/- and accidental benefit of Rs. 1,00,000/- under Reliance cash flow plan risk period of which was from 18.01.2011 to 18.01.2033 in which complainant who is wife of insured was made nominee.
- Insured who was husband of complainant died on 26.07.2011 by accidental fall from tower and complainant submitted claim form along with relevant documents to the insurance company but her claim was not settled and thereafter she gave a legal notice to the insurance company but same was not replied as such complainant filed a consumer Complaint case before the District Consumer Forum for payment of sum assured amount of Rs. 1,00,000/- as well as accidental benefit amount of Rs. 1,00,000/- along with interest and compensation and cost of litigation.
- Upon notice opposite party no. 1 and 2 appeared and filed their written statement stating therein that the complaint case is time barred and complainant has not submitted copy of FIR, Post mortem report, final police report as such her claim was not settled in terms of insurance policy.
- After hearing both the parties the District Consumer Forum held that although no repudiation letter has been issued by the insurance company yet from the written statement it transpires that they have rejected the claim of complainant as the claim of complainant remained pending before the insurance company and no decision was taken by the insurance company as such the complaint case is not barred by limitation.
- Exibit-1 is the proposal form in which sum assured amount is Rs. 1,00,000/- and further accidental benefit amount is Rs. 1,00,000/-. Nominee is the complainant and date of issuance of policy is 18.01.2011., Exibit-2 is the insurance policy, Exhibit-3 is first premium receipt dated 18.01.2011 of Rs. 7,179/-, Exhibit-4 is claim form, Exhibit-5 is death certificate issued by competent authority in which date of death is 26.07.2011, Exhibit-6 is medical attendant certificate which bears signature of medical officer dated 20.10. 2011 and in column 7 date of treatment is 26.07.2011 at 1:00 pm and cause of death has been shown as pain and shock, respiratory and circulatory failure from accidental fall from the tower. Nature of complaint is accident. Exhibit-7 & 7/1 is legal notice and registry receipt dated 01.03.2014.
- Exhibit-A is letter dated 03.02.2012 issued by insurance company to the complainant in which for final settlement of claim following documents were demanded: copy of FIR, postmortem report, final police report, clipping of news published in newspaper of the accident, Exhibit-B documents related to terms and conditions of policy of insurance, Exhibit-C appointment of investigator by the insurance company.
- The District Consumer Forum held that insured died from accidental fall from mobile tower. It was further held that in absence of FIR and postmortem report accidental benefit can not be denied if it is established by other evidences that it was an accidental death and held that claimant is entitled for sum assured amount of Rs. 1,00,000/- as well as accidental benefit amount of Rs. 1,00,000/- and directed insurance company by order dated 24.05.2016 to pay Rs. 2,00,000/- with interest from the date of death i.e 26.07.2011.
- Aggrieved by order dated 24.12.2011 appellant/insurance company filed an appeal before the State Commission being Appeal no. 219 of 2016 and by order dated 30.08.2017 the order passed by the District Consumer Forum was set aside and matter was remanded to the District Consumer Forum to pass a fresh order and pursuant thereto a fresh order dated 10.03.2018 has been passed by the District Consumer Forum, Vaishali at Hajipur by which the complaint case has been allowed and insurance company has been directed to pay sum of Rs. 2,00,000/- from the date of death of insured i.e 26.07.2011 with interest @7% p.a from the date of receipt of the copy of order failing which interest @10% p.a shall become payable.
- Aggrieved by judgment and order dated 10.03.2018 insurance company has preferred this appeal.
- The only issue involved in this appeal is whether in absence of FIR, Postmortem report, final police report the accidental claim can be settled /or not.
- The issue raised in this appeal stands decided by the National Commission in case of Geeta Devi Vs. United India Insurance Co. Ltd. since reported in 2015 (III) CPR (NC) 223 in which in paragraph no. 8, 10 & 11 it has been held as follows:
8. The learned counsel for the insurance Company submitted that the petitioner did not submit copy of police report, Panchnama, Postmortem report and the original policy and thereafter, the claim was rejected as ‘No Claim’. 10. A brief perusal of the patient’s history shows that at the time of admission in the hospital, the insured had a fall in the bathroom, vomited blood and was in semi-conscious state. The treatment record shows that the insured was taken to the hospital at 5:00 A.M immediately preceding the fall in the bathroom and he died at 6:30 A.M on the very same day. It can be safely construed that any internal injury suffered by him on account of fall in the bathroom has a direct nexus to his death. In fact, the hospital record clearly states that the insured did not suffer from any ‘chest pain’. The onus to prove that the death of the insured is a natural one and not an accidental death, shifts on the Insurance Company and they did not place any cogent or substantial evidence on record to establish their case that the death was no account of cardiac arrest and should, therefore, be inferred as a natural death. 11. when a death is caused by accidental fall, the question of reporting to the police and conducting a panchnama does not arise. Admittedly, the postmortem was not done as the death of the insured was not construed to be a suspicious one. Therefore, repudiating the claim on the ground that the claimant had not sent the documents, which were not relevant to the nature of death, is totally unjustifiable. - In present case death of insured from accidental fall is well established by oral, documentary, medical evidence placed before the District Consumer Forum. The accidental claim was denied for want of FIR, Postmortem report and final police report which has been held to be not mandatory and repudiation of claim on said basis is not justified.
- For the reasons as stated above this Commission does not find any error or infirmity in the judgment and order passed by the District Consumer Forum, accordingly this appeal is dismissed.
(Ram Prawesh Das) (Sanjay Kumar,J) Member President Md. Fariduzzama | |
