Orissa

Jagatsinghapur

CC/111/2021

Anupama Sahoo - Complainant(s)

Versus

Reliance Insurance co .ltd - Opp.Party(s)

Mr.N.C.Barik

12 Aug 2022

ORDER

                                                                                                   JUDGMENT

 

            Complainant has filed this consumer complaint U/s.35 of C.P. Act, 2019 seeking the following reliefs:

            “Direct the opposite party No.1 to pay the claim to the complainant within the time and pay the compensation of Rs.50,000/- to the complainant and cost of litigation”.

            The brief fact of the complainant case is that the deceased husband of the complainant namely Surendra Kumar Sahoo insured his motor cycle bearing Regd. No.OD-21-L-5009 on dt.10.6.2020 vide policy No.R10062002692 under the opposite party No.1 and the aforesaid policy is valid from 10.6.2020 to 09.6.2021. The deceased husband of the complainant purchased the said motor cycle insuring the loan from the opposite party No.2. The policy holder died on 06.6.2021 due to heart attack. The death of the policy holder covers the insurance period. As the death of the policy holder cover the insurance period, the complainant who is the nominee is entitled to get the insurance value but opposite party No.1 till date has not settled the claim in favour of complainant. The opposite party No.1 by practicing unfair trade practice has not settled the insurance claim for which the opposite party No.1 is liable to pay compensation to the complainant. After the death of the husband of the complainant the complainant is unable to deposit the monthly EMI to the opposite party No.2, and the opposite party No.2 is now trying and threatening to seized the motor cycle and sale the same in public auction.

            The opposite party No.1 filed written version stating as under;

            From the complaint petition it transpires that the complainant has filed this case alleging non settlement of her P.A. claim, till date the complainant has not lodged any claim under the personal accident coverage of the insurance policy as such question of settlement of his personal accident claim does not arise at all. It is admitted to have issued a two wheeler policy bund vide policy bearing No.604322023750003505 against the proposal submitted vide proposal No.R10062002692 in favour of the husband of the complainant which was registered as OD-21-L-5009 and the risk of the vehicle was valid from 10.6.2020 to 09.6.2021 subject to certain terms and conditions of the insurance policy.

            The complainant should have given notice in writing to the insurance company immediately upon the occurrence of any accident or loss and damage or fatal injury in respect of any occurrence which may give rise to a claim under the policy to give immediate notice to the policy but in the case at hand in order to avail the benefit of personal accident coverage under the policy complainant has stated in the claim application that the deceased insured died due to heart attack, not due to any accident, for which her claim cannot be entertained. Complainant has filed written note of argument on 10.8.2022 in which he has relied on three decisions out of which one is relied by the counsel by opposite party i.e. Alka Shukla Vrs. LIC. In other two cases complete judgment has not been given only relevant two pages of case of Smt. S. Sawant and five pages of the case of Pappathi has been given and we do not have the adequate infrasture to get the complete judgment. In addition to that complainant has relied on the judgment of Oriental Insurance Vrs. Smt. S. Sawant and another, while it is explained in which circumstances heart attack can be an accident and evidence to that effect has to be lead by the party. In this case there is no evidence to the effect that heart attack was caused due to any accident as such the same has not relevance. The complainant has also relied on decision of Hon’ble Madras High Court in case of National Insurance Company Ltd. Vrs. Pappathi, where in the deceased vehicle driver died in an accident which arose in course of employment he was heavy vehicle driver and was on duty. Hon’ble Madras High Court while deciding the case has been pleased to observe as under;

“Circumstances must exist to establish that death was caused by reason of failure of heart was because of stress and strain of work. Stress and strain resulting in a sudden heart failure in a case of the present nature would not be presumed. No legal fiction therefore can be raised. As a person suffering from a heart disease may not be aware thereof, medical opinion therefore would be of relevance. Each case, therefore, has to be considered on its own fact and no hard and fast rule can be laid down therefor. Only because the cause of death was due to heart attack, the same by itself may not be a ground to arrive at a conclusion that an accident had occurred resulting in injury. Unless evidence is brought on record to elaborate that the death by way of cardiac arrest has occurred because of stress or strain, the Commissioner would not have jurisdiction to grant damages. In other words, the claimant was bound to prove jurisdictional fact before the Commissioner. Unless such jurisdictional facts are found, the Commissioner will have no jurisdiction to pass an order. It is now well-settled that for arriving at a finding of a jurisdictional fact, reference to any precedent would not be helpful at a finding of a jurisdictional fact, reference to any precedent would not be helpful as a little deviation from the fact of a decided case or an additional fact may make a lot of difference by arriving at a correct conclusion. For the said purpose, the statutory authority is required to pose unto himself the right question.”   

 

            Admittedly the husband of the complainant has expired due to normal heart attack and not due to accident which caused stress and resulted in heart attack as such the claim of the complainant for availing the benefits under the personal accident benefit cannot be entertained in view of the decision of Hon’ble Apex Court in the case of Alka Shukla Vrs. LIC 11(2019) CPJ 67 (S.C.). As such the consumer complaint is dismissed. No cost.

            However taking into consideration of the situation and plight of the complainant, we direct the opposite party No.2 not to claim any penal interest and overdue charges in defaulting the payment due to the death of the sole bread earner. The opposite party No.2 shall give six months time to repay the actual loan amount with normal interest as applicable.

 

            Pronounced in the open Commission on this 12^th August, 2022.