Sri Shyamal Gupta, Member

Instant Appeal u/s 15 of the C P Act, 1986, has been filed challenging the Judgment and Order dated 08/09/2016 passed by the Ld. District Forum, Kolkata Unit III, in Complaint Case No. CC/116/2016, allowing the Complaint on contest against the Respondent Nos. 3 & 4/OP Nos. 1&2.

The Appellant/OP No. 3 was directed to pay to the Respondent/Complainant a sum of Rs. 2,00,000/-within two months from the date of the impugned order. Alternatively, as directed, the OP No. 3 might remit directly the said amount to the Respondent Nos 3 & 4/OP Nos 1&2 for effecting adjustment of the same against the loan amount of Banani Chatterjee, since deceased.

The Appellant/OP No. 3 was also directed to pay to the Respondents/Complainants a cost and compensation for the amounts of Rs. 5000/- and Rs. 10,000/- respectively within the same deadline of two months from the date of the impugned Judgment and Order.

Briefly stated, the fact having relevance with the instant controversy was that the mother of the Respondents/Complainants received loans from the Respondent No. 3 and 4/OP No. 1 and 2 against the deposit of gold ornaments. Said mother, subsequently, at the insistence of the Respondent Nos 3 and 4/OP Nos 1 and 2, received one Sarv Suraksha Policy of a sum assured of Rs. 2,32,700/-and a validity period from 26/11/2014 to 25/05/2015 from the Appellant/OP No. 3. The mother of the Respondents/Complainants died intestate on 12/03/2015 at RSV hospital. As per death certificate, she died of lower respiratory tract infection as immediate cause, Gastro Intestinal Infection as antecedent cause and Septic shock with multi organ failure and cerebro vascular accident as other significant causes, all were claimed to have been covered under the above policy.

The Respondents/Complainants submitted a claim with Respondent No. 3/OP No. 1 on behalf of their deceased mother on 18/03/2015 but, the Respondent No. 3/OP No. 1, without making any effort to adjust the outstanding dues against the claim as per policy, sent a final notice for sale of the pledged gold ornaments dated 16/09/2015. A Notice dated 24/09/2015 was also published in the news paper. The Respondents/Complainants sent a letter to the Appellant/OP No. 2 urging it not to sale the pledged ornaments till settlement of the claim submitted by them against their mother’s policy.

There being no response from the Appellants/OPs, the Respondents/Complainants smelt a foul motive of the Appellants/OPs for realizing their mother’s loan, selling her pledged ornaments. They found in the Ld. District Forum a competent legal Forum to file the Complaint against the Appellants/OPs for their grievances to be addressed. Impugned Judgment and Order was the outcome of the said Complaint Petition.

Heard Ld. Advocates appearing on behalf of both sides that made their respective submission securing the interest of their respective client.

Considered submission appearing on behalf of both sides and perused the papers on record. It transpired from the policy bond, running page-22, issued in the name of the deceased that a total premium of Rs. 197/-including the service tax was paid against the policy of sums insured of Rs. 2,00,000/-, Rs.2,00,000/-and Rs. 32,700/-only for accidental death, permanent total disability/permanent partial disability and credit shield insurance respectively as per provision envisaged u/s 2 under Head “Personal Accident of the Policy.”

The details of the policy coverage appeared to have been shown in the communication dated 26/11/2014 addressed to the deceased loanee by the Appellant/OP Insurance Company.

The said deceased loanee, as it transpired on perusal of the Death Certificate, running page 26, died on 12/03/2012 of Lower Respiratory Tract infection as immediate cause. Besides, Gastro Intestinal Infection was shown as antecedent cause and septic shock with multi organ failure and cerebro vascular accident were shown as other significant causes of death.

Since the insurance policy was related to accidental death or disability, the Respondents/Complainants probably emphasized more on the word ‘accident’ in Cerebro Vascular Accident, being one of the recorded causes of death shown in the Death Certificate at running page 27 and the Ld. District Forum passed the impugned Judgment and Order based on the submission made before it by or on behalf of the Respondents/Complainants in the same lines.

The causes of death mentioned in the Death Certificate appeared to be all related to natural death due to clinical and physiological disorders having no relation with any kind of accidental injury. In view of the above, we found in the instant complaint a claim, too optimistic to be accommodated under the provisions of the subject policy.

The Ld. District Forum, we are afraid, had made material irregularity in passing the impugned Judgment and Order which was needed to be set aside.

Hence, ordered that the Appeal be and the same stands allowed. Impugned Judgment and Order stands set aside. Consequent thereof, the Complaint Petition also stands dismissed. No order as to costs.