Order No.  32  dt.  25/03/2019

        The case of the complainants in brief is that the complainant no.1 is the widow and the complainant nos.2 and 3 are the sons of the deceased Asish Chowdhury who was an employee of State Bank of India and was insured with o.p. nos.1 and 2. The husband of the complainant no.1 was requested by the representative of o.p. no.1 to join a group accident insurance policy and he was also joined in the said policy and a policy no.137300000000 was issued to Asish Chowdhury. During the subsistence of  the said policy on 5.8.13 while Asish Chowdhury went for a morning walk he met with an accident in the railway crossing gate and he had fallen while crossing the railway line and a passing by inspection train had run over him. Said Asish Chowdhury was removed to M R Bangur Hospital wherefrom he was transferred to Ruby General Hospital at about 7-40 a.m. The injured remained alive for two hours and thereafter he succumbed to his injuries and after the demise of said Asish Chowdhury the complainant no.1 filed a death claim. The husband of the complainant no.1 had few policies with LICI which were paid by LICI after depositing the death certificate and P.M. report. The complainant no.1, thereafter, made death claim to o.p. no.1 and all the documents were provided, but o.p. no.1 failed to pay the insured sum of Rs.4 lakhs on the ground that the complainant no.1 was unable to provide viscera report. On the basis of the said fact the complainants stated that the death was caused due to road accident for which the claim was made and the P.M. report also stated that the death was caused due to an accident and since in the P.M. report the autopsy surgeon disclosed that the viscera of the deceased was sent for opinion, therefore the same was not released in favour of the complainants. On the basis of the said fact the complainants filed this case praying for direction upon the o.ps. for payment of the claim amount of Rs.4 lakhs along with interest as well as compensation and litigation cost.

            The o.p. nos.1 and 2 contested this case by filing w/v and denied all the material allegations of the complaint. It was stated that the complainants failed to file the proper documentary evidence for which the claim of the complainants was not entertained. It was also stated that after lodging of the claim the investigator was appointed by insurance company and the investigator had also visited the premises of the complainants and conducted investigation and visited personally the house of the complainants and had also asked for relevant documents, but they were not able to furnish the same. Thereafter o.p. no.2 issued several letters to the complainants demanding for necessary documents asking for the certain documents namely copy of viscera analysis / chemical report, copy of P.M. report, etc. Since the same could not be provided and in the P.M. report submitted by the complainants it was categorically stated that viscera preserved for chemical analysis for further opinion, if any. Until and unless the viscera report is produced to the insurance company the fund could not be released. On the basis of the said fact o.ps. stated that the claim of the complainants has been kept pending provided the viscera report is produced the amount may be released in favour of the complainants. In view of the said fact o.ps. prayed for dismissal of the case.

            On the basis of the pleadings of parties the following points are to be decided:

1. Whether Asish Chowdhury was covered with the insurance policy of o.ps.?
2. Whether Asish Chowdhury died in an accident?
3. Whether viscera report of the deceased at all necessary for disposal of the claim of the complainants?
4. Whether there was any deficiency in service on the part of o.ps.?
5. Whether the complainant will be entitled to get the relief as prayed for?

Decision with reasons:

            All the points are taken up together for the sake of brevity and avoidance of repetition of facts.

            Ld. lawyer for the complainant argued that the complainant no.1 is the widow and the complainant nos.2 and 3 are the sons of the deceased Asish Chowdhury who was an employee of State Bank of India and was insured with o.p. nos.1 and 2. The husband of the complainant no.1 was requested by the representative of o.p. no.1 to join a group accident insurance policy and he was also joined in the said policy and a policy no.137300000000 was issued to Asish Chowdhury. During the subsistence of  the said policy on 5.8.13 while Asish Chowdhury went for a morning walk he met with an accident in the railway crossing gate and he had fallen while crossing the railway line and a passing by inspection train had run over him. Said Asish Chowdhury was removed to M R Bangur Hospital wherefrom he was transferred to Ruby General Hospital at about 7-40 a.m. The injured remained alive for two hours and thereafter he succumbed to his injuries and after the demise of said Asish Chowdhury the complainant no.1 filed a death claim. The husband of the complainant no.1 had few policies with LICI which were paid by LICI after depositing the death certificate and P.M. report. The complainant no.1, thereafter, made death claim to o.p. no.1 and all the documents were provided, but o.p. no.1 failed to pay the insured sum of Rs.4 lakhs on the ground that the complainant no.1 was unable to provide viscera report. On the basis of the said fact the complainants stated that the death was caused due to road accident for which the claim was made and the P.M. report also stated that the death was caused due to an accident and since in the P.M. report the autopsy surgeon disclosed that the viscera of the deceased was sent for opinion, therefore the same was not released in favour of the complainants. On the basis of the said fact the complainants filed this case praying for direction upon the o.ps. for payment of the claim amount of Rs.4 lakhs along with interest as well as compensation and litigation cost.

            Ld. lawyer for the o.p. nos.1 and 2 argued that the complainants failed to file the proper documentary evidence for which the claim of the complainants was not entertained. It was also stated that after lodging of the claim the investigator was appointed by insurance company and the investigator had also visited the premises of the complainants and conducted investigation and visited personally the house of the complainants and had also asked for relevant documents, but they were not able to furnish the same. Thereafter o.p. no.2 issued several letters to the complainants demanding for necessary documents asking for the certain documents namely copy of viscera analysis / chemical report, copy of P.M. report, etc. Since the same could not be provided and in the P.M. report submitted by the complainants it was categorically stated that viscera preserved for chemical analysis for further opinion, if any. Until and unless the viscera report is produced to the insurance company the fund could not be released. On the basis of the said fact o.ps. stated that the claim of the complainants has been kept pending provided the viscera report is produced the amount may be released in favour of the complainants. In view of the said fact o.ps. prayed for dismissal of the case.

            Considering the submissions of the respective parties it is an admitted fact that Asish Chowdhury who was retired employee of State Bank of India and he was in enjoyment of group accident insurance policy. It has not been denied by o.ps. that he was not insured with o.p. insurance company at the relevant point of time. It appears from the materials on record that while Asish Chowdhury, insured was doing morning walk, at that time he fell on the railway track and a train ran over him, for which he sustained severe injuries, initially he was taken to M R Bangur Hospital and from there he was shifted to Ruby General Hospital. On perusal of the documents filed by the complainants it appears that the injured Asish Chowdhury was removed to Ruby General Hospital at 7-40 hours and immediately after removing the said patient to the hospital he was admitted there and amputation of hand was made and subsequently he died at 9-30 a.m. due to the said accident and the P.M. was held and in the P.M. report it was also mentioned that due to accident Asish Chowdhury died. On perusal of the P.M. report it appears that the doctor who held the P.M. report also mentioned that the death was due the fact of injuries sustained by the deceased owing to RTA. Since in the P.M. report it was mentioned that viscera was sent for chemical analysis and on the basis of the said fact insurance company did not entertain the claim of the complainants. But in the P.M. report autopsy surgeon who held the P.M. examination over the dead body of the deceased opined that the death was due to the effects of injuries sustained by said Asish Chowdhury owing to RTA. After the objection raised by insurance company for not providing the viscera report this Forum asked the policy for production of viscera report. In response to the same the police officer sent a report to this Forum on 5.9.17 whereby it was categorically stated that after going through the records it appears that Asish Chowdhury was admitted to Ruby General Hospital on 5.8.13 at 8-17 a.m. due to road traffic accident and expired on 5.8.13 at 9-35 hours in the said hospital. Thereafter requisition was sent and P.M. of the deceased was done at ACMOH, Alipore vide P.M. No.1857/13 dt.6.8.13. It is also found that the autopsy surgeon remarked in the P.M. report that the cause of death was due to the facts of antemortem injuries following RTA and the viscera preserved for chemical analysis for further opinion. After thoroughly searching the record the police officer intimated that no reference of the viscera sending for chemical examination for opinion could be found. Furthermore the State Forensic Laboratory at Belgachia was contacted, but they also could not provide any reference of viscera report in the name of deceased Asish Chowdhury. Since in the police report it was clearly stated that no viscera examination was done in respect of the said deceased. Therefore we must hold that the death of said Asish Chowdhury caused due to the accident which has also been observed by the autopsy surgeon who held that P.M. examination of the deceased. In view of such background of the case and whenever o.ps. agreed that the deceased was covered with the insurance at the relevant point of time, therefore because of non production of the viscera report is not at all necessary for determining the claim of the complainants, particularly when the facts and circumstances of the case clearly stated that the victim died on the self same day and he sustained severe injuries due to an accident on the railway tract and because of the victim sustained injuries since he was run over by a train. Having regard to the facts and circumstances of the case we hold that denial of the claim of the complainants caused deficiency in service on the part of o.p. insurance company and the complainants will be entitled to get the relief. Thus all the points are disposed of accordingly.

            Hence, ordered,

            That the CC No.783/2014 is allowed on contest with cost against the o.p. nos.1 and 2. The o.p. nos.1 and 2 are jointly and/or severally directed to pay the claim amount of Rs.4,00,000/- (Rupees four lakhs) only to the complainants along with compensation of Rs.20,000/- (Rupees twenty thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 8% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.