STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

United India Insurance Company Limited, Regional Office, SCO No.123-124, Sector 17-B, Chandigarh through its Deputy Manager Shri Anil Kakkar (Div. Office SCO No. 183-185, Sector 17-C, Chandigarh).

……Appellant/OP-1

V e r s u s

1.       Smt. Veena Bhardwaj w/o Late Sh. Sushil Kumar Bhardwaj, R/o House No.1326, Sector 22-B, Chandigarh.

              ....Respondent No.1/complainant

2.       Bank of Baroda, Sector 22B Branch, Sector 22-B, Chandigarh through its Branch Manager.

…. Respondent No.2/OP-2

Appeal under Section 15 of the Consumer Protection Act, 1986.

BEFORE:     JUSTICE SHAM SUNDER, PRESIDENT.

                   MRS. NEENA SANDHU, MEMBER.

Argued by: Sh. D.P. Gupta, Adv. for the appellant

                   Sh. B.J. Singh, Adv. for respondent No.1

                   Sh. G.S. Ahluwalia, Adv. for respondent No.2

PER  NEENA SANDHU, MEMBER

                   This appeal is directed against the order dated 19.10.2011, rendered by the learned District Consumer Disputes Redressal Forum-II, UT, Chandigarh (hereinafter referred to as the District Forum) vide which it allowed the complaint filed by Respondent No.1/complainant and directed the appellant/ Opposite Party No.1 as under :-

“7.     Hence in the light of above observations we allow the present complaint and direct the OP-1 to:     

(a)      Release the Insured sum of rupees 4,60,000 (lacs) along with an interest @9% per annum since the date of lodging of the claim.

(b)      Further OP-1 is also saddled with Rs.7000/- as costs of litigation.

8.       The above said order shall be complied within 30 days of its receipt; thereafter OP-1 shall be liable for an interest @18% per annum on the said insured amount.”

2.                     The facts of the complaint, in brief, are that the late husband of the complainant, Sh. Sushil Kumar Bhardwaj opened a bank account with opposite party No.2 on 26.2.2004, and availed of loan of Rs.4,60,000/- on 16.9.2006, for renovation of his house. Along with the loan, the deceased had obtained a “Uni Home Care Insurance Policy” valid from 19.11.2004 to 18.11.2019 by paying a premium of Rs.2,540/- to opposite party No.1, which covered Personal Accident Risk cover of Rs.4,60,000/- and Fire Risk worth Rs.4,60,000/- for House No.1326, 2nd Floor, Sector 22-B, Chandigarh.  It was stated that on 10.3.2006, the late husband of the deceased suddenly fell, on a water bucket, due to slippery conditions, as the renovation work was already in progress. After the fall, he complained of abdominal pain, and was taken to Dr. S.K. Khanna, Sector 22, Chandigarh, for consultation, on 11.3.2006.  Thereafter, he was admitted in General Hospital, Sector 16, Chandigarh, where he was operated upon.  Subsequently, he was referred to the Post Graduate Institute of Medical Education and Research (PGIMER) due to more complications.  The late husband of the complainant, ultimately, expired on 4.8.2006 during his hospitalization at the PGIMER. The late husband of the complainant, being covered under the policy, was entitled to a maximum cover of Rs.4,60,000/- and she (complainant) being the beneficiary, was entitled to the said amount, on account of the unfortunate death of her husband, due to the said accidental fall.  It was further stated that the complainant lodged claim with opposite party No.2, vide letter dated 01.10.2006 and supplied all the documents, as desired by opposite party No.1, through its investigator K.K. Puri long back. It was further stated that even after replying to different letters dated 23.10.2008, 5.12.2008 and 10.6.2009 the opposite parties failed to respond for a long time and there was no intimation qua the status of the claim. It was further stated that the aforesaid act of the opposite parties amounted to deficiency, in service.  When the grievance of the complainant was not redressed, left with no alternative, a complaint under Section 12 of the Consumer Protection Act, 1986 (hereinafter referred to as the Act) was filed.

3.                   Opposite Party no.1, in its written version, stated that the claim of the complainant was not maintainable, as the death was not attributed to any accident.  It was further stated that the complainant was a chronic patient of Cholecystitis with cholelithiasis and had developed complications because of the same.  The said complications were not attributable to the alleged slipping/fall. It was further stated that the complainant was entitled to the claim only, in the event of death of her husband, due to accident, whereas, he died due to Enterocutaneous Fistula with Sepsis/ileal perforation peritonitis, and the same was not connected with the alleged slipping/fall.  It was further stated that the claim of the complainant was repudiated vide letter dated 17.12.2009, as she was not entitled to the claim, since the deceased died due to diseases and not accident. With regard to delay, it was stated that it was the complainant who failed to furnish all the requisite documents, necessary for completing the formalities for the said claim. The remaining averments were denied, being wrong. 

4.                     Opposite Party No.2, in its reply, admitted that the complainant had obtained house loan from it, a personal accident policy and fire risk cover for H.No.1326, 2nd Floor, Sector 22-B, Chandigarh, from opposite party No.1.  It was stated that the claim of the complainant was required to be processed, and settled by opposite party No.1, hence it had nothing to do with the same.  The remaining averments were denied, being wrong.

5.                     After hearing the Counsel for the parties, and on going through the evidence and record, the learned District Forum allowed the complaint, as stated in the opening para of this order

6.                     Feeling aggrieved, the instant appeal, has been filed by the appellant/Opposite Party No.1.

7.                     We have heard the Counsel for the parties and have gone through the evidence and record of the case carefully. 

8.                     In order to ascertain (a) whether there was any co-relation between the immediate cause of death and the antecedent cause of death, as mentioned in the death certificate dated 4.8.2006 (Annexure C-5) and (b) whether the terminal illness was consequence of the accidental injury, due to fall, on the iron bucket on account of slippery floor, the District Forum sought the expert opinion, from the PGIMER.  In order to submit the report, a committee of two doctors, was constituted, by the Medical Superintendent of PGIMER, but the said doctors showed their inability stating that, in the absence of detailed record of Sector 16 Hospital, it was difficult to comment whether the primary cause of death was related to the antecedent cause.  It was further stated, in their report, that there was mention of multiple with enteric perforation, but there was no mention of cause of perforation i.e. whether it was due to bowel pathology or it was because of trauma from fall on the bucket.  However, as no such information was provided by the parties, therefore, the District Forum was left with no other alternative, but to decide the case, by relying upon the evidence, already adduced by both the parties. 

9.                     In the discharge certificate (Annexure C-4) under the heading diagnosis, it was specifically mentioned “Acute Abd. (Ileal perforation) Enteric”.  It was also mentioned that the patient remained admitted till 21.4.2006, and necessary surgical and medical treatment was given from time to time, but the said discharge certificate did not mention any previous history or chronic ailment of the deceased.  Even, in the medical certificate of cause of death (Annexure C-5/R-1), issued by the PGIMER, the cause of death, mentioned under the heading ‘immediate cause’ in clause 1(a) was ‘Enterocutaneous Fistula with Sepsis’ and under the heading ‘antecedent cause’ in clause 1(b) ‘Ileal perforation peritonitis’ was mentioned. The dictionary meaning of the word ‘antecedent’ is “a thing that existed before or logically precedes another”. Meaning thereby, as per clause 1(b), the complainant was already/previously suffering from ‘Ileal perforation peritonitis’ and, due to the fall on the iron bucket, it got aggravated, and the complainant suffered from ‘Enterocutaneous Fistula with Sepsis’, as mentioned in clause 1(a), and, ultimately, he died.   Had the accident not occurred, then probably the ileal perforation would not have aggravated leading to the death of the husband of the complainant.  The word peritonitis has been defined in the medical dictionary as under :-

“An acute or chronic inflammation of the visceral and parietal peritoneum occurs in a variety of conditions. Bacterial infection results from blood stream infection or by local spread from a neighbouring inflammatory focus such as appendicitis. In liver disease spontaneous bacterial infection of ascites occurs probably because of diminished ability of liver to remove Escherichia coli. Chemical peritonitis may result due to surgical power or gloves left inside.  Chronic peritoneal infection may occur in patients on long terms chronic peritoneal dialysis.  Symptoms may be of sudden onset following perforation of a duodenal ulcer or more gradual when there is peritonitis due to spread from local inflammatory focus.  Pain is severe and constant.  Vomiting is effortless and faeculent.  Physical signs include fever, abdominal rigidity and absent or diminished bowel sounds.”

In Life Insurance Corporation of India Ltd. Vs. Saroj Rani-2010(2) CPC 79, a case decided by the Punjab State Consumer Disputes Redressal Commission, Chandigarh, the insured was going on yatra to a temple when he fell down, as his foot slipped, leading to perforation of intestine and he succumbed to injuries in the hospital.  It was revealed from the hospital record that the insured had died because of some abdominal pain and from gastric problem. The claim was repudiated, by the Insurance Company. From the evidence it was proved that the deceased had ulcer in the abdomen which had burst due to fall and, as such, death was caused by accident.  In these circumstances, the State Commission, in the appeal, held that had the insured not received injury, in accident, his death would not have occurred, on account of ulcer. Thus, the State Commission, held that the cause of death was obviously, on account of accident, and the complainant was entitled to the amount of claim. The facts of the aforesaid case, are almost identical to the facts of the instant case.  Hence, we are of the considered opinion that there is no doubt/confusion that the primary cause of death of the deceased was due to accident, on account of fall on the iron bucket and, therefore, the complainant was entitled to the insured sum, as per the terms and conditions of the policy.  Thus, the District Forum rightly directed Opposite Party No.1, to release the insured sum, to the complainant.

10.                  In view of the above discussion, we are of the considered opinion, that the order, passed by the learned District Forum, is perfectly legal and does not suffer from any illegality or perversity, warranting the interference of this Commission. Accordingly, this appeal is dismissed, leaving the parties to bear their own costs.

11.                  Copies of this order be sent to the parties free of charge.

Pronounced.

26.4.2012.

[JUSTICE SHAM SUNDER]

PRESIDENT

[NEENA SANDHU]

                      MEMBER