STATE CONSUMER DISPUTE REDRESSAL COMMISSION

BIHAR, PATNA

Appeal No. 313 of 2018
 

The Branch Manager, National Insurance Company Ltd, Sasaram, Rohtas, represented through the Regional Manager and the constituted Attorney, Regional Office, National Insurance Company Ltd. 4^th Floor, Sone Bhawan, B.C. Patel Marg, PS- Sachivalaya, District- Patna

                                                                                                                                              … O.P. No. 1 to 3/ Appellant

Versus

1.    Tej Pratap Dwivedi, Son of Late Haridwar Dwivedi

2.    Lalita Kunwar, Wife of Late Haridwar Dwivedi, Resident of Village- Samhuta, PO- Pipra Sakarwar, PS- Kargahar, District- Rohtas presently residing at Mohalla- Saketnagar, Company Sarai (Near National Public School), PO & PS- Sasaram, District- Rohtas

                                                                                                                             …. Complainants/Respondents

Counsel for the appellant: Adv. Raj Kumar Singh Vikram

Counsel for the Respondent: Adv. Lal Bahadur Singh & Adv. Ashok Kumar

Before,

Hon’ble Mr. Justice Sanjay Kumar, President

Mr. Ram Prawesh Das, Member

Dated 21.02.2023

As per Sanjay Kumar, President.

O r d e r

1. Present appeal has been filed on behalf of National Insurance Co. Ltd. through its Branch Manager, for setting aside the judgment and order dated 05.06.2018 passed by the Ld. District Consumer Disputes Redressal Forum, Rohtas in CC no. 14 of 2012 whereby and whereunder the District Consumer Forum has allowed the Complaint case and directed appellant-insurance Co. to pay Rs. 5,00,000/- sum assured amount as well as Rs. 5,000/- as compensation to the complainant within two months from the date of order failing which interest @8% shall become payable.
2. Case of complainant is that his father Haridwar Dwivedi had taken an accidental Insurance policy on 23.02.2004 which was valid for the period from 2004 to 2019 in which the complainant was made nominee.
3. The father of complainant was traveling on a passenger train on 19.07.2004 and at Shiv Sagar Station he de-boarded the train for drinking water and while boarding the train due to rush fell down and got injured. He was rushed to Sadar Hospital, Sasaram by Station Manager by another train from where he was referred to Varanasi for better treatment and he was admitted in Alaknada hospital, Varanasi where he died on 25.07.2004 during treatment and his last rites were performed in Varanasi.
4. The death of the insured Haridwar dwivedi was intimated to the insurance company and complainant being the nominee in the insurance policy filed his claim on 28.08.2004 for payment of sum assured amount of Rs. 5,00,000/-. However, when no action was taken by the insurance company on the claim made by complainant he approached the District Consumer Forum, Rohtas for redressal of his grievances.
5. Appellant- insurance company appeared before the District Forum, Rohtas and filed its written statement that, claim was not maintainable and also barred by limitation. They denied the incident as detailed in the complainant petition. They also raise suspicion that accident is of 19.07.2004 and insured died on 25.07.2004 but FIR was lodged in 2006, as such on account of in-ordinate delay claimant is not entitled for any relief.
6. It has further been stated that after submission of claim form on 28.08.2004 several correspondences were made with the complainant on 07.01.2005 & 02.03.2005 to submit relevant documents including postmortem report but nothing was submitted by the complainant. In order to settle claim under accidental insurance policy, postmortem report is mandatory in terms of accidental insurance claim, In absence of which no claim is payable, as cause of death could not be ascertained.
7. In support of his claim case two witnesses (Markandey Dubey & Lalita Devi) filed their evidence on affidavit. Complainant had submitted copy of FIR & Final report (Exhibit-1), Case filed in the court of S.D.O, Sasaram (Exhibit-2), Certificate dated 19.07.2004 issued by Manager, Railway Station (Exhibit-3), the insurance policy (exhibit-4), Certificate granted by Mukhiya (Exhibit-5), Letter of GTFS (Exhibit-6 series), Documents called for by the insurance company from complainant (Exhibit-7), Demand of Postmortem report (Exhibit-7/1), Reminder (Exhibit-7/2), Letter send by complainant to insurance company (Exhibit-8), Receipt (Exhibit-9).
8. After submitting claim form, the insurance company demanded certain documents such as copy of FIR, Police Report and postmortem report to settle the claim and thereafter, the claimant filed a complaint case before the S.D.O. Sasaram for an enquiry into the death of her husband/insured in a rail accident and accordingly, the SDO referred the matter to the concerned railway police who registered a UD case being UD case no. 30 of 2006 which was enquired by the police and final report was submitted by the police in the court of SDO, Sasaram in which the case of the complainant was found to be true by the police (Exhibit-1 & 2).
9. To deny  the claim of claimant opposite party submitted following documents Claim notesheet (Exhibit-A), Letter of repudiation (Exhibit-A/1), Insurance policy (Exhibit-A/2), Letter of Insurance company addressed to complainant (Exhibit-A/3), Reminder letter (Exhibit-A/4), Letter of Insurance company to claimant demanding relevant documents (Exhibit-A/5).
10. The District Consumer Forum after considering and appreciating materials available on record held that it is an admitted position that insured Haridwar Dwivedi took an accidental insurance policy on 23.02.2004 for sum assured amount  of Rs. 5,00,000/- and while traveling on a train he met an accident on 19.07.2004 and thereafter he was sent to Sasaram Sadar Hospital for treatment from where he was referred to Varanasi for better treatment however, he died on 25.07.2004 in Alaknanda Hospital Varanasi and thereafter he was cremated in Varanasi.  
11. The District Consumer Forum has heavily relied upon certificate granted by Station Manager of Shiv Sagar road, Railway Station dated 19.07.2004 issued in official capacity stating therein that deceased Haridwar Dwivedi was traveling from 302 down passenger train from Varanasi to Sasaram on valid rail ticket. He de-boarded the train to drink water mean while train started and as he tried to board the running train he fell down on the platform and thereafter, the station master send him to Sasaram from Train no. 4027 for treatment and authenticity of certificate issued by the Station Manager has not been doubted/denied by the opposite party which is sufficient to establish the case of complainant that insured died in accident and allowed the complaint case of complainant.
12. Aggrieved by the order dated 05.06.2018 passed in Complaint Case no. 14 of 2012 passed by District Consumer Forum, Rohtas appellant/opposite party –insurance company has filed this appeal.
13. Heard the parties.
14. The claim of the complainant was repudiated by insurance company solely on the ground that complainant failed to submit postmortem report which is mandatory requirement to ascertain cause of death and in absence of which claim cannot be settled in favour of claimant.
15. In the claim note sheet filed by insurance company (Exhibit-A) the claim of complainant has been repudiated on 14.06.2010 solely on the ground of non submission of postmortem report same being mandatory as such complaint case is not time barred as same has been filed within two years from the date of repudiation of claim i.e 14.06.2010.
16. The postmortem report is certainly and important document to ascertain the cause of death and is a desirable document but accidental claim can not be repudiated solely on ground of non submission of postmortem report when accidental death can be establish on basis of cogent and reliable evidences. In present case postmortem of the dead body of deceased was not performed and he was cremated. There were cogent and trustworthy material placed on record, on basis of which the District Consumer Forum held that insured died in an accident and as such the District Consumer Forum rightly held that complainant /respondent are entitled for grant of sum assured amount. The District Consumer Forum has very aptly and elaborately dealt with the evidences available on record and after proper, in depth and meticulous appreciation and examination of evidence has arrived at finding that insured died in an accident and as such the claimants are entitled for payment of sum assured amount under accidental insurance policy.
17.  This court does not find any error or infirmity in the order passed by the District Consumer Forum, Rohtas nor does find any improper and mis appreciation of evidence requiring any interference by this Commission, accordingly appeal is dismissed.

(Ram Prawesh Das)                                                                          (Sanjay Kumar,J)

       Member                                                                                             President

Md. Fariduzzama