Jharkhand

Bokaro

CC/16/86

Yasoda Devi - Complainant(s)

Versus

The Branch Head, Reliance General Insurance Company Limited - Opp.Party(s)

Sudhanshu Kumar Mandal

28 May 2022

ORDER

District Consumer Commission, Bokaro.

Case No. 86/2016

  Date of Filing-20-07-2016

 Date of Order-28-05-2022

Yasoda Devi, W/o Late Mansa Ram Rajwar

R/o Village- Diwanganj, Post- Kura, P.S.- Pindrajora,

District- Bokaro, Jharkhand, 827013

                                      Vr.

1. The Branch Head, Reliance General Insurance Company Limited, Plot No. M-5, Chandrakali Bhawan 3^rd Floor, City Centre Sector-4, P.O & P.S- Sector-4, District- Bokaro, Jharkhand.
2. The Reliance General Insurance Company Limited,

1-89/3/B/40 To 42/Ks/301, 3^rd Floor, Krishe Block, Kirshe Sapphire, Madhapur, Hydrabad- 500081

3. Bokaro Steel Samuhik Durghatna Bima Samity,

Room No. E-45, Old Adminstrative Building, Bokaro Steel Plant, Bokaro Steel City, District- Bokaro, Jharkhand 827001

Present:-

          Shri Jai Prakash Narayan Pandey, President

             Smt. Baby Kumari, Member

                                                -Order-

1.       Complainant has filed this case with prayer for direction to O.Ps. to make payment of Rs. 5,00,000/- as insurance claim with interest @ 12% per annum from the date of accident i.e. 19.06.2014 and to pay Rs. 50,000/- & Rs. 10,000/- respectively as compensation and litigation cost to her.
2.      Complainant’s case in brief is that the husband of the        complainant namely Mansa Ram Rajwar was an employee of SAIL, Bokaro Steel Plant (in short BSL) vide staff No. 262783 who was covered under group insurance policy No. 2410342914000013 valid from 16.05.2014 to 16.05.2015 for the sum insured Rs. 5,00,000/- with Reliance General Insurance Co. Ltd. (here in after referred as insurance co.). Further case is that said Mansa Ram Rajwar met with an accident on 19.06.2014 in his bathroom and died whose postmortem was conducted on 19.06.2014 for which U/D case No. 24/2014 dt. 26.06.2014 was registered in B.S.City P.S.  As per postmortem report cause of death was due to head injury leading to shock & cardio respiratory failure . Complainant being wife of the deceased has filed claim before the O.P. No.1 &2 but it was turned down on the ground that death was due to heart attack and it was not due to any accident. Inspite of issuance of legal notice grievance was not settled hence case has been filed with above mentioned prayer.
3.      O.P. No.1&2 have filed W.S. mentioning therein that case is time barred, there is no cause of action for the case and deceased died due to heart attack hence claim is not maintainable. Further reply is that as per terms and conditions of the policy intimation of accident was to be made within one calendar month and alleged claim is not under the preview of accident hence it has been denied.
4.     O.P. No.3 being BSL Authority has filed W.S. mentioning therein that statement made in para 1,3,4,&5 of the complaint petition are not denied. It has been admitted that deceased was employee of BSL and he died due to accident as it was intimated by the complainant and its intimation was given to the O.P. No.1 &2.
5.      On perusal of the pleadings of the parties it appears that only points for consideration is whether death of the deceased was due to accident or otherwise ? Whether complainant is entitled to get any relief as claimed or not? Whether claim is time barred?
6.     Following facts are admitted facts of the parties :-

1. That deceased Mansa Ram Rajwar was an employee of SAIL/BSL Bokaro.
2. That deceased was insured with O.P. No.1 &2 with the insurance policy covering accidental death.
3.  That deceased died on 19.06.2014.
4. That the complainant is wife of the deceased.

7.    First of all we would like to decide the point No. 3 which is related to  limitation in filing of the case. It reveals from the record that claim of the complainant has been repudiated by the O.P. No.1 &2 vide letter dt. 06.07.2015 hence cause of action of the case will arose on 06.07.2015 and since then two year period has been prescribed for filing of the case. This case has been filed on 26.07.2016 just after one year 20 days from the cause of action. In this way case is within prescribed period of limitation and it cannot be said that it is time barred. Accordingly this point is being decided in favour of the complainant and against the O.Ps.
8.     Point No. 1 &2:- Since both points are interlinked  with each other hence they are being taken up for decision together. Main objection is that death was due to heart attack hence complainant is not entitled to get benefit of insurance policy covering accidental death. Therefore, we have to see whether it was accidental death or death due to heart attack. Photo copy of U/D case No. 24/2014 has been filed which shows that deceased died in the BGH during treatment and postmortem was conducted on the body of the deceased in which it has been found that death was due to injuries sustained due to fall. Photo copy of the postmortem report is also on record and accordingly postmortem on the body of deceased was conducted on 19.06.2014. As per postmortem report there was compound fracture of left ankle, swelling of 2” X 1.5” at post part of head C/o blood and blood clot found under scalp on postmortem, part of head. On further section blood and blood clot also found in cranial cavity. As per opinion of the doctor injuries were of ante-mortem in nature caused by hard blunt object. Cause of death is head injury leading to shock and cardio respiratory failure.
9.     On careful perusal of the report submitted by the Police officer in connection with U/D case and postmortem report of the deceased it is very much clear that death of the deceased was caused due to shock and cardio respiratory failure as a result of injuries sustained during accident and there was no any other cause of the death. Therefore, we are of the opinion that the reason for rejection/repudiation of the claim given by the O.P. No.1&2 is completely against the evidence available on record hence there is deficiency in service by O.P. No.1&2.
10.     Therefore, we are of the opinion that complainant is entitled to get relief as claimed and death of the deceased was due to accident , accordingly both points are being decided in favour of the complainant and against the O.P. No.1&2.
11.    Thus we find and hold that the claim of the complainant is being   

allowed in the manner indicated here in below:-

O.P. No. 1 & 2(Reliance General Insurance Co. Ltd.)are directed to pay Rs. 5,00,000/- (Rs five lac) only to the complainant within 60 days from today otherwise they will pay interest thereon @ 10% per annum from 16.07.2016 (the date of filing of the case). Further O.P. No. 1 & 2 are directed to pay Rs. 20,000/- as compensation related to various type of harassment and Rs. 5,000/- as litigation cost within 60 days from today.