SMT. BANDANA ROY, PRESIDENT

In a nutshell, complaint case is that   Binapani Mondal, wife of the complainant had an A/C with the OP Bank, vide A/C No. 1047010199872.  At the instance of the OP No.1 Bank, wife of the complainant took a group Personal Accident Policy from the OP No. 2 on 26.07.2014 against savings A/C being Policy No. OG-15-2422-6401-00000008 for the period from 26.04.2014 to 25.07.2015 at the insurance value of Rs. 1,00,000/-.  The complainant was the nominee in that policy. Unfortunately wife of the complainant died on 07.12.2014 due to an accident by burning in gas oven. The said matter was informed to the OP Insurance Co in due time and the complainant claimed the insurance coverage amount. The Co. investigated into the matter  and the OP no. 2 opened a claim docket being No OC-17-2401-6401-00000110 and claim ID No. is 1126525. Bur till now the OP Insurance Co. did not pay the claimed amount nor repudiated the claim.

Hence, the instant case with the prayers as made in the complaint petition on the allegation of deficiency of service on the part of the OPs.

Summons were issued upon both the OPs. OP No 1 did not appear to contest the case. Other OP ie OP no. 2 filed written version and contested the case by denying all the material allegations of the complaint.

The specific defense of this OP is that the insured Binapani Mandal died by committing suicide  on 01.12.2014 by pouring kerosene oil  and ignition on herself,  not due to burn injury as alleged by the complainant. She was first taken to Tamluk Government hospital and then was shifted to Peerless Hospital and Research Centre.  The police investigation report also divulged the true fact that due to a family dispute the deceased poured kerosene oil on herself and fired  for committing suicide. In the intimation the complainant reported that his wife died due to burn injury of stove bursting and in the claim application he stated that his wife died of burning due to gas oven firing.  The facts disclosed by the complainant is quite in contravention to the terms and conditions of the insurance policy and the company is not liable to pay the insured amount as claimed by the petitioner.

Ultimately the Insurance Co. has prayed for dismissal of the complaint case.

The points required discussion are whether the case is maintainable and whether the complainant is entitled to get the reliefs  as prayed for.

Decision with reasons

            The  point on maintainability is taken up first  for consideration.

            The OP no. 2 did not dispute that  there was an insurance policy in the name of the wife of the complainant and the complainant was the nominee of that policy.  So, according to Section 2 (d) of the C P Act, the complainant is a consumer and he has a specific allegation against the OPs regarding non-payment of the insured amount.

            This point is thus decided in favor of the complainant.

            Now let us see whether the complainant is entitled to get any relief in this case.

            We have carefully perused the affidavit of the complainant, examinant in-chief on affidavit filed by the complaiat and the reply thereto, filed by the OP, the written version and all  the documents filed by both the parties and heard the submission of the ld advocate for the complainant as  also the OPs. Considered.

            The complainant has alleged that his wife died on 07.12.2014 by accidental death due to burn by gas oven at the time of cooking. On the contrary it is the defence of the OP no. 2 that during their agency investigation as well as from the police report and hospital report is has been established that the insured committed suicide by pouring kerosene oil and firing on herself  for commission of suicide and it  is not an accidental death.

             In order to stake upon their claim the complainant has filed the copy of insurance policy standing in the name of his deceasedwife, which is not disputed.  The document W B Form No. 4279 which is disposal order accompanying corpses to cremation speaks that the deceased Binapani Mondal, aged 30 years died on 07.12.2014 but the cause of death in col. no. 7  has been written “To be ascertained after PM examination”.  Appendix 4 is a police investigation report sent to  Pradosh Mandal, husband of the deceased,  issued by Kolkata Police Directorate

            From the above documents the accidental death of the insured is not established whatsoever.        

            To defeat the claim of the complainant the OP no. 2 has filed a lot of documents viz.  Emergency Department History Sheet of the Peerless Hospitex Hospital and Research Centre Ltd. In the said report the history of present illness has been shown as “It was apparently a symptomatic till today afternoon suddenly she pour kerosene oil over herself  and sustained burn by lightening  fore on herself after some argument with her husband. Initially taken to another hospital after the incident). In the police investigation report the ASI of Chandipur PS has Submitted inquiry report to the OC Chandipur PS by stating in col no. 7 “During  enquiry it is learnt that a quarrel took place regarding family dispute and deceased poured kerosene on her body and set fire.”

            These two reports are sufficient to defeat the claim of the complainant which prove that the death of the insured was not due to any ‘accident’, but suicidal in nature.

            The OP no. 2 has filed copy of Premium Personal Guard/Relationship beyond Insurance.

            On thorough scrutiny of the terms and conditions embodied in it, it is found in Column no. 1(a) that the Insurance Co. will not pay in the event of death through suicide, attempted suicide or self inflicted injury or illness.

            The complainant has filed examination in-chief on affidavit and the OP no 2 as also filed questionnaires; but from the discussions made above, we do not find any necessity to ventilate anything more from the reply of the complainant as the documentary evidence already discussed earlier are sufficient to nullify the claim of the complainant.

            As a result the complaint fails and the complainant is not entitled to get any relief from this Forum.                         

            Hence, it is

O R D E R E D

That CC/103 of 2018 be and the same is dismissed on contest against the OP No 2 and dismissed ex parte against the OP No.1.

Parties to bear their own cost.

Let copy of the judgment be supplied to all the parties free of cost.