Orissa

Cuttak

CC/111/2015

Bhabani Swain - Complainant(s)

Versus

The Divisional Manager,M/s Oriental Insurance Co Ltd - Opp.Party(s)

S Sen

15 Dec 2016

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

                                                                                    C.C. No.111/2015

1.    Bhabania Swain,

W/O: Batakrushna Swain,

 

2.            Bata Krushna Swain,

F/O: Pramod Kumar Swain,

 

Both are residing At:Puruna Matha,(Umar),

PO:Ostapur,Via:Nischintakoili,

P.S:Mahanga,Dist:Cuttack.                                                 … Complainants.

 

                Vrs.

 

1.         The Divisional Manager,

M/s. Oriental Insurance Co. Ltd.,

Bajrakabati Road,Cuttack.

 

2.        The Divisional Manager,

M/s. Oriental Insurance Co. Ltd.,

City-D.O No.I.5149 Lewis Road,

                  Bhubaneswar,Dist-Khurda

 

 

Present:    Sri Dhruba Charan Barik,LL.B. President.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:   16.10.2015

Date of Order: 15.12.2016.

 

For the complainant       :               Sri Sujit Sen,Adv. & Associates.

For Opp.Parties.1 & 2.    :               Sri G.P.Dutta,Adv. & Associates.

 

 

Sri Dhruba Charan Barik,President.

                Both the complainants have lodged this complaint on the allegation that the O.ps are deficient in rendering service to them and as such the former has sought for the reliefs in terms of their prayer I n the complaint petition.

1. The case of the complainants briefly stated is that both the complainants are parents of their deceased son Pramod Kumar Swain.  During his life time the deceased had obtained a Janata Personal Accident Insurance Policy bearing No.345300/47/2012/170 dt.6.5.2011 for the insured sum of Rs.1,50,000/- in respect of the period from 7.5.2011 to 6.5.2016.  Annexure-1 is the copy of the said Janata Personal Accident Insurance policy.
2. In the night intervening 8/9.2.2013 the deceased went out of his rented house to urinate but fell down on the ground for which he sustained severe internal injury on his heart.  He also developed breathing problem.  Two of his colleagues sent him to the Govt. Headquarters Hospital,Kanchipuram and the attending doctor declared him dead.  On 9.2.13 the matter was reported to police station at Kanchipuram and post mortem was also conducted over the dead body.  Annexure-2 & 3 are respectively the copies of the F.I.R and post mortem report.  The copy of the death certificate and legal heir certificate of the deceased have been filed and marked as Annexure-4 & 5 respectively.
3. Complainant No.2 who is the father of the deceased immediately lodged complaint before the O.P.2 claiming insurance benefit.  But the O.P No.2 sat over the matter for about 1 & ½ year in spite of repeated approaches.  Lastly on 25.6.14 he repudiated the claim of the complainant No.2 by his letter dt.25.6.14 and copy of the same has been filed and marked as Annex-6.  The ground of repudiation as revealed from Annex-6 is the heart shock being the sole cause of death of the deceased which is not covered by the Janata Personal Accident Insurance Policy.  It is specifically stated that the repudiation of the claim of the complainant by the O.P.2 is unjust, improper and illegal and it is tantamount to deficiency in service.  Accordingly it is prayed that the O.Ps may be directed to pay Rs.1,50,000/- towards policy amount,Rs.50,000/- towards compensation together with interest @ 12% per annum till the amount is realized as well as litigation cost as deemed fit and proper in the interest of justice.
4. Both the O.Ps have not filed written version of their case but the counsels for them have participated in the argument.
5. We have heard the learned counsels for the complainant as well as the O.Ps and gone through the documents filed in the case.  Before the prayer of the complainants is allowed, onus is on them to satisfactorily prove that the cause of death of the deceased was one which was covered under the policy and as such the O.Ps without any excuse repudiated their claim.  In the instant case, the learned advocate for the complainant has vehemently argued that the death of the deceased was caused due to heart attack but no document is filed to this effect.  Even the post mortem report is silent on this point.  Rather it is revealed from Annex-3 that the cause of death of the deceased could not be opined pending chemical analysis of the Viscera.  The learned advocate for the complainant has also miserably failed to prove that heart attack which is said to be the cause of death of the deceased has been covered under the policy obtained by the policy holder.  Rather it is revealed from Annex-6 which is the repudiation letter issued by the O.Ps that the deceased died of  heart shock which is not coming under the purview of Janata Personal Accident Insurance Policy.  No document has been filed to our satisfaction that the O.Ps in any manner are deficient in rendering service to the complainants.

ORDER

In the facts and circumstances of the case, the prayer of the complainants is dismissed.  There is no order as to cost.

Typed to dictation, corrected and pronounced by the Hon’ble President in the Open Court on this the 15^th     day of December, 2016 under the seal and signature of this Forum.

                                                                                                                                                  

    (   Sri D.C.Barik )

                                                                                                                      President.

                                                                                                                                                                           

                                                                                                         Smt. Sarmistha Nath)

             Member(W)