Date of hearing : 17.01.2023.
Date of order : 07.02.2023.
Anupama Rout, W/o:- Late Babaji Charan Rout,
At:-Achak Po:-Maharampur, P.S:- Tihidi,Dist- Bhadrak.
……………………. Complainant.
Versus
- The Divisional Manager, Oriental Insurance Co. Ltd.,
Police Line Square, O.T. Road Balasore, Odisha-756001.
- The Secretary, Bhatapada S.C.S. Ltd., Tihidi,
At/Po/PS:-Tihidi, Dist:- Bhadrak-756130.
…………….……Opposite parties.
Counsel For Complainant : Sri J.B. Agasti, Advocate & Associates,
Counsel For the O.P. No. 1 : Sri A.K. Panda, Advocate,
Counsel for the O.P. No. 2 : Sri U.A. Akhtari, Advocate & Associates.
J U D G M E N T.
SRI SHIBA PRASAD MOHANTY, PRESIDENT.
In the matter of an application filed by the complainant alleging deficiency of service against the Opposite Parties under Consumer Protection Act, 2019.
Brief fact of the case is that, the husband of the complainant namely Late Babaji Charan Rout has died on dt.23.06.2018 due to snake bite. After death of her husband one U.D. Case No.39 of 2018 which corresponds to U.D. GR Case No.- 291 of 2018 initiated by the Tihidi Police Station & the Investigation Officer (I.O.) of the said case has submitted final form. Cause of death of Babaji Charan Rout has been mentioned in the final form,the inquest report done U/s 174 of Cr.P.C. & thereafter in post mortem report has been clearly mentioned as the death was casue due to snake bite. Complainant states that her husband was a farmer &he had taken group loan on dt.08.05.2018 & his K.C.C. No.1316 with a deposited of an amount of Rs.11,506/- by Cheque bearing No.407338 with O.P. No.1& as per terms & conditions of the said policy if any farmer accidently dies his legal representatives are entitled to get Rs.5,00,000/- (Rupees five lakhs)only as compensation. So after death of her husband, complainant has informed O.P. No.2 with regard to death of her husband due to snake bite & claimed compensation of Rs.5,00,000/-& thereafter O.P. No.2 has sent the said claim to O.P. No.1 for sanction of claimed amount on dt.28.08.2018& thereafter O.P. No.1 has issued letter to the complainant with regard to submission of all the papers to settle claim amount in favour of Nominee who is the complainant of this case, but after submission ofall the documents with regard to K.C.C. bearing No.1316 but O.P. No.1 was not satisfied & mentioning in his report that there is a contradictory statement & suppression of material facts by the complainant & also O.P. No.1 issued letter again to give clarification with seven days. Complainant clarified & sent on dt.20.03.2020 with regard to death of deceased Babaji Charan Rout, but lastly O.P. No.1 mentioned in his letter that there is no new fact in letter as clarified by the complainant as such claim has been rejected by competent authority with a letter ondt.16.07.2020. Complainant has submitted inquest report & post mortem report, wherein cause of death of deceased Babaji Charan Rout has been stated as “Snake Bite”, but O.P. No.1 intentionally refused to settle the claim in favour of complainant. Due to above unreasonable repudiation of the claim, the complainant has suffered mental agony. Complainant’s deceased husband has deposited Rs.11,506/- by Cheque bearing No.407338 on dt.08.05.2018 as he was a K.C.C. holder & his number was 1316. Complainant is a poor & an illiterate lady after death of her husband complainant is running under poverty due to financial crisis. After death of her husband having no alternative way of sustenance, the complainant has filed this case for settlement of the claim amount in favour of complainant by the O.P. No.1. Cause of action arose on dt.23.06.2018 when deceased had died due to snake bite & dt.16.07.2020 when the claim has been rejected by O.P. No.1.
The O.P. No.1 states that all allegations made in the above complaint are false & the complaint is not maintainable either in facts or in law. O.Ps denies all the allegations contained in the complaint except those, which are specifically admitted herein after in their written version & nothing stated in the complaint should be deemed to be admitted merely because same is not specifically traversed. O.P. states that present complaint is wholly misconceived, groundless & unsustainable in law as the complainant have no locus standi to initiate the present proceeding &the same has been filed only to harass. theO.P. further states that the complaint is false, frivolous & vexatious. O.P. submits that it is well established through a catena of judgments including that of the Apex Court in United India Insurance Co. Ltd. Vs. Harchand Rai Chand Rai Chandanlal I (2003) CPJ 393 &Vikram Greentech (I) Ltd. & Anr Vrs. New India India Assurance Co. Ltd. II (2009) CPJ 34 that an insurance policies is to be construed strictly as per the terms & conditions of the policy documents which is a binding contract between the parties & nothing can beadded or subtracted by giving a different meaning to the words mentioned therein. Therefore in light of this, applicant is bound by the terms & conditions of policy. Insurance being a legal contact between the policy holder & the company, both parties are governed by the terms & conditions mentioned in the policy document & all the benefits are payable as per the said policy’s terms & conditions.
Case is bad for non-joinder of necessary party such as Balasore Bhadrak Central Co-operative Bank Ltd., O.T. Road, Balasore who has obtained the Group Personal Accident Insurance Policy. O.Ps categorically states that post mortem report in the name of deceased Babaji Charan Rout in connection to Tihidi U.D.P.S. Case No.39 dt.29.06.2018 reveals that after examination of dead body of deceased Babaji Charan Rout, Dr. Deepak Das, M.O., Bhadrak has opined in Section 1 External Appearance & Section More detailed description of injury of disease of the said post mortem report that “no external injury found over his body” as such the cause of death due to snake bites is false, baseless, contradictory & hypothetical. O.P. No.1 states that Group Personal Accident Insurance Policy No.345700/48/2018/230 obtained by Balasore-Bhadrak Central Co-operative Bank Ltd., O.T. Road, Balasore from O.P. No.1 reveals that in case of death of any Kishan Credit Card Holder of 251 PACS/Lamps of Balasore Bhadrak Central Co-operative Bank within 12 Calendar Months of bodily injury resulting solely & directly from accident caused by external, violent & visible & evident means, the legal heirs of the said Kishan Credit Card Holder is entitled to get Rs.5,00,000/- subject to compliance of terms & conditions of the policy. The statement i.e. “so after death of her husband of the complainant the complainant has informed O.P. No.2 with regard to death of her husband due to snake bite & claimed for settled of Rs.5,00,000/- made in same para is not within the special knowledge of O.P. No.1 for which O.Ps does not admit the same.O.P. No.1 has repudiated the claim of the complainant as per the terms & conditions of the policy & intimated the same to the complainant vide letterdt.16.07.2020 which does not constitute any deficiency of service on the part of the O.Ps. O.Ps states that no cause of action has arisen either on 23.06.2018 or 16.07.2020 to file this case against the O.P. No.1. because on 23.06.2018 complainant has not lodged any claim with the O.P. No.1 for the death of deceased Babaji Charan Rout for which O.P. No.1 has repudiated the claim as per the terms & conditions of the issued Group Personal Accident Insurance Policy which does not constitute any deficiency of service on the of the O.Ps. Thus no cause of action has arisen on 16.07.2020 to file this case. O.Ps states that complainant has not filed this case within the period of limitation as provided U/s 69 (1) of C.P. Act, 2019for which this case is barred by limitation.
O.P. No.2 also resisted that the deceased Babaji Charan Rout was K.C.C. holder in Society & his number is 1316 & at the time his death Insurance was covered & the deceased Babaji Charan Rout is entitled to get Rs.5,00,000/- as because the complainant’s husband has deposited Rs.11,506/- along with other members in favour of O.P. No.1 through Cheque bearing No.407338 on dt.08.05.2018 as deceased was K.C.C. holder & it is admitted that there is no foul play by the complainant for getting claim amount though her husband was dead due to snake bite. Further O.P. No.2 has no objection if the claim amount will be settled in favour of complainant. In view of the above objection, the case may be disposed of according to the process of law.
After hearing the rival contentions and examining the undisputed contentions and the material evidences available in record these following issues cropped up to be answered before arriving into the rightful conclusion of the dispute:
Issue No.1
Whether the complainant has lodged claim within 12 Calendar Months of bodily injury resulting solely & directly from accident and filed this instant complaint within the period of limitation as provided U/s 69 (1) of C.P. Act, 2019?
Issue No.2
Whether the case is bad for non-joinder of necessary party such as Balasore Bhadrak Central Co-operative Bank Ltd., O.T. Road, Balasore who has obtained the Group Personal Accident Insurance Policy from OP No.1?
Issue No.3
Whether the writing of Dr. Deepak Das, M.O., Bhadrak in Section VI of Post Mortem Report on “External Appearance & Section More detailed description of injury of disease” heading as “no external injury found over his body” negates the whole Post Mortem Report?
Issue No.4
Whether the absence of mentioning “Fang Marks” as external injury found over body can vitiate the claim of the complainant? Is snake bite not anaccident caused by external, violent & visible & evident meanswhich took the life of husband of the complainant?
Issue No.5
Whether the OPs are deficient in providing service and committed unfair trade Practice?
Issue No.6
If so, then what relief the complainant is entitled to ?
The husband of the complainant died on 23/06/2018 and the complainant has lodged claim before the OPs on 28/08/2018 within 2 months and filed this instant complaint on 04/09/2020 after the claim was repudiated on 20/07/2020 i.e. after 2 months of repudiation of the claim. So, the complaint has been filed very much within the period of limitation within the meaning of section 69 of COPRA, 2019. So, issue no.1 is answered in favour of the complainant.
The husband of the complainant was a farmer & he had taken group loan on dt.08.05.2018 & his K.C.C. No.1316 with a deposited of an amount of Rs.11,506/- by Cheque bearing No.407338 with O.P. No.1 who is the intermediary of the said Bank. There was no need to make Balasore Bhadrak Central Co-operative Bank Ltd., O.T. Road, Balasore party. Further, there is no claim against the said Bank made in the complaint by the complainant and the said Bank is not a necessary party. So, issue no.2 is also answered in favour of the complainant.
The M.O.,Dr. Deepak Das, in Section VI of Post Mortem Report on “External Appearance & Section More detailed description of injury of disease” heading has written that there is “no external injury found over his body”. Fatal Snake Bites sometime even do not leave any Fang Marks. There may be scratches and bruises so trivial that it can go unnoticed. It shall be wrong to say that the said M.O. did not found any injury of snake bite, particularly when the same doctor has abundantly clearly opined after giving thoughtful consideration to the results and symptoms of P.M. examination as cause of death is ‘SNAKE BITE’. It shall be improper if the OP is allowed to pick up a single line out of context and use the same as per its suitability. So, there is no doubt in the mind of this commission after thorough examination of the materials available in the P.M. Report that the deceased has died of SNAKE BITE and this commissions reckons P.M. Report as a very important piece of evidence.When a person is bitten by a snake, it is definitely an external entity which caused the violent act and resultantly the deceased died and it is clearly understood that the person died due to snake bite. So the cause of death becomes evident.Further, the evidence of OP No.2 does not help the case of the OP No.1. So, issue no.3& 4are answered against the OP No.1.andin favour of the complainant.
The OP No.1 has tried to thwart a genuine claim by raising trivial technicality and thereby willfully causing unnecessary delay in settlement of a genuine claim. Thus the OP No.1 has committed composite unfair trade practice and deficiency in service. So, it is liable to compensate the loss and damage caused to the complainant. So, issue no.5 & 6 are answered in favour of the complainant.
Accordingly it is ordered that:
O R D E R.
In the result complaint be and same is allowed and the O.P. No.1 is directed to pay the claim amount of Rs.5,00,000/- along with 6% interest from the date of filing of the complaint and Rs. 10,000/- towards harassment and mental agony caused to the complainant for the unjust repudiation and deliberate delay in settlement of the claim and another Rs.5,000/- towards cost of litigation. No order against O.P. No.2.
This order is pronounced in the open Court on this the 7th day of February 2023 under my hand and seal of the Commission.
