(Delivered on 08/11/2024)

Per Mrs Kalyani Kapse, Hon’ble  Presiding Member

1.         Appellant /complainant  has preferred the  present  appeal  challenging the impugned order  dated 01/09/2022 passed by the  learned District Consumer Disputes Redressal Commission, Chandrapur in Consumer Complaint No. CC/112/2020 by which  the consumer complaint  filed by the complainant /appellant  came to be dismissed.

            Short  facts  leading  to  filing of the appeal may be narrated  as under:-

2.         That, the  appellant had filed  a complaint  before  the  Learned District Consumer Disputes Redressal Commission, Chandrapur which was  registered as complaint No. 112/2020. In  a nutshell it is a case of the appellant that  the appellant is a widow of Shri Yadav Jairam Pendor who was an agriculturist of agricultural  field at Mouza Pomphurna, Tah. Pombhurna, Dist. Chandrapur. The entire family members of the late Shri Yadav Jairam Pendor are depending upon the only income from the said agricultural filed. The husband of the appellant was insured under Farmers Janta Personal Insurance Policy during the year 2018-2019 for Rs. 2,00,000/- by the Government  of Maharashtra through  the respondent Nos. 1&2 i.e . the Oriental  Insurance  Co. Ltd.. Respondent No. 3 is Insurance  Broker Company & Respondent No. 4 Taluka Krushi Adhikari appointed  by the Government  of Maharashtra for receiving  the claim from farmers at Taluka level itself and then to forward it to respondent  No. 1 & respondent No. 2.

3.         The husband of complainant Shri Yadav Jairam Pendor met with an accident  on 28/09/2019 as he fell from tree of  moha and subsequently  died due to injuries. The claim  under  Farmer’s Janta Personal  Insurance  Policy was submitted by the appellant  to the Respondent No. 4 and the accident occurred during the validity of the said policy.  The appellant  after  providing all relevant documents as per instructions of non applicant No. 4 for settlement of the claim did not received the compensation  and non applicant  has not conveyed any information on the  status  of the claim. Being  aggrieved  by the inaction  on the part of the  respondents  the appellant  had filed complaint case before  the learned District Consumer Disputes Redressal Commission, Chandrapur.

4.         That, the respondent Nos. 1&2 had appeared  in the matter  and  filed their reply submitting  that they  have not receive FIR and other  policy  papers, P.M. Report and hence, accident  is not proved  hence, question  of payment of compensation does not  arises at all but did  not mention  whether  claim  was  repudiated for want  of  documents. That  the appellant had filed  affidavit  and written notes on  the reply of respondent  Nos. 1&2, that the  District Forum vide its order dated 01/09/2022 dismissed  the entire  complaint  by findings that since only one basis of  referral  card of  Rural Hospital  is not proved. Hence, the complainant  was constrained  to file  complaint.

5.         After  filing of the complaint , notices  were came to  be issued  to the O.P.Nos. 1&2 who were the  Oriental  Insurance Company Ltd. through  its Divisional  Manager and  Branch  Manager. O.P.No. 3  Jaika Insurance  Brokers Pvt. Ltd.  and O.P.No. 4 Taluka Krishi Adhikari, Chandrapur  appeared and resisted  the complaint by filing written  version  on record.  The O.P.Nos. 1&2 has denied all the contentions  and allegations  levelled by the complainant.

6.         The learned District Consumer Disputes  Redressal Commission, Chandrapur  thereafter  recorded  the evidence  led by the complainant  as well as O.P. The learned  District Consumer Disputes Redressal Commission, Nagpur also went  through  the documents  filed by both the parties  as well as written notes of arguments. After  appreciating  the oral and documentary  evidence, the learned District Consumer Disputes Redressal Commission, Chandrapur dismissed the complaint.

7.         We have heard, Mr. Uday Kshirsagar, learned advocate  appearing   for the appellant /original  complainant. We have  also heard  Mr. Lalit Limaye, learned advocate for the   respondent /original  O.P.   We have also  carefully  gone through  the documents  and papers which are  placed on record by both the parties.

8.         On the basis  of the facts stated above, the following  points are arises for our determination  with our finding  recorded  against  the same.

Reasons

As to point No. 1:-

9.         That the appellant had filed a complaint before the learned District Consumer Disputes Redressal Commission, Chandrapur which was registered  as complaint  No. 112/2020. In a nutshell  it is a case of the appellant  that the appellant is a  widow of Shri Yadav Jairam Pendor who was an agriculturist of agricultural field at Mouza Pomphurna, Tah Pombhurna , Distt. Chandrapur. The entire family members of the late Shri Yadav Jairam Pendor are depending upon the only income from the said agricultural  field. The husband of the appellant wa insured under the Farmers Janta Personal Insurance  Policy  during the year 2018-2019 for  Rs. 2,00,000/- by the Government of Maharashtra through  the respondent  No. 1&2 i.e. the  Oriental Insurance  Co. Ltd.. The respondent No. 3 is Insurance Broker Company & Respondent No. 4 Taluka Krushi Adhikari appointed by the government  of Maharashtra for receiving the claim from farmers  at Taluka leveal itself and then to forward it to  the respondent  No. 1 and respondent No. 2.

10.       The  husband of complainant Shri Yadav Jairam Pendor met with an accident  on 28/09/2019 as he fell from tree of moha and subsequently died due to injuries. The claim under  Farmer’s Janta  Personal  Insurance Policy  was submitted by the appellant  to the respondent  No. 4 being  a lone legal  heir and the accident  occurred  during the validity of the said policy. The appellant  after providing  all relevant  documents as per instructions of non applicant No. 4 for  settlement of the claim did not received the compensation  and non applicant  has not conveyed any information  on the status of the claim. Being  aggrieved by the inaction  on the part of the respondents  the appellant  had filed complaint case before the learned District Consumer Disputes Redressal Commission, Chandrapur.

11.       That  the respondent  No. 1&2 had appeared  in the matter and filed their reply submitting  that they have not received FIR and other  policy  papers , P.M. Report  and therefore,  accident  is  not proved  hence the question  of payment  of compensation  does not arises at all.

12.       The learned advocate for the appellant  raised  first ground of appeal  that the learned District Consumer Disputes Redressal Commission, Chandrapur also failed  to  appreciate  the  fact that  the appellant  had already  in her complaint  on oath , affidavit and written  notes of arguments  specifically stated that  the learned District Consumer Disputes Redressal Commission, Chandrapur also failed  to appreciate the fact that cause regarding   death is due to  fall from tree is already  given in  referral card and letter from Tahsildar, Pombhurna to Talathi Pombhurna and since F.I.R. is not registered  and P.M. is not  done these  documents  cannot be given. The respondent Nos. 1&2 had submitted that they have demanded those documents and not stated anywhere in the reply that claim was repudiated. The lower Commission did not truly appreciate the  contents of the reply of respondent  no. 1&2 and did not carefully go through the documents  filed on record. The appellant  has informed the O.P. that F.I.R. is not registered at all and is not necessary  as per various rulings  given by  the Hon’ble  National Commission.

13.       The appellant further contended that the learned District Consumer Disputes Redressal Commission, Chandrapur erred  in his conclusion that  the appellant failed  to submit the documents  as per demand of Taluka Krushi Adhikari, i.e.  respondent No. 4 then the claim was repudiated on wrong  ground  as the condition of providing F.I.R. and P.M. Report  is not at all necessary as per various rulings given by Hon’ble National Commission and as per G.R. alternative documents  can be considered. The learned District Consumer Disputes Redressal Commission, Chandrapur failed  to appreciate the  judgment  filed by the appellant  given by the Hon’ble National Commission in  II (2008) CPJ 371 (NC), New India Assurance Co. Ltd. Vs. State of Haryana and ors, wherein the  Hon’ble National Commission observed that  insurer cannot  discount  and reject reports and statements of Government  Hospital Authorities, Gram Panchyat and other  Government  authorities without  evidence to  contrary. Wheil  the  Hon’ble National Commission in  II(2013) CPJ 486 (NC), New India Assurance  Co. Ltd. Vs. Jatinderkumar Sharma  gave ruling that  merely because FIR is not lodged regarding accident  and complainant  was not  admitted for medical treatment immediately it can not be inferred that  complainant did not sustain any injury on account of  accident.  The Hon’ble National  Commission in latest ruling  in 2018 (1) CPR 305(NC), Bajaj Allianze Vs. Harpal Singh  & Anr.  observed that  logically  if a person accidently falls in his/her  death a doctor  will be called  and he certifies cause of death. The family  members will not take his/her body for  post mortem. In order to prove that  deceased had died  in accidental  fall complainants besides their  own  affidavits by way of evidence also filed affidavit of registered  medical practioner.

14.       The respondents have  not proved any non receipt  of documents except FIR and P.M. report which are not necessary in view of all  Hon’ble  National  Commission rulings and even a referral  card and letter by Tahsildar to Talathi informing  him cause of death is sufficient to prove  accident  and respondent No. 1&2 should have  settled the claim  as said  Farmers Janta Insurance  Policy  is a policy  issued by the Government  for a social cause. The appellant  had properly submitted  her claim through  proper  channel with all documents  except  FIR and P.M. Report   which are  not necessary and filed referral card of Government  Medical  Hospital, Chandrapur showing “Blunt Trauma Chest” as cause for  reference to Government  Medical  College, Nagpur and there is no fault  of appellant  in this matter. The learned District Consumer Disputes Redressal Commission, Chandrapur also  failed to appreciate that fact that  the respondent  No. 1&2 should have  considered the claim during  the pendency of the complaint  as all documents  are  supplied with the complaint  itself .

15.       The  respondents appeared in the consumer  complaint No. CC/112/2020 and filed their  written  version.  The respondents  has also  filed  the  affidavit  and  written  notes of  arguments in  respective stages. The  respondents  has raised  the specific  defence that the appellant has  not filed the papers such as the FIR, Spot Panchanama, Inquest Panchanama and Post mortem  Report  to establish the cause of the death  of the deceased . The respondents  has  also  raised  the defence about  the filing  of the claim at belated stage. The  respondents  are  relying  on the  defence  raised  in their written  version , affidavit  and the written  notes of arguments.

16.       It is  submitted by the  appellant  has filed the false  and baseless complaint  without  any documentary proof. The  appellant has lodged her claim as per the G.R. of Maharashtra Government . As per the G.R.  of the Maharashtra Government  the filing of the police  documents are  mandatory.  In  case of the accident   it is mandatory to file all the police  papers along with  the 7/12 extract, 6 dand 6k. Those documents  are necessary to ascertain the claim. Here, the appellant  has completely failed to  file copy  of police papers such as FIR, Spot Panchanama, Inquest Panchanama and Post Mortem Report . Thus, there is  violation  of the conditions  of the G.R. The respondents f has duly asked for the copies of the police  documents  but the appellant  has mentioned that no police  complaint  was  lodge and therefore, those police  documents  are not filed.  The respondent  No. 3 had also filed their written  version  and stated that  the respondent  No. 3 has  asked documents  that is FIR, Spot Panchanama, Inquest Panchanama, Post Mortem Report  from the appellant  but those documents  were  never supplied  by the appellant.

17.       It is submitted by the respondent   that the police  papers  are necessary  to  decide  the claim, as the G.R. covers the risk towards the accident  only. It is necessary  to prove that the deceased was  died due to  the accident . Here in  the  present  matter  the appellant  has only  mentioned in her complaint that the deceased  died as he  fallen  from the tree but there  is no documentary  evidence  that  the  deceased  has climbed on the tree  and then he fallen from the  tree. Mere  giving the facts  on oath in consumer complaint  will not  solve the purpose  that the deceased  was died due to  the accident.  The appellant  has also failed to file the report of the  Police  Patil in village  that  any such  incident  have happened. Without  any documentary proof  it cannot  be said that  the  deceased  was died  due to the accident.

18.       We have  carefully gone through the documents  filed on record  by the  parties , medical  documents. Appellant  relying   on  one medical document  field on page no. 46 which is transfer letter which  states to transfer the patient from one hospital  to another.  But, said  document  does not shows cause of the death of the deceased . The appellant  ought to have filed doctor  certificate  mentioning the cause  of the death  of the deceased . The said  document is vague and the same is not establishing the cause  of  the death  or who is the  treating  doctor or name of doctor  who has issued the certificate . There is  no stamp affixed of nay hospital  and / or of any doctor. Therefore, is hard to believe that the deceased  was died  due to  the accident.  The initial  burden is on the appellant  to establish  that  deceased  was died  due to the  accident  but , in the present  case the appellant  has not  discharge her  burden and therefore the learned District Consumer Disputes Redressal Commission, Chandrapur has rightly  rejected the consumer  complaint.

19.       It is submitted by the respondent  that  the appellant  has submitted  some case laws and  that are not applicable to the  present  case. In the  last case law filed by the  appellant  viz Bajaj Vs. Harpal  the  observation  is given  that  in case  of accidental  fall the  complainants  besides their own  affidavit by way of evidence  also filed  affidavit of the registered  Medical Practioner. Herein  the present  case  no such evidence  is brought  on record  by filing the  evidence of the doctor  to establish that  the deceased  was died  due to the accident.

20.       The respondent has specifically  argued that  the  appellant  has  intentionally  suppressed  the medical  paprs /treatment papers  of the  deceased  with ulterior motive. The appellant  ought to have filed all the medical report  to establish the correct story of the incident . But  the appellant  failed to file the medical  papers  and therefore, there  is no occasion for the answering  respondents  to verify the  true story  of the incident . Even also the claim was lodged at belated stage and therefore   there  was not occasion to verify the incident.

21.       The respondent Insurance  Company is relying on the following  authorities.

a.         Shakuntala Vs. Oriental Insurance  Co. and Ors., I (2008)CPJ 135(NC).

            The Hon’ble National  Commission  has held that  petitioner  failed to brought any admissible  evidence to prove the accident.

b.         In Shakuntala Vs. National  Insurance Company Ltd and Ors, R.P. No. 3975/2011.

             It was held that  onus lies upon the petitioner  to prove  the fact that  deceased  died due to accidental  injury.

c.         In HDFC ERGO General  Insurance  Company Vs. Smt. Rashlal [F.A. No. 845/2017]

            “A bare perusal  clearly shows that the documents is not  reliable as doctor has not  made any diagnosis rather after death  of the person  a certificate  has been issued  which is not  the common practice of doctors in preparing  prescription  slip, and further  more when the deceased had  died a unnatural death  the concerned  doctor has not referred the matter  for post-mortem.

d.         In Smt. Budhwara Bai  Vs. Oriental  Insurance  Co. Ltd. & Anr. [F.A./14/688]

            “Being  an administrative officer  of the village it is  duty  caste upon the Sarpanch to give  information  regarding  death of the  deceased”.

e.         In United  India  Insurance  Company Ltd Vs. Sewaram [F.A. No. 60/2010]

            "Mere statement in the Consumer  Complaint  of bald averment  of the complainant  in his affidavit  would not be sufficient to satisfy the condition  of the policy  of the insurance”.

22.       We have carefully  gone through  the impugned  order dated 01/09/2022 passed by the  learned District Consumer  Disputes Redressal Commission, Chandrapur in Consumer Complaint No. CC/112/2020. On  appreciating  the submission  of the parties  and carefully  consideration  of material  on record, we have found  that the learned District Consumer  Disputes Redressal Commission, Chandrapur while passing  the impugned  order dated  01/09/2020 has appreciated  the evidence  on record  produced by the parties  concerned in right  perspective.  It has also seen  from  impugned order  that  the findings  recorded  by the learned District Consumer  Disputes Redressal Commission, Chandrapur made  on the basis of sound material  to support  it. We found  that  the learned District Consumer  Disputes Redressal Commission, Chandrapur has dealt with  grounds raised before  it which do not  suffer from any infirmity. The learned District Consumer  Disputes Redressal Commission, Chandrapur has elaborately dealt with  all these aspects  and has also given  findings  which do not suffer from any  patent illegality  needs no interference of this  Commission.

23.       We are of the view There is no evidence  to analyse that it was  a death that took place  due to  the accident.  The document filed  on  page No. 46 is not conclusive  proof  that  the deceased  met with an accident. The document only show the transfer  of patient  from one hospital  to another  hospital . The said document is not a doctor  certificate  to establish  the cause  of the death  of the  deceased  and  therefore  the said  document cannot be   relied which  deciding the said  dispute. The  appellant  failed  to  show the deficiency in service  on the part of the respondents, hence,  the said appeal  is liable  to be rejected.  In the light of aforesaid discussion, we are unable to accept  the contentions  advanced by the learned  advocate  of the appellant  against  the impugned order challenged  under this  appeal.  Thus, we proceed to pass the following order,

ORDER

i.          Appeal is hereby dismissed.

ii.          Parties  to bear their  own cost, in the  peculiar  facts of the case.

iii.         Copy of order be furnished to both the parties free of cost.