C.F. CASE No. : CC/11/51
COMPLAINANT : Bela Mahajan,
W/o. Lt. Sridam Mahajan,
Vill. Bera Kamgachhi,
P.O. Ranaghat, P.S. Taherpur,
Dist. Nadia, Pin – 741201
OPPOSITE PARTIES/OPs: 1) The Sr. Divisional Manager,
National Insurance Co. Ltd.
Div. III, 8 India Exchange Place (Gr. Floor)
Kolkata – 700071
2) The Manager,
National Insurance Co. Ltd.
Krishnagar Branch, M.M. Ghosh Street,
P.S. Krishnagar, P.S. Kotwali, Dist. Nadia
3) The Manager,
Golden Trust Financial Services,
Krishnagar Branch,
R.N. Tagore Road,
P.O. Krishnagar, P.S. Kotwali,
Dist. Nadia
PRESENT : SHRI KANAILAL CHAKRABORTY PRESIDENT
: SHRI SHYAMLAL SUKUL MEMBER
DATE OF DELIVERY
OF JUDGMENT : 20th January, 2012
: J U D G M E N T :
In brief, the case of the complainant is that her husband, Late Sridam Mahajan purchased one insurance policy from the OP No. 1 through the OP No. 3 valued at Rs. 2,00,000/- on 23.10.03 and the policy is valid upto 22.10.18. It is her further case that subsequently, Sridam Mahajan shifted to Nishiganj, Dist. Coochbihar where he resided for work. On 29.07.2007 he came back home from his work and entered into his living room. Suddenly, a snake (Gokhro) tried to bite him which was lying on the floor of that room. Then he tried to escape himself by coming out his room when his head was dashed against the door, as a result of which he received injury and to that effect fell down on the ground in a unconscious state. He was then removed to M.J.N. Hospital, Coochbehar where the attending doctor declared him dead on 30.10.07. The matter was intimated to Nisiganj P.S. (outpost) which made a GD Entry also and forwarded to I.C. Mathabhanga P.S. for necessary action. Thereafter, the present complainant being the nominee and wife of the deceased submitted a claim form before the OP, but to no effect. She then moved before the Hon’ble High Court by writ petition on 11.09.09 and the Hon’ble Court after hearing directed the OP to take decision and intimate his decision to the petitioner within six weeks. After a long delay the OP No. 1 repudiated the claim of the petitioner by intimating her by a letter dtd. 11.01.10 without hearing her contention which is an illegal act on the part of the OP No. 1. So having no other alternative she has filed this case praying for the reliefs as stated in the petition of complaint.
Written version is filed on behalf of National Insurance Co. Ltd., inter alia, stating that the complainant has no cause of action to file this case. It is his submission that he received a claim form from the petitioner in respect of her claim and during process she filed a writ petition before the Hon’ble High Court, Calcutta and the Hon’ble Court passed an order on 11.01.09 which was communicated to the OP. On receipt of the order of the Hon’ble Court and after perusing the documents filed by the complainant he came into finding that the case of the complainant did not fall within the terms and conditions of the policy. It was not an accidental death as there was no external injury on the body of the victim and no post mortem was held also. So as per rule of the Insurance Co. her claim was rightly repudiated by this OP. Therefore, she is not entitled to get any relief as prayed for. Hence, the case is liable to be dismissed against him.
The OP No. 3, GTFS has filed a separate written version in this case, inter alia, stating that the policy was purchased by the husband of the complainant through him and the policy belongs to OP No. 1. The policy namely Janata Personal Accident Insurance Policy was issued by the OP No.1 valued at Rs. 2,00,000/- for the period from 23.10.03 to 22.10.18. He has also submitted that as per memorandum of understanding between the OP No. 1 and this OP No. 3, he has no liability to settle the claim of the complainant. He already forwarded the claim application of the complainant to the OP No. 1 for settlement who did not settle it in time and ultimately repudiated the same. So this OP has no liability regarding settlement of payment of any amount to this complainant. All the liabilities rest upon the OP No. 3. Therefore, the complainant has no cause of action to file this case against him and so it is liable to be dismissed against him also.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
Both the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint and the written versions filed by the OPs and after hearing the arguments on behalf of the ld. lawyers of all sides it is available on record that admittedly the husband of the complainant Late Sridam Mahajan purchased one Janata Personal Accident Insurance Policy from the OP No. 1 through the OP No. 3 on 23.10.03 which is valid upto 22.10.18 and the insured amount is Rs. 2,00,000/-. It is also established that the complainant is the wife and nominee of that policy. Complainant’s specific case is that Sridam Mahajan died in an accident when he tried to come out of his bedroom out of fear to see one snake when he dashed against the door of that room as a result of which he fell down and became unconscious. He has removed to M.J.N. Hospital, Coochbehar where the attending physician declared him dead. On the other hand, it is the submission of the OPs that this death of the complainant is a natural one and not an accidental one. So he repudiated the claim of the complainant. Complainant has filed some documents which are A-2 to A-8. A-2 is the death certificate issued by M.J.N. Hospital, Coochbehar stating that the death was caused due to Cerebro Vascular Accident. Admittedly, in this case no post mortem of the dead body was held by the Hospital authority. From the A-4 it is available that the complainant intimated the incident to the Officer-in-Charge, Nisiganj P.S. (outpost), inter alia, stating the fact how her husband received the accident which ultimately caused his death. Officer of the outpost forwarded that letter to I.C. of Mathabhanga P.S. One G.D. Entry was done by Nisiganj P.S. being No. 567 dtd. 30.07.07. From the report of the Officer-in-Charge of the outpost it is available that as per opinion of the medical officer as well as death certificate given by Dr. Tushar Kanti Chanda, M.O. M.J.N. Hospital, Coochbehar, cause of death is mentioned as follows, “Sridam Mahajan, S/o Late Bhim Chandra Mahajan, age-52 years, sex-male, was admitted to this Hospital on 29.07.07 and expired on 29.07.07 at 9.35 pm due to Cerebro Vascular Accident. Actually post mortem examination is required to ascertain the real cause of death, in this case attending Medical Officer has clearly opined in this regard. So question of post mortem examination does not arise.” He has also stated in his report that on enquiry he has come to the finding that the death of her husband is true and there is no foul play or unfair means detected behind this death.
Now the main question is whether this death of the victim falls within the category of accidental death as this insure was done against accidental death / loss of limbs / permanent total disablement etc. In those cases the benefit is available to the insured party. Ld. lawyer for the complainant has drawn our attention to the definition of accident from Taylor’s book Principles and Practice of Medical Jurisprudence, page 424 where it is stated that “The term ‘accident’ has not a precisely defined legal meaning, and it may refer either to the personal injury which has resulted or to the mechanical cause of the injury. It may be described as any unexpected or unforeseen mishap or untoward event which is not expected or designed. The distinction between an unforeseen event and the result of that event is not always clear.” It is also stated in that book that “As a result of numerous judicial decisions, the term ‘accident’ has been amplified and extended beyond its original meaning, and includes many conditions which have arisen from natural disease, but in which the occupation has contributed in some degree to the result.” In this book it is also stated that “The victim of injury may have become exposed to hurt as a result of natural disease such as hypertension, coronary occlusion, epilepsy and the like – capable of causing momentary faintness or even complete loss of consciousness.”
On a careful perusal of the definition of accident as given by Dr. Taylor, we find that there is no agreed definition of accident. Rather we hold that it happens suddenly without a previous incident. Here in this case, we find that the victim on seeing a snake (Gokhro) at his bedroom tried to come out of that room quickly to escape himself, when he suddenly dashed against the door of that room and fell down on the ground in an unconscious state of affairs. Undoubtedly it is an accidental case. The doctor who examined him at the Hospital has clearly stated in the death report that the death was caused due to Cerebro Vascular Accident. This disease cropped up suddenly when he fell down on the ground being dashed against the door and ultimately expired. There is no hard and fast rule that post mortem of the dead body is compulsory to detect the death caused by an accident. It is the doctor who examined the patient did not advise for post mortem examination as he was satisfied that the death was caused due to Cerebro Vascular Accident.
Therefore, considering the facts of this case along with the annexed documents and the Medical Jurisprudence book, we have no hesitation to hold that the death of the victim was caused due to an accident. Actually it is an accidental death. We do further hold that it falls within the category of coverage of the policy. So the OP Insurance Co. is not right at all in repudiating the claim of the complainant. Besides this, from ‘Annexure – 7’ it is available that in the writ petition filed by the complainant the Hon’ble High Court directed this OP No. 1 that before settling the claim of the complainant, he should give the petitioner a personal hearing in this matter and also directed to consider that. It is the petitioner’s case that the Cerebro Vascular Accident took place upon the insured having come into contact with a snake when the snake did not actually bite the insured. But no where in the written version, we find that the OP heard the contention of the complainant. He only repudiated the claim coming into the conclusion that it was a natural death as there was no post mortem report of the dead body.
In view of the above discussions and considering all these we find that the OP Insurance Co. is not at all correct in its decision to repudiate the claim of the complainant. Rather we hold that the complainant has become able to prove her case. So she is entitled to get the reliefs as prayed for. As per Memorandum of Understanding between the OP No. 1 & 3, it is the liability of the OP No. 1 to settle the claim of the complainant which is also admitted by the ld. lawyer for the OP No. 1 at the time of argument. In result the case succeeds.
Hence,
Ordered,
That the case, CC/11/51 be and the same is decreed on contest against the OPs. The complainant is entitled to get a decree amounting to Rs. 2,00,000/- plus Rs. 5,000/- for the harassment caused to her along with Rs. 2,000/- as litigation cost, i.e., in total Rs. 2,07,000/-. The OP No. 1 & 2 are jointly and severally liable to pay the decretal amount of Rs. 2,07,000/- to this complainant within a period of one month since this date of passing this judgment, in default, the decretal amount will carry interest @10% per annum since this date till the date of realization of the full amount. We make no order against the OP No. 3.
Let a copy of this judgment be delivered to the parties free of cost.
