DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: BHADRAK : (ODISHA).
C. C. No. 65 of 2019.
Date of hearing : 23.05.2023.
Date of order : 13.06.2023.
Dated the 13th day of June 2023.
- Basanti Sethi , W/o:- Late Abhiram Sethi,
- Tapan Kumar Sethi , S/o:- Late Abhiram Sethi,
- Jyotirmayee Sethi , D/o:- Late Abhiram Sethi,
- Sabitri Sethi , D/o:- Late Abhiram Sethi
All are of Vill/Po:- Brahmanigan,P.S:- Basudevpur,
Dist:- Bhadrak. .................Petitioners.
(Versus)
- The Secretary, Brahmanigan Co- Operative
Service Society, Brahmanigan,
Vill/Po:- Brahmanigan , P.S:- Basudevpur,
Dist:- Bhadrak, Pin- 756165.
Balasore-Bhadrak Central Co- Operative Bank Ltd.
At:- Remuna Golei , Balasore , O.T Road.
Dist:- Balasore , Pin-756001.
M/S Oriental Insurance Co. Ltd.,
At- Police Line Square, O.T. Road,
Po/PS/Dist:- Balasore, Odisha. ……………… Opp. Parties.
P R E S E N T S.
1. Shri Shiba Prasad Mohanty, President,
2. Smt. Madhusmita Swain, Member.
Counsel appeared for the parties.
Counsel For Complainant : Sri A.K. Swain, Advocate.
Counsel For O.P.No.1& 2 : None,
Counsel for O.P. No. 3 : Sri A.K. Panda, Advocate.
J U D G M E N T.
SMT. MADHUSMITA SWAIN, MEMBER.
Complainant filed Consumer Complaint U/s 12 of C.P. Act, 1986 seeking following reliefs “allow this claim application and direct opposite to pay the claim amount of Rs.5,50,000/- to complainant along with interest @ 12% per annum w.e.f. 11.04.2019.”
Brief fact of the case is that, complainant’s husband late Abhiram Sethi S/o:- Late Krushna Chandra Sethi of village Brahmanigan, P.S:- Basudevpur, Dist:- Bhadrak was a member of Brahmanigan Service Co-Operative Society Ltd. of Balasore-Bhadrak Central Co-Operative Society Ltd. of Balasore Bhadrak Central Co-operative Bank Ltd., vide Membership No.1734 & KCC No. 040401734 and continuing transaction with the same society. The O.P.No.1 i.e. Society purchased Group personal accidental policy for each members of society from Oriental Insurance Company who is O.P.No.3 of Rs.5,00,000/- vide Policy No.-345700/48/2018/230. The deceased Abhiram Sethi was also insured through the policy. The Group Personal Accident Policy in case of accidental death of the member of the society. The legal heirs of the deceased member of the society will get an accidental death benefit of Rs.5,00,000/- from the Oriental Insurance Company i.e. O.P.No.3. Late Abhiram Sethi was a tractor driver & his D.L. No. is 4321 valid upto 10.03.2018. On 22.01.2018 while late Abhiram Sethi was driving the tractor bearing Regd. No. OD-22-J-6079 from Bikamudi to Bachhipur road under Basudevpur Police Station near Bachhipur Tarini Chhaka suddenly one bull came in front of the tractor and the deceased driver suddenly applied break to stop the vehicle but unfortunately he lost his control & the tractor capsized into the roadside canal and after accident the local people rescued the driver Abhiram Sethi and immediately shifted him to C.H.C. Basudepur where doctor declared him dead.
The matter was reported to Basudevpur Police Station, Bhadrak where FIR No. registered with P.S. Case No.13/2018 U/s 279/304 (A) of IPC was registered and inquest on dead body of the deceased was conducted. Postmortem examination was done by C.H.C. Basudevpur where the doctor mentioned the cause of death is due to Asphyxia due to drowning
After accident claimants intimate all facts to Oriental Insurance Company who is O.P.No.3 with all relevant documents & claim was lodged through the Secretary Brahmanigan Service Co-Operative Society vide Claim No.345700/48/2019/ 000004. The O.P.No.3 sent a repudiation letter stating as per post mortem report death caused due to Asphyxia due to drowning. But as per inquest report the death has been caused due to tractor accident. Investigator has opined that there is no conclusive evidence about the cause of death. On this ground claim may be repudiated. Hence this complaint.
Complainant submitted following documents in favour of her case.
- Xerox copy of K.C.C.,
- Xerox copy of Aadhaar Card,
- Xerox copy of letter of Brahmanigan Service Society Ltd. Brahmanigan,
- Copy of cheque book issued in favour of the deceased,
- Copy Repudiate letter
- Xerox copy of FIR,
- Xerox copy of final form,
- Xerox copy of Inquest form,
- Xerox copy Dead body Chalan of the deceased,
- Xerox copy of Post Mortem Report,
- Xerox copy of three seizure lists,
- Xerox copy of two Zimanamas,
- Xerox copy of Crime details forms,
- Xerox copy of D.L. of the deceased and
- Xerox copy of claim form.
O.Ps filed their written version and stated that the group personal accident insurance unnamed policy bearing No.345700/48/2018/230 for the period from 20.08.2017 to midnight of 19.08.2018 taken by the Balasore Bhadrak Central Co-Operative Bank Ltd. O.T. Road Balasore-756001 covers the death of the Kishan Credit Card holder of 251PACS/LAMPCS of the Bank within 12 months of bodily injury resulting solely and directly from an accident caused by external, violent and visible means. But in the instant case Dr. Karunakar Rout, Sr. Medical officer of DHH, Bhadrak who has conducted post mortem examination over the dead body of the deceased Abhiram Sethi has not found any external injury over his dead body. Hence the deceased Abhiram Sethi has not died due to bodily injury resulting solely and directly from an accident caused by external, violent and visible means and as such the claim lodged by the complainant is not covered/admissible under the said Group Personal Accident Insurance Policy for which the insurer/O.P.No.2 has repudiated the claim of the complainant and intimated the same to the complainant 1 vide letter dated 20.06.2019.
Following issues are framed to adjudicate the case.
Issue No.1.
Whether complainant is a consumer or not ?
It is clear that complainant is a member of Brahmanigan Service Co-Operative Society Ltd. of Balasore-Bhadrak Central Co-Operative Bank vide Membership No.1734 & KCC No.040401734 & the Society purchased Personal Accident Policy (Group) from the O.P.No.3 i.e. the Oriental Insurance Company united for the complainant vide Policy No.345700/48/2018/230 with consideration. The complainant is a consumer as per section 2 (7) of C.P. Act, 2019. Issue No.1 is answered in favour of the complainant.
Issue No.2.
Is there any deficiency in service on the part of the opposite party ?
It is clear from O.P’s averment that the group personal accident insurance policy bearing No. 345700/48/2018/230 was in force from 30.08.2017 to midnight of 19.08.2018. On 22.01.2018 while deceased Abhiram Sethi was driving the tractor of Arun Kumar Satpathy with registration No. OD-22-J-6079 near Bachhipur Tarini Chhaka suddenly one bull came in front of the tractor and the deceased driver although applied the break to stop the tractor unfortunately he lost his control on the said tractor capsized to the roadside canal and the driver was under the tractor and after the accident the local people rescued the deceased Abhiram Sethi and immediately shifted to CHC, Basudevpur where the doctor declared him dead. The accident occurred within the policy period. The O.P. insurance company repudiated the claim only because of there is no bodily injury resulting solely and directly from an accident caused by external, violent & visible means. But in the post mortem report the doctor stated in Brief history that “Deceased was a tractor driver where tractor got upside down and the driver was drowned and cause of death in the post mortem report is Asphyxia due to drowning. As per Police Investigation report of Basudevpur P.S. the deceased Abhiram Sethi has died due to accident of tractor.
From the post mortem report & police investigation report it is clear the deceased Abhiram Sethi died due to accident of the tractor which resulted solely & directly in the death of the deceased by drowning. So repudiation of O.P. is a clear negligence which creates deficiency of service on the part of O.P. So Issue No.2 is in favour of complainant.
O R D E R.
In the result, complaint be and same is allowed. We direct the O.P. No.3 to settle the claim of complainant within 30 days from the receipt of the order along with 6% interest from 11.04.2019 till finalization of the claim.
The consumer complaint is disposed of.
This order is pronounced in the open Court on this the 13th day of June 2023 under my hand and seal of the Commission.
