Haryana

Karnal

CC/341/2022

Savita Devi - Complainant(s)

Versus

United India Insurance Company Limited - Opp.Party(s)

Ajay Kumar

05 Aug 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

 

                                                        Complaint No.341 of 2022

                                                        Date of instt.15.06.2022

                                                        Date of Decision:05.08.2024

 

Savita Devi wife of late Shri Pankaj son of Shri Surat Singh, resident of village Rasoolpur Khurd, District Karnal. Aadhar no.4124 4498 6265.

 

                                                                   …….Complainant.

                                              Versus

 

United India Insurance Company Limited, through its Senior Divisional Manager, G.T. Road, Karnal.

                                                                   …..Opposite Party.

 

Complaint under Section 35 of Consumer Protection Act, 2019.

 

Before   Shri Jaswant Singh……President.     

      Shri Vineet Kaushik…….Member

      Ms. Sarvjeet Kaur..…..Member

 

 Argued by: Shri Ajay Kumar, counsel  for the complainant.

                    Shri Virender Adlakha, counsel for the OP.

 

                     (Jaswant Singh, President)

ORDER:   

                

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite party (hereinafter referred to as ‘OP’) on the averments that husband of complainant namely Pankaj was working as Assistant with the OP and had taken the insurance policy bearing no.1107014220P112097072 from OP.  On 25.10.2021, the husband of complainant was having some giddiness and the problem remained continued for next day. The patient was got admitted in Shree Hari Hospital, Karnal on 26.10.2021 at about 11.50 a.m. where the doctors took him in intensive care unit. After complete diagnosis, the doctors of Shree Hari Hospital, Karnal told the complainant and her family members that Pankaj is suffering from Dengue and his platelets have comes to the count of 24000. The doctors further suggested for transfusion of the platelets and asked to bring platelets from Sikka Blood Bank, Hospital Chowk, Karnal. Surat Singh father of Pankaj brought one unit of platelets from Sikka Laboratory, Karnal by making payment of Rs.11,000/-, vide receipt no.3558 dated 26.10.2021. The said platelets were transfused by Dr. Kanuj to the patient. On next date i.e. on 27.10.2021, Dr. Kanuj Arora further asked to bring one more unit of platelets from Sikka Blood Bank, Karnal and same was taken from Sikka Blood Bank, after making payment of Rs.11,000/- vide receipt no.3585 dated 27.10.2021. Immediately, after transfusion of the second unit of platelets by Dr. Kanuj Arora, the health of Pankaj started deteriorating and when the matter was reported to the Doctor, Dr. Kanuj Arora immediately stopped the transfusion and said that this unit of platelets is of poor quality and asked the family members of the complainant to give it back to Sikka Blood bank. He further told to bring one fresh unit of platelets from the Blood Bank but when Shri Surat Singh-father of Pankaj approached Sikka Blood Bank, one Shri J.K. Sikka, was present at the counter immediately took the possession of the returned unit and further told him that he had conversion with Doctor and now there was no need for the Platelets and even did not return the money of returned unit. On 27.10.2021 at about 4.30 p.m. when patient’s health started deteriorating, the doctors of hospital grossly neglected the patient and shift him to some tertiary medical centre and on being questioned there was nobody give a befitting reply to the query of the attendant and subsequently the death of patient ensued. Since the patient was having accidental insurance policy from the OP, hence the complainant lodged the claim with the OP and submitted all the required documents. Thereafter, complainant requested the OP several times to settle the claim but OP did not pay any heed to the request of complainant and lastly repudiated the claim of complainant, vide letter dated 31.03.2022 on the false and frivolous ground. In this way there is deficiency in service and unfair trade practice on the part of the OP. Hence this complaint.

2.             On notice, OP appeared and filed its written version raising preliminary objections with regard to maintainability; mis-joinder and non-joinder of parties; premature and concealment of true and material facts. On merits, it is pleaded that the Platelets supplied by Sikka Blood Bank were of poor quality as opined by Dr. Kanuj Arora, as such Sikka Blood Bank is necessary party and the death has occurred on account of supply of poor quality platelets by Sikka Blood Bank. It is further pleaded that as per investigation report, Mr. Pankaj had died due to Dengue fever which is not covered under the scope of policy.  Thus, the claim of complainant has rightly been repudiated by the OP. There is no deficiency in service and unfair trade practice on the part of the OPs. The other allegations made in the complaint have been denied and prayed for dismissal of the complaint.

3.             Parties then led their respective evidence.

4.             Parties then led their respective evidence.

5.             Learned counsel for the complainant has tendered into evidence affidavit of complainant Ex.CW1/A, copy of death certificate of Pankaj Ex.C1, copy of letter dated 31.03.2022 Ex.C2, copy of newspaper cutting dated 06.02.2022 Ex.C3, copy of complaint to CM Window Ex.C4, copy of complaint to SP Ex.C5, copy of complaint to IGP Ex.C6, copy of complaint to Anil Vij (Health Minister) Ex.C7, copy of letter to Civil Surgeon Ex.C8, copy of statement of father of deceased Ex.C9, copy of investigation report Ex.C10, copy of complaint to Health Minister Ex.C11, copy of PMR Ex.C12, copy of OPD slip Shree Hari Hospital Ex.C13, copy of admission from Ex.C14, copy of general admission form Ex.C15, copies of progress sheets Ex.C16 and Ex.C17, copy of death summary Ex.C18, copies of Transfusion record Ex.C19 and Ex.C20, copy of Nursing Admission Assessment Ex.C21, copy of medication chart Ex.C22, copy of 24 hours outpatient chart Ex.C23, copy of blood sugar chart Ex.C24, copy of blood report dated 26.10.2021 Ex.C25, copy of Diagnostic Information Ex.C26, copy of blood report Ex.C27, copy of morning shift report Ex.C28, copy of report dated 26.10.2021 Ex.C29, copy of blood requisition form Ex.C30, copy of newspaper cutting Ex.C31 and closed the evidence on 21.12.2022 by suffering separate statement.

6.             On the other hand, learned counsel for the OPs has tendered into evidence affidavit of Shamsher Singh, Investigator Ex.OPW1/A, affidavit of Raj Kamal Saini, Assistant Manager Ex.OPW2/B, copy of application dated 24.02.2022 Ex.OP1, cop of statement of Surat Singh Ex.OP2, copy of application by complainant to OP Ex.OP3, copy of insurance policy Ex.OP4, copy of surveyor report Ex.OP5, copy of newspaper cutting Ex.OP6, copy of Transfusion record Ex.OP7, copy of post mortem report Ex.OP8, copy of repudiation letter dated 31.0.2022 Ex.OP9, postal receipt Ex.OP10, copy of death summary Ex.OP11 and closed the evidence on 13.12.2023 by suffering separate statement.

7.             We have heard the learned counsel for the parties and perused the case file carefully and have also gone through the evidence led by the parties.

8.             Learned counsel for the complainant, while reiterating the contents of complaint, has vehemently argued that husband of complainant had purchased the insurance policy from the OP.  On 25.10.2021, he was suffering from Dengue and on 26.10.2021 was admitted in Shree Hari Hospital. The claim was submitted with the OP but OP has rejected the claim of the complainant on the ground that the ‘Dengu’ is not cover under the terms of the policy whereas Dengu was covered.  In this regard, learned counsel for the complainant relied upon the case law titled as Branch Manager National Insurance Company Ltd. Vs. Mousumi Bhattacharjee and others in Revision Petition no.1270 of 2016, decided on 12.05.2016.

9.             Per contra, learned counsel for the OP, while reiterating the contents of written version, has vehemently argued that Mr. Pankaj had died due to Dengue fever which is not covered under the scope of policy.  Thus, the claim of complainant has rightly been repudiated by the OP and lastly prayed for dismissal of the complaint. Learned counsel for the OP relied upon the case law titled as National Insurance Co. Ltd. Vs.Smt. Mousumi Bhattacharjee and others in Civil appeal no.2614 of 2019, decided on 26.03.2019.

10.           Admittedly, Mr. Pankaj (since deceased)  purchased the insurance policy from the OP. It is also admitted during the subsistence of the insurance policy, he had taken treatment of Dengu and had expired.

11.           The claim of the complainant has been repudiated by the OP, vide letter Ex.C2/Ex.OP9 dated 31.03.2012 on the ground  that Dengu Fever which is not covered under the scope of the policy.

12.           The only question which arises for consideration is as to whether the death due to Dengu on account of mosquito bite fall under the purview of the accident or not?

13.           The onus to prove her case was relied upon the complainant. To prove her case, complainant  relied upon the case law  Mousumi Bhattacharjee’ case (supra) wherein Hon’ble National Commission held that  the death due to mosquito bite fall an accident. But said judgment has been reverted by the Hon’ble Supreme Court, vide judgment dated 26.03.2019  wherein Hon’ble supreme Court held that the mosquito bite cannot be considered as an accident.

14.           Keeping in view that law laid down in the abovesaid judgment by the Hon’ble Supreme Court, facts and circumstances of the case, the present complaint is devoid of merit and deserves to be dismissed and same is hereby dismissed. No order as to costs. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated:05.08.2024                                                                     

                                                               President,

                                                     District Consumer Disputes

                                                     Redressal Commission, Karnal

 

 (Vineet Kaushik)       (Sarvjeet Kaur)

                          Member                          Member