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GUJARAT STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, AHMEDABAD
Hon’ble Mr. Justice M.S. Parikh, President &
Dr. Mahendra K. Joshi, Member
NEW INDIA ASSURANCE CO. LTD.—Appellant
versus
CHANDULAL DHULABHAIPANCHAL—Respondent
Appeal No. 46 of 1997—Decided on 19.12.2000

Counsel for the Parties :
For the Appellant :Mr. S.C. Shah, Advocate.
For the Respondent:Mr. H.J. Trivedi and Mr. M.A. Trivedi, Advocates.

Headnote:Consumer Protection Act, 1986 - Sections 15 and 2(1)(g) - Complainant wife met with accident Died due to tetanus - Insurance company demanded post mortem report - Not supplied as no postmortem carried out on dead body Claim repudiated - District Forum allowed complaint - Ordered payment of Rs. 50,000/- as claimed by complainant - Appeal - Accidental injuries - Tetanus in all probabilities would be complication in injured patient -Stand of opposite party about repudiation of claim both on ground of non-supply of post mortem report and nexus between accident and death having not been established neither acceptable nor tenable - Deficiency in service Order of District Forum upheld Complainant entitled to insured amount alongwith interest.

       Held: When the cause of death is certain without any ambiguity, subsequent requisition of post mortem report was apparently not proper on the part of the opposite party. It is true that in the repudiation letter, reference has been made to non-supply of post mortem report. But in the circumstances noted above, such a requisition was neither here nor there. The repudiation letter is dated 19-7-1991 and it is the case of the complainant that there was repeated compliance of submission of the medical treatment papers. The opposite party has not adverted to the action taken by the complainant who supplied all the medical treatment papers to the opposite party. No further investigation has been carried out by the opposite party with regard to the cause of death. Under such circumstances, the stand of the opposite party about the repudiation of the claim both on the ground of non-supply of post mortem report and nexus between the accident and the death having not been established is neither acceptable nor tenable. It is here that the deficiency in service on the part of the opposite party dearly surfaces. (Para 6)

       The disclaimer could not be said to be an absolute disclaimer inasmuch as even in the affidavit in reply the opposite party expressed its readiness and willingness to process the claim if necessary details and documents were furnisned in support of the claim. Therefore, the process of finalising the claim did not end even at that stage. Under such circumstance, the opposite party can hardly claim benefit of the aforesaid forfeiture clause. (Para 8)

       Result: Appeal dismissed.

       

ORDER

Mr. Justice M.S. Parikh, President—The New India Assurance Company Limited being the opposite party in Complaint No. 1111/92 has subjected to challenge in this appeal order dated 24.12.1996 rendered by the learned City Consumer Disputes Redressal Forum, Ahmedabad. The respondent being the complainant filed complaint against the opposite party on the ground that he was a joint policy holder alongwith his wife Prabhavatiben Chandulal under Policy No. 42-06914 for the period from 24.3.1990 to 23.3.1991. As per the terms and conditions of the policy, in case the insured or either of them suffers disability or death as a result of accident, opposite party would be liable to pay compensation for the sum insured. It was the case of the complainant that on 8.8.1990, the complainant’s wife Prabhavatiben met with an accident when one autorickshaw dashed against her on her way to Kalupur Swaminarayan Temple. As a result, she sustained serious injuries and was removed to the hospital. After her treatment in the hospital, she was discharged. Once again, on account of development of some complication in her heath, she was admitted to the hospital [Shardaben Hospital] and on 18.8.1990, she died due to tetanus. Consequently the complainant being the insured’s husband lodged claim as per the policy. On 16.11.1990, all the necessary documents were supplied by the complainant to the opposite party but the opposite party failed to pay the insured amount. Instead, it demanded post mortem report from the complainant. It was not possible the complainant to supply said document as no post mortem was carried out on the dead body of the complainant’s deceased wife Prabhavatiben. Since the opposite party did not settle the claim, the complainant filed aforesaid complaint praying for insured amount of Rs. 50,000/- and further sum of Rs. 50,000/- for mental pain and agony, coupled with interest.

2. The opposite party resisted the claim on the ground that the complainant was informed to obtain the post mortem report, that the complainant failed to supply such report, that the opposite party had, therefore, no option but to repudiate the claim, that the cause of death was not established to be accident for which insurance was accorded in favour of the complainant and his wife and that there was no deficiency in service accordingly on the part of the opposite party. It was also contended by the opposite party at a later point of time during the proceedings before the City Forum that the complaint was time barred as it was filed after one year of the repudiation of the claim by the opposite party.

3. The learned City Forum after considering the evidence and the submissions made on behalf of the rival parties, held that it was possible that tetanus might have been caused due to injuries sustained in the accident in which the deceased sustained injuries including fracture of clavicle, that, according to Dr. Deasi who was examined before the City Forum, it was not necessary to carry out the post mortem of the dead body of Prabhavatiben, that the opposite party failed to settle the claim of the complainant and that there was deficiency in service on the part of the opposite party. With regard to the subsequently raised plea of limitation as aforesaid, the City Forum held that the condition with regard to such limitation in the policy would not help the cause of the opposite party inasmuch as such restriction in the policy will not bar the complaint which was within the period of limitation under the relevant provisions of the Consumer Protection Act, 1986. The City Forum has made reference to the decision of the Honourable Supreme Court in Food Corporation of India v. New India Assurance Company Limited, 1994 (3) SCC P. 324. The City Forum, therefore, allowed the complaint to the extent of the amount of insurance viz. Rs. 50,000/- claimed by the complainant and interest @ 18% p.a. from 1.1.1991 till payment and also cost quantified at Rs. 2,000/-. The City For















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