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2009(4) CPR 279 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION,
NEW DELHI
Ashok Bhan, President and B.K. Taimni, Member
Gitaben —Petitioner
versus
The Regional Manager National Insurance
Co. Ltd. —Respondent
Revision Petition No. 237 of 2006
Decided on 27.8.2009
Counsel for the Parties:
For the Petitioner:Mr. Amar Dave, Advocate for Mr. Hriday Buch, Advocate.
For the Respondent:Mr. Sumeer Sodhi, Advocate for Mr. Atul Nanda, Advocate.
IMPORTANT POINT
In the Insurance claim onus to prove that the deceased had died due to the injury suffered by him was on the claimant.
Headnote:Consumer Protection Act, 1986—Sections 12 and 17—Insurance claim—Deceased insured husband of complainant was covered under Janata Group Policy in sum of Rs. 5,00,000—While taking bath he slipped and sustained injury in head and later on died—Claim was repudiated on ground that death was not due to accident—District Forum allowed the claim —State Commission set aside the order—Revision—Onus to prove that deceased died due to injury suffered in accident was on petitioner—No person was examined that deceased had slipped and suffered injury in head—Doctor who examined insured was also not produced—Post mortem was also not done—Complainant filed CT Scan report, discharge summary and certificate issued by doctor that deceased had suffered injuries which resulted in cerebral heamorrhage but those documents were not proved—Investigator appointed by Insurance Company and its doctor had opined that deceased had suffered no accident injury—No reason to interfere. (Paras 6 to 9)
Ashok Bhan, President—Petitioner herein, who was the complainant before the District Consumer Disputes Redressal Forum, Ahmedabad (Rural) District, Ahmedabad, Gujarat (hereinafter referred to as ‘the District Forum’ for short), being aggrieved by the order dated 7.10.2005 passed by the State Consumer Disputes Redressal Commission, Ahmedabad, Gujarat (hereinafter referred to as ‘the State Commission’’for short) in Appeal No. 1298 of 2004, has filed the present revision petition. By the impugned order, the State Commission has reversed the order passed by the District Forum and held that the petitioner is not entitled to the insured amount as the husband of the petitioner did not die because of an accident.
2. Briefly stated, the facts of the case are:
Deceased Dharmendrasinh Jitubhai Chudasama, husband of the petitioner/complainant had taken a Janta Group Policy No. 01931/003/149/98-99 from the respondent/Insurance Company in the sum of Rs.5,00,000. The facts set out in the complaint are that the husband of the petitioner had gone to take bath in the Patadiya (kund) situated at Dholera. While bathing, he slipped and, on account of the same, he sustained serious injuries on his head and was taken to a local doctor, who after examining him, referred him for treatment to Rana Surgical Hospital at Bhavnagar where his CT Scan was done. Doctors at Bhavnagar advised the attendants of the patient to take him to Ahmedabad. On his way to Ahmedabad, he succumbed to his injuries on 11.11.1999. He was brought back to the village and cremated without getting the post-mortem done. F.I.R. was lodged on 15.11.1999. Petitioner filed an insurance claim with the respondent/Insurance Company, which was repudiated on the ground that the petitioner has failed to prove that her husband had died due to any accident. That no post-mortem was got done and the F.I.R. was also registered later after 4 days of death. Being aggrieved, petitioner filed a complaint before the District Forum.
3. District Forum, relying upon the history recorded by Dr. Rana at Bhavnagar, held that the death was accidental and, accordingly, allowed the complaint. Petitioner was directed to pay a sum of Rs. 5,00,000, i.e. the insured amount along with interest @ 9% p.a. from the date of filing of the complaint till realization. Rs. 10,000 were awarded towards mental harassment and Rs. 5,000 were awarded as costs which were to be paid within one month.
4. Aggrieved by the order passed by the District Forum respondent/Insurance Company filed an appeal before the State Commission, which has been allowed by the impugned order. State Commission has set aside the order passed by the District Forum, and dismissed the complaint. It has been held that petitioner’s husband did not die due to an accident. That the post-mortem was not got done and the Affidavit of the Doctor, who had examined the deceased at Bhavnagar, had not been filed. That documents produced were required to be proved by filing the Affidavit of the Doctor who had examined the petitioner’s husband. That the death of petitioner’s husband was due to “cerebral” hemorrhage from which it could not be concluded that the death occurred due to an accident.
5. Learned counsels for the parties have been heard at length.
6. Onus to prove that the deceased had died due to the injury suffered by him was on the petitioner. Petitioner/complainant was not present at the time of the alleged accident. Any person who may have been present at the time of the alleged accident has also not been produced as witness. Local doctor who had examined the deceased in the village has not been produced. Dr. Rana, to whose Clinic the deceased was taken, has also not been produced. Post-mortem was also not got done. Counsel for the petitioner relies upon three documents: (i). The Certificate issued on 16.11.1999 by Dr. Rana; (ii). CT Scan Report; and (iii). Discharge Summary to contend that the deceased had suffered injuries, which resulted in “cereb
