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2010(2) CPR 300 (NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
B.N.P. Singh, Presiding Member and S.K. Naik, Member
New India Assurance Co. Ltd. —Petitioner
versus
B. Shivappa —Respondent
Revision Petition No. 785 of 2009
Decided on 1.4.2010

Advocates:
Counsel for the Parties:
For the Petitioner:Mr. D. Sushil Kumar Gupta, Advocate.
For the Respondent: Nemo.

Headnote:Consumer Protection Act, 1986—Sections 12 and 17—Claim under Janata Personal Accident Policy—Policy for Rs. 10,00,000 was taken on 31.12.1998 for three years—Insured died on 14.7.2000 allegedly pursuant to fall from stair case sustaining head injury—Certificate issued by doctor showed that insured died due to cardiac respiratory failure caused by head injury—Panchnama was conducted by village administrative officer and villagers filed affidavits as to cause of death—Claim was repudiated on ground of belated submission of claim and that no recourse to lodging any police report or autopsy was taken and death was described due to cardiac failure—District Forum dismissed complaint—State Commission allowed complainants’ and claim in appeal—Revision—Certificate of doctor was not supported by treatment papers—Affidavits of villagers were filed after five months of incident of cause of death—Belated filing of claim could not facilitate insurance company to hold proper investigation of claim—Finding of doctor did not speak about presence of any external injury on internal haemorrhage—Unusual features did not sound well about genuineness of claim—Repudiation of claim could not be said to be erroneous—Impugned order was liable to be set aside. (Para 2)

       

ORDER

B.N.P. Singh, Presiding Member—The revision under consideration is against order of reversal of the finding of the District Forum. The factual backgrounds are that deceased B. Chinna Swamy, the brother of respondent, who obtained Janata Personal Accident Insurance Policy from respondent for Rs.10,00,000 on 31.12.1998 for a period of three years, died during currency of policy on 14.7.2000 pursuant to fall from stair case, sustaining head injury in his house. Allegedly, he was taken to Dr. S. Chandra Sekhar Goud, Civil Surgeon, Head Quarters Hospital Mahabubnagar, where insured died of incident. A certificate came to be issued by Dr. S. Chandra Sekhar Goud on 15.9.2000 stating therein that the insured died on 14.7.2000 due to cardiac respiratory failure caused by head injury. The village Sarpanch too give a certificate on 18.12.2000 holding that that the insured died on 14.7.2000 due to head injury on fall from stair case. The villagers too filed affidavits on 4.12.2000 as to the cause of death. Panchanama was conducted by village Administrative Officer on 15.7.2000, attested by Additional Revenue Inspector and eventually claim was submitted to the Insurance Company on 21.12.2000. The claim was, however, repudiated by petitioner holding belated submission of claim to them, respondent not taking recourse to the police lodging FIR pursuant to death of the insured, no autopsy having been carried out over the dead body of the insured and above all death being due to cardiac failure, which was not an accidental death.

2. Dissatisfied with repudiation of claim, petitioner took recourse to consumer grievance redressal agency filing a complaint with District Forum, which was resisted by petitioner Insurance Company reiterating the grounds of repudiation made by them. The District Forum, however, having overruled contentions raised on behalf of respondent herein dismissed complaint. In appeal that was preferred by respondent, order, as has been noticed was reversed putting reliance on finding of doctor, panchanama and also belated filing of claim by respondent, those being no valid grounds for rejection of the claim by Insurance Company. Now aggrieved Insurance Company is in revision before us. Certain redeeming features however need to be noticed. Though insured on 14.7.2000 itself was shown to have been taken to Dr. S. Chandra Sekhar Goud Civil Surgeon, Head Quarters Hospital Mahabubnagar, shortly, after the incident where he died within one hour, it was not before 15.9.2000 that certificate is shown to have been issued by aforesaid doctor and that too being not supported by treatment papers. If there be treatment provided to the insured not only medical certificate, but other documents too belatedly put on record by respondent in quick succession are affidavits filed of villagers after five months of incident as to cause of death of the insured. Though panchanama was shown to have been conducted by Village Administrative Officer on 15.7.2000, which was also attested by Additional Revenue Inspector, it is suggested that said panchanama was conducted after the dead body was buried. As we have noticed even claim was lodged to petitioner Insurance Company not before lapse of five months. Even though treating doctor was a Civil Surgeon of the Hospital, the insured was not treated in the Hospital, but at his clinic, which was not followed by post-mortem of the dead body. Respondent also failed to take recourse to public authorities. We do not mean to say that merely belated filing of claim by respondent with Insurance Company would get defeated if there be legitimate claim, but what we mean to say that such belated filing of claim did not facilitate the Insurance Company to hold proper Investigation of the claim. Had this been a solitary issue about belated filing of claim, no fingers could have been raised, but as noticed, claimant had not pursued the matter with promptitude at the earliest. Even there being belated issuance of medi





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