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MADHYA PRADESH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BHOPAL
MRS. NEERJA SINGH, PRESIDING MEMBER & MR. SUBHASH JAIN, MEMBER
Pushpa Giri - Appellant
Versus
New India Assurance Co. Ltd. - Respondent
Appeal No. 1998 of 2007
Decided On : 29-01-2013
Advocate Appeared:
For the Appellant :Mr. S.K. Gupta, Advocate.
For the Respondent:Mr. Chitra Sharma, Advocate.
Liability of an Insurance Company in the case of accidental death, and the relevance of evidence such as FIR and post mortem reports in determining the validity of a claim.
Headnote:
Insurance - Accidental Death - Liability of Insurance Company
Fact of the Case:
The insured, a student, fell from his cycle and hit his head, resulting in his death. The Insurance Company repudiated the claim due to lack of FIR and post mortem reports.
Finding of the Court:
The court found that the insured's death was a clear case of accidental death, and the Insurance Company was liable to pay the sum insured. The absence of FIR and post mortem report was not fatal to the claim.
Issues: Dispute over the cause of the insured's death, liability of the Insurance Company, and the relevance of FIR and post mortem reports in the claim.
Ratio Decidendi: The court held that the insured's death was a result of accidental head injury, making the Insurance Company liable to pay the sum insured. The absence of FIR and post mortem report was not considered fatal in this claim.
Final Decision: The appeal was allowed, and the Insurance Company was directed to pay the appellant the sum insured with interest and bear the cost of the appeal.
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ORDER :
1. The following order of the Bench was delivered by Smt. Neerja Singh, Member.
This appeal is by the complainant, aggrieved by the order dated 17.08.07, passed by District Consumer Disputes Redressal Forum Raigarh, dismissing her complaint against the New India Assurance Co. Ltd. thereinafter referred to as the Insurance Company in CC No. 1111/2006.
2. The facts in brief are that the appellant’s son thereinafter referred to as the insured, was a student of B.Com 2nd Year. He was covered under the Student Safety Insurance Policy issued by the respondent Insurance Company for the sum insured Rs. 50,000/-. On 18.2.06, while going for union, he fell from his cycle on some stones on the road and became unconscious. He was treated at various hospitals but died on 6.3.06. As it was a case of accidental death, a claim was filed before the Insurance Company, who repudiated it on the ground that there was no FIR nor was any post mortem done.
3. The District Forum dismissed the complaint on the ground that there were no FIR or post mortem reports.
4. Heard.
5. Both parties have filed documents under Order 41 rule 27 of CPC. They are permitted to be taken on record for the just adjudication of the case.
6. From the documents filed on record, including the investigator’s report, the sequence of events reveal that on 18.2.06, the insured went for tuition in the morning. He was found lying on the road unconscious as his head had hit some stones on the road. He was brought to the local doctor who sent him to Civil Hospital, Narsingarh. From there he was referred to Hamidia Hospital, Bhopal. A CT Scan was done and he was sent to Mayo Hospital, Bhopal, where Dr I.D. Chourasia and Dr. A.K. Jaiswal conducted a brain surgery. In an unconscious state he was brought bacl to Narsingarh and admitted in the Civil Hospital on 3.3.06. He died on 6.3.06.
7. The Insurance Company in their reply state that the insured was already suffering from headaches prior to taking the policy and the fall was the result of medical complications. In support of this contention, they have in appeal, filed a photocopy of CT Scan report, purportedly of the insured dated 27.1.06. This report is signed by Dr R.C. Tiwari, Chief Radiologist of Bhopal Medical Centre. The Insurance Company states that this report shows that the insured had a CT Scan done before the date of the accident. In rebuttal, the appellant has filed the affidavit of Dr R.C. Tiwari stating that the records show that the insured had got a CT Scan done on 1.3.2006 and not on 27.1.2006. Dr. R.C. Tiwari avers that the photocopy is fabricated.
8. A perusal of this CT Scan report, dated 27.01.2006, filed by the Insurance Company, makes it evident that it cannot be relied upon. First the person who purportedly signed it, denies the report, secondly the report is of a postoperative cases of head injury. It is not the case of the Insurance Company that the insured had a head injury and brain surgery in January 2006, 20 days after which he went to tuition and fell down the cycle and had a second head injury and surgery done in February 2006. The Insurance Company have filed a report and affidavit of an advocate who they asked to investigate. He states that Dr. R.C. Tiwari admitted that the photocopy contained his signatures and further stated that he could not give any information about the CT Scan, as the old records are deleted. The learned counsel for the respondent vehemently argued that DR. R.C. Tiwari should be cross examined. However, having alleged that the insured suffered from medical ailments prior to the accident, the onus to prove it was on the Insurance Company. If the CT Scan report of 27.1.06. was in dispute, they could have taken an affidavit from the referring doctor, Dr. I.D. Chourasia to establish that he treated the insured in January 2006 and referred him for a scan. The CT Scan report of 27.1.06 is apparently fake and we do not find any merit in the contention of the Insurance Company that the
