MEENA DEVI vs NEW INDIA ASSURANCE CO. LTD

COMPLAINANT /Petitioner has filed the present Revision Petition against the judgment and order dated 11.6.2008 passed by the State Consumer Disputes Redressal Commission, Jharkhand (in short, ''the State Commission '') in appeal No. 30/08 whereby the State Commission has set aside the order and judgment dated 16.12.2007 passed by the Consumer Disputes Redressal Forum, District Godda, Jharkhand directing the Respondent Insurance Company to release an amount of Rs. 5 lakh, i.e., the insured amount to the Petitioner along with interest @ 9% p.a.w.e.f. date of the death of the insured till the realization. Rs. 5,000 were awarded by way of compensation for harassment and mental agony. Facts:

BRIEFLY stated the facts of the case are that Shiv Kumar Bhagat, Respondent No. 3 approached Vidhya Sagar Ujjala, husband of the Petitioner to get himself insured under the Golden Trust Financial Scheme under Janata Personal Accident Insurance Policy, a social company of the New India Assurance Company, Respondent No. 1 herein. Vidhya Sagar Ujjala got himself insured for a sum of Rs. 5 lakh under the said scheme and paid premium of Rs. 1,900 on 28.11.98. Policy No. 4751220001522 was issued for the insured in the name of Golden Trust Financial Services and the same was to expire on 7.12.2013. As per terms and conditions of the policy, the company was liable for 100% risk cover to the insured person in case of accidental death, permanent disability, permanent loss of eye sight, etc. and a certificate to such effect dated 8.12.1998 was issued by the company to him. It is alleged that the husband of the Petitioner met with an accident on 1.4.2001 when he was coming to his house after closing his shop. That he dashed against "Thokar " meant for checking the speed of vehicles and as a result thereof he fell on the P.C.C. Road and became unconscious. Insured was taken to Dr. Bishnu Kumar Singh who referred the insured to Bhagalpur from where he was referred to Patna for better treatment and was admitted at Indira Gandhi Institute of Medical Sciences. Insured died during the course of treatment on 24.4.2002 and his dead body was released along with the release certificate of dead body and death certificate. Petitioner being the nominee of the insured approached the Respondent for release of the insured amount which was not done. Being aggrieved, Petitioner filed the complaint seeking a direction to the Respondents to release the insured amount along with compensation and costs.

RESPONDENT Insurance Company (hereinafter to be referred to as ''Respondent '') filed its written statement. It took the stand that the insured was given coverage of accidental death as a result of external, visible and violent means. That there was no accident and the insured did not die as a result of accident. That the Petitioner failed to submit certain documents sought for by the Respondent to settle her claim. That the insured died due to a natural death which did not come within the coverage of the policy.

GOLDEN Trust Financial Services, Respondent No. 2 herein filed its separate written statement, inter alia, alleging that the District Forum had no jurisdiction to entertain and adjudicate upon the dispute as the grievance raised by the Petitioner was not a ''consumer '' dispute and was exclusively triable by Civil Court. That the Petitioner had no locus standi to initiate the proceedings and the complaint was bad for non-joinder of proper and necessary parties. On merits, it was submitted that for the insurance claims, the Insurance Company would be liable and under no circumstances, would the answering Respondent have any liability in this respect. Petitioner examined five witnesses in support of her claim, namely, PW-1 Shri Amod Kumar, PW-3 Sanjay Kumar Gupta who deposed as regards the factum of accident of insured, PW-2, Smt. Meena Devi/Petitioner herein who deposed her entire case including the accident of the deceased, his medical treatment and ultimate demise, Dr. Gajendra Mohan Thakur-PW 4 who had given the opinion that the cause of death was due to subdural haemorrhage and PW-5, Shri Pinku Kumar, Compounder who proved the prescription of Dr. Bishnu Kumar Singh to whom the insured was taken soon after the accident. Petitioner in support of her claim adduced the medical report of the deceased. Petitioner also produced the death certificate.

DISTRICT Forum after considering the rival contentions raised by the parties, allowed the complaint and directed the Respondent Insurance Company to pay the insured amount of Rs. 5 lakh along with interest @ 9% p.a.w.e.f. death of deceased till realization. Rs. 5,000 were awarded by way of compensation for mental agony.

AGGRIEVED against the order passed by the District Forum, Respondent Insurance Company filed the appeal before the State Commission. State Commission by the impugned order set aside the order of the District Forum and allowed the appeal and dismissed the complaint filed by the Petitioner. State Commission has held that the insured died a natural death. That he did not die as a result of accident and, therefore, in terms of the policy nothing was payable. Since the coverage was given for accidental death as a result of external, visible and violent means, the only question which falls for consideration before us is as to whether the insured died solely and directly as a result of accident.

THERE is no direct evidence on record to show that the insured died due to accident. PW -1 and PW-3 have deposed that the insured stumbled and fell down when he was going from Hatia Chowk to his house after closing his shop. That he was taken to Dr. Bishnu Kumar Singh who gave the first aid and thereafter referred the insured to Bhagalpur from where he was referred to Patna for better treatment where he died during the course of treatment. They did not say that they were present at the time when the insured allegedly fell on the road. PW-2, Meena Devi, Petitioner herein, was also not present at the place where the insured allegedly fell. In her statement, she deposed that she was informed that her husband has fallen down while coming from mill to home. Some boys came from nearby and took her husband to Dr. Bishnu Kumar Singh who gave him some treatment and later on referred her husband to Bhagalpur from where he was further referred to Patna. PW-4, Dr. Gajender Mohan Thakur identified the signatures of Dr. Bishnu Kumar Singh on the prescription slip marked as ''X ''. Dr. Bishnu Kumar Singh had written in his prescription that the insured had suffered "Hemiplegia " which was caused due to high blood pressure. PW-5, Pinku Kumar simply deposed that he was a compounder working with Dr. Bishnu Kumar Singh. That prescription slip marked ''X '' had been written by Dr. Bishnu Kumar Singh. No other evidence was adduced. Dr. Bishnu Kumar Singh who died during the pendency of the complaint and to whom the insured was taken soon after he became unconscious, has written in his prescription slip marked ''X '' that the insured was 70 years of age and his blood pressure was measured as 220/100. The said doctor diagnosed "Hemiplegia " and prescribed treatment. Dr. Bishnu Kumar Singh in his prescription did not note that the insured had suffered any injury. Even the scratches and bruises were not noted in the prescription slip marked as ''X ''.

''HEMIPLEGIA '' is a condition where there is paralysis of one half of the body. It is usually the result of C.V.A. This was found by Dr. Bishnu Kumar Singh on 1.4.2001 and was also confirmed at Indira Gandhi Institute of Medical Sciences, Patna where the insured was taken for treatment on 2.4.2001 and was an indoor patient from 9.4.2001 to 30.4.2001. Insured was again registered as Out Door Patient in June, 2001 for treatment of CAV (L), HEMIPLEGIA and Ischaemic infraction. It was mentioned on the OPD card of 6.6.2001 that he was advised to repeat PT and on 28.6.2001 some medicines were prescribed. Again in September, 2001 another medicine was added. Insured did not visit the OPD of Indira Gandhi Institute of Medical Sciences for a long time and only on 2.4.2002 he was examined and diagnosed "Sub-Dural Haemorrhage (F) Frontal Region and was referred to Neurosurgery Department of Indira Gandhi Institute of Medical Sciences where he was admitted as Indoor Patient on 2.4.2002 itself and was discharged on 15.4.2002. He died on 23.4.2002. There is nothing on record about the treatment given to him between 16.4.2002 to 23.4.2002. Only a certificate has been produced that the dead body was released from Indira Gandhi Institute of Medical Sciences and was received by his wife on 24.4.2002. Pws-1 and 3 in their statements did not state that they were present when the insured allegedly fell down after getting a "Thokar " meant for checking the speed of vehicles. There is no opinion or expert evidence of any Doctor confirming the stand of the Petitioner that the insured died due to any accident caused by external, visible and violent means. Dr. Bishnu Kumar Singh who examined the insured on 1.4.2001 did not note any injury which may have been suffered by the insured due to accident. Had the insured suffered any injury due to fall, then Doctor Singh who examined the insured soon after the accident would have noted the injury in the prescription slip. Insured was not given any treatment for the injuries allegedly suffered by him. No scratches or bruises were noticed by the Doctor in his prescription slip.

PETITIONER has failed to produce the copies of the FIR or the Post Mortem Report of the deceased despite repeated requests and reminders by the Respondent. The aforesaid documents were mandatorily required to support the claim. In the absence of Post Mortem Report, the exact cause of death of the deceased is not established. Insurance Company was liable to compensate the insured only if the death or permanent total disablement or loss of limb, loss of eyes, etc. has occurred solely due to accident by external, visible and violent means. There is no evidence on record to show that the insured died as a result of accident caused by external, visible and violent means. In the absence of such evidence, it cannot be held that the insured died due to accident.

THE insured died after one year of the alleged fall. There is no evidence to support the claim that the insured died due to injuries sustained by him a year earlier due to fall on the road. There is no material to suggest the close-proximity of the accident and the death. Under the policy, the claim was payable only when the death occurred due to accident. Natural death was not covered under the policy. We agree with the view taken by the State Commission that the Petitioner has failed to prove that the insured died as a result of accident caused by external, visible and violent means. For the reasons stated above, we do not find any merit in the Revision Petition and dismiss the same. Revision Petition dismissed.