NATIONAL INSURANCE CO. LTD. vs Aparna Kahar

THIS revision petition has been filed by the petitioner against the order dated 19.07.2013 passed by the West Bengal State Consumer Disputes Redressal Commission, Kolkata (in short, ''the State Commission'') in S.C. Case No. FA/107/2012 - National Insurance Co. Ltd. Vs. Aparna Kahar & Ors. by which, while dismissing appeal, order of District Forum allowing complaint was upheld.

BRIEF facts of the case are that complainant/respondent''s husband Tinku Kahar obtained Group Janata Personal Accident Insurance Policy for Rs.5,00,000/ - from OP/petitioner. During the subsistence of the policy, on 17.9.2008 insured fell down while dancing on the occasion of Viswakarma Puja, sustained injuries and ultimately he died. Complainant submitted claim which was repudiated by OP on the plea that it was not an accident case and insured died due to coronary heart disease. Alleging deficiency on the part of OP, complainant filed complaint before District Forum. OP resisted complaint and submitted that claim was rightly repudiated as death of insured was not accidental one and prayed for dismissal of complaint. Learned District Forum after hearing both the parties allowed complaint and directed OP to pay Rs.5,00,000/ - with 10% p.a. interest. Appeal filed by OP was dismissed by learned State Commission vide impugned order against which, this revision petition has been filed. Heard learned Counsel for the parties finally at admission stage and perused record.

LEARNED Counsel for the petitioner submitted that as death of insured was not accidental caused by external visible and violent means, claim was rightly repudiated by petitioner and learned District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal; hence, revision petition be allowed and impugned order be set aside. On the other hand, learned Counsel for the respondent submitted that concurrent findings by Fora below, cannot be challenged in revision and order passed by learned State Commission is in accordance with law; hence, revision petition be dismissed.

IT is not disputed that deceased Tinku Kahar obtained Group Janata Personal Accident Insurance Policy for Rs.5,00,000/ - for 7 years from 23.10.2002 to 22.10.2009 and insured died on 17.9.2008. As per post -mortem report dated 18.9.2008, neither injury on the external part of the body nor any fracture on his body was found and as per report of CMO, New Civil Hospital, Surat, cause of death was Coronary Heart Disease associated with pulmonary oedema". As per terms and conditions of the policy, claim was payable only when death was result of accident caused by external visible and violent means and in the case in hand as there was no external injury on the body of the deceased and death was not caused by accident due to external visible and violent means, claim was not payable and District Forum committed error in allowing complaint and learned State Commission further committed error in dismissing appeal. Learned State Commission observed in its order that there was no question of presumption that insured died due to coronary heart disease which is apparently contrary to medical report as death was caused due to coronary heart disease associated with pulmonary oedema and in such circumstances, impugned order is liable to set aside.

LEARNED Counsel for the respondent placed reliance on : 2011 (3) SCALE - Mrs. Rubi (Chandra) Dutta Vs. M/s. United India Insurance Co. Ltd. in which it was held that revisional power can be exercised only if there is some prima facie jurisdictional error appearing in the impugned order. I agree with the law laid down by Hon''ble Apex Court and this judgment does not help to the respondent, but rather helps to the petitioner because in the case in hand cause of death was coronary disease which was not covered under the policy. As no external injuries were found on the body of deceased insured and death was not accidental caused by external visible and violent means, findings of District Forum and State Commission are contrary to record and revisional jurisdiction has to be exercised and impugned order is liable to set aside.

CONSEQUENT LY , revision petition filed by the petitioner is allowed and impugned order dated 19.7.2013 passed by learned State Commission in Appeal No.FA/107/2012 - National Ins. Co. Ltd. Vs. Aparna Kahar & Ors. and order of District Forum dated 6.1.2012 - Aparna Kahar Vs. National Ins. Co. Ltd. is set aside and complaint stands dismissed with no order as to costs.