NATIONAL INSURANCE COMPANY LIMITED vs MOHINI DEVI

THIS appeal is directed against the order dated 2.5.2005 passed by District Forum, Yamuna Nagar in Complaint Case No. 240 dated 16.5.2003, whereby while accepting the complaint of the respondent -complainant, direction has been given to the appellant to pay Rs. 10,00,000 along with 12% interest from the date after three months of death and also to pay Rs. 50,000 as compensation on account of mental agony and harassment as well as cost of proceedings. The compliance of this order was to be done within 30 days from the date of the order.

PUT shortly, the facts as can be gathered from the record briefly stated are that Kali Ram, husband of Mohini Devi complainant employed with State Bank of India, was insured under Group Janta Personal Accident Insurance Policy bearing No. 420301/47/61/98/4389 issued in the name of State Bank of India Staff Association, Chandigarh Circle for a sum of Rs. 10,00,000 for the period 31.3.1999 to 30.3.2011. The said policy provided that if at any time during the currency of the policy the insured suffered any bodily injury resulting solely and directly from accident and is the direct cause of death of the insured, the insured sum will be payable by the company to the nominee under the policy. On 4.12.2002 at about 6.30 p.m. the insured -Kali Ram fell from staircase of his house and suffered accidental injuries. He was admitted in Gaba Hospital located at Yamuna Nagar on 5.12.2002. He died there at 4.00 a.m. on 7.12.2002. The complainant informed the opposite party Nos. 1 to 3 about the death of her husband and claimed the insured sum as per her letter dated 19.12.2002. The necessary documents which were asked from the complainant were supplied by her to the opposite parties. She also informed them that no post mortem had been conducted and no report was lodged with the police so that these documents could not be supplied to them. Finding no response from them, a registered letter dated 3.3.2003 was also sent to the opposite parties to settle the claim of her husband at an early date. In response, the opposite parties as per letter dated 11.4.2003 repudiated the claim. Forced by these circumstances, the complainant filed the present complaint. Upon notice, the opposite parties put in their appearance. They pleaded in the written statement filed that the complainant has not produced any FIR or DDR report so as to prove that Kali Ram had suffered injuries in the accident and on that account had met with an accidental death. Further, according to the Medical Officer, who has treated the deceased, had not stated that Kali Ram died due to accidental injury. They further raised the plea of want of jurisdiction of the District Forum at Yamuna Nagar to try the claim because the policy was issued at Hisar while it was taken by State Bank of India Association at Chandigarh and that the claim is bad for mis -joinder of necessary parties as the policy holder State Bank of India Association has not been impleaded as part to the complaint.

THE District Forum on appraisal of pleadings of the parties and evidence adduced on record, accepted the complaint and issued directions as noticed in the earlier part of the order. It is against this order, the present appeal has been filed.

THE learned Counsel representing the parties have been heard at length. During the course of arguments, only ground pressed into service for assailing the order dated 2.5.2005 of the District Forum by the Counsel representing the appellant was that the District Forum did not give consideration to the fact that the complainant has failed to establish that death of Kali Ram was caused solely due to the injuries suffered by him on account of accidental violence and visible means which was the pre -requisite of the insurance policy and even failed to furnish any copy of the FIR and post mortem report and cause of death stated by the treating doctor was heart failure and for that reason the appellants were justified in repudiating the claim. In support of the stand taken, reliance was placed by him on the following cases hereinafter referred to. In case, Oriental Insurance Company Limited v. Sony Cheriyan, II (1999) CPJ 13 (SC)=, the facts were that the respondent was carrying either solvent described as hazardous and highly inflammable article. Under the permit granted to the respondent, he could transport only non -hazardous articles. The insurance policy covered only these goods permissible under Motor Vehicles Act to be carried by the respondent. Under these circumstances, it was held that either transported by the respondent in his vehicle is hazardous substance and in view of the specific prohibition operating against the respondent from carrying hazardous inflammable substance in his vehicle under the permit granted to him, could be utilised only for carrying unhazardous goods under the Motor Vehicles Act and for that reason the order of the District Forum dismissing the complaint was upheld. In case, Satish Sharma v. United India Insurance Company Limited, III (2002) CPJ 305=First Appeal No. 154 of 2000, decided on 14.11.2000 by the State Commission, U.T. Chandigarh, damage was caused to the colour T.V., German make, worth Rs. 35,000 on 25.5.1994 while shifting the house hold luggage and the claim filed by the complainant was dismissed by the District Forum as it came to the conclusion that the loss had not occurred due to the accident and this order was upheld by the State Commission. In case, United India Insurance Company Limited v. Harchand Rai Chandan Lal, IV (2004) CPJ 15 (SC) it was observed that the terms of the contract has to be strictly read and natural meaning be given to it. No outside aid should be sought unless the meaning is ambiguous. In that case, under the policy obtained by the complainant, only theft or burglary, which took place preceding with force or violence was covered and if that was not the position, the Insurance Company was well within their right to repudiate the claim, as was held in the above mentioned case.

OPPOSING the submissions made, the learned Counsel representing the respondent justified the order of the District Forum for the reasons stated therein and prayed that the appeal being without any merit, deserves to be dismissed. He too placed reliance to several cases noticed hereinafter. In case Rameshwar Dayal Tiwari v. Branch Manager, the Oriental Insurance Company Limited, 2003 (1) Judicial Reports Consumer 444, the facts were that the deceased had obtained a Janta Personal Accident Policy, who was mentally below normal since the age of 3 years. The insured while siting as a pillion rider fell from the scooter as a result of which he suffered fracture neck femur right and remained bed ridden for 25 days and thereafter died on 7.5.1997 for respiratory obstruction. The claim was repudiated by the Insurance Company on the ground that the cause of death was not accidental. There was also absence of FIR and post mortem report and for that reason it did not fall within the purview of the policy. The District Forum accepted the stand of the Insurance Company and dismissed the complaint. The State Commission allowed the appeal by observing that repudiation of the claim or treating the claim as ''no claim'' was not justified for want of FIR and report of the accident. Notice was taken of the fact that the insured had suffered injuries by fall and not because of any disease. In case, Branch Manager, LIC of India v. Raj Kumar Mishra, I (2000) CPJ 113=2000 (1) CPR 32, the deceased had taken accidental policy in her name and while sitting on the motor cycle and on account of saree being caught in the wheel of the motor cycle, she fell down and sustained injuries and died after a month. The claim lodged by her husband was repudiated. Under these circumstances, death of the deceased was taken to be accidental and not natural. In this case, it was observed that non -furnishing of FIR and post mortem report would not mean that no accident had taken place. In case, the Divisional Manager, LIC of India v. Y. Ratnamma, I (2000) CPJ 548, the husband of the complainant had fallen from palm tree and succumbed to injuries. The accident benefit was denied as no FIR was lodged nor any post mortem was conducted. While rejecting the stand of the Insurance Company, it was held that ''since the complainants husband fell from the palm tree and died on the spot there was no question of filing FIR as there was no crime committed''. In case, National Insurance Company Limited v. Mrs. Urmila Sindhuria, 1998 (1) CPC 399, the deceased had an accidental fall in the toilet and thereafter died due to cardiac arrest. It was held ''the immediate cause of death may be cardio -respiratory arrest but that was a direct consequence of the accident, for which the insured had taken out the personal accident policy. Therefore, the objection raised by the Insurance Company is wholly arbitrary and without any basis''. In Life Insurance Corporation of India v. Rajinder Singh, III (2000) CPJ 150, the facts were that the scooter had slipped and had fallen in the canal along with the pillon rider Amarjeet Kaur. She died on 22.4.1991. The complainant being the nominee of the policy submitted a claim with the LIC, which was repudiated. Repelling the stand taken by the LIC, it was held that ''the appellant -Corporation has failed to prove that the death of the deceased was not an accidental and at a private place''. In case Oriental Insurance Company Limited v. Sharadchandra Harilal, 1996 (2) CPR 76, the complainant suffered accidental injuries as a result of fall in the bath -room, his claim was repudiated by the Insurance Company on the ground that he had not suffered accidental injuries. Rejecting the stand of the Insurance Company, it was held that the claimant was entitled to claim reimbursement of the expenditure incurred by him for taking medical treatment for the injuries sustained by him in the accidental fall in the bath -room. In United India Insurance Company Limited v. Gurdev Kaur, III (2002) CPJ 134 (NC), the deceased had slipped down from house roof top and subsequently died of a heart attack. The claim was repudiated, but the State Commission accepted the complaint and awarded compensation, which was upheld by the Honble National Commission. In Karamjit Kaur and Others v. Directorate Personnel, Punjab State Electricity Board and Others, I (1994) CPJ 487=XI -XII - 1993 (3) Consumer Protection Reporter 450, husband of the complainant was employed as Assistant Lineman in the Electricity Board, who was covered by the Group Personal Accident Policy, had fallen from the stairs on 18.10.1990 and had sustained head injury and on account of this injury, he died on 11.11.1990. It was held that direct cause of the death was head injury and not the intake of liquor and on that basis the stand of the Insurance Company was rejected and compensation was allowed. In case of Dr. Meena Raghunathan and Others v. Oriental Insurance Company Limited, 2003 (1) CPC 669, the insured had an accident when a brick had fallen on his head from third floor of the hospital and he was rushed to emergency of PGI for treatment, where he became unconscious and subsequently was declared dead on 11.3.2001. In that case, no post mortem was conducted and even FIR was not lodged with the police. The claim put up by the appellant was repudiated on the ground that there was no record that the brick had fallen on the head of the insured on the date of accident. While rejecting the stand of the Insurance Company, it was held by the State Commission that the cause of death was Intraventricular Haemorrhage. There is thus a clear nexus between the incident of 14.2.2001 of the brick fall on the head and eventually hospitalization on 6.3.2001 where the insured suffered from Intraventricular Haemorrhage as a result of which he died. It was held that the opposite party -Insurance Company was not justified in relying on the report of the investigator, which is not creditworthy. Accepting the complaint of the complainant, compensation was awarded.

IN this case, there is no factual dispute that the husband of the complainant was insured with the appellant under the Group Janta Personal Accident Policy for a sum of Rs. 10,00,00. This policy was for the period 31.3.1999 to 30.3.2011. Apart from the affidavit of the complainant, there is a certificate of Dr. B.S. Gaba (Annexure P -5) that Kali Ram had died on 7.12.2002 because of accidental injuries suffered by him on 4.12.2002. Under the circumstances, repudiation of the claim made by the appellants only on the ground that no FIR was lodged with the police and even post mortem report of the deceased was not done, cannot be justified in view of the position explained in the cases noticed earlier. The appellants could not procure any evidence so as to establish that Kali Ram died because of his natural death. Under the circumstances of the case, no fault can be found with the findings of the District Forum in this regard. While upholding the order of the District Forum giving direction to the appellant to pay the insured sum of Rs. 10,00,000 to the complainant, the other order with regard to interest @ 12% per annum, being on excessive side, has to be modified. Under the circumstances of the case, the complainant is entitled to interest @ 9% instead of 12%. As interest amount has been awarded, the other direction given to the appellant to pay a sum of Rs. 50,000 as compensation on account of mental agony and harassment, cannot be sustained and is accordingly set aside. With the above modification in the award of the District Forum, the appeal is disposed of accordingly.