Oriental Insurance Co. Ltd. vs Mohan Lal

THIS appeal has been preferred under Section 15 of the Consumer Protection Act, 1986, against the order dated 23.7.2001, passed in Case No. 322/2000 by the District Consumer Disputes Redressal Forum, Durg (hereinafter referred to as the ''District Forum'' for short) whereby the complaint for deficiency in service by the opposite party was allowed by the District Forum.

THE facts not presently in dispute are that the respondent/complainant Sri Mohan Lal and his wife Smt. Chandrika Bai had takan Janata Personal Accident Policy No. 152501/47/99/00176 which was effective from 9.1.1999 to 8.1.2011. It is also not in dispute that Smt. Chandrika Bai sustained burn injuries on 18.1.1999 and was admitted to Jawahar Lal Nehru Hospital, Bhilai for treatment. It is also not disputed that Smt. Chandrika Bai later died on 25.1.1999, during her treatment at the aforesaid hospital. According to the facts narrated in the complaint, the complainant and his wife Smt. Chandrika Bai had taken Janta Personal Accident Policy No. 152501/47/99/00176 which was effective from 9.1.1999 to 8.1.2011. On 18.1.1999, Smt. Chandrika Bai, sustained burn injuries while preparing tea on stove, resulting in her death on 25.3.1999. A case was registered against the complainant and her mother under Section 304-B of the Indian Penal Code. The judgment in the aforesaid case was delivered on 16.11.1999 whereby the accused were acquitted. It was held therein that Smt. Chandrika Bai had died due to burn injuries sustained accidentally. After acquittal as aforesaid, the complainant filed a claim before the appellant/opposite party No.1 on 25.1.2000 and claimed the sum assured under the insurance policy. The opposite party No.1 had appointed Sri M.P. Tiwari as Surveyor. Finally, on 31.7.2000 the claim was repudiated by the appellant/opposite party No. 1 solely on the basis of the Sureyor''s report, on the ground that Smt. Chandrika Bai had committed suicide and did not meet an accidental death.

The learned District Forum made detailed reference to the material placed on record by the parties, the deposition recorded during the Sessions trial against the complainant and his mother and finally came to the conclusion that the death of Smt. Chandrika Bai was an accidental death and by repudiating the claim, the opposite party has committed deficiency in service and had directed the opposite party No. 1 to make payment to the complainant in terms of the order.

THE learned Counsel for the appellant assailed the impugned order and urged that the report of the Surveyor and the police diary statements clearly indicated that Smt. Chandrika Bai committed suicide and, therefore, the learned District Forum erred in holding that her death was accidental. It was urged that the appellant/insurer had bona fide repudiated the claim of the respondent. As against this, the learned Counsel for respondent supported the impugned order and submitted that the judgment in the Sessions trial and other material on record clearly established that the death of Smt. Chandrika Bai was accidental and that the report of the Surveyor appointed by the appellant was based on wrong premises.

THE only question to be decided is as to whether the claim was rightly repudiated by the appellant/opposite party No. 1 ? It is settled legal position that the burden to prove that Smt. Chandrika Bai had committed suicide was on the appellant/opposite party No. 1. It is noticed that the appellant had repudiated the claim solely on the basis of the report of the Surveyor Sri M.P. Tiwari and intimated to complainant/respondent vide letter dated 31.7.2000 that ''the death of Smt. Chandrika Bai was suicidal which does not fall within the scope of Group Janta Personal Accident Policy''. A bare perusal of the report of Sri M.P. Tiwari dated 7.5.2000 reveals that the same is based solely on the statements recorded by the police. However, on the date of the report the Sessions trial had been decided. In view of the depositions made on oath and the judgment dated 16.11.1999 the appellant/opposite party cannot at all take the benefit of the statements recorded by the police. Moreover, it is abundantly clear from the deposition of independent witnesses, including Dr. Anjana Patle who had treated the deceased, that the deceased had stated that she had accidentally sustained burn injuries from the stove while preparing tea. It may also be noticed that Dr. Anjana Patle had categorically admitted during trial that there was no smell of kerosene when Chandrika Bai was examined by her. This statement also negatives the proposition of the appellant that Chandrika Bai committed suicide by pouring kerosene oil on herself. It is further noticed that the deceased remained in the hospital for a long period of more than two months and no report was made to the police by the deceased or her relatives while she was alive. This also supports the version of the complainant that the report was only an after-thought and the deceased had died an accidental death.

IN view of the above it is apparent that the appellant/opposite party No. 1 has failed to discharge the burden of proving that the death of Smt. Chandrika Bai was suicidal. Hence we are of the considered opinion that the appellant/opposite party has, by repudiating the claim of the complainant, committed deficiency in service. There is no need for any interference with the order of the learned District Forum. Consequently, the appeal is dismissed. The appellant shall bear their own costs and shall pay that of the complainant/respondent which is quantified as Rs. 1,500/-.Appeal dismissed.