BEFORE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SHIMLA, H.P.
Consumer Complaint No: 367/2006
Date of presentation: 12.12.2006
Date of decision: 02.12.2009
1. Ms. Guddi Devi, W/o late Sh. Hem Singh,
R/o Village & P.O. Khunni, Sub Tehsil Nankhari, District Shimla, H.P.
2. Vipen S/o Late Sh. Hem Singh.
3. Kaushal S/o late Sh. Hem Singh(both minor through their mother, the natural Guardian)
… Complainants.
Versus
1. State of Himachal Pradesh
Through its Commissioner cum Secretary, H.P.P.W.D. Department. Shimla-2.
2. Assistant Engineer, H.P.P.W.D. Department, Sub- Division Nankhari, Tehsil, Rampur, District, Shimla, H.P.
3. The Divisional Manager, New India Assurance Company, Ltd, Shimla.
…Opposite Parties
For the complainant: Mr. B.N. Mehta, Advocate.
For the Opposite Party No. 1&2: Mr. Anoop Sharma, Advocate.
For the Opposite Party No. 3: Mr. Ratish Sharma, Advocate.
O R D E R:
Sureshwar Thakur (District Judge) President:- This complaint has been filed by the complainant, by invoking the provisions of Section 12 of the Consumer Protection Act, 1986. The complainants avers, that, they are legal heirs of deceased Shri Hem Singh, who was employed as a Beldar, with the OP No.2, had been insured under Group Personal Accident Insurance Policy Scheme, with the OP No.3, by the OPs No.1 & 2, for a sum of Rs.2,00,000/-. The complainants averred that, the deceased worked with the OPs No.1 & 2, till 01.10.2005, on which date, he died while performing his duties. It is averred that the deceased died, due to accidental death, hence, the factum of his death was immediately brought to the notice of the OPs, where-after, the complainants, formally lodged the insurance claim for payment of insurance amount, with the OPs, who dilly-dallied its settlement, and failed to indemnify the insured. Hence, it is averred that there is apparent deficiency in service on the part of the OPs and accordingly relief to the extent as detailed in the relief clause be awarded in favour of the complainant.
2. The OPs No.1 & 2, in their written version, to the complaint, contended that the death of the deceased was due to cardio failure, hence, not covered under the policy. It is admitted that the deceased was covered under Janta Personal Accident Scheme, for Rs.2,00,000/-. The OP No.3, in its reply, contended that, the deceased died on 01.10.2005, due to cardio circulatory failure due to M.I., hence, the claim was repudiated, as the death on account of heart attack is not accidental death, but is, natural death, which is not covered under the policy. Hence, it is denied that there was any deficiency in service, on their part.
3. Thereafter, the parties adduced evidence, by way of affidavits, and, documents in support of their respective, contentions.
4. We have heard the learned counsel for the parties at length and have also thoroughly scanned the entire record of the case.
5. The parties do not wrangle over the fact that, the deceased Hem Singh, was employed, as, a Beldar and was duly covered under the Group Personal Accident Insurance Scheme, for, a, sum of Rs.2,00,000/-. The death of the deceased Hem Singh, during the currency of the insurance contract, interse the parties, is, also not in dispute. However, the grievance of the complainants, is, that, the repudiation of their claim, by the OP-Company, is, illegal and untenable, inasmuch, as, it, comprises a deficiency in service. The OP-Company, in its reply, has contended, that, the deceased, died due to cardio circulatory failure, hence, the death on account of heart attack, cannot be construed to be an accidental death, hence, the repudiation of the claim, is, tenable.
6. Annexure R-1, is, the copy of the terms and conditions of the insurance contract, and as per exclusionary clause, natural death & death due to disease is, not covered. Now, the only adjudication, which is to be rendered by this Forum, is, whether the death on account of heart attack, is, accidental or natural. In case, it is, accidental, then, certainly the legal heirs of the deceased are entitled for the insured sum, rather, if, it is natural, then, they are not entitled for any sum.
7. From the perusal of postmortem, it is clearly discernible, that, the deceased died owing, to, cardio circulatory failure. It has been contented on behalf of the OPs, that, since the deceased died owing, to, a heart attack, hence, it being a, natural death, as such, not covered under the policy, and in this behalf has placed reliance on the case law as reported in II (2008) CPJ 5, Madhya Pradesh State Consumer Disputes Redressal Commission, Bhopal, in case New India Assurance Co. Ltd. Versus Bhagwatibai and another, wherein it has been held that, heart attack, though, sudden cannot be termed as an accident. Therefore, in view of the law laid down by the Hon’ble Madhya Pradesh State Commission, which is fully applicable to the instant case, the death of the deceased Hem Singh, cannot be construed to be accidental, hence, disentitling the complainants to claim the insured sum, from the OPs, hence, the repudiation of the claim of the complainant, by the OPs, cannot be said to be a deficiency in service or unfair trade practice, on the part f the OPs.
7. Resultantly, the complaint merits dismissal and we order accordingly, leaving the parties to bear their own costs. The learned counsel for the parties undertook to collect the certified copy of this order from the office, free of cost, as per rules. The file after due completion, be consigned to record room.
Announced on this, the 2nd day of December, 2009.
(Sureshwar Thakur)
President.
NMehta) (Karuna Machhan) (Charanjit Singh)
Member Member.