The Hoshiarpur Central Cooperative Bank Ltd.
Smt Dalbir Kaur widow of Sh Gurmit Singh resident of village and post office Rajpur Bhiyan Tehsil and District Hoshiarpur at present resident of H.No.106, Mount Avenue, Hoshiarpur.
- The Hoshiarpur Central Cooperative Bank Ltd., main branch, near Distt. Court Complex Road, Hoshiarpur Tehsil and District Hoshiarpur through its Manager.
- Reliance Insurance Company,Regional Office, SCO 212-214, Sector-34A, Chandigarh through its Manager.
Complaint u/s 12 of the Consumer Protection Act, 1986.
Present; Sh Harjot Kamal Singh, counsel for the complainant.
Sh Manu Kaushal vice Sh. S.L.Handa, counsel for OP No.1.
Sh A.K.Gupta, counsel for OP No.2.
- The complainant namely Smt Dalbir Kaur widow of Gurmit Singh has filed the present complaint under section 12 of the Consumer Protection Act,1986 (as amended upto date) “hereinafter referred as the Act.”. In short,the facts of the case are that the husband of the complainant opened the bank account no. 8366 with OP No.1-The Hoshiarpur Central Cooperative Bank Ltd., and thereafter, the pass book was issued to him. It is further the case of the complainant that her husband got himself insured under the insurance scheme”Sekhari Bank Bima Youjna”.
- The complainant has averred that OP No.1 deducted the amount of Rs.40/-per annum as premium for the year 2006-07. It is further the allegation of the complainant that her husband met with an accident at Piplanwala, Hoshiarpur. The husband of the complainant remained admitted in Civil Hospital, Hoshiarpur for couple of days. It is further the case of the complainant that her husband received multiple injuries on his person, thus,was operated in Satnam Hospital, Hoshiarpur. It is further stated that the husband of the complainant died . The complainant submitted an application to OP No.1 for getting the insurance claim and also completed all the formalities. The OPs repudiated the claim vide letter dated 10.6.2008, hence this complaint.
- OP No.1 filed the reply. On merits, the claim put forth by the complainant has been denied. However, it is admitted that the replying OP deducted the amount of Rs.40/- from the saving account of deceased Gurmit Singh for insurance and paid the same to OP NO.2 - Reliance Insurance Company. Deceased Gurmit Singh was not the consumer of the replying OP. It is further replied that after completing the formalities,the replying OP sent the claim application alongwith post mortem report, death certificate, FIR and list of insured persons etc. vide letter no.Stat.Cell/39065 dated 28.3.2008 to OP No.2. However, OP No.2 repudiated the claim of the complainant on the ground that deceased died due to heart attack and not due to injuries suffered by him in the road accident. The replying OP is not liable to settle or pay any claim to the complainant.
- OP No.2 filed a separate reply. Preliminary objection that this Forum has no jurisdiction was raised. It is replied that Gurmit Singh was insured with the replying OP through OP No.1 under Sekhari Bank Bima Youjna”. The premium was being paid by OP No.1. The Insurance policy issued by replying OP only covers the claim of accidental insurance and not natural death. It is denied that Gurmit Singh died unnatural death. It is also denied that complainants are the legal heirs of deceased Gurmit Singh. It is admitted that the claim was filed on 28.3.2008 with the replying OP, and thereafter, the investigator was appointed to investigate the matter . It was found that Gurmit Singh had died due to heart attack and not due to any injury sustained in the accident, thus, the claim was rightly repudiated. It is further replied that no post mortem report was submitted which is pre requisite for considering the claim.
- In order to prove the case, the complainant tendered in evidence affidavit Ex.C-1, legal notice Mark C-2, copy of letter dated 14.3.2008 Mark C-3, letter dated 28.1.2007 Ex.C-4, admission record of complainant Mark C-5, death certificate of Gurmit Singh Ex.C-6, certified copy of DDR Ex. C-7, DDR No.52 Ex. C-6 and DDR No.54 dated 28.11.2007 Ex.C-7 and closed the evidence.
- In rebuttal, the opposite party tendered in evidence affidavit of Kishan Gopal Ex.OP-1, claim application Ex.R-1, medical certificate Ex. R-2, statement of account Ex. R-3, death certificate Ex. R-4, pass book Ex. R-5, death certificate Ex. R-6, ration card Ex. R-7, DDR Ex. R-8, post mortem report Ex.R-9 and MLR Ex.R-10 and closed the evidence.
- The learned counsel for the parties have filed written arguments. We have gone through the written submissions and record of the file minutely.
- The OP No.2 had repudiated the claim of the complainant vide repudiation letter Ex.R-4 on the ground that the death of deceased-Gurmit Singh has been caused due to heart attack and further no post mortem was carried out which is pre requisite for the death claim. Ld. Counsel for the parties during the course of arguments submitted that the other facts are admitted, therefore, the only point which calls decision from this court is whether the death occurred due to accidental injuries or otherwise ( i.e. due to heart attach)?
- The complainant has produced Dr.Gurbachan Singh as CW-1. The statement of this witness is very material to decide the present controversy . He has admitted in the cross examination that the injuries suffered by deceased-Gurmit Singh cannot cause death in ordinary course. This witness was reexamined by learned counsel for the complainant and in reexamination , he has stated that the death can occur due to these injuries afterwards due to post matic sequally or complications . This witness was again cross examined by learned counsel for OP NO.2 . This witness has categorically admitted that there can be complication , which can lead to death vis a vis infection, aspiration or some operative complications. The close scrutiny of statement of CW-1 makes it clear and leaves no doubt in the mind of this Court that the injuries sustained by deceased cannot cause death in natural/ ordinary course although the death can occur due to these injuries afterwards due to post matic sequally or complications .
- Now it is established from the statement of CW-1 that the injuries sustained by deceased cannot cause death in ordinary/natural course , therefore, it can legitimately be concluded that the death had not occurred due to accidental injuries. Admittedly, the claim is payable only, if it is proved on record that the death has occurred due to accidental injuries
- CW-1 has also stated that the patient was examined by Dental Surgeon on 29.11.2007 and was referred for further management to Punjab Govt. Dental College and Hospital, Amritsar. Admittedly, the patient was not taken for further management to Punjab Govt. Dental College and Hospital, Amritsar but on the contrary and against the advice of the doctor, he was taken to Satnam Hospital, Phagwara Road, Hoshiarpur.. The complainant has also examined Dr Kamaljit Kaur of Satnam Hospital,Hoshiarpur on 25.2.2009 as CW-2. OP No.2 has produced on record the certificate issued by Dr Kamaljit Kaur -Mark R-2 on the record and its perusal makes it clear that the said doctor has certified that Gurmit Singh was admitted in the hospital after suffering injuries and fractures in road traffic accident. The patient underwent plating for the fractures under general anesthesia and expired post operatively on the same day after extupatias as a post operative complication of general anesthesia having suffered sudden cardio respiratory arrest.. The said certificate issued by Dr.Kamaljit Kaur does not tally with her statement recorded in this court as CW-2. This doctor has also certified that deceased expired post operatively as a post operative complication of general anesthesia having suffered sudden cardio respiratory arrest. Since, the certificate issued by the doctor is contradictory to her statement made as CW-2, therefore, her evidence as CW-2 cannot be looked into and is liable to be ignored. More so, CW-2 has admitted that she is M .Sc, ENT and Head and Neck Cancer Surgeon. She has also stated that the patient was referred by Civil Hospital to Punjab Govt. Dental College and Hospital, Amritsar . She has further admitted that there is no Dental Surgeon in Satnam Hospital, Hoshiarpur.
- Now it is clear that deceased Gurmit Singh was referred to Punjab Govt. Dental College and Hospital, Amritsar but against the advice of the doctor, he was admitted in Satnam Hospital, Hoshiarpur. It is also proved that CW-2 attended upon Gurmit Singh, who is not a qualified Dental Surgeon as she is M .Sc, ENT and Head and Neck Cancer Surgeon. It is also established on record that death of Gurmit Singh had not occurred due to accidental injuries. Therefore, as per terms and conditions of the insurance policy, the claim is not payable. It is also an admitted fact that the complainant has also not produced post mortem report.
- Confronted with this type of situation, it is held that the injuries suffered in the accident by deceased Gurmit Singh are not responsible for his death as there is no direct nexus between the injuries sustained in the accident and cause of death as the complainant has failed to produce sufficient evidence on the file that the deceased Gurmit Singh died due to accidental injuries. More over, CW-1- Dr.Gurbachan Singh has categorically stated that the injuries sustained in the accident are not sufficient to cause death in the normal course.
- As a result of the above discussion, it is held that OP No.2 was legally competent to repudiate the claim. The complainant has also failed to prove any deficiency in service on the part of the OPs, with the result, the complaint is dismissed. No order as to cost.
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