(From the order dated 22.6.2004 in MP No.38/04 arising from order dated 10.9.2003 passed in Appeal No.1072/03, of the State Commission, Chhatisgarh)
S/o of late Shri Murlidhar Jaiswal,
Village Bhapholi, P.S. Dhaurpur,
Distt. Surguja (C.G.) Petitioner
The Oriengal Insurance Co.
Ambikapur, Chhatisgarh Respondent
HONBLE MR. JUSTICE M.B.SHAH, PRESIDENT.
DR. P.D. SHENOY, MEMBER.
For the Petitioner : Ms.Astha Tyagi, Advocate
For the Respondents : Mr. D.N. Ray, Advocate
M.B.Shah, J., President.
Petitioner filed Complaint No. 169 of 2001 before the District Forum, Ambikapur, contending that the Respondent M/s.Oriental Insurance Company had unjustifiably repudiated the claim arising under the Janta Personal Accident Policy for a sum of Rs.1 lakh which was taken by his father, late Murlidhar Jaiswal. By the order dated 6.2.2003 the complaint was dismissed by accepting the contention raised by the Insurance Company that death was due to hypertension which resulted in brain haemorrhage.
Against that order, the Petitioner preferred Appeal No. 38 of 2004 before the State Commission, Chhattisgarh. That appeal was dismissed in default. The application for restoration was also dismissed. Hence, the Petitioner has preferred this revision application.
we would state that the State Commission erroneously dismissed the appeal on
the ground of absence of the appellant. Normally, in such cases, even in the
absence of appellant, the State
Commission ought to have decided the appeal on merits. It is to be remembered that proceedings
before the Consumer Fora are inquisitorial and not adversary. The orders are required to be passed in
accordance with justice and equity on the basis of the evidence available on
record. The Act is for the protection of
the consumers and matters are required to be decided by having rationale
approach and not technical one. This is
made clear in Indian
Photographic Co. Ltd. Vs. H.D.Shourie, (1999) 6 SCC
428 wherein the
4. The Consumer
Protection Act, 1986 has been enacted to provide for better protection of the
interests of the consumers by making provisions for the establishment of
consumer councils, other authorities for the settlement of consumer disputes
and for matters connected therewith. The Act was enacted as a result of
widespread consumer protection movement. On the basis of the report of the
Secretary General on Consumer Protection dated
Therefore, in our view, the State Commission, in such cases, ought to have decided the appeal on merits even in the absence of the Complainant. That would have been a rationale and non-technical approach which is the mandate of law.
Complainant was not in a position to engage an Advocate. We have appointed Amicus Curiae and heard learned Advocates for the parties. Fortunately, in this revision application, Insurance Company has filed exhaustive reply along with the copy of the policy, CT Scan Report, copy of the claim form and the report submitted by the investigators who were appointed by it.
the said reply it is apparent that the repudiation of the claim made by the
Petitioner is totally unjusfified. Undisputedly, the deceased had taken a Janata Personal Accident Policy for a sum of Rs.1 lakh for the period 15.1.1999 to 14.1.2011. On 29.12.1999
the deceased fell down from the staircase and was brought to the
In the CT Scan report of the brain (plain) (as produced by the insurance company on record) it is stated as under:
Serial axial sections of brain were studied from base of skull to vertex without giving intravenous contrast.
The CT study shows large intra cerebral haematoma in left putamen (5.5 x 7.3 x 3.6 cm.) causing compression and ipsilateral ventricle with subfalcine herniation towards right side. There is evidence of blood seen in basal cisterns. The left vertebrobasilar system appear dolichoectatic.
As per the report of the Consultant Radiologist, in conclusion, his impression is as under:
Impression: CT study shows intra cerebral haematoma in left putamen causing subfalcine herniation towards right side with sub-arachnoid haemorrhage and dolichoectasia of left verterbro-basilar system.
From the aforesaid report it is apparent that the deceased was having head injury. Thereafter he got himself discharged from the hospital on 7.1.2000 and expired on 8.1.2000.
is the contention of the Insurance Company that one Mr.H.N.Tiwari
was appointed to conduct
preliminary inquiry. Thereafter, Maj. R.K.Tiwari
(Retd.) was appointed for final investigation, who
reported that the insured, Murlidhar Jaiswal, was suffering from hyper-tension. He became
unconscious on 29.12.1999 and was brought to the
In our view, undisputedly, the deceased fell down while going to bathroom and from this it cannot be presumed that he fell down because he was suffering from hypertension. A fall can be for various reasons such as slippery surface or missing of a step from the stair. Therefore, it would be difficult to draw an inference that the fall of the insured must be because of hypertension. Further, there is nothing on record to establish that the deceased was having hypertension and that it was known to him before taking the policy. Hence, it can be held that insurance company has failed to establish that the assured fell down because of hypertension.
the brain scan reports specifically mentions that the study reveals that large
intra cerebral haematoma in left putamen (5.5 x 7.3 x 3.6 cm.) causing
compression and ipsilateral ventricle with subfalcine
herniation towards right side. This means that death was due to accidental fall
which resulted in the head injury which caused cerebral haematoma which caused
the death. It is undisputed that as soon as the deceased fall down while going
to the bath room he was taken to the hospital. Treatment was given at the
In support of his claim, the Petitioner has also produced a copy of the death report in which the cause of the death was mentioned as due to head injury because of accidental fall from the stairs. Panchnama was also produced on record in which it was stated that while going to bathroom on 29.12.1997 at . the assured slipped from the stairs and became unconscious. In this view of the matter, the stand taken by the Insurance Company was unjustifiable.
the result, the Revision Petition is allowed. The Insurance Company is directed
to pay Rs.1 lakh with interest at the rate of 10%