Oriental Insurance Company Ltd. vs MEENA RAGHUNATHAN

THIS order will govern the disposal of FA Nos. 390 of 2003 and 826 of 2003 which arise out of a common order dated 13.3.2003 passed by Consumer Disputes Redressal Commission UT, Chandigarh. In FA No. 390 of 2003, the appellant/opposite party seeks setting aside of the order dated 13.3.2005 whereby it was directed to pay to the appellants/complainants in FA No. 826 of 2003 a sum of Rs. 5 lakh being the sum assured and Rs. 20,000 by way of compensation for mental agony as also cost. In FA No. 826 of 2003, enhancement of compensation has been sought.

DR. M. Raghunathan, husband of complainant No. 1 and father of complainants 2 and 3 took a personal accident policy from Oriental Insurance Co. Ltd.-opposite party for Rs. 5 lakh. The policy was to commence on 11.1.1999 and to remain valid up to 10.1.2001. It was alleged that assured was working as an Additional Professor in the Department of ENT, PGIMER, Chandigarh and on 14.2.2001 around 4. p.m. when he was passing through the building of Department of Oral Health Sciences, a brick fell on his head from the 3rd floor of the building. He was rushed to emergency of PGI where stitches were sutured on his head and he was discharged on 15.2.2001. On 6.3.2001, assured suddenly fell unconscious and was taken to ICU of PGIMER and there he was diagnosed to have intra-ventricular haemorrhage and he died on 11.3.2001. It was further alleged that complainants were not aware of their right to claim money under the policy and immediately after they came to know about that right, they lodged claim with the opposite party through the letter dated 1.2.2002. Vinod C. Kapoor was appointed as Investigator by the opposite party. On receipt of the report of Shri Kapoor, the opposite party repudiated the claim by the letter dated 4.7.2002. Complaint filed by complainants thereafter was contested by the opposite party by filing written version. It was not disputed that a policy of Rs. 5 lakh for 12 years was purchased by DR. M. Raghunathan and he died on 11.3.2001, as alleged. However, liability to pay the amount claimed was denied on the grounds taken in repudiation letter dated 4.7.2002. It was further alleged that death of the assured was not due to injury sustained on 14.2.2001. By way of evidence, the complainant No. 1 filed her affidavit and that of DR. Naresh K. Panda, Additional Professor and Head, Department of Otolaryngology and Head and Neck Surgery and DR. Aditya K. Aggarwal, Assistant Professor in the Department of Orthopaedics. Opposite party filed the affidavit of R.K. Behl, Senior Divisional Manager by way of evidence. On appreciation of evidence and material on record, the State Commission allowed the complaint in the manner noticed above. Main submission advanced by Mr. S.L. Gupta for opposite party-Insurance Company was that complainants have not been able to prove that cause of death of Dr. M. Raghunathan was due to the injury received by fall of a brick on 14.2.2001. Submission is, however, without any merit. It is not in dispute that none of the deponents of the affidavits filed by way of evidence by the complainants were cross-examined on behalf of opposite party. In FA No. 826 of 2003, complainants have filed the copies of affidavit of Dr. Naresh K. Panda, letter dated 2.5.2002 (Annexure C-9) sent by Dr. Panda to the Senior Divisional Manager of opposite party-Insurance Company at Chandigarh and case sheet of Dr. M. Raghunathan from 6.3.2001 to 11.3.2001. Letter dated dated 2.5.2002 finds mention in para No. 3 of the affidavit of Dr. Panda. Last but one para of this letter (copy at pp 20-21) which is material, reads as under : "After his stitch removal, when he had joined back his duty, he always used to complain of sudden giddiness on and off. Thus, I had advised him not to strain himself for few more days. No FIR was lodged in this case as no third party was involved and it seemed to be a mere accident that had occurred. A few days later, on the evening on 6.3.2001, I received a message from Mr. Sanjay Kumar that Dr. M. Raghunathan had been admitted in the ICU with the complaint of severe headache and repeated bouts of vomiting followed by loss of consciousness. I did rush immediately to the ICU and apprised myself of the whole situation. I also advised Mrs. Meena Raghunathan to call her nearby relatives so that she will have good moral and family support by her side. He remained in the ICU for six days and was later declared dead on 11th afternoon at 12.15 p.m.. Thus, following his first head injury, he died subsequently of brain haemorrhage. (The certificate of cause of death has been already submitted to your office on the prescribed proforma by the Competent Authority of PGIMER, Chandigarh). He is survived by his wife and two daughters. Further, as there was no FIR registered initially, the case of M. Raghunathan was not treated as a case of medico-legal case and no post-mortem was conducted on the body of M. Raghunathan."

It may be noticed that Dr. Panda has attributed the brain haemorrhage of Dr. M. Raghunathan to head injury received by him on 14.2.2001. In absence of cross-examination, there seems to be no reason to disbelieve this part of assertion made by Dr. Panda. Further, in the case sheet dated 6.3.2001 (copy at P-25) Dr. M. Raghunathan was diagnosed as having Spontaneous Post Traumatic B/L intra-ventricular haemorrhage. Though in the report dated 8.5.2002 said Vinod C. Kapoor indicated the possibility of Dr. M. Raghunathan having died of brain tumour or otherwise but neither the affidavit of Shri Kapoor nor that of any medical expert in support of that possibility was filed by the opposite party. Thus, there was clear nexus between the incident on 14.2.2001 and death on 11.3.2001 of the assured as rightly held by the State Commission. FA No. 390 of 2003 , therefore, deserves to be dismissed being without any merit.

COMING to FA No. 826 of 2003 in addition to sum of Rs. 20,000 as compensation for mental harassment etc. which amount is to carry interest @ 9% p.a. till payment, the State Commission has awarded Rs. 5 lakh being the sum assured to the complainants. In the facts and circumstances of case, we do not find any justification to further enhance the said amount of compensation. For the foregoing discussion, both the appeals are dismissed. No order as to cost. Appeals dismissed.