SUMAN GUPTA Vs. ORIENTAL INSURANCE COMPANY LIMITED

JUDGEMENT

(1.) Facts from which this complaint enacts are detailed below.

(2.) Complainant's husband Shri Vijay Kumar Gupta was a practising Advocate at Jammu, secured a Janta Personal Accident Policy from the Oriental Insurance Company Limited, Branch Office-II, 1st Floor, Town Hall Building, Jammu through its Branch Manager on 13.3.1997 for Rs.5.00 lacs. Complainant is his nominee in the said policy. Period of Insurance admittedly was from 13.3.1997 to 12.3.2009. The case of complainant is that her husband on 18.6.1999 at about 5.45 a. m. while coming out of the bath room had a fall. He suffered serious fatal injury as a result of fall and died instantaneously. A doctor of near Nursing Home was called who declared her husband dead. Dr. Vishav Gupta who examined the deceased issued certificate on the same day which is Annexure-B. According to the complainant he had no male member in the house. Her father-in-law and brother-in-law were in Srinagar. They joined the funeral at the final stage. In the Seva Samiti, Jammu where the dead body was cremated recorded the cause of death as natural and they forwarded such certificate to Jammu Municipality also where Sub-Registrar Vital (Statistics) also recorded the case of death as natural. After some time when it was known to her that the cause of death was written as natural she apprised the Seva Samiti, Jammu who corrected their records by adding the words UN-NATURAL and forwarded the copy of the same to Jammu Municipality to whom complainant also approached with an application to change the records from NATURAL and UNNATURAL death. The complainant raised the claim with O. P. and gave a written application to O. P.2 that she may be exempted from submitting post-mortem report which was not done in the case. According to the complainant they exempted her and did not press for such certificate when she prayed for the settlement of the claim after 2 months, she was served a finding of the O. P. that the case was of natural death, so insurance claim could not be entertained. This gave the cause of action to the complainant to file the complaint before the Commission.

(3.) O. PS. were summoned who filed their written version wherein they alleged that it was the case of natural death. As it is the complainant and his relative who is serving as Development Officer in the Insurance Company have concocted case and tried it to give a turn from natural death to unnatural death just to grab the public money. In the written version it was stressed that Seva Samiti, Jammu in the ordinary course has recorded the cause of death as NATURAL which was got recorded by the complainant side when after some time they became conscious they tried to get the record of Municipality and Seva Samiti record changed by inserting words UNNATURAL to the NATURAL which became UNNATURAL but the Municipality stuck to their own certificate which reveals that the cause of death was natural. According to the written version it further reveals that the certificate which is issued by the Doctor was a Gynaecologist and ENT Specialist. He had no experience about the Neurology. He was their own person who tried to help the complainant by giving a wrong certificate. It has further been alleged that the O. P. deputed Col. R. M. Khanna to investigate the matter regarding the cause of death who also reported the cause of death was NATURAL. It has further been alleged that production of post-mortem certificate was not exempted by the Company though they have admitted that there is an exemption clause in the Insurance Contract.