The Consumer Disputes Redressal Forum, Ahmedabad (Rural), held United India Insurance Company Limited, Ahmedabad Regional Office, and its office at Palanpur, Banaskantha district, guilty of deficiency.Â
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The Forum ordered the company on 22 December 2011, to pay her Rs. 1,00,000 with nine per cent interest from 19 February 2008 till the payment, Rs. 5,000 towards her mental agony and harassment, and Rs. 1,000 towards cost. It also directed the company to pay CERS Rs. 1,000 towards cost. CERS received a copy of The Forum’s order on 29 December 2011.
Jyotsna’s husband, Ambalal, had been insured for Rs. 1,00,000 under a group insurance scheme of United India Insurance through the Kadi Taluka Madhyamik Shala Karmachari Dhiran Grahak Mandali Limited, Kadi, and the Mehsana-Patan District Cooperative Credit Societies Federation Limited, Mehsana.
Ambalal suffered a severe head injury at his residence on 17 February 2008 and was admitted to the Indus Hospital, Ahmedabad. He was under the care of Dr. Ajay N. Prajapati. Ambalal died at the hospital the next day.
Jyotsna claimed the insurance money and submitted all necessary papers to the company. Instead of the payment, it repudiated the claim on ground that neither a first information report (FIR) nor a post-mortem examination report had been submitted. The company treated the claim as rejected and closed.
Jyotsna and CERS, of which she is a member, filed a complaint with the Forum against United India Insurance, accusing it of deficiency in service and claiming Rs. 1,00,000 with 12 per cent interest from 19 February 2008, Rs. 5,000 for her mental agony and harassment, and Rs. 2,000 towards cost.
It was pointed out that Dr. Prajapati of the Indus Hospital had clearly stated that as the medical findings were sufficient for diagnosis and ascertaining the cause of Ambalal’s death, the hospital authorities had not proceeded with a post-mortem examination.
United India Insurance contended that ‘a post-mortem note’ is required after a death involving an accident insurance claim. The complainants had not fulfilled this condition and such a claim cannot be sanctioned on the basis of Dr. Prajapati’s certificate. Besides, the company was not bound to accept such a certificate.
Citing several precedents, the complainants stated that when a person dies following a serious injury suffered at home, the case does not warrant an FIR, or a panchnama or a post-mortem examination report.
The Forum admitted the complaint and held United India Insurance guilty of deficiency in service, directing the company to pay the insurance amount with interest, compensation for harassment and agony, and cost.
