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IN THE SUPREME COURT OF INDIA

CIVIL APPELLATE JURISDICTION

CIVIL APPEAL Nos. ___________ OF 2024

[@ SPECIAL LEAVE PETITION (C) NO. 15529 OF 2015]

MADHUMITA BOSE APPELLANT (s)

VERSUS

THE MANAGER, RETAIL PA CLAIMS

TEAM HDFC ERGO GENERAL
INSURANCE CO. LTD. & ANR. RESPONDENT(s)

ORDER

Leave granted.

Against the rejection of the death claim by the

Insurance Company vide communication dated

21.05.2012, the proceedings have been brought before

the State Consumer Disputes Redressal Commission,

West Bengal [in short, “the State Commission”] seeking

compensation to the tune of Rs. 25 Lakhs along with

interest. The claim filed by the appellant was rejected

relying upon the CT Scan Report without considering

Signature Not Verified

the post mortem report of the deceased. The findings
Digitally signed by
Jayant Kumar Arora

as recorded by the State Commission have been

Date: 2024.03.20
11:14:16 IST
Reason:

affirmed in an appeal filed by the National Consumer

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Disputes Redressal Commission [in short, “the National

Commission”] vide order dated 02.02.2015.

Being aggrieved by rejection of the Consumer

Complaint, the appellant is before this Court. We have

perused the facts of the case, whereby it is apparent

that the deceased Sucheta Bose met with an accident

on 05.05.2011 when she was travelling in a bus. At the

time of getting down from the bus, she fell down and

received injury over the head. Immediately she was

admitted in Divine Nursing Home, later shifted to

Saviour Clinic and then to S.V.S. Marwari Hospital. The

FIR of the incident was lodged on 06.05.2011. Since

the time and date of the accident, she continuously

remained in hospital and died on 16.05.2011. After the

death of Sucheta Bose, a claim was submitted to the

Insurance Company under cover of the Insurance

Policy, which was rejected on 21.05.2012. The reason

of rejection of the claim, as stated in the said order, is

relevant, therefore, it is reproduced as thus :­

“We have gone through the Post

mortem note submitted by you,
and noted that the cause of death
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was kept reserved for viscera

report. Further, the FSL report
speaks that no poison could be
detected in viscera. No external
grievous injuries were noted to
the deceased person either in the
treatment case papers or at the
time of conducting the Post
Mortem. In absence of the
treatment documents to support
your version of accident injuries,
we are constrained to conclude
that the death has not occurred
on account of accidental injuries.
In view of the above, we have to
inform you with regret that the
claim does not fall within the
policy coverage.”

On filing the consumer complaint, the defence was

taken by the respondents that the deceased was

suffering from Epilepsy, as per CT Scan Report no

injury over the head is reported, however, looking to the

cause of death, the claim has been rejected.

Heard learned counsel for the parties and perused

the material placed before us. On perusal thereto, it is

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clear that immediate from the date and time of

accident, she was got admitted in Divine Nursing Home

and because of having vomits, she was urgently shifted

to ICU and CT Scan of brain was done. In the CT Scan

Report, Supratentorial Ventricles are mildly dilated, but

it was opined that it may be ‘age related’. In Report, it

was said that no fracture was detected, but follow up

was suggested and the deceased patient kept in

hospital under observation, wherein as per the

prognosis report available from Medical College &

Hospital, Kolkata, it is clear that the patient was

drowsing due to head injury and having vomits. The

patient was admitted in CB Tap female in floor under

General Surgery, later CB TP (Female) flowing under

normal surgery was reported. Thereafter, she was

admitted to Saviour Clinic, where the hematoma was

found and the patient was kept under conservative

treatment. Later, she died on 16.05.2011. The Report

of Medical Officer, S.V.S. Marwari Hospital indicates

that due to bus accident, injury was present on lower

back of the head.

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As per the Post Mortem Report, in Clause 1, in the

subject, condition of head is reported as– stout,

emaciated, decomposed etc., cerebral ordema was

mentioned. When final opinion of cause of death was

sought from the Doctor, who conducted the Autopsy, he

opined on 25.02.2012 as under :­

“Based on the findings noted in my

postmortem report No. 457 dt.
17/5/2011 and the Chemical
examiners report No. 216
FSL/Tox/1926/11 dated 1/2/12,
I am of the opinion that death was
due to the effect of the injuries
which were antemortem in nature.
As per the injury report of Medical
College Hospital No. 4606 dated
5/5/11 there was history of head
injury and vomiting. In my P.M.
report also cerebral oedema was
noted resulting from head injury.
Thus in all probability death was
due to the effects of injuries which
were antimortem in nature.”
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On the basis of the above material, we have no

scintilla of doubt that the findings as recorded by the

State Commission as well as the National Commission

merely relying the CT Scan report, without looking to

the prognosis reports co­relating with post mortem

report in our view is perverse. In the facts of the case,

mere CT Scan Report, which is of the same day

wherein also, a follow up is suggested, and the

Supratentorial Ventricles are mildly dilated, which may

be on account of the injury and not due to age related,

cannot be relied upon, as confirmed by the subsequent

post mortem report. In our view, the defence of

Epilepsy is an afterthought and the rejection of claim

by the State Commission and National Commission is

not based on sound reasoning and liable to be set

aside.

In view of the above, the findings as recorded by

the State Commission and the National Commission

stand set aside. We allow the appeal filed by the

mother of the deceased (appellant) and grant the

compensation to the tune of Rs. 25 Lakhs, as claimed,

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for the death of Sucheta on account of accidental

injuries covered under Insurance Policy. The amount

shall be deposited before the State Commission within

eight weeks from today and shall carry interest at the

rate of 7% from the date of filing of the claims petition

till its realization. Pending interlocutory application(s),

if any, is/are disposed of.

……...........……........J.
[ J. K. MAHESHWARI ]

…..............…..........J.
[ SANJAY KAROL ]

New Delhi;
March 01, 2024.
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ITEM NO.36 COURT NO.9 SECTION XVII-A

S U P R E M E C O U R T O F I N D I A
RECORD OF PROCEEDINGS

Petition(s) for Special Leave to Appeal (C) No(s). 15529/2015

(Arising out of impugned final judgment and order dated 02-02-2015

in FA No. 64/2014 passed by the National Consumers Disputes
Redressal Commission, New Delhi)

MADHUMITA BOSE Petitioner(s)

VERSUS

THE MANAGER, RETAIL PA CLAIMS TEAM

HDFC ERGO GENERAL INSURANCE CO. LTD. & ANR. Respondent(s)

Date : 01-03-2024 This petition was called on for hearing today.

CORAM : HON'BLE MR. JUSTICE J.K. MAHESHWARI

HON'BLE MR. JUSTICE SANJAY KAROL

For Petitioner(s) Mr. Amlan Kumar Ghosh, AOR

For Respondent(s) Mr. Joy Basu, Sr. Adv.

Ms. Prerna Mehta, AOR
Mr. Anoop George, Adv.

UPON hearing the counsel the Court made the following

O R D E R

Leave granted.

The appeal is allowed in terms of the signed order.

Pending interlocutory application(s), if any, is/are disposed of.

(JAYANT KUMAR ARORA) (VIDYA NEGI)

ASTT. REGISTRAR-cum-PS ASSISTANT REGISTRAR

(Signed order is placed on the file)