Karnataka

Chitradurga

CC/110/2017

Smt. Suvarnamurthy W/o Late B.S. Chandrashekaramurthy - Complainant(s)

Versus

. The Divisional Manager, LIC of India, Claims Department - Opp.Party(s)

Sri.B.K.Govardan

24 Aug 2018

ORDER

COMPLAINT FILED ON:03/11/2017

DISPOSED      ON:02/08/2018

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO:110/2017

 

DATED: 2^nd AUGUST 2018

PRESENT: - SRI. T.N. SREENIVASAIAH  : PRESIDENT                          B.A., LL.B.,

SMT. JYOTHI RADESH JEMBAGI : MEMBER

                        BSc., MBA., DHA.,

                               

……COMPLAINANT/S	1. Smt. Suvarnamurthy,  W/o Late B.S.Chandrashakarmurthy, Age: 55 Years, House wife, R/o Suvarna Nilaya, IUDP 11th Cross, Sri Sai Layout, 4th Main, Chitradurga.   2. Sri. C. Sachin, S/o Late B.S. Chandrashakarmurthy, Age: 23 Years, Advocate, R/o Suvarna Nilaya, IUDP 11th Cross, Sri Sai Layout, 4th Main, Chitradurga.   (Rep by Sri.B.K. Govardhan, Advocate)
V/S
…..OPPOSITE PARTY	The Divisional Manager, Life Insurance Corporation of India, Claims Department, Divisional Office, Jeevan Prakash, 100 Feet Road, Gopalapura Extension, Shivamoga-577 205. (Rep by Sri.L. Madhusudan, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P. Act, 1986 for the relief to direct the OP to pay a sum of Rs.1,50,000/- towards double accident claim benefit along with interest at the rate of 18% p.a, Rs.25,000/- towards mental agony and such other reliefs.

2.      The brief facts of the case of the above complainants are that, complainants No.1 and 2 are the wife and son of deceased B.S. Chandrashekaramurthy respectively who died on 07.09.2015, due to accidental injuries which took place on 15.08.2015 at about 5-30 PM, when the deceased Chandrashekaramurthy who was returning to Chitradurga from his native place Ramagiri through vehicle bearing Reg. No.KA-16 M 9509 along with his Driver.  It is submitted that, after completion of his work due to rash and negligent manner of the driver of the said vehicle, near Arehalli-Jaipura, near Holalkere Railway Station, the said vehicle was fell down from the right side of the road.  Due to the same, the said B.S. Chandrashekaramurthy was sustained injuries all over the body.  Immediately, he was shifted to Government Hospital, Holalkere and on the advice of the Doctors, he was shifted to Basaveshwara Hospital, Chitradurga for treatment, then shifted to Manipal Hospital, Bangalore.  After treatment in the Manipal Hospital, Bangalore, he shifted to Sunita Nursing Home, Chitradurga for regular treatment.  In spite of taking treatment, the said B.S. Chandrashekarmurthy was died on 07.09.2015.  During the life time of said B.S. Chandrashekaramurthy has obtained LIC policy bearing No.620907743.  After his death, the complainants being the legal heirs of life assured have filed a claim petition before the OP for settlement.  The OP has repudiated the claim of the complainants stating that, the deceased B.S. Chandrashekaramurthy was not died due to accident, before the accident, he was suffering from diabetic and other diseases.  Due to the said disease, he died.  Therefore, complainants have issued a legal notice through their counsel on 13.04.2016 but, the OP has not settle the claim.  The cause action for the complaint arose when the OP issued the policy and when the premium has been collected from the deceased which is within the jurisdiction of this Forum.  Therefore, the complainants respectfully prayed before this Forum to allow their complaint with cost. 

3.      On service of notice, OP appeared through Sri. L. Madhusudan, Advocate and filed version.  The allegations made in para-2 to 5 are denied as false and the complainants are put to strict proof of the same.  It is further submitted that, it is true that, the deceased B.S. Chandrashekaramurthy was holding LIC policy bearing No.620907743 for a sum of Rs.1,00,000/-.  As the death of the life assured had taken place on 07.09.2015 and the policy was in force as on the date of death, the OP has settled the death claim in favour of complainant for a sum of Rs.1,41,999/- on 04.10.2015.  The main contention taken by the OP in its version that, the complainant has not produced the death certificate of the deceased B.S. Chandrashekaramurthy and PM report was not conducted.  The deceased B.S. Chandrashekaramurthy was died due to other diseases and not due to the accident and hence, prayed for dismissal of the complaint.

4.      Complainant No.2 has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-8 were got marked.  On behalf of OP, one Sri. Shamanna, the A.O of OP has examined as   DW-1 by filing the affidavit evidence and Ex.B-1 to B-6 documents have been got marked.  

 

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

 

(1)  Whether the complainants prove that the OP has committed deficiency of service in settling the double accident claim benefit made by them under the insurance claim due to accident and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      Point No.1:- It is not in dispute that, the husband of complainant No.1 and father of complainant No.2 the deceased B.S. Chandrashekaramurthy has taken double accident policy bearing No.620907743 from the OP.   On 15.08.2015, at about 5-30 PM the said B.S. Chandrashekaramurthy after completion of his work he was returning to Chitradurga from his native place Ramagiri along with Driver from his Swift-dizire vehicle bearing Reg. No.KA-16 M 9509.  When the said vehicle came near Arehalli-Jaipura road near Holalkere Railway Station, due to rash and negligent driving of the driver of the said vehicle, the said vehicle fell down.  Due to the said accident, the deceased B.S. Chandrashekaramurthy was suffered grievous injuries all over the body.  Then, immediately he shifted to Government Hospital, Holalkere and thereafter, he shifted Basaveshwara Hospital, Chitradurga and then shifted to Manipal Hospital, Bangalore for treatment.  After the treatment, he was returned to Chitradurga and admitted to Sunita Nursing Home, Chitradurga.  While taking treatment in the said nursing home, he died on 07.09.2015.  After his death, being the LR’s complainants have filed a claim petition before the OP claiming double accident benefit.  After receiving the necessary documents from the complainants, the OP has sent a letter stating that, the complainants are not entitled for the benefit because, they have not produced PM report.  The OP has settled the claim of Rs.1,41,999/- but, they have not settled the double accident benefit claim to the complainants.  As per the documents produced by the complainant and OP it clearly shows that, the life assured was died due to accidental injuries as per the certificate issued by the Sunita Nursing Home, Chitradurga, the same has been marked before this Forum at Ex.A-10.  The OP also produced the same document.  The decision reported in 2016 Part-II Volume-4 at page 328 (NC) in the case of National Insurance Co. Ltd., Vs. Mousumi Bhattacharjee and others wherein it has been held as under:

Consumer Protection Act, 1986 – Sections 2(1)(g), 14(1)(d), 21(b) – Insurance – Accidental policy to secure house loan – Death of assured due to mosquito bite – claim repudiated – Exclusion clause – Deficiency in service – District Forum allowed complaint – State Commission dismissed appeal – Hence revision – Contention, death due to mosquito bite cannot be treated as accidental death – Not accepted – An accident is something that happens unexpectedly and is not planned in advance – It can hardly be disputed that a mosquito bite is something which no one expects and which happens all of a sudden without any act of omission on part of victim – Contention that malaria due to mosquito bite is a disease and not an accident cannot be accepted – Impugned order upheld.

Result: Revision Petition dismissed.  

Another decision reported in 2018(2) CPR 432 (NC) in the case of United India Insurance Co. Ltd., wherein it has been held as under:

Consumer Protection Act, 1986 – Sections 15, 17, 19 and 21 – Insurance – Accident claim – cum Accidental death policy – OP 1 repudiated claim on ground that as per provisions of policy, cover was granted for death by accident on air/rail/road and not otherwise, whereas de4ceased was shot by some miscreant – State Commission modified order of District Forum and OP 1 was directed to pay insured amount of Rs.5 Lac to complainants and mother of deceased with cost of Rs.10,000/- - Happenings which are not covered under policy, have been specified in exclusion clause – It nowhere excludes murder – Repudiation done by insurance company is unjustified – No reason to interfere with reasoned order passed by State Commission – Revision petition dismissed.

Result: Revision Petition dismissed.

   

9.   We have gone through the entire documents filed by the complainant and OP.  The husband of the complainant No.1 while returning from his native place through his car bearing Reg. No.KA-16 M 9509.  When the said vehicle came near Arehalli-Jaipura road near Holalkere Railway Station, due to rash and negligent driving of the driver of the said vehicle, the said vehicle fell down.  Due to the said accident, the deceased B.S. Chandrashekaramurthy was suffered grievous injuries all over the body.  Immediately he shifted to Government Hospital, Holalkere and thereafter, he shifted Basaveshwara Hospital, Chitradurga and then shifted to Manipal Hospital, Bangalore for treatment.  After taking treatment from the Manipal Hospital, he was returned to Chitradurga and admitted to Sunita Nursing Home, Chitradurga.  While taking treatment in the said nursing home, he died on 07.09.2015.  After his death, being the LR’s complainants have filed a claim petition before the OP claiming double accident benefit.  But, the OP repudiated to settle the claim and stated that, the above said person was died not due to accident, he was suffering from diabetic and other diseases.  The OP has produced the documents to show that, the said person was suffering from other diseases.  But as per the decisions cited above, due to bite of mosquito, the same comes under the accidental death even if the PM report was not conducted.  Moreover, the Doctors of the Sunita Nursing Home, Chitradurga has issued a certificate stating that, the deceased B.S.Chandrashekaramurthy was died due to accident.  Hence, the OP is liable to pay the double accident benefit to the complainants.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.          

            10.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

The complaint filed by the complainants U/s 12 of C.P Act 1986 is partly allowed.

It is ordered that, the OP is hereby directed to pay a sum of Rs.1,41,999/- to the complainants under the double accident benefit along with interest at the rate of 9% p.a from the date of repudiation i.e., 02.03.2016 till realization.

It is further ordered that, the OP is hereby directed to pay Rs.5,000/- towards mental agony and Rs.5,000/- towards costs of this proceeding.  

It is further ordered that, the OP is hereby directed to comply the above order within 30 days from the date of this order.

(This order is made with the consent of Member after the correction of the draft on 02/08/2017 and it is pronounced in the open Court after our signatures)         

 

                                     

MEMBER                                                   PRESIDENT

-:ANNEXURES:-

 

Witnesses examined on behalf of Complainant:

PW-1:  Complainant by way of affidavit evidence.

Witnesses examined on behalf of OP:

DW-1:  Sri. Sri. Shamanna, the A.O of OP by way of affidavit evidence. 

Documents marked on behalf of Complainants:

01	Ex-A-1:-	Letter dated 02.03.2016 by the OP to complainant No.1
02	Ex-A-2:-	Legal Notice dated 13.04.2016
03	Ex-A-3:-	FIR
04	Ex-A-4:-	Complaint given by complainant No.2
05	Ex-A-5:-	Spot Panchanama
06	Ex-A-6:-	Death Certificate of B.S. Chandrashekarappa
07	Ex-A-7:-	Premium paid receipt
08	Ex.A-8:-	Letter dated 07.09.2015

 

Documents marked on behalf of OP:

01	Ex-B-1:-	Discharge Summary dated 28.08.2014
02	Ex-B-2:-	Discharge Summary dated 14.04.2015
03	Ex-B-3:-	Discharge Summary dated 26.08.2015
04	Ex.B-4:-	Discharge Summary dated 22.12.2015
05	Ex.B-5:-	Copy of policy
06	Ex.B-6:-	Discharge summary

 

 

 

MEMBER                                                   PRESIDENT

Rhr**