BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD
F.A.No.48/2013 against C.C.No.59/2010, Dist. Forum, Adilabad.
Between:
National Insurance Company Limited,
DAB-1st Floor, Palika Bhavan,
R.K.Puram, Ring Road,
New Delhi – 110 066,
Rep. through its Divisional Manager. …Appellant/
Opp.party no.3
And
1.M.Vandana, W/o. Mencha Ravi,
Age 26 Yrs., Occ:Household,
R/o.H.No.1-6-356,
Shanti Nagar Locality, Adilabad Dist.
Adilabad, A.P. Respondent/
Complainant
2. M/s. Chandra Motors,
Rep. by its Prop. Mr.Ravinder Reddy,
Sainagar,Dasnapur NH No.7,
Adilabad Dist. Adilabad.
3. Hero Honda Passport Programe Member,
Hero Honda Motors Limited,
34, Basant Lok , Vasanth Vihar,
New Delhi 110057. … Respondents
Opp.parties 1 & 2
Counsel for the Appellant : Mr.M.Ramgopal Reddy
Counsel for the respondents : M/s. Vakkanti Narasimha Rao-R1.
R2 & R3 – Notice served.
QUORUM: SRI T.ASHOK KUMAR, HON’BLE MEMBR,
AND
SRI S.BHUJANGA RAO, HON’BLE MEMBER.
WEDNESDAY, THE TWENTY SIXTH DAY OF MARCH,
TWO THOUSAND FOURTEEN.
Oral Order: (Per Sri S.Bhujanga Rao, Hon’ble Member).
****
This appeal arose out of order dt.13.08.2012 of the District Forum, Adilabad made in C.C.No.59/2010 filed by the respondent no.1/complainant claiming Rs.1,50,000/- towards the insured amount and compensation.
The appellant is the opp.party no.3 and the respondent no.1 is the complainant and the respondents 2 and 3 herein are the opp.parties 1 and 2 respectively in the compliant. For the sake of convenience, the parties are described as arrayed in the complaint.
The brief case of the complainant is that the complainant’s husband Mencha Ravi was the owner of Hero Honda CD Deluxe Drum Kick Start bearing registration no.AP I.G. 5607 (in short: the motor cycle). He was holding valid driving license, which was valid from 22.11.2005 to 21.11.2025 and the said motor cycle was insured with the opposite parties 1 and 2 under Group Personal Accident Policy bearing no.350700/42/03/02/00062 which is valid for three years i.e. upto 12.08.2010.
While so, on 09.04.2010 the said Mencha Ravi was proceeding on his motor cycle towards his house at Shanti Nagar, Adilabad, from Vinayaka Chowk,Adilabad, when he reached near his house, all of a sudden, one small boy came infront of his motorcycle, due to which, he applied sudden brakes and fell down. The said Mencha Ravi was shifted to Government Hospital RIMS, Adilabad, where he succumbed to injuries on the same day i.e. on 09.04.2010, while undergoing treatment. Immediately, the complainant intimated the death of the deceased, to the opposite parties and also made claim with them by submitting all required documents. The opposite parties repudiated the claim of the complainant without any valid reasons, which amounts to negligence and deficiency in service, on the part of the opposite parties. The complainant is entitled to claim the insured amount of Rs.1 lakh and compensation of Rs.50,000/- i.e. Rs.1,50,000/-. Hence the complaint.
Opposite party no.1 filed counter denying the material allegations made in the complaint and contended that the deceased Mencha Ravi died due to cardiac arrest while undergoing treatment in RIMS hospital, Adilabad, but not due to accidental injuries sustained in a motor cycle accident as stated in the complaint/claim petition. The policy issued to the said Mencha Ravi does not cover the cardiac arrest/natural death. The complainant did not intimate the death of the deceased Ravi to this opposite party no.1 and did not submit the documents to opposite party no.1 at any time. There is no deficiency in service on the partof this opposite party no.1 and if any amount is to be awarded , the opposite parties 2 and 3 are only liable to pay to the complainant. There is an agreement in between the opposite parties 2 and 3 with regard to the covering of accidental death liability of holder of Hero Honda Passport. The complaint is notmaintainable against this opposite party no.1. Therfore, the complaint is liable to be dismissed with costs.
The complaint against opposite party no.2 was dismissed for not taking steps to serve the notice on opposite party no.2.
Opposite party no.3 filed version/counter denying the material allegations made in the complaint and contended that there is no privity of contract between the complainant and this opposite party. The insurance company office has no record of information about the claim. This opposite party never refused to pay the amount, if the complainant is found entitled. The deceased died only due to cardiac arrest, as certified by the doctor who treated him. It is denied that the death is an accidental death. Since the deceased died only due to cardiac arrest, it cannot be termed as accidental death. The claim does not fall within the ambit of the policy. The complaint is pre matured. There is no deficiency in service on the part of this opposite party . The complaint is therefore liable to be dismissed.
During the course of enquiry, before the District Forum, the complainant and opposite party no.1 filed affidavit evidence and the complainant got marked Exs.A1 to A7 .
Having considered the evidence on record and having heard both sides, the District Forum came to the conclusion that there is deficiency in service on the part of the opp.parties 1 and 3 and directed them to pay a sum of Rs.1 lakh towards the insured amount with interest @ 7.5% p.a. from the date of filing of the complaint till realisation and also awarded costs of Rs.500/-.
Aggrieved by the said order, the opposite party no.3 filed this appeal questioning the legality and validity of the order.
Now the point for consideration is whether the impugned order of the District Forum is vitiated for misappreciation of fact or law?
The learned counsel for the appellant/opposite party no.3 argued that the appellant insurance company had issued Group Personal Accident Policy for a period of three years from 13.08.2007 to 12.08.2010. Ex.A1 policy was invalid policy since it had already been lapsed as on the date of the alleged death i.e. on 9.04.2010. The learned counsel further submitted that the deceased Mencha Ravi died due to ‘heartache’ but not due to any accident. The complainantwas not entitled for any benefit under Group Personal Master Policy, which was issued to Hero Honda Motors Ltd. The opposite party no.3 or opposite parties 1 and 2 never received any claim intimation or any claim documents from the complainant, in respect of the death of the deceased to enable this appellant/opposite party no.3 to process the claim of the complainant, as per the terms and conditions of the subject policy. The learned counsel further submitted that it is very clear from the certificate of insurance (Ex.A1) under the heading “coverage” such as that death only, arising out of accident as per the terms and conditions, exclusions and exceptions of standard Group Personal Accident Policy, under Table I. The claim should be supported by FIR, Postmortemreport etc. for the accidental death. There are no such documents filed and for the same reasons, the claim is not entertainable. Therefore, the claim of the complainant is not payable under the subject policy. Therefore, the impugned order of the District Forum is liable to be set aside.
The learned counsel for the respondent no.1 /complainant submitted the arguments supporting the order of the District Forum.
It is an admitted fact that the deceased Mencha Ravi is the husband of the complainant and the owner of the Motor Cycle Hero Honda CD Deluxe Drum Kick Start bearing registration no. AP IG 5607. It is also an admitted fact that the deceased Mencha Ravi died on 09.04.2010, while undergoing treatment at RIMS , Adilabad.
The case of the complainant is that her deceased husband Mencha Ravi insured his motor cycle with the opposite parties 1 and 2 under the Group Personal Accident Master Policy bearing no.350700/42/03/02/00062 for a period of 3 years ending on 12.08.2010. The opposite party no.1 M/s. Chandra Motors denied that the deceased Mencha Ravi insured his motor cycle with it and contended that opposite party no.1 is not an insurance company, as such, the question of insuring the life of the deceased Mencha Ravi with opposite party no.1, under the above said policy does not arise and that there is no privity of contract between the complainant and opposite party no.1. The opposite partyno.1 has denied the allegation that the deceased Mencha Ravi died in a motor vehicle accident on 09.04.2010 and therefore there is no deficiency in service on the part of the opposite party no.1.
In order to prove his case, the complainant filed Ex.A1 to A7 before the District Forum in addition to his evidence affidavit. Ex.A1 is the Certificate of Insurance dt. Nil signed by the Divisional Manager of opposite party no.3 insurance company. Ex.A2 is the attested copy of Passport Undertaking of Hero Honda Bike. Ex.A3 is the Membership Benefits Guide. Ex.A4 is the attested copy of Medical Certificate of Cause of Death. Ex.A5 is the attested copy of the Death Certificate relating to the deceased Menchu Ravi. Ex.A6 is the attested copy Driving License of the deceased M.Ravi and Ex.A7 is the attested copy of Certificate of Registration issued by A.P.Transport Department with regard to the Motor Cycle belonging to the deceased.
Ex.A1 Certificate of Insurance states that the holder of this certificate being a Hero Honda Passport Programme Member is insured against the loss of life due to an accident under Group Personal Accident Policy No. 350700/42/03/82/00062 for three years as applicable, which was taken by Hero Honda Motors Ltd. The sum insured is Rs.1 lakh. Under the heading “Coverage” it is mentioned that “death only arising out of accident as per terms and conditions, exclusions and exceptions of the Standard Group Personal Accident Policy under Table 1”, and the period is three years from the date of issue as mentioned in the Hero Honda Passport issued in favour of Menchu Ravi by Hero Honda Motors, the copy of which is marked as Ex.A2.
It is mentioned in Ex.A3 Membership Benefits Guide “You are automatically covered for a Personal Accident Insurance worth Rs.1 lakh”. It is thereforeevident that each member of the Hero Honda Passport Programme is entitled to free accident insurance policy.
From Exs.A1 to A3 it is clear that the deceased Menchu Ravi was a member of Hero Honda Passport Programme and that Hero Honda Motors Ltd. obtained the policy and it is not the deceased Menchu Ravi personally insured his motor cycle with the opposite parties 1 and 2 under the policy. Only the life ofMenchu Ravi was insured against the loss of life due to accident under the policy.
In view of the above discussed facts and circumstances, the complainant failed to prove that he insured his motor cycle either with opposite party no.1 or opposite party no.3. Opposite party no.1 is no way concerned with the policy obtained by Hero Honda Motors Ltd. from opposite party no.3 Insurance Company. Therefore, we are of the view that opposite party no.1 is not liable to pay any damages or the sum assured under the policy as claimed by the complainant. Thus the complainant failed to establish that there is deficiency in service on the part of the opposite party no.1 as alleged by the complainant. Hence the complaint is not maintainable against the opposite party no.1.
As stated above, from Exs.A1 to A3 it is evident that the death only arisen out of accident is covered as per the terms and conditions of the Standard Group Personal Accident Master Policy under Table I. It is the case of the complainant that her husband Menchu Ravi died due to heart attack as a consequence of motor cycle accident. On the other hand, the contention of the opposite party no.3 is that the deceased Menchu Ravi died only due to cardiac arrest and denied that the death is an accidental death. The opposite party no.3 contended that since the deceased died only due to cardiac arrest, it cannot be termed as accidental death and the claim does not fall within the ambit of the policy, as such the complaint is not maintainable against the opposite party no.3.
The case of the complainant is that on 09.04.2010 at about 8 a.m. the deceased Mencha Ravi was proceeding on his motor cycle towards his house atShanti Nagar, Adilabad, from Vinayaka Chowk, Adilabad and when he reached near his house, all of a sudden, one small boy came infront of his motorcycle, due to which, he applied sudden brakes and fell down and due to this accident, he experienced shock and immediately he was shifted and admitted to Government Hospital RIMS, Adilabad, but he could not survive and he succumbed to the injuries on the same day i.e. 09.04.2010 at about 2.45 p.m., while undergoing treatment at RIMS, Adilabad.
The opposite parties 1 and 3 have vehemently denied the above case of the complainant and contended that the complainant invented the story of the accident, in order to bring the death of the deceased within the ambit of the policy to have illegal gain.
In view of the contention of the opposite parties 1 and 3, the burden is on the complainant to prove that her husband Menchu Ravi was met with an accident as alleged by her in the complaint. Except her interested statement regarding the alleged accident, in her evidence affidavit, the complainant has not adduced any documentary evidence in proof of the alleged accident. It is not the case of the complainant that she gave a complaint to the police about the accident and the police registered the case regarding the alleged accident. In support of her evidence affidavit, the complainant filed evidence affidavit of one K.Mahender, S/o.Poshetty, Shantinagar, Adilabad. The said K.Mahender claimed that he was the eye witness to the accident in this case and he stated in his affidavit about the manner of the accident as alleged by the complainant in the complaint. His name is not mentioned by the complainant either in the complaint or in her evidence affidavit as eye witness to the accident. It appears that the said K.Mahender is set up by the complainant for filing his evidence affidavit in support of her evidence affidavit, in proof of the alleged accident. Therefore, we are not inclined to accept the interested statement of the complainant in her evidence affidavit and the evidence affidavit of the said K.Mahender in proof of the alleged accident.
Ex.A4 is the attested copy of Medical Certificate of Cause of Death in Form No.4 issued by the Medical Practitioner Attendant of the Hospital. In Ex.A4, the cause of death is mentioned as Cardiac Arrest due to ventricular fibrillation. It is not mentioned in Ex.A4 that the deceased was brought to the hospital with injuries sustained by him in the accident. If really the deceased met with an accident, as alleged by the complainant, the hospital staff would have mentioned the same in Ex.A4.
Ex.A5 is the attested copy of the Death Certificate issued by the Commissioner, Birth & Death Registrar, Adilabad Municipality wherein the cause of death ofMenchu Ravi is not mentioned. Ex.A5 proves only the death of the deceased on 09.04.2010. The cause of death of the deceased Menchu Ravi was not mentioned in Ex.A5. Except these two documents i.e. Exs.A4 and A5, the complainant has not filed any documents to prove that the deceased Menchu Ravi met with an accident and in that accident he sustained injuries and was shocked and due to that shock, he got heart attack and died in the hospital, while undergoing treatment.
The only document filed by the complainant to show the cause of the death of the deceased Menchu Ravi is Ex.A4 certificate which clearly proved that the deceased died only due to cardiac arrest as certified by the doctor who treated him. Since the deceased died only due to cardiac arrest, it cannot be termed as accidental death. We are fortified, in our view by the decision of the Hon’ble National Commission in R.P.No.3375/2009 in SBI LIFE INSURANCE CO.LTD. vs. Mrs. Y.DAYAMANI , wherein at the end of its order, the Hon’ble National Commission observed that “The nearest Acute Myocardial Infarction (heart attack) can be said to be an accidental death would be if such an attack takes place as a result of some external and sudden incident such as trauma or shock induced by external factors/forces but it cannot certainly be said that a death due to heart attack in the normal course would fall in the category of an accidental death”.
In view of the above facts and circumstances, the complainant failed to prove that the deceased Menchu Ravi died due to accidental injuries sustained in a motor cycle accident as alleged in the complaint and that Ex.A4 Medical Certificate proved that the deceased Menchu Ravi died due to cardiac arrest as stated above. Exs.A1 to A3 made it clear that the death due to cardiac arrest/natural death is not covered under the subject policy. Therefore, the complainant is not entitled to claim any benefit under the subject policy and the opposite party no.3 is not liable to pay any amount under the policy to the complainant for the death of her husband Menchu Ravi.
The complainant has not filed a piece of paper to show that she intimated the death of the deceased to the opposite parties 1 to 3 and submitted claim form to opposite party no.3. Since the beginning, the case of the opposite parties 1 and 3 is that the complainant did not intimate the death of her husband to them and no claim in that regard has been submitted to them along with required documents. Therefore, the complainant has also failed to prove that she submitted the claim form to any of the opposite parties along with documents. The District Forum has not considered the above aspects in its order. The District Forum relying on Ex.A4, erroneously came to the conclusion that the deceased died due to cardiac arrest and that the opp.parties failed to prove that the deceased not died due to cardiac arrest and passed the impugned order observing that the deceased died due to heart attack and it comes under the accidental death.
For all the afore discussed facts and circumstances, the complainant failed to prove her claim under the subject policy and that there is deficiency in service on the part of the opp.parties 1 and 3. The impugned order of the District Forum passed against opposite parties 1 and 3 is not sustainable under law and is liable to be set aside .
In the result, the appeal is allowed. The impugned order of the District Forum is set aside. The complaint in C.C.No.59/2010 is dismissed. The parties to bear their own costs in these proceedings.
MEMBER
MEMBER
Pm* Dt.26.03.2014
