BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt.C.Preethi, Hon’ble Lady Member
Wednesday the 27th day of September, 2006
C.C.No.73/2006.
Sri. S. Vijaya Gopal,
H/o late Smt. V.Vijaya Lakshmi,
H.No:1-402, Main Bazaar,
Near I-Town,
Kurnool Dist. …Complainant
-Vs-
1. The Branch Manager,
L.I.C. of India,
Kurnool.
2. The Divisional Manager,
L.I.C. of India, Kadapa, …Opposite parties
This complaint coming on this day for Orders in the presence of Sri. C.Prabhakara Reddy, Advocate, Kurnool for Complainant, Sri. S.Viswanatha Reddy, Advocate, Kurnool for Opposite Parties No.1 & 2 , and stood over for consideration till this day, the Forum made the following:-
O R D E R
(As per Smt.C.Preethi, Hon’ble Lady Member)
1. This Consumer complaint of the complainant is filed under section 12 of C.P.Act 1986, seeking a direction on the opposite parties to pay accident benefit of Rs.1,00,000/- with interest, Rs.1,00,000/- for mental agony, costs of the complainant and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s wife Smt.V.Vijaya Lakshmi has taken a Jeevan Anand Policy on 22.12.2003 by paying premium of Rs.1,407 from opposite party No.1 and nominated the complainant as her nominee. On 16.09.2004 at about 10.30.A.M while the policy holder was cooking food by accident her saree caught fire and was admitted in Govt. General Hospital in burns ward and while under going treatment the policy holder died on the same day i.e., 16.09.2004. The complainant preferred a claim by submitting all relevant documents but to the dismay of the complainant the opposite party No.1 repudiated the policy, on the condition that clause 4(b) of the policy, is applicable to the policy holder as the policy holder died in an accident in her house other than an accident in a public place within a year from date of policy. But the complaint submits that once premium is received by opposite parties and policy issued in favour of the policy holder, the entire burden is shifted to opposite parties as per policy terms and conditions and the opposite parties are responsible to pay accidental benefit to the complainant. Therefore, the complainant resorted to the forum for redressal.
3 In substantiation of her case the complainant relied on the following documents viz. (1)Attested copy of F.I.R. in C.r.No.142/2004 of Police Station,
I town, Kurnool.(2)Attested copy of inquest report in Cr. No.142/2004.(3)Attested copy of Postmortem examination.(4)office copy of personal notice of complainant dated:21.05.2005.(5)office copy of legal notice dated:02.11.2005 issued by complainants advocate to opposite parties and (6) copy of award of Insurance Ombudsman, Hyderabad dated:30.01.2006, besides to the Sworn Affidavit of the complainant in reiteration of his complainant’s averments and the above documents are marked as Ex.A1 to A6 for its appreciation in this case. The complainant caused interrogatories to opposite parties and suitablely replied to the interrogatories caused by the opposite party.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case by filing denial written version.
5. The written version of opposite parties admits the complainant’s wife has taken a policy bearing No:653392111 for Rs.1,00,000/- and the death of the policy holder on 16.09.2004 due to accidental burns and the same was intimated by the complainant. As the death claim aroused within two years from the date of commencement of the policy the claim was treated as earlier claim and investigation was conducted and it revealed that the policy holder died due to accidental burns in her house and which was an un natural death. The policy holder was admitted in Govt. General Hospital on 16.09.2004 and died on the same day while under going treatment. The police reports Viz., F.I.R., P.M.R and P.I.R revealed that the policy holder while cooking food on a Gas Stove in her house, suddenly her clothes caught fire and died in the hospital.
6. The opposite parties further submits that clause 4(b) attached to the policy bonds was issued to ladies who are less than 30 years of age and consent was also obtained from the policy holder to the said clause 4 (b)attached to the policy clause 4(b) says that “Notwithstanding anything within mentioned to the contrary, it is hereby declared and agreed that in the event of death of the life assured occurring as a result of Internal self-injury, suicide or attempted suicide, insanity, accident other than an accident in a public place or murder at any time on or after the date on which the rise under the policy has commenced but before the expiry of three years from the date of this policy, the corporation’s liability shall be limited to the sum equal to the total amount of premiums (exclusive of extra premiums………”
7. As the policy holder death was due to accidental burns in her house and the said clause 4(b) is applicable in this case, since the death occurred in an accident other than an accident in a public place before to the expiry of 3 years from the date of the policy.
8. Hence, the repudiation by opposite parties is justified and the complainant is not entitled to any of the reliefs as claimed and lastly seeks for
the dismissal of complaint with costs.
9. In support of their case the opposite parties, relied on the following documents Viz (1)Original policy with terms and conditions and clause 4(b). (2)Repudiation letter dated:11.04.2005 addressed by opposite parties to the complainant.(3)letter dated 27.06.2005 addressed to the complainant by opposite parties and(4)Attested copy of authorization letter infavour of P.Rajanna besides to the Sworn Affidavit of opposite party No.2 in reiteration of his written version averments and the above documents are marked of Ex.B1 to B4 for its appreciation in this case. The opposite party caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
10. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:?
11. It is case of the complainant that his wife V.Vijaya Lakshmi has taken a policy bearing No:653392111 for Rs.1,00,000/- and on 16.09.2004 the policy holder died due to accidental burns while cooking food in her house, the complainant alleges that he is entitled to accidental benefit of Rs.1,00,000/-. But the opposite parties on the other side in their written version averments alleges that the death of the policy holder aroused within two years from the date of accident and investigation was conducted which revealed that the policy holder while cooking food on a gas stove in her house, suddenly her clothes caught fire and was admitted to Govt. General Hospital and while under going treatment the policy holder died due to burns. The policy holder while submitting proposal for the said policy gave consent to clause 4(b) for imposition of said clause at the time of obtaining the said policy, Clause 4(b) limits the liability of opposite parties to premium actually collected, when the death is as a result of intentional self injury, suicide, or attempted suicide insanity accident other than an accident in a public placed or murder at any time on or after the date on which the risk under policy has commenced but before to the expiry of three years from the date of this policy. The clause 4(b) excludes such cases and limited the amount payable under the policy to the premium actually collected.
12. The policy holder died as a result of accidental burns sustained by her from the gas stove while cooking food in her house and the death is an unnatural one and the death occurred within three years from the date of policy. Hence, the claim of the complainant for accidental benefit under the said policy was rightly repudiated by the opposite parties under clause 4(b) and the same is justified. Therefore, the complainant is not remaining entitled to the accidental benefit under the said policy. But the complainant is entitled to the premiums actually collected by the opposite parties in respect of said policy.
13. In the result the complaint is dismissed in other aspects, allowing the
complaint to the limited liability of the opposite parties under clause 4(b) of the
policy and there by directing the opposite parties the refund the premiums received under the said policy to the complainant within a month of receipt of this order. Hence the complaint is allowed partially accordingly.
Dictation to the stenographer, transcribed by him, corrected and pronounced in the Open Forum this the 27th day of September, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of Exhibits marked for the Complainants:
Ex.A1 Attested copy of F.I.R. in Cr.No.142/04 of police station I Town,
Kurnool.
Ex.A2 Attested copy of inquest report of in Cr.No.142/04.
Ex.A3 Attested copy of Post Mortem certificate.
Ex.A4 Office copy of legal notice dt:21.05.2005.
Ex.A5 Office copy of legal notice dt:02.11.2005 along with postal
Receipt (No.288)
Ex.A6 Copy of the award of Insurance Ombudsman, Hyderabad.
Dt:30.12.2005.
List of Exhibits marked for the opposite parties :
Ex.B1 Original policy with terms and conditions clause 4(b).
Ex.B2 Repudiation letter dt:11.04.2005.
Ex.B3 Letter, dt:27.09.2005 of Insurance Company to the complaint.
Ex.B4 Attested authorization letter in favour of P.Rajanna.
MEMBER PRESIDENT
Copy to:
1. Sri. C. Prabhakara Reddy Advocate, Kurnool.
2. Sri. S. Viswanatha Reddy Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
