Complaint is filed on 15-12-2008
Compliant disposed on 5-5-2010
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM::AT:: KARIMNAGAR
PRESENT: HON’BLE SRI K. DEVI PRASAD, B.Sc., LL.B., PRESIDENT
SMT. E. LAXMI, M.A.,LL.M.,PGDCA (CONSUMER AWARENESS), MEMBER
SRI. K. CHANDRA MOHAN RAO, B.COM., LL.B., MEMBER
WEDNESDAY, THE FIFTH DAY OF MAY, TWO THOUSAND TEN
CONSUMER COMPLAINT NO. 179 OF 2008
Between:
Smt. Bomma Srilatha, W/o. Late Bomma Ramesh, Age 28 years, Occ: Household, R/o. H.No.E-19, A Colony, Po: Ramagundam, Karimnagar district presently R/o. at Bhagathnagar locality of Karimnagar town.
… Complainant
AND
- The Divisional Manager, National Insurance Company Ltd., A. Govt. of India undertaking, National Insurance Building, Ground Floor, 8 India Exchange Palace, Kolkotta – 700 001.
- The Divisional Manager, National Insurance Company Ltd., R/by it’s Branch Manager, Branch Office, Karimnagar.
…Opposite Parties
This complaint is coming up before us for final hearing on 22-4-2010, in the presence of Sri B.Raja Reddy and B. Mallesh, Advocates for complainant and Sri K.Madhava Rao, Advocate for opposite parties, and on perusing the material papers on record, and having stood over for consideration this day, the Forum passed the following:
:: ORDER::
1. This complaint is filed under section 12 of C.P. Act, 1986 seeking direction to the opposite parties to pay a sum of Rs.3,00,000/- towards Personal Accident Insurance Coverage with interest, compensation and costs.
2. The brief averments of the complaint are that the complainant is the wife of the one Bomma Ramesh who had taken Personal Accident Benefit Policy from the opposite parties on 15.4.2004 for a sum of Rs.3,00,000/- by paying Insurance Premium. The policy holder nominated the complainant as his nominee to claim the sum assured in case of his death. As per the terms and conditions of the said policy the opposite parties undertook to pay a sum of rs.3,00,000/- to the nominee in case of unnatural death of the policy holder. It is submitted that on 19.8.2005 her husband was killed by the extremists at about 11.00 PM at Vennampalli Village. The incident was reported to the Policy who registered a Criminal Case. The complainant being the nominee under the policy submitted a claim to the opposite parties by enclosing documents showing death of the policy holder and requested them to pay the assured sum of Rs.3,00,000/-. But the opposite parties did not consider her claim on untenable grounds stating that she filed claim after expiry of the stipulated period. The complainant got issued a Legal Notice on 14.8.2007 demanding the opposite parties to pay the sum assured. Inspite of service of notice the opposite parties failed to pay amount. Therefore, the complainant sought direction for payment of Rs.3,00,000/- with compensation, interest and costs.
3. The opposite parties filed counter stating that the complainant is the wife and nominee of the policy holder Bomma Ramesh. The opposite parties admitted that Bomma Ramesh obtained Personal Accident Insurance Policy for an assured sum of Rs.3,00,000/- for a period of six years commencing from 15.4.2004 to 14.4.2010. It is also admitted by them that the policy holder was killed by Naxalites on 19.8.2005 at 11.00 PM at Vennampalli. The opposite parties submitted that the claim submitted by the complainant was not considered as she submitted the claim after expiry of the stipulated period in the policy. Further the Insurance Policy did not cover the death of the policy holder by way of murder, but under the policy the opposite parties undertook to pay sum assured in case of his death in an accident. Since the death was a murder and the claim was made after expiry of the period it was repudiated on 17.4.2006 and it was communicated to the complainant. There is no liability on the part of the opposite parties to pay the sum assured, as such the complaint is not maintainable. Hence, prayed for dismissal of the complaint.
4. The complainant filed Proof Affidavit reiterating the averments made in the complaint and filed documents which are marked as Ex.A1 to A8. Ex.A1 is the Claim form of Bomma Ramesh Dt: 21.9.2005. Ex.A2 is the attested copy of F.I.R. Dt: 19.8.2005 in Crime No.45 of 2005. Ex.A3 is the attested copy of Postmortem Report Dt: 19.8.2005. Ex.A4 is the Xerox copy of certificate issued by Medical Officer, Peddapalli Dt: 21.9.2005. Ex.A5 is the Xerox copy of Insurance Certificate Dt: 15.4.2005. Ex.A6 is the office copy of Legal Notice Dt:14.8.2007. Ex.A7 is the Postal Acknowledgement card Dt: 20.8.2007. Ex.A8 is the Postal Acknowledgement Card Dt: 20.8.2007.
5. The opposite party filed Proof Affidavit of it’s Divisional Manager reiterating the averments made in the counter and filed documents which are marked as Ex.B1 to B4. Ex.B1 is the attested copy of Janatha Personal Accident Insurance Policy issued by the National Insurance Company Ltd. Ex.B2 is the attested copy of letter sent by Gold Trust Financial Services, Kolkata Dt: 15.3.2006. Ex.B3 is the attested copy of claim form submitted by applicant Dt: 21.9.2005. Ex.B4 is the attested copy of Register of claim letter Dt: 17.4.2006.
6. The points for consideration are:
- Whether there is any deficiency of service on the part of opposite parties?
- If so, to what relief the complainant is entitled?
7. Heard both sides.
8. It is contended by the complainant that her husband obtained Janatha Personal Accident insurance Policy from the opposite parties on 15.4.2004 for an assured sum of Rs.3,00,000/- under Ex.A5. As per the terms and conditions of the said policy the opposite parties undertook to pay an assured sum of Rs.3,00,000/- in case of accidental death of the policy holder. Under the said policy the complainant is shown as nominee of her husband. Admittedly the policy holder Bomma Ramesh was killed by Naxalites on 19.8.2005 at Vennapalli Village. After his death the complainant submitted claim form under Ex.A1 by submitting the copies of FIR in Crime No.45 of 2005 P.S. Kalva Srirampur, PME Report, Death Certificate requesting the opposite parties to pay the assured sum of Rs.3,00,000/-. A perusal of FIR under Ex.A2 and PME Report under Ex.A3 disclose that the policy holder was killed by the Naxalites at Vennapalli Village. When the opposite parties did not consider her claim the complainant got issued a Legal Notice to the opposite parties under Ex.A6 Dt: 14.8.2007 demanding the opposite parties to pay the sum assured. Inspite of service of notice the claim was not settled.
9. The opposite parties repudiated the claim of the complainant on the ground that the policy holder was killed by the Naxalites and as per the terms and conditions of the policy the opposite parties are not liable to pay the assured sum if the death is caused by outward violence. The opposite parties filed copy of the policy under Ex.B1 along with a letter sent by golden Trust Financial Services under Ex.B2 sent to the opposite parties to settle the claim made by the complainant. They have also filed copy of the claim form under Ex.B3 and repudiation letter under Ex.B4.
10. As per the contents of the complaint, counter and documents it is clearly established that the policy holder Bomma Ramesh obtained JPA Policy from the opposite parties for a sum of Rs.3,00,000/- on 15.4.2004. It is also clearly established that the policy holder died as he was killed by extremists at Vennampalli village on 19.8.2005 as per the criminal records. After his death the complainant submitted a claim for payment of Rs.3,00,000/- towards the sum assured under the policy. The opposite parties did not settle the claim for payment on the ground that the policy holder died as a result of killing by Naxalites. As per the terms of the policy the assured sum would be paid only the policy holder dies in an accident. Basing on the reported judgment CPR 1998 III page 5, the Hon'ble National Commission in a case Smt Mandala Savarna Vs the Branch Manager, LIC of India and Another. The Hon'ble AP State Commission delivered judgment in FA No.230/2000 in CD 115 of 1997 DCF Chittoor between the Branch Manager, LIC of India, Gaunter Vs Smt T.Leelavathi in which held it is “that injured died due to external injuries. The result of attack by rival faction culminating into several injuries on the insured and as such it was observed that the said injuries caused by external violation and visible means. Therefore, it can be stated that the death of insured is an accident”.
11. The opposite parties also opposed the claim on the ground that the complainant failed to submit her claim within the stipulated period. But a perusal of the claim form under Ex.A1 and Ex.B3 discloses that the complainant for the first time intimated about the death of the deceased and obtained claim form on 21.9.2005 itself i.e. within a period of 32 days from the death of the policy holder and after collecting the required documents he submitted claim form on 23.1.2005. Therefore, the claim is within the limitation.
12. The opposite parties issued policy under Ex.B1 under taking to pay assured sum of Rs.3,00,000/- under JPA Coverage. The death of the policy holder is not natural but it is caused by extremists. In view of the above authority the death due to murder is to be considered as accidental death. The opposite parties can’t escape their liability to pay the sum assured on this ground. Having issued the policy the opposite parties are under an obligation to pay the assures sum of Rs.3,00,000/-. Further the opposite parties can’t refuse to pay the assured sum on the ground of limitation. When the complainant lost her husband due to murder by Naxalites she can’t be expected to submit Insurance claim immediately by collecting all the required documents. But at the same time she obtained claim form by intimating about the death of her husband. As per the terms and conditions of the policy the opposite parties ought to have paid the assured sum of Rs.3,00,000/- to the complainant and failure to pay the same constitutes deficiency of service. In view of the above said reasons, we hold that the opposite parties are liable to pay Rs.3,00,000/- towards the sum assured under the policy together with interest @ 9% per annum along with costs.
13. In the result the complaint is partly allowed directing the opposite parties no.1 & 2 jointly and severally to pay a sum of Rs.3,00,000/- together with interest @ 9% per annum from the date of filing the complaint i.e. 15.12.2008 till the date of realization along with Rs.1000/- towards costs of the complaint within period of one month from the date of receipt of this order.
Typed to my dictation by Stenographer after correction the orders pronounced by us in the open court this the 5th day of May of 2010.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
NO ORAL EVIDENCE HAS BEEN ADDUCED ON EITHER SIDE FOR COMPLAINANT:
Ex.A1 is the Claim form of Bomma Ramesh Dt: 21.9.2005.
Ex.A2 is the attested copy of F.I.R. Dt: 19.8.2005 in Crime No.45 of 2005.
Ex.A3 is the attested copy of Postmortem Report Dt: 19.8.2005.
Ex.A4 is the Xerox copy of certificate issued by Medical Officer, Peddapalli Dt: 21.9.2005.
Ex.A5 is the Xerox copy of Insurance Certificate Dt: 15.4.2005.
Ex.A6 is the office copy of Legal Notice Dt:14.8.2007.
Ex.A7 is the Postal Acknowledgement card Dt: 20.8.2007.
Ex.A8 is the Postal Acknowledgement Card Dt: 20.8.2007.
FOR OPPOSITE PARTIES:
Ex.B1 is the attested copy of Janatha Personal Accident Insurance Policy issued by the National Insurance Company Ltd.
Ex.B2 is the attested copy of letter sent by Gold Trust Financial Services, Kolkata Dt: 15.3.2006.
Ex.B3 is the attested copy of claim form submitted by applicant Dt: 21.9.2005.
Ex.B4 is the attested copy of Register of claim letter Dt: 17.4.2006.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
