BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Wednesday the 27th day of August, 2008
C.C.No.140/07
Between:
Motakatla Yesu Dasu, S/o Motakatla Yesu Ratnam,
R/o. Banaganapalle Village and Mandal, Kurnool District.
… Complainant
Versus
1. Peoples Organization for the Self Help, Sai Teja Complex,
Raichur Road, Mahaboob Nagar.
2. The Oriental Insurance Company Limited,
Snehalatha, 6-3-871, Green lands road, Post Box No.45, Begam pet,
Hyderabad - 16.
3. The Oriental Insurance Company Limited,
Bhupal Complex, Kurnool.
… Opposite parties
This complaint is coming on this day for orders in the presence of Sri. A. Jagadeesh Kumar, Advocate, for the complainant, and Sri. P. Jagan Mohan Rao, Advocate for opposite party No.1 and Sri Y. Jaya Raju, Advocate for opposite party No.2 and 3 and upon perusing the material papers on record, the Forum made the following
ORDER
(As per Sri. K.V.H.Prasad, President)
C.C.No.140/07.
1. This case of the complainant is filed U/S 12 of C.P.Act, seeking direction on the opposite parties for payment to complainant Rs.2,50,000/- as insurance amount with interest, RS.25,000/- as compensation for mental agony , Rs.25,000/- as compensation for deficiency of service alleging that Yesuratnam – complainants father joined the Nagarik Suraksha Scheme floated by the opposite parties and obtained policy bond No.5534/07/ 30017 /73 covering the risk for the period 26-5-2006 to 25-5-2007 for an assured amount of Rs.2.5 lakhs and complainants father died on 5-9-2006 due to fall while he was getting down the steps at Government General Hospital, Banaganapalle and police registered case inquest and post mortems were held and investigation was closed as action dropped as no foul play involved in the said demise of complainants father and when the claim is made it was not settled by the opposite parties denying the said accidental death of the complainants father and giving evasive reply to the notice of the complainant and the loss of the policy documents in heavy rains occurred in June, 2006 .
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant the opposite parties 1 to 3 contested the case through their counsels filling written version denying the liability and seeking the dismissal of the complainants case.
3. The counter ( written version ) of the opposite party No.1 even though admit the father of the complainant as policy holder and his demise on 5-9-2006 and the on ward transmission of the claim of the complainant by it to opposite party No. 3 , but allege of it no liability as the opposite party No.3 is to settle the claim.
4. The counter ( written version) of the opposite party No.3 adopted by opposite party No.2 , besides questioning the maintainability of the case and requiring the strict proof of complaint
averments and denying its liability to the complainants claim and alleged cause for demise of the policy holder , even though admits the status of the complainants father as Nagarik Suraksha policy holder . It alleges the claim enquiry reveled that the demise of the policy holder was not accidental but on account of illness and deterioration of health and the material of police investigation as managed and the policyholder was a retired gang coolly aged about 76 years at the time of demise and his declaration of age as 52 years at the time of joining the policy and on account of misrepresentation the demise as accidental demise voids the very contract of insurance under policy condition No.3 and so seeks dismissal of the complaint.
5. In substantiation of the contentions while the complainant side has relied upon documentary record in Ex.A1 to A8 and his sworn affidavit in reiteration of complaint averments , the opposite party side has relied upon documentary record in Ex.B1 to B10 besides to the sworn affidavit of opposite party No.3 in support of its defence.
6. Hence, the point for consideration is whether the complainant has made out any deficiency of the opposite parties towards settlement of his claim and thereby the liability of the opposite parties to it .
7. The Ex. B1 is certificate of Nagarik Suraksha Policy No.5534 / 2007 . It shows the name of the insured as Motakatla Yesuratnam resident of Banaganapalle insured for Rs.1 lakh i.e, Rs.80,000/- towards personal accident and Rs.20,000/- towards hospitalization expenses and M. Yesudas as his nominee covering the period of insurance from 26-5-2006 to 25-5-2007 . It says that it was issued subject to conditions, warranties and exclusions applicable to master policy No.30017 . The EX.B9 is the printed broacher concern to said terms and conditions Nagarik Suraksha Policy covering personal accident and hospitalization expenses . None of the exclusions of this Ex.B9 prescribes any age limit to be a member insured to that policy and so not declaring a correct age does not amount to misrepresentation of material fact contemplated under condition No.3 of general conditions of Ex.B9 . Hence there appears no merit in the contentions of the opposite party side that the alleged policy holder as concealed his real age at the time of joining the said policy declaring his age as 52 years even though retired in the year 1991 that is about 15 years ago to then as per Ex. B8 .
8. Now as to the alleged concealment of real cause of death of the deceased policy holder .
9. The Ex.A6 - certified copy of the FIR in Cr.No.123/06 of P.S. Banaganapalle registered U/S 174 Cr.P.C on the written report of M. Yesudas - complainant of this case . It alleges that in the early hours of 5-9-2006 at about 5-00 A.m his father Yesuratnam suffered with vomitings and motions and while being mood to hospital falling from steps and the duty doctor at hospital declared him died in Ex.A2. The Ex.A7 is certified copy of post mortem certificate of Mutakatla Yesuratnam age 55 years . It was said to have been conducted in above stated Cr.No.123/06 at the requisition of SHO , Banaganapalle. It opines the demise of said person due to head injury followed by Cardio Respiratory failure. The police investigation agency also accepted the said observation of Ex.A7 as to the cause of demise of the said Yesuratnam and submitted final report in Ex.A8 dropping further action and as no foul play involved , the Sub-divisional Police Officer has issued proceedings approving the said final report and directing to send the necessary proposals to MRO which was complied under Ex.A8 .
10. The opposite party No.3 in Ex.B2 dated 12-12-2006 authorizes P. Naganna an Advocate to conduct discreet enquiry as to the claim of the complainant on the demise of his father yesuratnam and submit investigation report . The Ex.B 10 report of said investigator opines the demise of the deceased was due to illness and not due to any accident .
11. The Ex.B3 dated 17-4-2007 of the opposite party No.3 authorizes R.Sreenivasa Rao an insurance surveyor for investigation into the real cause of death of insured Yesuratnam, who died on 5-9-2006 in reference to the police investigation of Banganapalli, done by the time in Cr.No . 123/06 and the Ex.B4 is reminder in that regard on receipt of legal notice in E.x.A4 .
12. The Ex.B5 is the investigation report of said surveyor of R Sreenivasa Rao basing on the statements set to have been recorded by him during his enquiry with M. Daveedu ( another son of the deceased) S. Hussain Basha ( a family friend of the deceased) who says of the age of the deceased as 76 years old as retired a 11 years ago and as having an eldest daughter by name Mariyamma aged 50 years and the doctors opinion as to the cause of the death of the deceased was not definite . Without the examination of the said surveyors P. Naganna and R. Sreenivasa Rao and said M. Daveedu and S. Hussain Basha who were said to have been examined during investigation – with reference to Ex.B10 and B5 in proof of the same , the EX.B5 and B10 stands in no way in better position than the material of the police investigation envisaged in ex.A1 , A2 and A6 to A8 especially when the complainant deny a suggestion in interrogatory No.9 of the opposite party as to the demise of his father by mere illness, and the benefit of omission on the part of the opposite party in substantiation of their suspicion as to real cause of death of deceased, is to go to the complainant .
13. While the scheme of the said policy provides an insurance of Rs. 80,000/- for accidental death and Rs.20,000/- for hospital expenses to the insured covered under said Nagarik Suraksha Policy , the claim of the complainant for Rs.2.5 lakhs as insurance amount an accidental death of the insured, not only appear to be un reasonable being without any basis but also appears to be too greedy to make an easy money .
14. As the Ex.A7 post mortem examination certificate clearly says that the deceased died due to head injury followed with Cardio Respiratory failure and not due to any vomitings and motions and the alleged demise of insured due to any illness being not substantiated by the opposite parties to find any justification for their non settlement of the claim – the death of insured M. Yesuratnam is remaining established as accidental death entitling the complainant for the permissible amount entitled for personal accident of said insured .
15. As the complainant was driven to the Forum for redressal of his grievances by the opposite parties due to their lapsive conduct in settling the claim , the opposite parties are liable not only to compensate for mental agony suffered at the lapsive and deficient conduct of the opposite parties but also to the cost of this case.
16. As any cogent material is placed by complainant side to show any privy or concern and liability of the opposite party No.1 to the complainants entitled claim even, as his role as per his written version appears to be a mere processor in getting the deceased covered under said policy scheme and nothing more than that the case against opposite party No.1 is dismissed .
17. As the counter ( written version ) of the opposite parties 2 and 3 is not denying the issual of the policy under said scheme to the deceased and have entertained the claim of the complainant by ordering probe by its surveyors and as per the reasons stated supra as the complainant is remaining entitled to the benefits of insurance of his deceased father , the opposite parties 2 and 3 are remaining liable to the entitled reliefs of the complainant.
18. Consequently, the complaint is allowed against the opposite parties with their joint and several liability to pay to the complainant Rs.80,000/- towards the insurance amount arising out of personal accident death of insured M. Yesuratnam , Rs.10,000/- as compensation for mental agony at the lapsive deficient conduct of the opposite parties in not settling the claim and Rs.5,000/- as cost of this case within a month of receipt of this order. In default the opposite parties 2 and 3 shall be jointly and severally liable to pay to the complainant the supra award amount with 9% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 27th day of August, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Proceedings of Sub Divisional Police Officer, Dhone,
dated 15-10-2006.
Ex.A2. Out – patient Ticket , dated 5-9-2006.
Ex.A3. Death Certificate.
EX.A4. Office copy of legal notice, dated 2-4-2007 along with
Postal three receipts as one acknowledgement .
Ex.A5. Reply of OP.2 & OP.3. , dated 29-5-2007.
Ex.A6. Certified copy of FIR.
Ex.A7. Certified copy of post – mortem certificate.
Ex.A8. Certified copy of final report..
List of exhibits marked for the opposite parties:
Ex.B1. Policy No.5534/2007.
Ex.B2. Letter, dated 12-12-2006 of OP.No.3 to investigation
Naganna.
Ex.B3. Letter , dated 17-4-2007 of OP.No.3 to R. Srinivasa Rao.
Ex.B4. Letter, dated 9-5-2007 of OPs to R. Srinivasa Rao.
EX.B5. Investigation report dated 14-5-2007 of R.Srinivasa Rao.
ExB6. Statement of M.David.
Ex.B7. Statement of M.Hussain Basha.
Ex.B8. Letter dated 24-5-2008 of Executive Engineer( R & B )
as to the retirement of M. Yesuratnam.
Ex.B9. Terms and conditions of Nagark Suraksha Policy.
Ex.B10. Investigation report dated 16-4-2007.
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
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