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 3rd day of December, 2008
C.C.No. 88/08
Between:
T. Maheswari, D/o. Late T.Shiva Reddy, W/o. Raja Gopal Reddy,
H.No.1-78, Savitri Street, Kota Kandukuru Village, Allagadda, Kurnool District. … Complainant
Versus
- Peoples Organization for the self help, (POSH) Represented by its Branch Manager,
Sai Teja Complex, Raichur Road, Mahaboonagar District.
- The Oriental Insurance Company Limited, Represented by its Divisional Manager,
Bhupal Complex, Kurnool … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.A.Prabhakar Reddy , Advocate, for the complainant, and Sri.P.Jagan Mohan Rao, Advocate, for the opposite party No. 1 and Sri.V.V.Augustine, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C.Preethi, Lady Member)
C.C.No.88/08
1. This consumer complaint of the complainant is filed U/S 12 of C.P.Act, 1986, seeking direction on opposite parties to declare the repudiation as illegal, to pay an amount of Rs. 2 lakhs with 24% interest p.a, Rs.2,000/- as cost of the case, Rs.25,000/- as compensation for mental agony, 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 complainants father joined as a member in opposite party No.1 and opposite party No.2 issued an Insurance Policy bearing No. 433100/ 2006/10018 to the complainant on 15-09-2005 and a policy bond was also issued for Rs. 2 lakhs and the said policy commenced from 15-09-2005 to 14-09-2006 and the complainant was nominated as nominee in the policy bond. On 02-11-2005 the policy holder sustained injuries due to fallen from steps and died on 15-11-2005 during treatment in Government General Hospital, Kurnool . The complainant informed the death of her father to the opposite party and submitted relevant documents. The opposite parties intimated the complainant to submit FIR, Police Panchanama, Post mortem report etc., . But as the complainant did not give any police complaint , she could not submit the required documents to the opposite party. Subsequently on 28-11-2005 the complainant gave a report to District Collector seeking permission to conduct post mortem and D.R.O forwarded the same to M.R.O, Allagadda, and in turn M.R.O Allagadda visited the village of the deceased on 10-2-2006 and enquired about the cause of death of policy holder in the presence of Panchayat Secretary and Surpanch of the village and some village elders and prepared panchanama which revealed the policy holder died to accidental fall from steps. The M.R.I of Allagadda also visited the village in January 2006 and submitted his report to M.R.O, Allagadda . The complainant submitted all the above documents to opposite party No.2 on 06-07-2006 and opposite party No.2 replied on 11-07-2006 requesting the complainant to submit FIR, post mortem report and police panchanama , again the complainant replied on 19-07-2006 stating that no police complaint
was made and hence the above documents are not available and opposite party No.2 repudiating the claim of the complainant on 31-08-2006 with untenable reasons . The complianant being constrained resorted to the forum for reliefs, as there is deficiency of service on part of opposite parties for repudiating her valid claim.
3. In support of her case the complainant relied on the following documents viz., (1) Xerox copy of certificate of insurance of Nagarik Suraksha Policy, (2) Certificate issued by Panchyath Secretary Kota Kandukuru as to joining Telugupalli Siva Reddy in a hospital for treatment on 02-10-2005, (3) Certificate dated 05-11-2005 issued by Dr.Viswanath Reddy ,(4) Xerox copy of death certificate dated 10-12-2005 (5) letter dated 28-11-2005 of complainant to District Collector , (6) Repudiation letter dated 31-08-2006 of OP No.2 , (7) Office copy of reply letter dated 19-07-2006 of complainant (8) Xerox copy of report of MRI report and (9) Xerox copy of Panchanama dated 10-02-2006 , besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex.A1 to A9 for its appreciation in this case and replies to the interrogatories exchanged .
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties 1 and 2 appeared through their standing counsel and contested the case by filling separate written versions.
5. The written version of opposite party No.1 admits the complainants father jointed as a member in their organization and an insurance policy was issued by opposite party No.2 under Nagarik Suraksha Scheme to all the joined members of opposite party No.1 and policy bond was also issued to complainants father by opposite party No. 2. The complainant has submitted her death claim directly to opposite party No. 2 and it is the opposite party No.2 who is responsible to settle the claim and no liability stands on opposite party No.1 and lastly seeks for the dismissal of complaint as there is no liability or deficiency of service on part of opposite party No. 1.
6. The written version of opposite party No.2 denies the complaint as not maintainable either in law or on facts but submits that the alleged occurrence in which the policy holder fell down from the steps and has taken treatment in Government General Hospital, Kurnool from 02-10-2005 to 15-11-2005 and no intimation was given to the police nor to the insurance company during the long stay of 45 days in the hospital. No intimation was given to the opposite party No.2 about the accident to the insured nor produce any documents regarding the proof of treatment particulars nor any certificate of doctor is produced. After receiving the belated claim the opposite party intimated the complainant to produce vital documents such as FIR , Inquest and post mortem to ascertaining the cause of death , but the complainant submitted only doctor certificate and the doctor certificate does not indicate nature of case as accidental. The complainant deliberately changed the natural death to accidental death to order to claim wrongful gain. The repudiation of claim by the opposite party is perfectly justified and lastly seeks for the dismissal of complaint with costs.
7. In support of their case the opposite party relied on the following document 1. letter dated 31-07-2006 of opposite party No.2 to complainant , besides to the sworn affidavit of opposite party No.2 in reiteration of his written version averments and the above document is marked as Ex.B1 for its appreciation in this case and replies to the interrogatories exchanged.
8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties .
9. It is the case of the complainant that her father T.Siva Reddy was a member of opposite party No.1 organisation . The opposite party No.2 issued a policy covering the risk of opposite party No.1 member and a policy vide Ex.A1 was issued to the complainants father. On 02-10-2005 the policy holder fell down from the steps and was grievously injured and was admitted in Government General Hospital, Kurnool as per Ex.A2 certificate issued by Panchayath Secretary, Kota Kandukuru (V). The Ex.A3 is the certificate dated 05-11-2005 issued by Dr.Viswanath Reddy as to the admitting of T.Siva Reddy in Government General Hospital, Kurnool on 04-10-2005 due to fall in the house under the care of Dr.R.Viswanatha Reddy. Thereafter, on 15-11-2005 the policy holder T.Siva Reddy died due to injuries . The Ex.A5 is the letter of complainant dated 28-11-2005 to District Collector requesting for re post mortem and FIR ,as the insurance authorities are pressing for FIR and post mortem. The Ex.A8 is the report of MRI, where in it is reported that the policy holder fell down from the steps and grievously injured and died on 15-11-2005 while taking treatment. The EX.A9 is the Panchanama dated 10-02-2006 which also opines that the death of T.Siva Reddy was due to fell down from steps. All the above documents are submitted to opposite party No.2 by the complainant for settlement of the claim but the opposite party No2 vide Ex.A6 dated 31-08-2006 repudiated the claim stating that the death of T.Siva Reddy as natural and not as accidental one and no necessary documents such as FIR , post mortem are filed.
10. But the above documents relied by the complainant lends corroboration to the cause of death of deceased Siva Reddy as accidental due to fall from steps, the conduct of opposite party No.2 brushing aside the said material as can not be relied and pressing for documents like FIR and post mortem report et., without any justifiable material with it, appears to be a lame excuse to justify the repudiation .
11. The opposite party No.2 pleaded that the claim of the complainant could not be settled as the complainant did not file documents like FIR and post mortem report etc., to prove that the death of T.Siva Reddy due to accident only. It remains to be seen in the light of the documents filed by the complainant can the insurance company repudiate the claim or escape its liability by insisting on production of FIR and post mortem report etc., the answer is “No” and in support of their case the complainants side relied on the decision of our Hon’ble A.P. State Commission reported in 2000 ALD part II Pg.No.96, where in it was held that when cause of death is not of suspicious one obtaining FIR and other documents does not arise.
12. To sum up, the above discussions and relying the decision of our State Commission the opposite party No. 2 can not escape their liability from settling the claim of the complainant and in not doing so without any justifiable material as amounts to deficiency of service on part of opposite party No.2 and the complainant is perfectly remaining entitled to the assured amount under the policy in Ex.A1 as nominee of said policy holder.
13. As the opposite party by its lapsive conduct not only caused mental agony but also constrained the complainant to seek the forum for redressal of her bonafide consumer grievances , the opposite party is liable to compensate the suffered mental agony of the complainant and cost of this litigation. As no cause of action is made out against opposite party No.1 , case against opposite party No.1 is dismissed.
14. In the result, the case of the complainant is dismissed against opposite party No.1 and the complaint is allowed against opposite party No.2, directing opposite party No.2 to pay to the complainant the assured amount of Rs.2,00,000/- , Rs.3,000/- as compensation for mental agony suffered at the deficient conduct of the opposite party No.2 in settling the claim and Rs.2,000/- as costs of this case within one month from the date of receipt of this order. In default the supra stated award shall be payable by the opposite party No.2 with 12% interest p.a 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 3rd day of December, 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. Xerox copy of certificate of insurance of Nagaric Suraksha Policy.
Ex.A2. Certificate issued by Panchyath Secretary Kota Kandukuru as to joining Telugupalli Siva Reddy on 02-10-2005.
Ex.A3. Certificate dated 05-11-2005 issued by Dr.Viswanath Reddy.
Ex.A4. Xerox copy of death certificate dated 10-12-2005.
Ex.A5. Xerox copy of letter dated 28-11-2005 of complainant to
District Collector.
Ex.A6. Repudiation letter dated 31-08-2006 of OP.
Ex.A7. Office copy of reply letter dated 19-07-2006 of complainant.
Ex.A8. Xerox copy of report of MRI.
Ex.A9. Xerox copy of Panchanama dated 10-02-2006.
List of exhibits marked for the opposite parties:
Ex.B1. Letter dated 31-07-2006 of OP.No.2 to complainant.
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 :
Copy was dispatched on
