BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
F.A.No.6 OF 2012 AGAINST C.C.NO.02 OF 2011 DISTRICT FORUM –I KRISHNA AT MACHILIPATNAM
Between:
1. Jogi Samrajyam,
W/o. Suryaprakasa Rao,
Hindu, aged 50 years, Agricultural Coolie,
2. Jogi Pydeswara Rao,
S/o. Suryaprakasa Rao, Hindu, aged 32 years, Agriculture,
3. Jogi Yedukondaluu,
S/o. Suryaprakasa Rao, Hindu, aged 25 years, Agriculture,
4. Kesana Punyavathi,
W/o. Suribabu and D/o. Suryaprakasa Rao,
Hindu, aged 35 years, Agriculture,
All are R/o Barripadu, Bantumilli Mandal, Krishna District.
5. Pochina Renuka,
W/o. Venkateswara Rao and D/o. Jogi Suryaprakasa Rao,
Hindu, aged 20 years, Agriculture,
Chodavaram, Bantumilli Mandal, Krishna District. Appellants/complainants
A N D
1. The Oriental Insurance Company Ltd.,
Vijayawada, Represented by it’s Divisional Manager.
2. The Secretary,
Barripadu Primary Agricultural Co-operative
Credit Society Ltd., No.H.1143, Barripadu,
Bantumilli Mandal, Krishna Dist. Respondents/opposite parties
Counsel for the Appellant Party in Person
Counsel for the Respondent M/s KNV Radha Krishna
Served(R2)
QUORUM: SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
AND
SRI THOTA ASHOK KUMAR, HON’BLE MEMBER
WEDNESDAY THE SEVENTEENTH DAY OF APRIL
TWO THOUSAND THIRTEEN
Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)
***
1. The unsuccessful complainants are the appellants. They filed complaint claiming insured sum of `1,00,000/- with interest and costs.
2. The first appellant’s husband during his lifetime was the member of the second respondent-society which obtained Janata Personal Accident Insurance Policy for its members from the first respondent –insurance company for the year 2010-2011 for sum assured of `1,00,000/-. The appellants lodged claim with the respondent no.1 on the premise that the first appellant’s husband died on 6.06.2010 due to snake bite. The second respondent forwarded the claim to the first respondent and the first respondent failed to settle the claim and as such the appellants filed the complaint.
3. The first respondent resisted the claim on the premise that it issued Janata Personal Accident Insurance Policy in favour of the 2nd respondent-society covering the risk of its members and the members of its various branches. The appellants did not submit relevant documents along with the claim form and in the medical certificate issued by Dr.N.S.vishnu rao of Padmaja Nursing Home, Bantumilli there is no mention of any treatment and the death of the deceased before the 108 vehicle arrived, shows that he died without being administered with treatment.
4. The second respondent contended that the first respondent sought for copies of FIR, PME Report, Inquest Report and insurance policy for settlement of claim. The appellants submitted copies of death certificate of the deceased, house hold card and declaration from sarpanch of Grampanchayat, Barripadu and the second respondent had sent the documents to the first respondent. The second respondent paid an amount of `4,200/- to the deceased under L.No. 38 towards premium JPA Insurance Policy for the year, 2010-2011.
5. The first appellant was examined as PW1 and the appellants filed affidavit of Parnam Surya Prakash Rao. On behalf of the respondents, neither affidavits nor documents were filed.
6. The District Forum dismissed the complaint on the premise that there is no first-hand information to say that the insured died of snake bite and the material placed on record is insufficient to come to conclusion that the insured died of snake bite.
7. The point for consideration is whether the order of the District Forum suffers from misappreciation of facts or law?
8. The membership of the first appellant’s husband with the second respondent-society and the first respondent issuing Janata Personal Accident Insurance Policy for the members of the second respondent–society for the year 2010-2011 and the sum assured for each of the members, `1,00,000/- are beyond any dispute. Death of the first appellant’s husband is also not disputed. The first respondent-insurance company had not settled the claim nor repudiated it on the premise of non-submission of relevant documents by the appellants. The District Forum observed that the appellants failed to produce satisfactory material to establish that the insured died of snake bite.
9. The first respondent-insurance company had sought for documents, such as copies of FIR, Inquest report, Report of Post Mortem Examination, Insurance Policy and Death Certificate. The first respondent referring to the medical certificate withheld settlement of claim on the premise that the doctor had not mentioned of any treatment therein.
10. Two paragraphs of the affidavit of the Deputy Manager of the 1st respondent-insurance company would establish that the appellants submitted medical certificate which does not disclose any treatment administered to the deceased and the 1st appellant addressed letter, ExA1 to the first respondent would show that the insured died at his village even before the 108 vehicle arrived there. In his affidavit, the deputy manager has stated that:
“It is pertinent to note that a doctor certificate filed issued by the Padmaja Nursing Home doctor Dr.N.S.Vishnu Rao of Bantumilli cannot be relied upon. In the said certificate the doctor certifies that Jogi Suraiah, S/o J.Paydaiah died due to snake bite on 06.06.2010. There is no mention of the treatment in the certificate in any manner.
It is also pertinent to note that document no.1 filed by the complainant along with complaint, a letter addressed to OP-1, in which letter the complainant states that the said Suraiah died of snake bite as the arrival of 108 ambulance was delayed due to which her husband died. From the above statement in the letter it is also evident, that the said Suraiah died even without any treatment in the village itself”
11. The first appellant in her evidence stated that she would submit the documents sought for by the first respondent-insurance company. The medical certificate produced by the appellants would not be held sufficient to hold the death of the inured as of snake bite. As the appellant claimed that they would submit the documents such as FIR, report of postmortem examination etc, we deem it a fit case to direct the first respondent to consider the claim giving opportunity to the appellants to produce the documents sought for by the first respondent.
12. In the result the appeal is allowed, the order of the District Forum is set aside. Consequently, the complaint is allowed directing the First Respondent to consider the claim subject to submission of the documents sought for by it. There shall be no order as to costs.
MEMBER
MEMBER
కె.ఎం.కె* Dt.17.04.2013
