Before The District Forum:Kurnool

Present: Sri K.V.H.Prasad, B.A., LL.B., President

And

Smt C.Preethi, M.A., LL.B., Member

Sri R.Ramachandra Reddy, B.Com., LL.B., Member

 Thursday the 19^th day of February, 2004

C.D.No.29/2003

K.Silpa,

D/o. K. Prasad Rao,

R/o. T Gokulapad (V),

Kurnool Dist.                                    . . . Complainant represented by her

                                                                Counsel Sri G. Madhusudhan Reddy

        -Vs-

1. The Regional Manager,

National Insurance Co. Ltd.,

7^th Floor,

Moghul Courts,

Basheer Bagh,

Hyderabad.     

                                                                            . . . Opposite party

1. The Manager,

Divisional Officer,

National Insurance Com. Ltd.,

Ananthapoor Dist.

1. The Branch Manager,

National Insurance Company Ltd.,

P.B.No.42, Tula Complex,

1^st Floor,

Gandhinagar,

Kurnool.                                       . . . Opposite party No2 & 3 represented

                                                           By their counsel Sri P. V. Sudhakar Reddy

O R D E R

(As per Smt C.Preethi, Member)

1.       This CD complaint of the complainant is filed under section 12 of C.P.Act, 1986 seeking a direction on the opposite party to pay her insured amount of RS.2,00,000/- with 24% interest per annum from the date of death till realization, RS.25,000/- compensation and cost of the case.

2.       The gist of the complaint of the complainant is that the father of the complainant by name K.Prasad Rao accidentally fell on pointed sharp stone on 8.2.2001 and sustained grevious injury to his head and died in transit to the hospital. The deceased has taken a Janatha Personal Accident Insurance policy bearing No.55100/49/9600500/98 and nominated his daughter K.Slipa as nominee.  The complainant being the nominee on 31.3.2001 sent claim form along with original policy, death certificate issued by M.R.O, to the opposite party and there was no response from opposite party, hence the complainant was constrained to issue legal notice on 27.6.2002.  The opposite party replied through its communication dt 5.7.2002 repudiating the claim of the complainant on the reason of not producing relevant documents. The conduct of opposite parties in repudiating the complainant’s claim and not paying insurance amount amounting to deficiency of service.

3.       The complainant in support of her case relied on the following documents Viz (1) repudiation letter dt 5.7.2002 of the opposite party NO.3 to the complainant (2) office copy of legal notice dt 27.6.2002 (3) office copy of the letter of the complainant dt 31.3.2001 (4) true copy of death extract of K.Prasada Rao issued M.R.O Krishnagiri and (5) attested copy of death report issued by V.A.O.  T.Gokulapadu. The complainant in substantiating her case and documents filed her sworn-affidavit as evidence, hence the above documents are marked as Ex A.1 to A.5 for their appreciation in this case.

4.       In pursuance to the notice of this Forum of this case the opposite parties 2 & 3 appeared through their standing counsel and opposite party No.3 filed its written version and opposite party No.2 filed adoption memo, adopting the written version of opposite party No.3 and opposite party No.1 remained absent through out the case proceedings.  It denies the complaint as not maintainable under Law or on facts, excepts those facts that are specifically admitted.   Even though it admits the complainant’s father taken a Janata Personal Accident Insurance Policy and denies the death of complainant’s father due to grievous injuries to the head and the death is not accidental.  As per the terms and condition of the policy the complainant is entitled to insured amount only when it is established that the deceased died accidentally.   It further submits the complainant failed to submit required documents to prove her father’s death was accidental and the averments made in the complaint.  The repudiation of the claim of the complainant was delayed as the complainant was not available at T.Gokulapadu Village, the investigator appointed by the opposite party could not submits its report in time. Hence there is no deficiency on part of the opposite party in repudiating the claim of the complainant as there are laches on part of the complainant itself and further submits voluminous oral and documents evidence is necessary which cannot be led in summary proceedings.  As the repudiation of the claim is valid the opposite party is not liable to pay the insured amount with interest and RS.25, 000/- towards damages and prays for the dismissal of complaint.

5.       The opposite party in support of its case relies on the following document Janata Personal Accident Policy of K.Prasad Rao bearing Policy No. 98/9600500 and it also relies on its sworn affidavit in reiteration of its written version as evidence.  Hence the above documents is marked as Ex B.1 for its appreciation in this case.

6.       Hence the point for consideration is whether the complainant has made out any deficiency of service and deficient conduct on part of the opposite party in repudiating her claim and her entitleness to the relief’s sought:-

7.       It is not in dispute that  K.Prasad Rao has insured his life for RS.2,00,000/- with the opposite party vide policy bearing No. 55100/49/9600500/98 and the policy has commenced from 27.7.1998 to noon on 26.7.2008.  The complainant alleges that the insured died on 8.2.2001 due to grievous bleeding injury to his head.  The complainant filed Ex A.4 and A.5 attested true copies of death certificate and death extract in support of her contentions.    The Ex A.4 was issued by M.R.O Krishnagiri, which certifies that K.Prasada Rao died on 8.2.2001 and the cause of death showed as fell down, succumbed to injury due to heavy bleeding.  The Ex A.5 was issued by V.A.O T.Gokulapadu Krishnagiri (M), which certifies that K,Prasada Rao fell down, sustained bleeding injuries and died.

8.       The main contention of the opposite party is that the deceased death is not accidental and the complainant did not produce relevant documents to support her claim such as postmortem report, FIR etc., As there is no supporting material in support of complainant’s claim the opposite party repudiated the said claim.  On perusal of the documents on record particularly the Ex A.4 and A.5 i.e death certificate and death extract which are public records issued by competent authority indicates the death of Prasada Rao on 8.2.2001 and the cause of death is mentioned as fallen down, sustained grevious bleeding injury and succumbed to injuries, it is therefore proper to believe and accept the cause of death as mentioned in Ex A.4 and A.5.

9.       The judgement cited by the complainant reported in I (2000) CPJ pg 548 (APSCDRC) between the Divisional Manager, LIC of India Vs Y.Ratnamma, it was held that first information report, postmortem report and medical report are mandatory, as the complainant’s husband fell from palm tree and died on the sport, there was no question of filing FIR as there was no crime committed. The above decision is directly applicable to the complainant’s case, as the facts of the above case are similar to this case, in this case the complainant’s father fell on the sharp stone and succumbed to injuries, FIR and postmortem are not conducted as there is no crime committed and the death is not suspicious.

10.     The opposite party relied on the following judgments (1) LIC Vs Smt Anju Hunjan reported in II (2003) CPJ Pg 644, in this case insured slipped in bathroom and died on the way to the hospital, accident benefit denied to the claimant as no visible sign of internal or external injury are found on the body of the deceased which resulted in death.  An attempt is made by the opposite party to oust the entitleness of the complainants claim, so is the citation given by him.  The citation related to an Order by Punjab State Commission, it dismissed the complaint of the complainant, as there was no visible sign of external or internal injuries on the body of the deceased and the complainant failed to establish the same by placing any relevant, reliable evidence but this citation is not applicable to the complainants case as the complainant brought on record two public records issued by competent authority i.e Ex A.4 and A.5.  On the perusal of the said documents reveal that the deceased death was due to heavy bleeding caused by injury from the accident slip. Admittedly no postmortem was conducted on the body of the deceased, as there is no crime committed, from this it could be concluded that there was external severe injury on the head of the deceased which resulted in death.

11.     The second decision filed by the opposite party is reported in III 2003 CPJ Pg 98 NC, between Smt K.Shakuntalamma Vs Oriental Insurance Co Ltd., it was held that the complainant failed to establish the death of the insured due to snake bite, but the facts of the above case is not applicable to the complainants case as the death of the insured was not due to snake bite and death is caused due to bleeding injuries and no doubt it has been established by the complainant by lacing relevant, reliable material.

12.     On an over all consideration of aspects involve and in view of the ruling of our State Commission, similar circumstances holding that the complainant is entitled to accident benefit of the deceased. Hence the complainant is remaining entitle to the insured amount as it is clear from Ex A.4 & A.5 that the deceased death is due to accidental fall.

13.     In the result, the complaint is allowed directing the opposite parties to pay the insured amount of RS.2, 00,000/- to the complainant with 9% interest from the date of demise of the insured till realization along with RS.10, 000/- as compensation and RS.5, 000/- as cost of the case within one month from the date of receipt of this order.  In default the opposite parties shall be liable to pay the supra stated amount with 12% interest per annum from the date of default till realization.

Dictated to the Stenographer, Typed to the dictation corrected by us pronounced in the open Court this the 19^th day of  February, 2004.

Sd/-

PRESIDENT

       Sd/-                                                                                                                Sd/-

MEMBER                                                                                                       MEMBER