3

complainants 2 to 7 were added as parties to the proceedings as mere objections

were taken by R2 and to ensure better adjudication of the issue. Complainants 2

to 7 were added as parties to the present complaint vide orders in I.A. No. 126/08,

dt. 16-1-2009. The attitude of the respondents made much inconvenience along

with mental agony to the complainants. Hence, this complaint.

3. The R2 filed a counter denying all the allegations made by the

complainant. The complainant has filed the present complaint stating that her

husband i.e. policy holder died on account of hit by buffalo horn on 23-9-2006 and

who took treatment with Dr. P. Surendra Babu and died on 24-9-2006 is an

accidentally death and she is entitled to receive the policy amount from the

respondent. The R2 stated that to prove the death of the deceased is an accidental

death under the said insurance policy it is mandatory that FIR, inquest report,

post mortem and charge sheet shall be produced before this respondent. This

respondent intimated to produce all the above documents in letter dt. 9-2-2007

and reminder letter was issued to the complainant on 12-7-2007 if there was no

response from the complainant, this respondent was forced to treat the claim as no

claim and there is negligence or deficiency of service on the part of the respondents

without furnishing the required information the present complaint is not

maintainable. On enquiries by the respondents they came to know that the

deceased Narayana Reddy did not died accidentally on 24-9-2006 due to hit of

buffalo horn on 23-9-2006. But he was suffering with throat cancer and died on

the same. The complainant knowing fully well about the said fact willfully

suppressed the same by filing the frivolous complaint and her claim is not genuine

claim. Further the respondent stated that the certificate issued by Dr. P. Surendra

Babu dt. 23-9-2006 does not disclose, the actual cause of death of the deceased

and the injury caused was due to hit by buffalo. The complainant has not filed the

entire case sheet pertaining to the treatment given by Dr. P. Surendra Babu. In

4

the absence of the above material documents the death of the deceased cannot be

said to be buffalo horn. Further the respondent stated that Dr. P. Surendra Babu,

who gave treatment t o V. Narayana Reddy, had expressed that the deceased

Narayana Reddy was suffering with Malignancy i.e. throat cancer for which he gave

treatment on 23-9-2006. It is clear that the deceased died due to pre-existing

disease only but not due to buffalo horn. To prove the claim documentary evidence

is mandatory and in the present case the complainant failed to prove the death of

her husband, without filing FIR, Inquest, Post mortem and charge sheet etc. The

claim cannot be settled without these documents. The respondent further took

objection that non-joinder of necessary parties to the present case is bad, as the

deceased was having three sons and three daughters and they were not added as

parties to the present case. The complainant has to prove that there is deficiency

of service on the part of the respondents. Without any documentary proof, the

complainant cannot allege any deficiency of service on the part of the respondents

and the contract of insurance is with utmost good faith on the part of the parties,

suppression of material facts and health condition amount to violation of terms

and conditions of the contract. Hence, there is no liability on the part of the

respondents to pay the policy amount to the complainants.

4. The R1 was called absent and set exparte on 10-12-2008.

5. On behalf of the complainant Ex. A1 to A 11 were marked and on

behalf of the respondents Ex. B1 to B4 marked.

6. On the basis of the above pleadings the following points are settled for

determination.

i. Whether the complainants are entitled to receive the policy amount of

Rs. 50,000/- along with interest @ 18% p.a. from the respondents?

ii. Whether ther e i s any deficiency of service on the part of the

respondents?

iii. To what relief?

5

7. Point Nos. 1 & 2. Heard both sides and perused the records available

with the forum and forum made the following order. There are seven

complainants in the present complaint. 1

Varra Narayana Reddy and 2 to 7 are children of the deceased. The deceased

Narayana Reddy died due to collusion of buffalo horns o n 24-9-2006 at

Nallaiahgaripalli Village, Pendlimarry Mandal, Kadapa District. During his life

time he joined as member in Primary Agricultural Cooperative Society since 1996

and the respondents issued K.C.C to the deceased. The R1 issued passbook in

favour of the deceased. The R1 issued K.C.C. to the loanee providing insurance

facility to the tune of Rs. 50,000/- for the personal accident benefit to the K.C.C.

holers and R2 issued policy bearing No. 050900/47/05/00268 covering the period

from 21-10-2005 to 20-10-2006. Ex. A1 is the Xerox copy of policy. Ex. A2 is the

passbook issued by R1 in favour of the deceased. The complainant counsel argued

that the deceased was an agriculturist and he sustained injuries accidentally due

to hit by buffalo horns on 23-9-2006 at about 8.30 a.m at his residence and he

was shifted to Tirumala ENT Super Specialty Hospital, Kadapa and Dr. P.

Surendra Babu treated the injured and found that he was suffering from

respiratory obstruction and was not able to breath properly. Then the said Doctor

operated the deceased and inserted one tube i.e., jockson for better respiration.

Ex. A3 was issued by doctor that he has done tracheotomy to the deceased

Narayana Reddy and was discharged on the same day and the deceased died on

the very next day of accident i.e. 24-9-2006 at 5-00 a.m at his house and the

villagers were present at the time of death of the deceased. The death was

informed to the panchayat Secretary, Gondipalli Gram Panchayat of Pendlimarry

Mandal. The complainant counsel further stated that after enquiry the panchayat

Secretary issued death certificate was i.e. Ex. A4. The 1

added all the legal heirs were not added as parties to the present complaint and

the respondent took objection they filed I.A. No. 126/08, dt. 16-1-2009 and it was

6

allowed and all the legal heirs are added to the C.C. Ex. A5 is the Xerox copy of

family members’ certificate. Ex. A6 is the Death extract copy issued by Panchayat

Secretary stating that the deceased died due to buffalo horn. After the death of the

deceased the 1

before R1 and requested them to settle her claim as early as possible. Ex. A7 is

the sworn affidavit filed by the complainant. Ex. A8 is the Xerox copy of claim

form submitted by the complainant Annexure – B. Ex. A9 is the Xerox copy of

report of the claim verification and enquiry committee (Annexure – C) issued by R2.

Ex. A10 is the Xerox copy of letter issued by R2 to Panchayat Secretary, Vellatur to

submit FIR, Inquest, post mortem and charges sheet etc., Ex. A11 is the Xerox

copy of claim form in respect of accident submitted to R2 (Annexure – A).

8. The complainant counsel argued that even after receiving the claim

forms submitted by the complainant the respondents neither repudiated the claim

nor have settled the claim and he alleged gross negligence and deficiency of service

on the part of R2. Further he stated that it took two years to issue any simple

reply to the complainant and 1

which was issued by R2 to R1 stating that there is requirement of FIR, Inquest,

post mortem and charge sheet etc., which is marked as Ex. A10. The Act of the

respondents i.e. without settling her claim and without giving any reply caused

much mental agony to the complainant. Hence, filed the present complaint, R1

called absent and set exparte. R2 filed its counter denying all the allegations made

in the complaint except those are specifically admitted herein. The complainant

has lodged a complaint stating that her husband Narayana Reddy was K.C.C policy

holder died on account of accident hit by buffalo horns on 24-9-2006 and she

submitted claim form requesting the respondent to settle her claim. In case of

accidental death it is mandatory that FIR, Inquest report, Post mortem certificate

and charge sheet are necessary to prove the death of the policy holder. In the

7

absence of such information they cannot settle the claim of the complainant. They

issued a reminders dt. 12-7-2007 requesting the complainant to submit the above

said documents. But no response from the complainant and the respondent was

force to treat the claim as “no claim”. There is gross negligence on the part of the

complainant for not submitting the required information before respondent. The

respondent further stated that on enquiries they came to know that the deceased

had not died accidentally on 24-9-2006 due to hit by buffalo horns. But he was

suffering with throat cancer and died on the same. The doctor who treated the

deceased had not disclosed any such information that the deceased died due to

buffalo horns. But the doctor stated that the deceased was suffering with

respiratory problem and he did tracheotomy and inserted one tube by name

Jakson for better respiration and on the same day he was discharged and on the

very next day i.e. 24-9-2006 the deceased died at his residence in his own village.

The doctor who treated the deceased had expressed that he was suffering with

Malignancy i.e. throat cancer for which he gave treatment on 23-9-2006. The

respondents alleged that the deceased is having six children and non-joinder of

legal heirs to the present complaint is bad. The complainant has not came to the

form with clean hands. By perusing the documents and hearing of arguments it is

clear that the policy holder died on 24-9-2006. Point No. 1 consideration whether

the policy holder died in accident i.e. hit by buffalo horns or he was suffering with

pre-existing ailments as alleged by the respondents. By perusing the documents it

is clear that the deceased was treated by ENT doctor before one day of his death. If

really the deceased met with an accident i.e hit by buffalo horn there is no

mentioning about the accident in the certificate issued by ENT doctor. The

Counsel for the complainant argued at length and tried to convenience the forum

that the deceased died accidentally, but not with pre-existing ailments.

8

9. To substantiate the arguments he filed judgments with regard to FIR,

Post mortem, Charge sheet etc., he motioned that in 2004 I (CPR) 136 had clearly

stated that the complainant proving the death. No medical case FIR and Post

mortem report are not necessary and the Hon’ble State Commission, Chandigarh

came to conclusion that reasons for not entertaining the claim under the personal

accident insurance policy are not valid and proper as such the repudiation of

insurance claim by insurance company amounts to deficiency of service.

Assuming for a moment that the deceased died due to buffalo horns, there is no

mentioning about the accident in the certificate issued by Doctor who treated the

deceased instead of that the doctor has issued another certificate on the reversal of

the same certificate stating that the deceased was suffering with Malignancy i.e.

throat cancer for which he gave treatment on 23-9-2006. We believe that the

tracheotomy operation and respiratory problem are due to Malignancy only but not

hit by buffalo horns. If really the deceased was hit by buffalo. There is no

description how it happened when it happened the complainant simply stated that

at 8-00 a.m in the cattle shed he was hit by buffalo. We feel that it is not possible

if really the buffalo hit any person generally the buffalo horn will be on the chest

and body and on the stomach portion but not on the throughout as stated by the

complainant. Another judgment cited in 2004 (3) CPR 503 A.P. State Consumer

Disputes Redress commission, Hyderabad stated that where insured underwent

treatment for typhoid fever but did not disclose it and later died due to heart

attack, he cannot be alleged to have concealed such material fact as to enable the

Insurance Co. to avoid the policy on ground of fraud. The said judgement is not

applicable to the present case. The complainant counsel argued that when the

policy amount was taken by the respondent during his life time it is treated as that

the respondent has agreed to pay the policy amount to the policy holder. In case

of death or accident likewise the complainant counsel argued that the insurer

cannot avoid consequence of insurance contract by simply showing false

9

statement. The respondent has to pay the policy amount to the complainants.

The respondent counsel argued that it is a contract with utmost good faith and

they are ready to pay the policy amount to the deceased. If the claim is genuine

one but in the present case on their enquiry they came to know that the deceased

was suffering with Malignancy and the complainant has not approached the

forum with clean hands. After the completion of arguments by both the counsels

the respondent counsel agreed that i f there is any doubt with regard to the

certificate issued by doctor who treated the deceased they are ready to examine the

doctor. But no response from the complainant counsel. We are of the opinion

that the deceased was suffering with pre-existing ailments i.e. throat cancer and

he was treated one day before his death by Dr. P. Surendra Babu and immediately

on the evening he was discharged and on the very next day early morning he died

at his own residence and on the reversal of the certificate issued by same doctor

stated that the deceased Narayana Reddy was treated for Malignancy he came with

respiratory problem and he d i d tracheotomy and inserted Jockson for better

respiration and was discharged on the same day. So there is no deficiency of

service on the part of the respondents in repudiating the claim of the

complainants. Hence, the points are answered accordingly.

10. Point No. 3. In the result, the complaint is dismissed without costs.

Dictated to the Stenographer, transcribed by him, corrected and pronounced

by us in the open forum, this the 20

MEMBER MEMBER PRESIDENT

APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant : NIL For Respondents : NIL

Exhibits marked for complainant:-

Ex. A1 X/c of policy issued by R2 in favour of R1.

Ex. A2 Original pass book issued by R1 in favour of the complainant.

Ex. A3 Letter issued by Dr. P. Surendra Babu, dt. 23-9-2006.

Ex. A4 Death certificate issued by Panchayat Secretary, dt. 19-10-2006.

Ex. A5 X/c of family members certificate issued by Panchayat Secretary,

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Gondipalli Gram opanchayat, dt. 19-10-2006.

Ex. A6 Death extract issued by Panchayat Secretary,

Gondipalli Gram opanchayat, Kadapa Dist.

Ex. A7 Affidavit issued by Y. Sambasiva Reddy, Advocate and Notary,

dt. 15-11-2006

Ex. A8 X/c of form of application for intimation of claim (Annexure – B).

Ex. A9 X/c of report of the claims verifications and Enquiry Committee

(Annexure – C).

Ex. A10 X/c of letter from R2 to complainant, dt. 9-2-2007.

Ex. A11 X/c of (Annexure – A).

Exhibits marked for Respodnent.

Ex. B1 X/c of letter from R2 to complainant, dt. 9-2-2007.

Ex. B2 X/c of reminder – 1 letter from R2 to R1, dt. 12-7-2007.

Ex. B3 X/c of letter issued Dr. P. Surendra Babu, dt. 23-9-2006 in favour

of Narayana Reddy.

Ex. B4 Dr. P. Surendra Babu, written on reverse side of Ex. B3.

MEMBER MEMBER PRESIDENT

Copy to :-

1) Sri P. Anwar Basha, Advocate.

2) Sri D.V.S. Prasad, Advocate.

3) The General Manager, The Kadapa District Cooperative

Central Bank Ltd., Kadapa – 516 001 (AP).

1) Copy was made ready on :

2) Copy was dispatched on :

3) Copy of delivered to parties :

B.V.P - - - -