KERALA STATE CONSUMER DISPUTES REDRESSALCOMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.
APPEAL NO. 572/2003
JUDGMENT DATED. 26.02.2011
PRESENT:-
JUSTICE SHRI. K.R. UDAYABHANU : PRESIDENT
SHRI. M.K. ABDULLA SONA : MEMBER
APPELLANTS
The New India Assurance Co. Ltd.,
Rep. by its Deputy Manager, Regional Office,
M.G. Road, Ernakulam.
(Rep. by Adv.George Cherian.)
Vs
RESPONDENTS
1. Alice Ignatious,
W/o Ignatious, Aloor House, P.O. Nelluvai, Muringatheri, Thrissur.
2. Soji, D/o Late Ignatious,
Aloor House,
P.O. Nelluvai, Muringatheri.
3. Saijo, S/o Late Ignatious, Aloor House, P.O. Nelluvai,
Muringatheri, Thrissur.
4. Agricultural Officer,
Krishi Bhavan, Erumapetty,
Thrissur District.
(Rep. by Adv. Sri. R.V. Sujith Kumar)
JUDGMENT
SHRI. M.K. ABDULLA SONA : MEMBER
This appeal prefers from the order passed by the CDRF, Thrissur in O.P. No. 528/2001 dated 27th May 2003. The appellant is the second opposite party and the respondents are the complainant and first opposite party in the above said op respectively. The appellant prefers this order under direction of the forum below that the appellant /second respondent is directed to pay to the complainant Rs. 1,07,000/- with cost Rs. 600/-
In short, the complainants are the legal heirs of the late A.P. Ignatious . The late A.P. Ignatious was having a valid insurance pllicy of the second opposite party. As per the conditions of the policy, if agriculturist who is a member in the policy scheme dies due to accident, his legal representatives will be given Rs. 1,00,000/- as compensation Rs. 500/- for two children for their education Rs. 5,000/- each for two daughters for their marriage Rs. 1000/- to transport the dead body to the house and Rs. 1,000/- for burial expenses. Mr. Ignatious hit against a stump while he was doing agricultural operations on 31.3.2000 and consequently fell on the ground and his left radius was broken and the little finger of the left leg sustained deep injury. There were other injuries also. Immediately he was taken to Devine Medical Center hospital, Wadakkancherry and then he was treated in the Jubilee Mission hospital, Thrissur. Due to the infection in the wounds the kidney was affected and on 5.5.2000 he died away. After his death the petitioner made the claim to the second opposite party insurance company so the first opposite party but death was repudiated and a reply was given on 14.5.2001. The claim was repudiated on the ground that the death was not due to the injuries sustained in the accident. There is no justification for the repudiation since the doctor who treated as clearly certified that the death was due to infection in the injuries affecting kidney. Hence the complaint.
The opposite parties filed their written version and the first opposite party taken a contention that the government of Kerala has implemented group insurance scheme for farmers by name Karshaka Beksha, Padhathi through the department of agriculture in association with the second opposite party. The deceased Ignatious was already a member of the scheme the government had remitted the annual premium of Rs. 10/- to the second opposite party on behalf of late iIgnatous. It was reported that the insured fell down on 31.3.2000 while he was doing farming activities and had been treated on Devine Medical Centre, Wadakanchery and then admitted in Jubilee Mission hospital, Thrissur on 27.4.2000 and he died on 5.5.2001. The first opposite party forwarded the scheme to the second opposite party vide letter E.K. – 28/2000 dated 2.8.2000. As per the scheme and policy conditions it is for the second opposite party to pay all the benefits to the complainants on account of the death of late Ignatious, if the claim is admissible. The government had paid the annual premium of Rs. 10/- to the second opposite party. This opposite party is an unnecessary party. But the second opposite party take strong contention in the written version that the above said policy is valid for a period of one year from 2.10.1999 to 1.10.2000. But they taken a view that the cause of death as per the medical records was the real failure and therefore the proximate case of death of the insurer is not connected with the accident occurred on 31.3.2000 and hence the complainants are not eligible to claim any amount as compensation under the policy. The complainant sustained injuries on the left let and left hand while he was plucking fruits for collecting cashew nuts. He sustained injuries on the left leg and left hand. He was taken to Devine Hospital at Wadakanchery on examination he was found to gave sustained saturation wound on the base of 5th toe and fracture distal, end of left radius of the ulnar styroid. The wound was sutured and plaster was caused on his left arm. The suture was removed on 6.4.2000 and the plaster was removed on 22.4.2000 He resumed his regular activities as he had free himself from the infirmities caused as a result of the mishap, the patient under the terms of Doctor Purushothaman of Devine Hospital ,Wadakanchery. He has made known that the injuries sustained on 30.3.2000 were treated by him and the patient was fully cared of the same. The plaster was removed two weeks after the removal of the suture and at that time there was no abnormalities his body. Therefore the petitioner was admitted to Jubily Milssion Hospital on 27.4.2000 with a multiple pyaemic abscess due to trauma uraemia while continuing treatment. The patient expired on 5.5.2000 due to renal failure the subsequent treatment is not for the injuries sustained in the previous action. The complainants were also known that the insured died due to the renewal of failure. The doctor concerned who treated him in the hospital who is one Dr. Rajiv Rao who issued a certificate on 30.5.2000 which shows that he was under his treatment for multiple piaemic absess in both lower limps and uraemia. According to the insurance , Dr. Rajiv Rao refused to attribute the death hence as a result of injuries sustained on 30.3.2000, the above mentioned certificate bearing No. 169/00 was forwarded by the Agricultural Officer, Krishi Bhavan Erumapetty.
The complainants are not entitled to get any amount of compensation from the opposite parties. Hence the complaint may be dismissed with the compensatory cost. This is the defense of the opposite party
The Forum below framed two issues mainly
1) Whether there is any justification on the part of the seco9nd opposite party in repudiating medical claim ?
2) What is relief, complainants are entitled ?
The evidence consists of Ext. P1 to P11, Exts. R1 to R7. Ext. X1 and X1(a) and the depositions of Pw1 amd Rw1.
The Forum below discussed the entire evidence and answered all the points arised for consideration.
The Forum below taken a view that on 4.5.2000, the patient died on 5.5.2000. Rw1, Dr. Rajiv Rao says that the death was not due to the bone injury. The doctor concerned who is a competent witness he would say even if there were any previous medical records he was not away of those. During the course of examination the complainants the very same expert witness has admitted that multiple pyaemic abscess is noted on the left foot in the medical report. On going through the Ext. X1(a) he has deposed that on 27.4.2000, the patient was admitted that multiple pyaemic abscess and septicaemia In the fourth page of Ext. X1 it is noted that it is non case of I.H.D. (ISCHEMIAE Heart Disease. Septamia means infection from any sources in any part of the body which can spread through all body and took affect all vital organs of the body. In this case Rw1 is expert witness would say that the absence of left foot laid to septicaemea and multy organ failure which caused death. Septicaemea is infection in whole body. According to him cardio respiratory failure will takes place in all cases of death. It is normal or abnormal. He would say that the real cause of death in the particular course of peoginic abscess to the left foot leading to septceamea and failure of multi organs after assessing the evidence. It can not be said that the insured died due to ailment which was not connected with the accident on 31.3.2000. The evidence adduced shows that this fact made reasonable to think that the death was due to renal failure which was the result of the infection of the wound on the left foot which the deceased sustained on 31.3.2000. In the circumstances the Forum below taken a view that the repudiation of the claim by the second opposite party is not justifiable and it amounted to deficiency in service according to the provisions of the C.P. Act. The Forum below allowed the complaint. The appellant prefers this appeal from the above finding of the Forum below.
On this day this appeal came before this commission for final hearing the counsel for the appellant is appeared and argued his case vehemently on the grounds of appeal memorandum but there is no representation for the respondent. The counsel for the appellant argued mainly on two grounds. The death of the deceased occurred not due to accident but also due to the renal failure. He invited our kind attention that as per the medical evidence adduced by both the complainant and the second opposite party the injury sustained due to the accident. Immediately the accident he was approached to the Devine Hospital, Wadakkanchery and treated the competent and qualified orthopedic doctor, the patient as an out patient. Later he admitted in the Jubilee Mission hospital for the renal failure and the death was occurred in that hospital. The death and accident are not connected each other. In other words these are separate calamities. As per the policy conditions only the death due to the accident alone is giving the coverage and secondly he (deceased) did not undergo the treatment in the Devine Hospital as an in patient and spent any expenses for such treatment in that hospital.
The counsel for the appellant strongly argued and submitted that this death is not coming under the coverage of the policy as per the conditions of the policy. We this Commission heard in detail and perused the entire evidence from both sides. It is seeing that the accident was occurred and he was immediately approached the Devine Hospital, Vadakkancherry for the treatment of his injuries. The doctor in the causality attended the deceased and referred to the Orthopedic expert Dr. Purushothaman. He examined him as an out patient. But within a short period he approached to the Jubilee Mission hospital and admitted as an in patient. Then he died. Dr. Purushothaman is an orthopedic expert in the Devine Hospital, Vadakkancherry examined the deceased treated him as out patient. After the deceased approached to the Jubilee Mission hospital and treated he as an inpatient and he died due to renal failure. The Rw1 Dr. Rajiv Rao, he deposed on the strength of the case sheet that the death of the deceased due to the cardiac respiratory failure. It will take place any of case of death whether normal or abnormal and he would say that the cause of death in the particular case is pyogenic abscess to left foot leading to septecease and failure of multi organism. It need not say all the accident was having instant death. As per the forensic signs it is a settled position that so many injuries may accelerate the cause of death of a person. In a murder case some times the victim will died after so many months from the date of the stabb injuries. Here we are seeing that the Dr. Purushothaman the Orthopedic expert who attended the injuries of the patient in course of his treatment. He did not give any deposition in explanation about. He treated the deceased as an out patient in the hospital. It is nothing but a medical negligence from the part of the above Dr. Purushothaman. A person who involved in an accident and sustained injuries then so many days, weeks or months he can due to the infection of the accident. There is no doubt that the death is nothing but as a result of the accident. The patient has no right to choose his method of treatment. Dr. Purushothaman of the Devine Hospital taken decision about the treatment of the deceased. We are not seeing any reason to interfere in the order passed by the Forum below. The Forum below rightly answered all the questions and appreciated all the evidence adduced by both sides. But we are seeing that the cost ordered by the Forum below is not necessary and the Forum below did not direct the appellant to pay interest.
In the result, this appeal is allowed in part and set aside the direction of the Forum below that pay Rs. 600/- as cost by the appellant to the complainants and confirmed the other portions, according to these modifications this appeal is allowed in part.
The points of the appeal discussed one by one and answered accordingly.
No cost ordered.
M.K. ABDULLA SONA : MEMBER
JUSTICE. K.R. UDAYABHANU : PRESIDENT
ST
