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R.Jayanthi, filed a consumer case on 09 Jan 2017 against Branch Manager, United India Insurance Co Ltd, in the North Chennai Consumer Court. The case no is 98/2014 and the judgment uploaded on 25 Jan 2017.
Complaint presented on: 10.04.2014
Order pronounced on: 09.01.2017
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)
2nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3
PRESENT: THIRU.K.JAYABALAN, B.Sc., B.L., PRESIDENT
TMT.T.KALAIYARASI, B.A.B.L., MEMBER II
MONDAY THE 09th DAY OF JANUARY 2017
C.C.NO.98/2014
1. R.Jayanthi,
W/o. Late. B.Babu Sharma @ Brij Bushan,
2. B.Swetha Sharma,
D/o. Late. B. Babu Sharma @ Brij Bushan,
3. B.Durga Sharma (Minor),
D/o. Late.B.Babu Sharma @ Brij Bushan,
Rep.by M & N.F.R. Jayanthi.
All are residing at No.28, Ponniamman Koil Street,
Puzhuthivakkam,
Chennai – 600 091.
….. Complainants
..Vs..
Branch Manager,
United India Insurance Co. Ltd.,
No.21, Raja Annamalai Road,
Purasawalkam,
Chennai – 600 084.
| .....Opposite Party
|
|
Date of complaint : 23.05.2014
Counsel for Complainant : A.Shanmugaraj
Counsel for Opposite Party : M.B.Gopalan, N.Vijayaraghavan,
M.B.Raghavan
O R D E R
BY PRESIDENT THIRU. K.JAYABALAN B.Sc., B.L.,
This complaint is filed by the complainant u/s 12 of the Consumer Protection Act.1986.
1.THE COMPLAINT IN BRIEF:
The Deceased Babu Sharma @ Brij Bushan is the owner of the Motor Cycle TN 22BB 3215 and the same has been duly insured with the Opposite Party under policy No.010303/31/10/01/00000778 valid from 06.05.2010 to 05.05.2011. The above said policy also covered personal accident coverage for the owner-driver for Rs.1,00,000/-. On 01.02.2011 at about 10.00 p.m while the above said Babu Sharma @ Briij Bushan was riding his scooter TN 22BB 3215 at Memorial Hall Street, George Town, Chennai – 1, he fell down and died at the spot, due to heart attack and then taken to Government General Hospital. In respect of the above said accident a Criminal case has been registered at C-1, Flower Bazaar Police Station in Crime No.106/2011 and the autopsy has been conducted at Government General Hospital, Chennai.
2. The first Complainant sent the Claim Form to the Opposite Party on 25.01.2012 with necessary documents by Registered Post and the same has been received by the Opposite Party on 27.01.2012. Even after receipt of the Personal Accident Claim Form, the Opposite Party failed to settle the personal accident coverage amount of Rs.1,00,000/- to the Complainant. The first Complainant often approached the Opposite Party for getting the Personal Accident Coverage amount of Rs.1,00,000/- and her attempts are ended in vain. The Opposite Party has failed to settle the personal accident coverage amount of Rs.1,00,000/- even after receipt of claim form on 27.01.2012 is deficiency on his part and due to the act of the Opposite Party the Complainants suffered with mental agony. Therefore, the Complainant filed this Complaint for the claim of personal accident coverage for a sum of Rs.1,00,000/- with 12% interest from the date of claim in respect of the insured Babu Sharma and also compensation for mental agony with cost of the Complaint.
3. WRITTEN VERSION OF THE OPPOSITE PARTY IN BRIEF
The claim was made for payment of Personal Accident benefit under Motor Insurance Policy. The coverage for such benefit is available only for death solely and directly caused by violent accidental external and visible means which independent of any other cause results in death. While the Complainant submitted a belated claim for death of her husband while riding his motor cycle on 01.02.2011, Post Mortem Report revealed that
Thus the death was not due to any injury sustained by accident. On the other hand, it appears that the deceased had fallen down from the vehicle due to Heart Attack, but suffered no injuries whatsoever. Hence in the absence of death being caused by injuries sustained by accidental, external violent means, but was entirely due to natural heart failure, the Personal Accident cover was not triggered by the incident and the Complainants were not entitled to claim benefit of the said cover. In view of the same, the Complainants were personally informed of the said position by the Branch Manager incharge at the time during January 2012 and the Complainants accepted and did not pursue the matter thereafter. While so, it is surprising that after lapse of more than 3 years, the present Complaint is filed as if the Opposite Party did not consider the claim. In fact there was no correspondence, letter, reminder or notice before filing the Complaint. Due to afterthought and ill advice the Complainants have suddenly come forward with the present Complaint speculatively and it is nothing but an abuse of the Consumer Protection Act. The Opposite Party is not liable to pay Rs.1,00,000/- or interest since the death of the Complainant’s husband was not due to injury sustained by accident which alone is covered by the Personal Accident benefit of the policy and the Complaint is liable to be dismissed with costs.
4. POINTS FOR CONSIDERATION:
1. Whether there is deficiency in service on the part of the opposite party?
2. Whether the complainant is entitled to any relief? If so to what extent?
5. POINT NO :1
The admitted facts are that the Deceased Babu Sharma is the husband of the 1st Complainant and father of the 2nd & 3rd Complainants and he is the owner of the Motor Cycle TN 22BB 3215 and the same was insured with the Opposite Party under Ex.A1 policy, Ex.A2 is the RC book and Ex.A3 is the driving license of the deceased and the said policy is valid for the period of 06.05.2010 to 05.05.2011 and the policy covered personal accident coverage of owner-driver for Rs.1,00,000/- and while he was riding the bike on 01.02.2011 at about 10 p.m, he fell down from the said vehicle and died on the spot at Memorial Hall Street, George Town, Chennai – 1 due to heart attack and then he was taken to the Government General Hospital and Post Mortem was conducted on the deceased and the Post Mortem certificate issued by the said hospital is marked as Ex.A5.
6. The said accident was registered on a Complaint under Ex.A4 FIR dated 01.02.2011. The 1st Complainant made Ex.A10 claim based on Ex.A4 FIR to the Opposite Party and however the Opposite Party has not settled the accident coverage of Rs.1,00,000/- to the Complainant and hence the Complainant filed this Complaint for claim based on Ex.A1 Insurance Policy.
7. The Complainant contended he is entitled to claim based on Ex.A1 policy, since the deceased Babu Sharma died due to accident which was proved as in Ex.A4 FIR and the Opposite Party failed to honour the claim made by the Complainant proves that the Opposite Party committed Deficiency in Service.
8.The Opposite Party would contend that their own pleadings of the Complainant in the Complaint and Ex.A5 Post Mortem Certificate proves that the deceased died only due to heart attack and further the Complainant have not proved that the deceased died to injuries sustained during the course of accident and if the claimant fails to prove that the death was not due to injuries sustained in the accident, the Complainants are not entitled for accident claim and in support of their contention the Opposite Party relied the orders of the NATIONAL COMMISSION IN REVISION PETITION No.1073/2015 dated 30.04.2015 (SATYANARAIN VS. ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED) & in REVISION PETITION No.287/2015 dated 05.08.2015 (UNITED INDIA INSURANCE COMPANY LIMITED VS. KAMLA DEVI & ANR.) and therefore this complaint is liable to be dismissed.
9. Admittedly the deceased Babu Sharma while travelling in his motor cycle on 01.02.2011 at Memorial Hall Street, George Town, Chennai – 1, he fell down and died on the spot. The Complainant himself pleaded in the Complaint that due to heart attack he was died. Ex.A6 Report of death also reveals that the reason for death is heart attack. In Ex.A5 Post Mortem Certificate the opinion given by the Post Mortem Doctor is as “Myocardial infarction due to Coronary artery Heart disease- Natural Cause”. Therefore, the Complainants own pleading and opinion of doctor proves that the deceased Babu Sharma was died only due to heart attack.
10. The above referred order of the National Commission clearly held that the deceased should have died on account of injuries sustained in an accident and then only entitled for claim. However, in the case in hand in the Post Mortem Certificate the doctor observed that no external injuries seen anywhere on the body. However, the Complainant counsel contended that in the post mortem certificate, it is noted that 6x3x0.5 c.m contusion seen in the left parietal region and due to such injury, the deceased could have died. Absolutely, there is no evidence on behalf of the Complainant to prove that due to the aforesaid contusion only the deceased appear to have died. Therefore following the ratio held by the National Commission referred in the above referred orders, the Complainant has not proved that the deceased sustained the aforesaid contusion only when he fell from his vehicle and due to such contusion only the deceased was died. No medical evidence is available that the deceased was died due to the contusion found on the parietal region. Therefore, we hold that the Complainant has not proved that the deceased Babu Sharma died on account of injuries sustained by him in the accident and therefore by not awarding claim as claimed by the Complainants, the Opposite Party has not committed any deficiency in service.
11. POINT NO:2
Since the Opposite Party has not committed any deficiency in service, the complainant is not entitled for any relief as prayed by him and the complaint is liable to be dismissed.
In the result the complaint is dismissed. No costs.
Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 09th day of January 2017.
MEMBER – II PRESIDENT
LIST OF DOCUMENTS FILED BY THE COMPLAINANT:
Ex.A1 dated 05.05.2010 Copy of the Motor Insurance Policy
Ex.A2 dated 08.05.2008 Copy of the R.C.Book of TN 22 BB 3215
Ex.A3 dated 09.03.2007 Copy of the Driving License
Ex.A4 dated 01.02.2011 Copy of the FIR
Ex.A5 dated 02.02.2011 Copy of the Post Mortem Certificate
Ex.A6 dated 02.02.2011 Copy of the Report of Death
Ex.A7 dated 02.02.2011 Copy of the Burial Ground Chit
Ex.A8 dated 09.03.2011 Copy of the Death Certificate
Ex.A9 dated 27.05.2011 Copy of the Legal Heir Certificate
Ex.A10 dated 25.01.2012 Copy of the claim Form
Ex.A11 dated 27.01.2012 Acknowledge Card
Ex.A12 NIL Copy of the Ration Card
LIST OF DOCUMENTS FILED BY THE OPPOSITE PARTY :
…… NIL ……
MEMBER – II PRESIDENT
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