Tamil Nadu

North Chennai

99/2014

R.Jayanthi, B.swetha Sharma, B.Durgasharma, - Complainant(s)

Versus

Branch Manager, United India Insurance Co ltd - Opp.Party(s)

A.Shanmugaraj

09 Jan 2017

ORDER

                                                            Complaint presented on:  10.04.2014

                                                                Order pronounced on:  09.01.2017

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

    2^nd 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 09^th    DAY OF JANUARY 2017

 

C.C.NO.99/2014

 

 

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 took personal accident policy that covered for sum insured Rs.1,00,000/- + Rs.1,00,000/- + Rs.1,00,000/- = Rs.3,00,000/- as stated in the policy No.010303/42/10/010000011 and the same has been covered for the period valid from 10.04.2010 to 09.04.2011. Apart from that as per the policy the claimants are entitled to get the accumulated claim bonus benefit of Rs.25,000/- + Rs.10,000/- + Rs.5,000/- + Rs.40,000/- as mentioned in the policy.  The Complainant  humbly submit that in respect of the above said accident a Criminal Case  has been registered at C-1, Flower Bazaar Police Station under Crime No.106/2011 and the autopsy has been conducted at the Government General Hospital, Chennai . Since the policy covered for personal accident coverage, the first Complainant sent claim form on 25.01.2012 and the same was received by the Opposite Party on 27.01.2012 along with necessary documents. Even after receipt of the Personal Accident Claim Form, the first Respondent failed to settle the personal accident coverage amount of Rs.1,00,000/-+Rs.1,00,000/- + Rs.1,00,000/- =Rs.3,00,000/- as well as the accumulated claim benefit bonus amount of Rs.25,000/- + 10,000/- +Rs.5,000/- = Rs.40,000/- and thus a total amount of Rs.3,40,0000/- and the same has to be settled to the Complainant.

2.The first Complainant often approached the Opposite Party for getting the Personal Accident Coverage amount with accumulated claim bonus amount of Rs.3,40,000/- and her attempts are ended in vain. The Opposite Party has committed deficiency in respect of that he failed  to settle the personal accident coverage amount    even after receipt of claim form on 27.01.2012  and due to that the Complainant suffered with mental agony. Therefore, the Complainant filed this Complaint for the claim of personal  accident coverage for a sum of Rs.3,40,000/-including bonus 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 Rs.1,00,000/- and not Rs.3,00,000/- as falsely alleged by the Complainant. The Complainant is mixing up other benefits under Table III and IV as if the cover was separately for personal Accident death only. So far as death  due to accident, the cover is only for Rs.1,00,000/-  Further the Opposite Party states that the Personal Accident cover is 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

1. there were no injuries and
2. death was due to heart attack, specifically mentioned as “natural cause”

and 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 in charge 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.3,00,000/- or accumulated bonus or interest since the death of the Complainant’s husband was not due to injury sustained by accident which alone 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 1^st Complainant and father of the 2^nd & 3^rd 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 1^st 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 Momorial Hall Street, Geroge 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 09^th  day of January 2017.

 

MEMBER – II                                                               PRESIDENT

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1 dated 07.04.2010                   Copy of the personal Accident 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