Kerala

Alappuzha

CC/09/369

Anniamma - Complainant(s)

Versus

Chairman, Life India Education &Charitable Trust & another - Opp.Party(s)

28 Feb 2011

ORDER

 
Complaint Case No. CC/09/369
 
1. Anniamma
Kattezhom Veedu, Ramankari P.O., Alappuzha
 
BEFORE: 
 HONORABLE JIMMY KORAH PRESIDENT
 HONORABLE K.Anirudhan Member
 HONORABLE Smt;Shajitha Beevi Member
 
PRESENT:
 
ORDER

 

IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA

Monday   28th day of   February, 2011

Filed on 12.11.2009

Present

   

      1.   Sri. Jimmy Korah (President)

2.   Sri. K.Anirudhan (Member)

  1. Smt. N. Shajitha Beevi (Member)

in

CC/No.369/2009

between

 

 Complainant:-                                                                        Opposite Parties:-

 

Smt.Anniyamma                                                           1.         The Chairman ,

W/o Lonappan                                                                         Life India Educational   

Kattezhom Veedu,                                                                    & Charitable Trust,

Ramankary P.O,                                                                       Regd. Office, Surya

Mampuzhakary, Kuttanadu Taluk                                             Complex, Velloorkunnam

Alappuzha Dt.                                                                          Muvattupuzha ,Ernakulam-686673

(By Adv. SatheeshChandra)                                                     (By Adv.Viju Chakkalackan)

 

2.                  National Insurance Com. Ltd

Aluva Divisional Office,

            PB No.89,  Urubath Building,

                                                                                                Pump Junction, Aluva-683101

                                                                                                (By Adv. C. Muraleedharan)

 

O R D E R

SRI  JIMMI  KORAH (PRESIDENT)_

 

            The complainant is the wife and nominee of the deceased Lonappan who was the member of the 1st opposite party.     The 1st  opposite  party  had  issued  a certificate as to the

same to the deceased.  As per the said arrangement between the 1st opposite party for a sum of Rs.1,00,000/- (Rupees one lakh only).  The policy was in force since 18th November 2004 to 18th November 2008.  As per the policy, the insured is entitled to the accident/medical benefits.  On 23rd  December 2006,  the insured met with a road accident  and sustained very serious injuries.  Later he succumbed to the said injuries.  As per the terms and conditions of the policy,  the complainant is entitled to all the benefits namely  Rs.5000/- (Rupees five thousand only) as Medi claim policy,  Rs.25000/-(Rupees twenty five thousand only) as  Janatha personal Accident  policy   and the hospital expenses incurred for the treatment of the deceased.  The complainant produced all the relevant records with the opposite parties. The opposite parties without any proper reason, repudiated the claim lodged by the complainant vide letter dated 11th August 2009.  The premium of the said policy was being remitted without fail.  The repudiation of the policy claim amounts to the deficiency of the service.  Got aggrieved on this  the complainant approached this Forum for compensation and other relief.

2.      On   notice  being  sent,   the   opposite parties   turned  up, and  filed  separate

versions.  The crux  of the contentions of the 1st opposite party is that the 1st opposite party is not responsible for the service deficiency  if any committed by the 2nd  opposite party.  The insurance liability is vested with the 2nd opposite party.  The complainant is only to be dismissed with cost to the opposite parties, the 1st opposite party argues.  The contention of  the 2nd opposite party is that accident in question look place on 23rd December 2006, but the insured succumbed to death on  15th  December 2007 viz. one year after the  accident.  The death of the insured was due to  the defective treatment offered to him, the 2nd opposite party argues.  The complainant’s claim that the insured succumbed to the injuries sustained in the accident is false.  There is no rational  nexus  between the accident  and death.  The claim was repudiated on valuable grounds.  The  complainant  is disentitled to the policy benefits.  The complaint is only to be dismissed with cost to the 2nd opposite party, the  2nd opposite party asserts.

3.  The complainant’s evidence consists of the testimony of the complainant herself as PW1 and that of the   doctor who treated the insured as PW2, and the documents Exts.  A1 to A11 and XI to X5 were marked.  On the side of the opposite parties Exts B1 and B2 were marked.

4.  Bearing in mind the contentions of the parties, the questions come up for consideration are:-

(1) Whether the death of the insured was due to the accident in question?

 (2) Whether the treatment obtained to the insured was defective leading to his death?

(3)  Whether the complainant is entitled to the policy benefits?

            5.  Concededly, the deceased at the time of his death was the  holder of the policy from the opposite party.  The material accident and the subsequent  death of the insured are not in dispute.  What is flagrantly disputed by the 2nd opposite party is that the death of the insured is not the consequence of the accident.  In other  words,  according to the 2nd opposite party there is no direct  nexus between the accident  and  the death of the insured.  To put it mildly, the insured was  not succumbed to the injuries he sustained from the accident,   but  died due to some other complications that developed during the course of his treatment.  According to the opposite parties, the insured died consequent to the defective treatment provided to him.  We made a searching survey of the materials put on record by the parties.  We meticulously perused the version filed by the opposite parties .  Suffice it to say, no material is available on  record  to substantiate the above contention of the opposite parties.  It appears that the 2nd opposite party is absolutely  unarmed . A mere suggestion seemed to have put to PW2 doctor to the effect that the insured  would not have met with death, once proper treatment had been tendered to him, is stoutly   denied.  Save this, no effort has seemingly come up from the part of the said opposite party to bring home its contention.  We have no hesitation to hold that the 2nd opposite party  fail to rebut the case advanced by the complainant  that the insured had succumbed to the injuries sustained in the accident.  As far as the contention of the 1st opposite party, we concur with the same that its role was confined only to get the insured with the 2nd opposite party.  We reaffirm that the complainant is entitled to the policy   benefits .

            6.  In the light of the facts and circumstances discussed herein above the opposite parties are directed to pay to the complainant the insured sum of Rs.1,00,000/- (Rupees one lakh only) with 9% interest  from the date of her application  for claim till the recovery of the said amount . The opposite parties are further directed to pay a compensation of  Rs.15,000/-(Rupees fifteen thousand only) to the complainant  and a cost  of Rs.5,000/- (Rupees five thousand only) which will serve the purpose.  The opposite parties shall comply with the order within 45 days of receipt of this order.

            In the result the complaint is allowed accordingly.

            Complaint allowed.

Pronounced in Open Forum, on this the 28th day of February, 2011.

                                                          

                                                                                    Sd/-  Sri. Jimmy Korah:

         Sd/- Sri. K.Anirudhan:

                                                                                    Sd/- Smt. N. Shajitha Beevi:

 

Appendix:-

Evidence of the complainant:-

 

PW1                -                       Anniyamma Lonappan (Witness)

PW2                -                       Dr. Josiah Varghese (Witness)

 

Ext.A1             -                       Copy of the policy schedule

Ext.A2             -                       Copy of the letter dated 11.8.2009

Ext.A3             -                       Copy of the discharge summary dt. 15.2.2007

Ext.A4             -                       Copy of the discharge summary dt. 15.3.2007

Ext.A5             -                       Copy of the certificate  dt.23.1.2008    

Ext.A6             -                       Copy of the discharge summary dt. 7.5.2007

Ext.A7             -                       Copy of the bill for Rs.35,453.19/-

Ext.A8             -                       Copy of the discharge summary dt. 17.8.2007

Ext.A9             -                       Copy of the discharge summary dt. 26.7.07 & 2.8.2007

Ext.A10           -                       Copy of the discharge summary dt. 22.10.2007

Ext.A11           -                       Copy of the Final Report of Kerala Police

 

Ext.X1             -                       Certificate dt. 26.12.2007

Ext.X2             -                       Case sheet of Caritas Hospital

Exts.X3 to X5  -                       Medical records                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

 

Evidence of the opposite party:-  Nil

 

Ext.B1              -                       Copy of the Letter dt. 11.8.2009

Ext.B2              -                       Copy of the Final Report of Kerala Police

 

 

                                                           

 // True Copy //

 

                                                                                                                        By Order

 

 

                                                                                                            Senior Superintendent

To

         Complainants/Opposite parties/S.F.

 

 

 

Typed by :-pr/-

Compared by:-                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

 

 

 

 

 

 

 

 

 

 

 
 
[HONORABLE JIMMY KORAH]
PRESIDENT
 
[HONORABLE K.Anirudhan]
Member
 
[HONORABLE Smt;Shajitha Beevi]
Member

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