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)
- 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:-
