IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Saturday the 30th day of October, 2010
Filed on 05.05.09
Present
- Sri. Jimmy Korah (President)
- Sri. K. Anirudhan (Member)
- Smt. Shajitha Beevi (Member)
in
C.C.No.184/09
between
Complainants:- Opposite Parties:-
1. Mrs.Rema, W/o Remesan, 1. The Chairman, Life India Children’s Birthday Fund
Residing at Mattathil, Reg.No.128/IV/99, Regd. & Admn. Office,
Muhamma.P.O., Alappuzha. Surya Complex, Vellookunnam,
Muvattupuzha, Ernakulam.
2. Sreeja, D/o Remesan, (By Adv.Viju Chakkalackan)
Residing at Mattathil,
Muhamma.P.O., Alappuzha. 2. National Insurance Co.Ltd.,
Aluva Divisional Office.
3. Reshma, D/o Remesan, (By Adv.C.Muraleedharan)
Residing at Mattathil,
Muhamma.P.O., Alappuzha. 3. Mr.Sunil.A.D.,
Alunkal Veedu,
4. Hymavathy, W/o Gangadharan, Porthankuzhi,
Residing at Mattathil, Vettackal.P.O.,
Muhamma.P.O., Alappuzha. Cherthala, Alappuzha.
(By Adv.P.Roy)
O R D E R
SRI.JIMMY KORAH (PRESIDENT)
The complainant’s case is as follows: - The complainants are the legal heirs of the deceased Ramesan. Remesan was the holder of the group insurance policy issued by the 2nd opposite party. On 2nd October 2006, consequent to an ailment, the deceased was taken for treatment. But during the course of the treatment, on 4th October 2006, Ramesan breathed his last following defective treatment by an impersonated doctor. At the time of the death of the deceased, the policy was in force. The complainants duly preferred a claim with the opposite parties. The opposite parties repudiated the claim on the flimsy reason that the only accidental death would come within the ambit of the material policy. The complainants caused to issue lawyer notice to the opposite parties.
The opposite parties responded with unsustainable contentions. Got aggrieved on this, the complainants approached this Forum for relief and compensation.
1. On notice being sent, the opposite parties turned up and filed versions. The 1st opposite party contends that the said opposite party only caused the deceased to insure with the 2nd opposite party. According to the said opposite party, the role it played is very limited, and the 1st opposite party is not a necessary party to the just disposal of the complaint. The 2nd opposite party vehemently argues that the death of the deceased was not due to an accident. According to the complainants themselves, the same was the outcome of erroneous administration of medicine which would not be covered by the material policy. As such there is no deficiency on the part of the opposite parties. The complaint is ill motivated and without basis. The same is to be dismissed with compensatory cost to the opposite parties, the opposite parties assert.
2. The evidence of the complainants consists of the testimony of the 2nd complainant as PW1, and the documents Exbts Al to A6 were marked. On the side of the opposite parties, the 1st opposite party was examined as RW1, and the documents Exbts. B1 to B4 were marked.
3. Bearing in mind the contentions of the parties, the questions that come up before us for consideration is:-
Whether there is deficiency of service on the part of the opposite parties?
4. It is most significant to note that the death of the deceased nor the policy is not denied or disputed by the opposite party. The momentous contention of the 2nd opposite party is that the death of the deceased was not the result of any accident. According to them, as per the stipulations in the policy, the complainants are not entitled to the policy amount, as the death deceased met was not an accidental death. We meticulously analyzed the materials put on record by the parties. Concededly, the deceased succumbed to the imperfect treatment tendered to him by a fake doctor. Obviously, neither the complainants nor the deceased was aware that the doctor who has administered an injection to him was a quack. The people in the locality had been seeking treatment for their ailments from him for the last several years. As we have already observed, the deceased was taken for treatment to the said doctor unwittingly of his deceitful background. Thus indisputably, the acts of the deceptive doctor led to the death of the deceased. In this context, the immediate short question to be looked into is whether the death of the deceased is an accidental death which would come in the ambit of the material policy. What is accident or accidental death meant? When the expression 'accident' is referred to, it is true that the laity might take to mean the same as 'road accident' by reason of particular usage or handling that is being followed. But in legal parlance, the said word connotes a 'misfortune' or 'disaster'. In the same manner, when the word 'accidental' is referred to, the same implies the sense 'unplanned' or 'unintentional'. Thus coming down to the instant case, the death of the deceased occurred unexpectedly as a result of the precarious approach of a fake doctor. Viewing in that perspective, it can be seen that the death of the deceased was consequent upon an accidental administering of a dangerous medicine by a sham doctor. No doubt, the death of the deceased is the outright outcome of the accident perpetrated by the said doctor. Needless to say the death of the deceased is accidental. In this circumstance, the repudiation of the legitimate claim of the complainants amounts to deficiency of service on the part of the opposite parties. We regret, we are unable to accept the contentions advanced by the opposite parties. We have no hesitation to hold that the complainants are entitled to the policy amount of Rs.50,000/- (Rupees fifty thousand only).
From the forgoing discussions made herein above, the 2nd opposite party is directed to pay an amount of Rs.50,000/-(Rupees fifty thousand only) to the complainants with 6% interest from 5th May 2009 viz. the date of filing the complaint. The opposite parties are directed to pay an amount of Rs.5,000/-(Rupees five thousand only) as compensation. The opposite partiey shall comply with this order within 30 days from the date of this order.
The complaint is allowed accordingly. No order as to cost.
Pronounced in open Forum on this the 30th day of October, 2010.
Sd/-Sri. Jimmy Korah
Sd/-Sri. K. Anirudhan
Sd/-Smt. N. Shajitha Beevi
Appendix:-
Evidence of the complainant:-
PW1 - Sreeja Remesan (Witness)
Ext. A1 - The copy of the Schedule of Life India Children’s Birthday Fund and
Educational Project VII
Ext. A2 - The copy of the Janatha Personal Accident Insurance Policy Claim Form
Ext. A3 - The copy of the Post Mortem Certificate dated, 05.10.2006
Ext. A4 - The copy of the FIR dated, 18.12.2007
Ext. A5 - The copy of the Legal Notice dated, 05.01.2009
Ext. A6 - The Acknowledgment Cards
Evidence of the opposite parties:-
RW1 - C.K.Shaji (Witness)
Ext. B1 - The copy of the Licence No.530849 from the Insurance Regulatory and
Development Authority
Ext. B2 - The copy of the Master Policy Agreement dated, 27.01.2006
Ext. B3 - The Application Form of Life India Children’s Birthday Fund and
Educational Project VII
Ext. B4 - The copy of Advocate Notice
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite Parties/S.F.
Typed by:- k.x/- Compared by:-
