DOF.16.11.2006

IN THE CONSUMER DISPUTES REDRESSAL FORUM, KANNUR

Present: Sri.K.Gopalan:   President

Smt.K.P.Preethakumari:  Member

Smt.M.D.Jessy:              Member

Dated this, the 5^th  day of   April  2010

CC.260/2006

1. M.Vinodini, W/o.Late Narayanan

  Puthanveettil House,

  Mavilayi Amsom, Poduvachery desom.

2. Bhavya, (Minor) D/o. Late Narayanan

3. Anju, (minor) D/o Late Narayanan

  (Rep. by Mother & Guardian Vinodini)                                 Complainant

(Rep. by Adv.N.Gangadjaran)

1. General Manager.

   Mathrubhumi Printing & Publishing Co. Ltd.

   K.P.Kesavamenon Road, Kozhikode.

   (Rep. by Adv.T.Ravindran)

2. M/s.United India Insurance Co. Ltd.,                                    Opposite parties

   Regional Office,”Sharanya”,

   Hospital Road, Ernakulam,

   Kochi.

  (Rep. by Adv.V.V.Gopinathan)

O R D E R

Sri.K.Gopalan, President

            This is a complaint filed under section 12 of consumer protection act for an order directing the opposite parties to pay Rs.1,00,000/- as policy amount with 9% interest from the date of accident and to pay Rs.25,000/- as compensation with an amount of rs.5000/- as litigation expenses.

            The facts of the case in brief are as follows:-The complainants are the widow and children of late Narayanan, the member of Mathrubhumi family Insurance Scheme started and organized by both opposite parties. As per the scheme the dependence/legal heirs are entitled to get a sum of Rs.1, 00,000/- in the event of accidental death of the insurer. Sri.Narayanan met with an accidental fall from Heights while working on 22.6.05 and admitted to AKG Memorial co.op.Hospital. He breathed his last on 5.7.05 from the hospital itself. Since there was no suspicion doctors who attended Narayanan had opinioned that there was no necessity to conduct the postmortem. Hence Hospital authorities did not intimate to the police, as such FIR had not lodged. The accident was happened only due to fall from height which does not cover under Lego medical case. Claims submitted by the complainants and accordingly 1^st opposit party had also forwarded all necessary papers and documents to the 2^nd opposite party.Statement regarding FIR also filed by 1^st  opposite party. But the second opposite party rejected the claim and intimated to the complainant through 1^st opposite party. The reason assigned for repudiating the claims is that FIR and postmortem certificate is not produced. It is a vague contention not to grant the Insurance amount. Complainant further submitted that the deceased  Narayanan had another accident claim policy under the same 2^nd opposite party(No.100805/42/04/000402) covering the period for personal accident  claim for Rs.25,000/-. That was settled and   paid the amount holding that deceased P.V.Narayanan had met a personal accident. But a strange stand taken in this case on the very same accident and repudiated the claim. There is deficiency in service and both the opposite parties are liable. They have legal obligation to pay the insured amount. All original documents have already produced along with claim petition. The complainants under went major shock and mental pain due to arrogant attitude taken by the opposite parties. Hence this complaint.

            Pursuant to the notice opposite parties 1 and 2 entered appearance and filed version separately.

            1^st opposite party contended as follows: Late Narayanan was a member of Mathrubhumi family Insurance Scheme floated jointly by both opposite parties.2^nd opposite party is the final authority for setting and paying the policy amount. The 1^st opposite party had forwarded claim to2nd opposite party with all the documents for scrutiny and settlement. As the claimants did not submit the postmortem and police reports the claim was rejected. The 2^nd opposite party had settled a claim made by the complainants without the postmortem and police report is false. 1^st opposite party is not party to that policy. It is the 2^nd opposite party who has to settle the claim finally. If the claim of the complainant is sustainable and entitled for any award 2^nd opposite party alone is liable to settle the claim under the scheme. Hence to dismiss the complaint against this opposite party.

            2^nd opposite party also filed version separately. 2^nd opposite party contended that since all the legal heirs are not made parties the complaint is bad for non joinder of necessary parties. 1^st opposite party and this 2^nd opposite party had signed an agreement under the Rural Accident policy of 2^nd opposite party and everything in respect of the claims  concerned is governed by the terms and conditions of  the agreement. The 1^st opposite party did not submit the written intimation and furnish the documents detailed under the heading claims documentation within the stipulated time to this opposite party.  Thus there is an inordinate delay on the part of 1^st opposite party. This is a breach of condition. So 2^nd opposite party is not liable for the relief sought in the complaint. In the case of an accident death FIR postmortem and other relevant documents have to be submitted to this 2^nd opposite party. No such documents have been submitted to prove the accidental death. In the case of accidental death, a crime should be registered and post mortem is to be conducted. No such formalities have been done in this case. So this opposite party does not admit that the cause of death of the deceased was due to an accident. In the absence of concrete and convincing documentary proof regarding the accidental death this 2^nd opposite party cannot be made liable. Hence to dismiss the case.

            On the above pleadings the following issues have been taken for consideration.

1. Whether there is any deficiency in service on the part of opposite parties?

2. Whether the complainant is entitle for relief as prayed in the complaint?

3. Relief and cost.

            The evidence consist of the oral testimony of Pw1Exts.A1 to A10 on the side of the complainant and oral testimony of DW1, Ext.B1 to B5 marked on the side of the opposite arties.

Issue Nos. 1 to 3

            Admittedly the husband of the 1^st complainant and father of second and rd complainants Sri.P.V.Naraynan was member of Mthrubhumi Family Insurance Scheme floated jointly by opposite parties. Sri.Narayanan met an accident fall from height, hospitalized but succumbed to it within a few days from the hospital itself. Complainants filed claim but repudiated on the ground that postmortem report and copy of the FIR has not been produced.

            Evidence adduced by opposite parties reveals that Mathrubhumi Family Insurance Scheme is a jointly floated scheme buy both t he opposite parties. Ext.B3 agreement dt.14.7.2004 reveals that the insurer agrees to provide insurance cover to the subscribers of Mathrubhumi daily and their named family members in the age group of 5 to 80 years, against accidental deaths. Both parties agreed that the cover shall be as per section 1 of the standard rural accident package commencing from date shown on the receipt cum certificate issued to the subscribers by Mathrubhumi. Ext.A1 is the receipt cum certificate dt.31stJuly 2004 issued to Narayanan which confirms that he was a member of the scheme during the relevant period. Ext.A6 dt.28.4.06 is the repudiation letter sent by 2^nd opposite party. The reason for the rejection was that the claimant had not submitted postmortem report and police report. Though some other reasons also stated in the version and affidavit the letters of repudiation contain only this reason. Hence the main point to be looked into is the justification of repudiation of claims on the ground of non production of post mortem report and police report. We have already seen that postmortem has not been done since there was no suspicion on the accident fall from the height during the course of his employment. Ext.A3 certificate issued by Dr.Anil S.M reveals that Sri. Narayanan 47 years was admitted in the hospital on22.6.05 due to fall from height.Ext.A3  also reveals that he expired on 5.7.05. That means he had been in his death bed in hospital for nearly ½ month. If there was any suspicion with regard to the accident it would have been reported to the police by the hospital authorities. But no such report had gone to police or police officers otherwise taken  any case in respect of the accident. It is quite natural that postmortem in ordinary course is done only if there is any suspecion.Ext.A2 and A3 only reveals the deceased was died by a personal accident fall from the height. Ext.A10- shows that the daily of 1^st opposite party Mathrubhumi published this news with the photo of the deceased Narayanan with detailed news stating that ho«nse sSen-t^m¬ XI-cmÀ ]-cn-l-cn-¡m³ sSd-Ên\p apI-fnÂI-bdn tP.-en-sN-¿th hogp-I-bm-bn-cp-¶p. Xe-¡v Kp-cp-X-c-amb ]cn-t¡-äp.- I-®qÀ-F.-sI.Pn Bip-]-{Xn-bn {]th-in-¸n-¨p. sNmÆmgvN Ime-¯m-Wv a-cn-¨-Xv.This is naturally a widely read news and if there was any suspicion  with respect to the accident that would have been definitely spread to police. No police case happened to be registered in this case. Thus it  can only assume that there was no suspicion in the accident. Genuinity of this incident also been tested true by  2^nd opposite party in allowing another claims in the same accident death. The claim in the policy No.100805/42/04/000402 of deceased Narayanan out of this same accident had settled by 2^nd opposite party and paid an amount Rs.27, 500/- on 30.9.05. It is quite evident that this claim settled without having police report and postmortem report. If that claim is settled what more details is to be confirmed with the help of police report and post mortem report. The very same company on very same incident one claim is allowed and the other claims is rejected for want of a document which  is not in existence at all and  knowing well it is not possible to produce. This much of technicalities without taking into account the actual state of affairs  is only a part of unfair trade practice ignoring the normal and legal obligation to protect the best interest of the consumer.

            In the light of the forgoing discussion we have no hesitation to hold that the repudiation of claim in the above policy is a deficiency in service on the part of 2^nd opposite party even if there is delay on the part of 1^st opposite party in sending any details or document. The contention of 2^nd opposite party on the question of delay in submitting the claims document by 1^st opposite party is not sustainable since the ground upon which the claim repudiated has nothing to do with the delay.  Moreover, it is pertinent to note that Ex.B3 contain no stipulation that his claim will be rejected if the claim has not been lodged by1st opposite party within the stipulated time. Hence we are of opinion that 2^nd opposite party is liable to settle the claim and to pay the amount of Rs.1, 00,000/- as the insured sum. Complainants are also entitled for a sum of Rs.5000/- as compensation together with Rs.1000/- as cost of these proceedings. Issues 1 to 3 are found in favour of complainants and order passed accordingly.

            In the result, the complaint is allowed directing the  2^nd opposite party to pay  Rs.1, 00,000/- (Rupees One lakhs only)as the insured sum and a sum of Rs.5000/- (Rupees Five thousand only) as compensation together with Rs.1000/- (Rupees One Thousand only) as cost of this proceedings to the complainants within one month from the date of receipt of this order failing which the 2^nd opposite party shall be liable to pay interest @ 9% on the insured sum from the date of filing of this complaint till realisation. Complainants are allowed to execute the order after the expiry of 30 days as per the provisions of consumer protection Act.

                             Sd/-                                         Sd/-                                       Sd/-

                        President                      Member                       Member

APPENDIX

Exhibits for the complainant

A1.Copy of the receipt cum certificate issued by OP1

A2.Copy of the treatment certificate issued from AKG memorial Hospital

A3.copyf the certificate dt.16.7.07 issued from Cannanore co.op.Hospital

A4.Inpatient bill issued from AKG memorial co.op.Hospital

A5.Copy of the affidavit

A6.Copy of the repudiation letter issued by OP2

A7.Letter dt.31.7.06 issued by OP1

A8.Copy of the letter dt.27.9.06 issued by OP1

A9.Certifiate dt.21.8.06 issued by OP2

A10.copy of the Manorama daily dt.6.7.05

Exhibits for the opposite parties

B1.Copy of the letter dt.22.7.05  sent by complainant

B2.Letter dt.1.9.05 sent by OP1 to O P2

B3.Copy of the letter dt.28.4.06  issued by OP2 to OP1.

B4.Copy of the agreement  with OP1 and 2

B5.Copy of the letter sent by2nd OP to Hospital authority  dt.31.8.05

Witness examined for the complainant

PW1.Vinodini.M

Witness examined for the opposite parties

DW1.K.R.Pradeep Kumar

                                                /forwarded by order/

                                                Senior Superintendent

Consumer Disputes Redressal Forum, Kannur