BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
and
Smt C.Preethi, M.A., LL.B., Member
Friday the 31st day of August, 2007
C.C. No.48/2007
J. Anjeneya ,
S/o Muneppa,
Agriculturist,
Motkur Village,
Aspari Mandal,
Kurnool District. ...COMPLAINANT
Verses
1. Golden Multi Services Club of Golden Trust
Financial Services Represented by its Branch Manager,
U Con Plaza, Kurnool.
2. Golden Multi Services Club of Golden Trust, Financial Services, represented by its Regional Manager,
16, R.N. Mukarjee Road, Kolkata-700001.
3. BAJAJ Allianz General Insurance Company Limited, Represented by its Branch Manager,
S.V.Complex, Kurnool.
4. BAJAJ Aliianz General Insurance Company Limited, Represented by its Regional Manager,
Macmet House, 10/B, O.C. Ganguly sarani (Lee Road) Kolkata-700020. OPPOSITE PARTIES
.
This complaint coming on this his day for orders in the presence of Sri M.L.Srinivasa Reddy, Advocate, kurnool for complainant, Sri.M.Azmathulla, Advocate, Kurnool for Opposite Party No.1 and opposite party No.2,3 and 4 is called absent set exparte and upon the persuing the material papers on record, the Forum made the following:-
ORDER
(As per Smt.C.Preethi, Member)
C.C.No.48/2007
1. This consumer complaint of the complainant is filed Under Section 12 of C.P.Act 1986, seeking a direction on opposite parties to pay Rs.3,00,000/- with 12% interest per annum, Rs.15,000/- towards mental agony, Rs.10,000/- towards cost of any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s father J. Muneppa was a member opposite parties 1 and 2, and the members of opposite parties 1 and 2 were covered under the accidental policy issued by opposite parties 3 and 4 for Rs.3,00,000/- under the master policy bearing No.OG/05 /2401/9960 /00000039 commencing from 8.8.2005 to 7.8.2006 and the deceased paid premium of Rs.600 to opposite parties 3 and 4 through opposite party 1 and 2. The insured J. Muneppa on 22.1.2006 while getting down the stair case of his house accidentally slipped and fell down and received injuries and was found dead by the doctor of Primary Health Center, Aspari. Immediately the complainant submitted claim form as nominee to opposite party 3 through opposite party No.1 with all documents, but opposite party No.4 repudiated the claim on 11.10.2006 stating that the complainant did not submit FIR, Police Investigation Report and post morten report . But the complainant submits that as the death of the insured was due to accidental fall and no body was responsible and question of giving information to the policies doesn’t arise. The certificate issued by Medical Officer, Primary Health Centre, Aspari, clearly shows the cause of death of the deceased. Therefore, the repudiation by opposite party No.4 is untenable and amounts to deficiency of service.
3. In support of his case the complainant relied on the following documents viz., (1) Repudiation letter dated 11.10.2006 (2) attested Xerox copy of death certificate (3) attested xerox copy of claim form (4)attested xerox copy of policy (5) attested xerox copy of medical certificate and (6) certificate issued Village Secretary, Muthukur (Village) Panchayath besides to the sworn affidavit of the complainant in reiteration of his complaint avernments and the above documents are marked as Ex.A1 to A6 for its appreciation in this case. The complainant caused interrogatories and replied to the interrogatories of opposite party.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties 2, 3 and 4 remained absent through out the case and were made exparte. The opposite party No.1 contested the case by filling written version.
5. The written version of opposite party No.1 submits that the complainant’s father J. Munappa was their member and obtained a Group Personal Accident Policy bearing No. 0G/ 05/ 2401/ 9960/ 0000039 for Rs.3,00,000/- and nominated his son / complainant Anjaneya as his nominee. On 19.5.2006, the complainant approached opposite party No.1 and obtained claim form and on 8.6.2006 the complainant submitted claim form with Insurance Policy, death certificate, panchanama etc., and the same was forwarded on 16.6.2006 to opposite party No.3 in order to transit to opposite party No.4. The opposite party No.4 is the sole and exclusive authority in settlement of the claim. On 11.10.2006 the opposite party No.4 repudiated the claim as FIR and Police Investigation Report are not supported to the claim form. There was no information with regard to the accidental slip by the deceased on 22.1.2006 and died at Primary Health Centre, Aspari and there is no proof to prove that the deceased death is accidental one only as its is for opposite party No.4 to settle the claim, there is no deficiency of service on part of opposite party No.1 and no cause of action is made out against opposite party No.1 seeks for the dismissal of complaint with costs.
5. In substantiation of their case the opposite party No.1 relied on the following documents viz., (1) letter dated 2.7.2006 of opposite party No.4 to opposite party No.2 and (2) attested Xerox copy of memorandum of understandings between opposite party No.2 and 4, besides to the sworn affidavit of opposite party No.1 in reiteration of his written version avernments and the above documents are marked as Ex.B1 to B2. The opposite party No.1 caused interrogatories to the complainant and reply to the interrogatories caused by the complainant.
6. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service: ?
7. It is the case of the complainant that his father J. Muneppa has insured his life with opposite party No.3 and 4 through opposite party No.1 and 2 vide Ex.A4. On 22.1.2006 the deceased while getting down the stair case of his house fell down and died. On the claim preferred vide Ex.A3, the opposite party No.4 repudiated vide Ex.A1 dated 11.10.2006 stating that FIR, Police Investigation Report, and post morten report are not submitted along with claim form.
8. The only contention of opposite party No.4 is that the complainant did not submit FIR, Police Investigation Report etc., The opposite party No.4 in this case did not contest the case and remained absent through out the case. The Ex.A5 and A6 are the attested Xerox copies of Medical Certificate and certificate issued by Village Secretary, Muthukur (V) panchayath, the Ex.A5 and A6 says, the deceased died due to accidental fall from the stair case, the said Ex.A5 and A6 are not disputed by opposite party No.4. The contesting opposite party No.1 submitted that it has forwarded the claim form submitted by the complainant to opposite party No.4 and it is for opposite party No.4 to settle the claim, and it has nothing to do with the claim of the complainant. Hence, the case of the complainant is remaining unrebutted and there by acceptable worthy of consideration as admitted without requiring any further proof.
9. To sum up, the cause of death of J. Muneppa in due to accidental fall from the stair case as per Ex.A5 and A6, the said exhibits are not disputed by the opposite parties and the loss suffered by the complainant is also not disputed, and the claim of the complainant is also not questioned. The only point urged in the repudiation letter vide Ex.A1 that FIR and other police records are not submitted by the complainant/nominee. It remains to be seen in the light of the admitted facts can the Insurance company reject the claim or escape his liability by insisting on the production of FIR, Police Investigation Report etc., as per the rulling of Honourable A.P.State Commission Reported in 2000 ALD part II Pg 96, where in, it was held that when cause of death is not a suspicious one, obtaining FIR and other police documents does not arise.
10. Thus, in the light of the above decision and discussions made the complainant is remaining entitled to the policy amount under the policy of his father. As the opposite parties driven the complainant to the forum he is entitled to costs of the case also. As no cause of action is made out against opposite parties 1 and 2 case against opposite parties 1 and 2 is dismissed.
11. In the result, the complaint is allowed directing the opposite parties 3 and 4 to pay to the complainant the assured amount under the policy bearing No.04-05-2401-9960 – 00000039 of J. Muneppa along with costs of Rs.1,000/- within a month of receipt of this order. In default, the opposite parties 3 and 4 shall pay the supra award amount with 9% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced in the open bench this day 31st August, 2007.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-Nil
Ex. A1. Repudiation letter, dated 11.10.2006.
Ex.A2. Attested Xerox copy of Death Certificate,dated 28.1.2006.
Ex.A3. Attested Xerox copy of claim form bearing the
Endorsement of opposite party No.1 as to its receipt.
Ex.A4. Attested Xerox copy of policy copy.
Ex.A5. Attested Xerox copy of Medical Certificate.
Ex.A6. Certificate issued by Village Secretary, Muthukur (V),
Panchayath, dated Nil.
List of exhibits marked for the opposite parties:
Ex.B1. Letter, dated 02.7.2006 of opposite party No.4 to
Opposite party No.2.
Ex.B2. Attested Xerox copy of Memorandum of understanding
Between opposite party No.2 and 4 (No. in 4 papers)
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1. Sri.M.L.Srinivasa Reddy, Advocate, Kurnool.
2. Sri.M. Azmathulla, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
