BEFORE THE DISTRICT CONSUMER FORUM :: WARANGAL
Present : Sri D. Chiranjeevi Babu,
President.
And
Sri.Patel Praveen Kumar,
Male Member.
Wednesday, the 8th day of June, 2011.
CONSUMER COMPLAINT No.44/2010
Between:
Arebelli Kavitha, W/o.Late Chander Rao,
Age:25 years, Occu:Household,
R/o.H.No.7-5-121, Behind:S.C.Hostel,
Jammikunta Town, Karimnagar Dist.,
Presently resideing at Julywada, Hanamkonda,
Warangal City & District. …Complainant
And
The Oriental Insurance Co.,Ltd.
Rep.by its Branch Manager,
Branch Office at H.No.9-6-54,
II Floor, Dr.K.S.R.Shasty Building,
Warangal-506 002. …Opposite Party
Counsel for the Complainant :: Sri.V.Venkateshwar Rao, Advocate.
Counsel for the Opposite Party :: Sri.Ch.Upender, Advocate.
This complaint is coming for final hearing before this Forum, the Forum pronounced the following order.
ORDER
Sri D. Chiranjeevi Babu, President.
This complaint is filed by the complainant Arebelli Kavitha against the Opposite Party under section 12 of Consumer Protection Act, 1986 for a direction to pay the policy sum insured amount of Rs.1,00,000/- along with interest @ 12% p.a. from the accident to till its realization, award Rs.10,000/- towards mental agony and costs.
The brief averments contained in the complaint filed by the complainant are as follows:
The case of the complainant isthat the husband of the complainant namely Arebelli Chander Rao died on 26-06-2009 due to Heart Attack. During his life time, the said Chander Rao obtained P.A. Individual Policy No.431403/48/2009/2374 from Opposite Party valid from 29-11-2008 to 28-11-2009, the said policy covered the insurance amount of Rs.1,00,000/- on the death of the insured, for which the complainant is the nominee. On 18-03-2010 the complainant made an application along with copies of the insurance policy and Death Certificate to Opposite Party for grant of sum assured amount of Rs.1,00,000/-. But the Opposite Party has not settled the matter and postponed the same on one or other reasons. The Opposite Party sent a letter dated:24-03-2010 to the complainant asking to give cause of death of her husband with proof of documents i.e. F.I.R. and Panchanama. Due to sudden heart stroke, her husband died, hence, there is no documentary proof of cause of death and there is no Panchanama and FIR and the same was intimated to the Opposite Party through reply notice dated:17-04-2010. The Opposite Party un-necessarily dragging the matter and not settled the claim. The acts of Opposite Party amounts to deficiency of service. Hence, filed this complaint praying to direct the Opposite Party to pay the policy sum assured amount of Rs.1,00,000/- with interest and to award Rs.10,000/- towards damages and costs.
The Opposite Party filed the Written Version stating that the interest of Sri.Arebelli Chander Rao was covered at the material time under the policy of insurance issued by this Opposite Party subject to terms, conditions, exceptions and limitations thereof. The insurance policy issued by this Opposite Party in favour of the insured bears No.431403/48/2009/2374 valid from 29-11-2008 to 28-11-2009 which is in possession of the complaint herein. The husband of the complainant has approached the Opposite Party and obtained the personal accident policy which is purely an accidental policy, which covers the risk only for accident. Further the Opposite Party stated that the complainant has made an application before the Opposite Party on 18-03-2010 to settle the claim but this Opposite Party went on dodging the matter and the complainant approached the Opposite Party number of times is utterly false and baseless, as a matter of fact the complainant has made an application before the Opposite Party through a letter dated: 18-03-2010 which was posted on 23-03-2010, after going through the claim papers immediately on 24-03-2010 only this Opposite Party has issued a letter calling upon the complainant to provide the particulars of the cause of death with a proof of supporting documents i.e. F.I.R., Panchanama since the policy issued to the insured was a accident policy. Hence the question of delay in between 23-03-2010 and 24-03-2010 and the complainant roaming around the Opposite Party does not arise. Since the complainant failed to provide the necessary documents i.e. F.I.R. and Panchanama which are very essential for settling the claim under the accident policy, the Opposite Party was unable to settle the claim but not intentional or to delay the payment and the Opposite Party requested this Forum to dismiss this case.
The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked Exs.A-1 to A-9. On behalf of Opposite Party Kalpana filed her Affidavit in the form of chief examination and also marked Ex.B-1.
Now the point for consideration is:
1) Whether there is any deficiency of service on the part of the Opposite Party?
2) If so, to what Relief?
Point No.1:-
After arguments of both side counsels, our reasons are like this:
In this case, the main point in this case is that whether the complainant i.e. wife of the deceased is entitled to get the insured amount because the insured died due to Heart Attack on 26-06-2009, prior to that the deceased obtained P.A. Individual Policy No.431403/48/2009/2374 from Opposite Party valid from 29-11-2008 to 28-11-2009, the said policy covered the insurance amount of Rs.1,00,000/- on the death of the insured, for which the complainant is the nominee.
The Opposite Party repudiated the claim, even though the insurance is inforce, on the ground that as the insured taken Personal Accident individual Policy and the insured died due to Heart Attack, the insured shall sustain any bodily injury resulting solely and directly from accident caused by external violent and visible means, then the Company shall pay to the insured or his legal heirs. Mentioning the above point, the Opposite Party also filed a copy of the Personal Accident Policy conditions i.e. Ex.B-1. So on the basis of this Ex.B-1, the insured nominee i.e. the complainant herein is not entitled to get anything because the insured only died due to Heart Attack, but not any bodily injury through accident.
Now this Forum has to see whether the Heart Attack comes under accidental or not.
The accident or accidental means, as per dictionary: an unfortunate incident that happens unfortunately, unexpectedly and unintentionally. Further an accident, that happens unconscious or without apparent cause and further accidental means happening by accident incidentally, subsidiary, calamities etc.
So the Heart Attack is accidental means it is unfortunate thing and accident means accidentally happens without knowing anything. So in this case without knowing anything to the insured he got Heart Attack and he died. So the Heart Attack comes under accidental. When the insured died with Heart Attack, certainly it comes under accidental death. In Ex.A-9 i.e. Death Certificate, it is simply stated that the date of death of the deceased is 26-06-2009 and place of death is Nagaram, on what condition the deceased died i.e. due to heart attack or accident not mentioned in the same Certificate. Even though it is not mentioned in the same certificate, we accept the Affidavit of the complainant as well as the reply notice given by the Complainant’s Advocate i.e. Ex.A-6, in this it clearly mentioned that the husband of the complainant by name Arebelli Chander Rao died due to Heart Stroke. So we accept the contention of the complainant that the deceased died due to Heart Attack and the Heart Attack comes under accidental death. We already mentioned in supra, that we have given meaning of the accidental. So certainly the Heart Attack comes under accidental death. When heart attack comes under accidental death, the Ex.B-1 i.e. Personal Accident Policy (individual) conditions, is not at all considerable document. Further it is the duty of the Opposite Party to serve a copy of the Ex.B-1 to the insured at the time of taking of the policy. Without serving the same copy to the insured, filing of the same copy before this Forum, it clearly goes to show that it is unfortunate thing and laziness of the Opposite Party, because to avoid the insurance amount only they have not serving the same to the insured at the time of taking of the policy. It is mandatory procedure whatever the documents from the insurance have to serve the same to the insured at the time of taking of the policy. But in this case, as per arguments of the complainant’s counsel, the Opposite Party has not served this type of copy i.e. Ex.B-1 at the time of taking of the policy to the insured. When the insurance i.e. Opposite Party has not served the copy of the Ex.B-1, it clearly comes under the fault of the insurance only and already mentioned with regard to the meaning of the accidental death in supra, it clearly goes to show that the insurance is liable to pay the insured amount to the nominee of the insured.
In the judgment of 2008 CTJ 22 (CP (NCDRC) clearly stated about the meaning of the accidental death.
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Revision Petition No.973 of 2007
Rita Devi @ Rita Gupta
Vs.
National Insurance Co.Ltd. and Others.
Death due to cold wave – Consumer Protection Act, 1986 – Section 2(1) (g) – Section 2 (1) (o) – Whether a death caused by cold wave is an accidental death for the purpose of an insurance cover? – Insured took a ‘Group Janata Personal Accident Insurance Policy’ for a sum of Rs.3 lakhs from respondent No.1 – Insured died allegedly of extreme cold wave – Claim not settled –Complaint filed by his wife before the District Forum dismissed solely on the ground that death of the insured caused due to cold wave would not be an accidental death –State Commission rejected the complainant’s appeal- Revision petition – Held, death not occurring in the usual course or natural course of events or due to the events/causes not reasonably anticipated is an accidental one – That being so, held that the death due to cold wave is not natural but is accidental as it is by natural external violent force –Further, the cold wave is an untoward event that cannot be anticipated by anybody – Hence, held that Insurance policy covered the death of the deceased insured – Revision petition allowed.
In the present case also the insured died due to Heart Attack and the Heart Attack comes under accidental or not. The Heart Attack comes under accidental as per above stated judgment. So the above cited judgment is applicable to the case of the complainant.
So the Heart Attack comes under accidental. When it comes under accidental death, certainly the insurance i.e. Opposite Party is liable to pay the insured amount, so we answered this point with regard to the accident accordingly. When we answered this point accordingly with regard to the meaning of the accidental death, certainly the nominee of the insured i.e. the complainant is entitled to get the insured amount. It is true the insurance is inforce as per the Ex.A-1, because the insured obtained the insurance policy on 28-11-2008 and hedied on 26-06-2009 and the insurance is valid from 29-11-2008 to 28-11-2009. So when the insurance is inforce and we come to the conclusion that the deceased died accidentally because we already stated supra the meaning of the accidental death i.e. Heart Attack comes under the accidental death, the insurance i.e. Opposite Party is liable to pay the compensation, as we reject the document i.e. Ex.B-1.
For the foregoing reasons given by us, we come to the conclusion that the nominee of the insured i.e. the complainant is entitled to get the insured amount from the insurance i.e. Opposite Party and accordingly this first point is decided in favour of the complainant against the Opposite Party.
Point No.2: To what Relief:- The first point is decided in favour of complainant against the Opposite Party this point is also decided in favour of complainant against the Opposite Party.
In the result, this complaint is allowed and we direct the Opposite Party to pay an amount of Rs.1,00,000/- (Rupees One lakh only) to the complainant along with interest @ 7.5% p.a. from the date of filing of the complaint i.e. 28-07-2010 till the date of deposit. The Opposite Party is also directed to pay an amount of Rs.500/- (Rupees five hundred only) towards costs.
A month’s time is granted to the Opposite Party for the compliance of the order.
(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 8th June, 2011).
President Male Member
District Consumer Forum, Warangal
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
On behalf of Complainant On behalf of Opposite Party
Affidavit of complainant filed. Affidavit of Opposite Party filed.
EXHIBITS MARKED
ON BEHALF OF COMPLAINANT
1. Ex.A-1 is the original P.A.Individual Policy Schedule issued by Opposite Party.
2. Ex.A-2 is the letter dt:18-03-2010 from the complainant to the Opposite Party.
3. Ex.A-3 is the Postal Receipt.
4. Ex.A-4 is the Acknowledgement.
5. Ex.A-5 is the letter dt:24-03-2010 to the complainant from the Opposite Party.
6. Ex.A-6 is the Reply Notice from the complainant’s counsel to the Opposite Party.
7. Ex.A-7 is the Postal Receipt.
8. Ex.A-8 is the Acknowledgement.
9. Ex.A-9 is the Death Certificate of the deceased Arebelly Chander Rao.
ON BEHALF OF OPPOSITE PARTY
1. Ex.B-1 is the Personal Accident Policy conditions (individual) from the Opposite Party.
PRESIDENT
