AT HYDERABAD

FA  179/2008  against C.C. 236/2003, Dist. Forum, Nellore.           

Between:

United India  Insurance Company Ltd.

Rep. by its  Branch Manager

Holding Office at Branch Office-II

Dargamitta, D.No. 24/385/2

Opp. Bollineni Hospital

Nellore-3.

United India  Insurance Company Ltd.

Rep. by its   Divisional Manager

Holding Office at D.No. 15/201

Brindavanam, Nellore-1.                             ***                        Appellants/

                                                                                                Opposite Parties

                                                                   And

Namallapudi Sankar Reddy

S/o. Veera Reddy

Age:  40 years

R/o. Molakalapudi (V)

Chittamuru (M)

Nellore Dist.                                                ***                         Respondent/

                                                                                                Complainant.

Counsel for the Appellant:                          M/s. S. Shravan Kumar

Counsel for the Resps:                               M/s.  R. S. Reddy  

CORAM:

HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT

&

SMT. M. SHREESHA, MEMBER

MONDAY, THIS THE NINETH DAY OF AUGUST TWO THOUSAND TEN

Oral Order: (Per Hon’ble Justice D. Appa Rao, President)

*****

1)                 This is an appeal preferred the   opposite party  insurance company against the order of the Dist. Forum  directing it to pay  Rs. 2,00,000/-  covered under the policy  together with interest, compensation  and costs.

2)                The case of the complainant in brief is that    his mother  late N. Sarasamma  had taken Janata Personal Accident   policy (JPA) for a sum of Rs. 2 lakhs  covering the risk of accidental death etc. for the  period from  30.7.1998 to 29.7.2008.   While so on 5.4.2003 while she was getting down from the stair case she slipped and fell down and immediately she was shifted to Nellore Hospital  and on the way she died.   The body was cremated and inquest was conducted.   When the claim was submitted the insurance company repudiated on 27.10.2003 on the ground that the claim was fraudulent.    Therefore he filed the complaint claming the amount covered under the policy together with interest, compensation and costs.

3)                The appellant insurance company resisted the case.  While denying each and every allegation made in the complaint, however, admitted that it had issued JPA policy for Rs. 2 lakhs subject to terms and conditions incorporated in the policy.     It denied that the death of the assured was due to a fall from stair case.  In the event of death,  post-mortem examination of the body of the assured is a must.   No report to the police was given.   There was neither FIR nor report from MRO in regard to death of the deceased.   No notice was given within 30 days as contemplated under terms and conditions of the policy.    He made the claim after   1-1/2 months   of the death of the deceased.  The complainant has managed to get the statement of villagers attested by the M.R.O.   Those members were enquired in connection with an enquiry conducted by the MRO in regard to sanction of ex-gratia payment of Rs. 1,000/- to one SK. Ramthu Saheb   whose house was gutted in a fire accident on 11.5.2003.    To determine the truth or otherwise it requires an elaborate enquiry before a civil court.   It is not amenable to summary proceedings under the Consumer Protection Act, and therefore prayed for dismissal of the complaint with costs. 

4)                 The complainant in proof of his case filed affidavit evidence and examined PWs 1to 3 and got Exs. A1 to A12 marked while the appellant insurance company examined RWs 1 to 4 and filed Exs. B1 to B9.   Ex. X1 letter of MRO has also been marked. 

5)                 The Dist. Forum after considering the evidence placed on record opined that the investigator of the insurance company found that the death of the deceased was due to a fall from staircase, an accidental death besides irrefutable documentary evidence opined that the death was accident and directed the appellant insurance company to pay Rs. 2 lakhs covered under the policy together with interest and costs. 

6)                 Aggrieved by the said decision, the insurance company preferred the appeal contending that the Dist. Forum did not appreciate either fats or law in correct perspective.    It did not consider the report Ex. B3 of Spy detective which clearly establishes that the deceased died of heart attack.    Ex. X1 further clarifies that an amount of Rs. 1,000/- was paid to one Mr. Ramthu Saheb towards fire accident and does not pertain to the death of the deceased.    Therefore it prayed that the appeal be allowed. 

7)                 The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law? 

8)                It is an undisputed fact that the mother of the complainant late N. Sarasamma is a subscriber of policy Ex. A7 covering the risk of accidental death commencing from 30.7.1998 to 29.7.2008 for Rs. 2 lakhs.   The complainant alleges that his mother while getting down from a staircase  suddenly fell down sustained injuries and died on the way to  the  hospital.    Later she was cremated and an inquest was conducted. 

9)                It is not in dispute that the insurance company has appointed   PW1   Sri I. Bhaskar Prasad, advocate as surveyor-cum-investigator.  He swore on oath and stated that he was appointed by the insurance company to investigate cause of death of the assured.    On that he went to the village, recorded the statements of villagers viz., Smt.   CH. Manemma, Sarpanch of Molakalapudi village, Sri V. Rajaogpal Redy Ex-President of Molakapudi Primary Agricultural Co-operative Society of the village and other neighbours and opined that she died due to fall from a staircase marked as  Ex. A1 together statements recorded vide Exs. A2 to A5.      At this juncture, we may state that though the insurance company had directed him to investigate and in fact obtained a report,   since it went in favour of the complainant,  they did not mention anything about it,  either in the counter or affidavit evidence filed by it.   The insurance company being an institution ought not to have resorted to this sort of practice in order to deny the just claim of the claimants.  They are all villagers and not aware of all these niceties.    A suggestion was made by the insurance company that the entire investigation made by him was false.  However, it  could not point out as to where he went wrong while conducting the investigation.    

10)               When the insurance company had suppressed it  and made the complainant to examine their own surveyor,  and there is no reason why the appellant insurance company should find fault with complainant.   The complainant has no other go than to examine in the light of the conduct of the insurance company in suppressing the very report. The contention that report was a confidential document and it cannot be disclosed to the third parties has no basis.  The insurance company having appointed a surveyor  and got  the report  in order to settle the  claim, it cannot accept it  only if  he refutes claim and disown if it goes against it.    It has to be fair in its dealings and more so in settling the claims. 

11)               Yet another contention was that when RW1 was examined this report was not confronted.    It is not as though by the date of examining RW1 Ex. A1 was not available.    It was very much available in the record.    It is for the insurance company to explain in the light of Ex. A1 report by its own surveyor. 

12)               The insurance company relied  on various statements recorded by the investigator vis-à-vis Sarpanch and  tried to contend that there were discrepancies and therefore it should not be given due weight.  It intends to contend that in Ex. A2 to A5 injury to the head was mentioned but   there is no mention about the head injury to head in Ex. A8 and Ex. B4.   There is no reason for this sort of picking up so called omissions and commissions.    It wants to explain by stating that Ex. A10 differs from Ex. B8.   In Ex. A10 the name of the deceased was mentioned as  ‘ Nemalapudi Sarasamma, W/o. Veera Reddy’  whereas in Ex. B8 it was mentioned as N. Sarasamma (Nemalapudi), W/o. Veera Reddy.    Name and surname could  be used either by sufficing or affixing to the name.   We are unable to appreciate this contention; on the other hand, we take serious note for raising  such sort of contention.   It is unfortunate that the insurance company has been raising irrelevant pleas in order to deny the just claim of poor villagers.   

13)               It is an undisputed fact there was no post-mortem report or report to the police.   The village Sarpanch and other villagers have seen the body and their statements were recorded with documents attested in order to make the claim.    In fact PW1 their own Surveyor had recorded the statements and confirmed the statements made by the villagers.  Since the report was against the   insurance  company, it  had  appointed  another   investigator   RW4.  

He procured  documents  Exs. B1 and X1 to state that the amount that was paid towards ex-gratia does  not pertain to the accident in question.    We do not see any relevancy.    The insurance company procured Ex. B3 through RW4 in order to deny the just claim of the complainant by connecting an un-related claim of a third party.      The evidence of RW3   Senior General Manager is only a repetition of counter.    Though it was stated that it was a typographical error it makes no difference in view of evidence let in by the complainant. 

14)               We may also state that in New India Assurance Company vs. Shree Shyam Cotspin Ltd reported in I (2009) CPJ 110 (NC) the National Commission held that insurance company cannot appoint another surveyor.

“We also like to observe that under Section 64 UM of the Insurance Act, if the insurance company is not satisfied with the assessment of loss made by the an approved surveyor then they can request the IRDA for appointment of another surveyor whose report would have been processed by the ‘Authority’ and then direction was to be given by them to insurer to pay a given amount. This was not done at all.”

15)               When the police were given powers under Cr.P.C.  question of appointing a private agency to prove that the claim was false cannot be up-held.    Their report was dt.  10.10.2003 while the death took place on 5.4.2003,   six months after her death.    We need not emphasize that they tried to undo what PW1 has done evident from a perusal of the report.   Since the very report contradicts Ex. A1 report issued by PW1 without any basis, we do not agree with his conclusion.   The Dist. Forum after considering the evidence in detail allowed the complaint in part and we have no hesitation in confirming the said order.    It has given valid reasons for granting the said amount.    We do not see any merits in the appeal.

16)               In  the result the appeal is dismissed with costs computed at Rs. 3,000/-  Time for compliance four weeks.

1)      _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER           

                                                                                Dt.  09. 08.   2010.

*pnr

“UP LOAD – O.K.”