F.A. 443/2008 against C.C.  62/2007,  Dist. Forum, Tirupathi

Between:

1)  M/s. Oriental Insurance Company Ltd.

Rep. by its Sr. Divisional Manager

Levi’s Road, Bhubaneswar

Orissa.

2)  M/s. Oriental Insurance Company Ltd.

Rep. by its Sr. Divisional Manager

Divisional Office, NRT Road

APSFC Buildings, Tirupathi

Chittoor Dist.                                              ***                           Appellants/

            Ops.     

                                                                   And

A. Shantha, W/o. A. Subrahmanyam

Age: 45 years, 10-5-269

Giridhar Street, Tirupathi.                          ***                         Respondent/

                                                                                                Complainant.

Counsel for the  Appellant:                         M/s.  Bhaskar Poluri

Counsel for the  Respondent:                     None.  

CORAM:

HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.

                                                                   &

                                 SMT. M. SHREESHA, MEMBER.
                                                         

FRIDAY, THIS THE TWENTY  THIRD DAY OF  JULY TWO THOUSAND TEN

ORAL ORDER:  (Per Hon’ble Sri Justice D.Appa Rao, President.)

***

1)                This is an appeal preferred by the opposite party,  insurance company against the order of the Dist. Forum          directing it to pay Rs. 2 lakhs with interest @ 9% p.a., together with costs.

2)                The case of the complainant in brief is that  her son   Prakash took   Nagarik Suraksha  policy for Rs. 2 lakhs  commencing from  28.11.2005  to  27.11.2006 keeping her as nominee.  While so on  16.12.2005  while he was going on road side, a motor cycle hit  against him, as a result of which  he sustained  head injury and  was admitted in  V.R.R.G. Govt. hospital, Tirupathi

and was discharged on  17.12.2005.  Later he was admitted in the hospital of Dr. C. Varasundaram clinic for better treatment.    However, he died on 19.12.2005  while undergoing treatment.    On a report the police registered a case in Crime No.  160/2005.  The investigation was  pending.  When claim was made the insurance company did not settle.  On that she issued a registered notice for which insurance company gave false reply stating that the said claim was closed  due to non-submission of proper documents.    This was not true.    In fact, she was an illiterate.    What all she could submit  she has submitted, and therefore prayed that  Rs.  2,50,000/- be awarded together with damages of Rs. 25,000/- and costs. 

3)                The appellant insurance company resisted the case.   While  admitting issuance of policy it alleged that the allegation that Prakash died due to sustained in a motorcycle accident  is not true.    In fact, he died of fever.    The documents were created  in order to claim compensation.   He died in his house after getting himself discharged from the hospital.   Final report of the police was not filed.    Therefore, it prayed for dismissal of the complaint with costs. 

4)                The complainant in proof of her case filed her affidavit evidence and got  Exs. A1 to A13 marked while  appellant did neither file affidavit evidence nor documents. 

5)                The Dist. Forum after considering the evidence placed on record opined that  Ex. A2 FIR together with  Ex. A6 final report besides Ex. A4 cause of death issued by   Asst. Surgeon,  SVRRGG Hospital  confirmed and  the death was due to accident  and therefore directed the insurance company to pay Rs. 2 lakhs  with interest @ 9% p.a., from  13.6.2006 till the date of realization together with costs of Rs. 2,000/-. 

6)                Aggrieved by the said decision,  the insurance company preferred the appeal contending  that the Dist. Forum did not appreciate either facts or law in correct perspective.    It ought to have seen that the assured was discharged against medical advice and  he died at his house due to fever.    There is no proof that he died of injuries  sustained in a road accident.   Since the death is  natural  the complainant was not entitled to any compensation. 

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  late Prakash son of the complainant  had taken an insurance policy for Rs. 2 lakhs commencing from 28.11.2005 valid up to    27.11.2006 keeping his mother complainant  as nominee.    She alleges that  he has sustained injuries in a motor vehicle accident  on  16.12.2005 admitted in SVRRGG hospital at  Tirupathi and was charged at his request.  Later took treatment with Dr.  C. Varasundaram, Civil Assistant Surgeon and died while undergoing treatment.    In proof of it, the complainant has filed voluminous  documentary evidence viz,  FIR  registered in Crime No.  160/2005 u/s  337 IPC,  wherein the fact that the assured had sustained injuries to his head in a scooter accident  was made a mention.   He was admitted in  SVRRG government hospital  at Tirupathi where  the doctors had categorically noted  under the coloumn diagnosis “ Medico Legal  Inquiry (Head injury) due to RTA on 16.12.2005 at 6.00 a.m.”    In the treatment advised column,   it was mentioned “  After explaining about the non-availability of Neurosurgeon and  Neurosurgery Department in this hospital to the  patient’s attendants, they decided to go to a higher centre where Neurosurgery  facility is available.  Hence discharged at request.”   On that he was taken to taken to a private clinic  of Dr. C. Varasundaram, Civil Assistant Surgeon, who has issued

a certificate Ex. A4  informing to the Registrar of Birth & Deaths  that the deceased  died due to accidental head injury  on 19.12.2005.  He confirmed that he was under his treatment from 18.12.2005 to 19.12.2005.   Municipal Administration Department, Tirupathi issued death certificate  vide Ex. A3.    The police investigated into the offence and filed final report Ex. A6  and referred the case as ‘Un-detectable’.    There was a mention that  the parents took him against medical advice, contrary to the facts  mentioned by the hospital authorities  under Ex. A5  which we have already referred to.    Obviously taking cue from this the insurance alleges that  he died of fever, contrary to an authenticated  government hospital record Ex. A5 besides Exs. A2 FIR and  Ex. A6 final report.    It is unfortunate  that the insurance companies are taking advantage  of illiteracy of the parties  repudiating the claims unjustly without even  verifying the records submitted  in this regard.    It is not known from where  the insurance company could state  that the deceased died of  fever.    This is contrary to the record.    Unfortunately,  the Dist. Forum did not take serious note of this  and did not award any compensation for deficiency in service which could be attributed to the appellant.    It is high time that the insurance officials  to scrutinize  the record carefully and  not to repudiate  the claims on extraneous ground  not borne out by record.    This is a classic case where the repudiation  is patently unjust and was made in order to deny the just claim of the complainant.  We do not see any merits in the appeal.

9)                In the result the appeal  is dismissed with costs computed at  Rs. 5,000/-.  Time for compliance four weeks. 

1)       _______________________________

PRESIDENT                 

2)      ________________________________

 MEMBER          

   Dt.   23.  07.  2010.

*pnr

“UP LOAD – O.K.”