FA 931/2008 in CC 205/2007 on the file of the District Consumer Forum I, Visakhapatnam.

Between :

Sri Sandina Srinivasa Rao, S/o late Ramu

Aged about 31 years, working

R/o D. No. 4-99, Kothapeta street

Thummapala Village and post,

Anakapalle Mandal,

Visakhapatnam District                          .. Appellant/complainant

And

1.                  M/s. Golden Trust Finance Services

Rep. by its authorized signatory

Head office at S. B. Mansion, 16,

R. N. Mukherjee Road, Kolkata – 700 001.

2.                  M/s. National Insurance Co. Ltd

Rep. by its Divisional Manager

Seethampeta Road, Dwaraka nagar

Visakhapatnam                           .. Respondents/opposite parties

Counsel for the appellant           :           Mr. A. S. C. Bose

Counsel for the Respondents    :           Mr. S. Rajkumar for R1.

Mr. N. Mohan Krishna  for R2.

CORAM    :   

SRI SYED ABDULLAH                  ..             HON’BLE MEMBER

AND

 SRI R. LAKSHMINARASIMHA RAO         .. HON’BLE MEMBER

Wednesday, the Fourth  Day of August, Two Thousand Ten

Oral order :   ( as per Sri Syed Abdullah, Hon’ble Member )

                                                                                                                        ********

The unsuccessful complainant in CD 205/2007 before the District consumer Forum I, Visakhapatnam nas assailed the order dated 28.4.2008 in dismissing the insurance claim covered by  personal accident policy 

The facts of the case as set out in the complaint are that the complainant’s father had  obtained a Group Personal Insurance Policy issued by the second opposite party. During subsistence of the policy his father had slipped from the slab steps and sustained head injury  on 28.01.2004 at 6.00 AM  and lost his consciousness. So he was shifted to King George  Hospital where the doctors expressed that there is no chance of survival and  advised him to take him back and the patient was taken home where he died on 29.01.2004. The complainant was unaware of the policy conditions. So he had  not intimated to the police. The policy was also misplaced.  After the policy was traced out, the  death intimation given to OP 1 and  submitted the claim but it was repudiated wrongfully. The act or omission amounts to deficiency in service.

OPs  1 and 2 filed separate versions denying the claim.

OP 1’s  stand is that he is an agent and he has no liability at all.

OP 2’s version is that as per the terms and conditions of the policy,  the insured shall issue  notice thereof and the intimation of the death of the insured. There ws  a delay of one month and five days. And further there is no documentary evidence to show that the insured died accidentally. Police report was not given,  so also,  no post mortem was done and the complaint is barred by limitation. Hence, he is not entitled  for the relief.

During enquiry, the complainant filed Ex. A1 to A8 along with evidence affidavit. While so, OP 1 filed its affidavit evidence and Ex B1 to B5. OP 2 field evidence affidavit without any documents.

The District forum adjudicated on the point  of deficiency in service and came to the conclusion that the complainant did not inform the death of his father to Opposite parties  within the stipulated  time and also came to a conclusion that the complainant failed to prove that  the death of his father was an accidental one and thereby dismissed the claim

Point for consideration is, whether the order suffers from factual and legal infirmity for its interference ?

The counsel for the appellant in his  appeal grounds reiterated that  Ex A4 letter sent by the complainant to the Opposite parties  explaining the delay in sending the intimation cannot be brushed aside and the fact that the complainant shifted his father to KG hospital for   necessary treatment supports his contention that due to emergency he was admitted in the hospital which the District forum failed to take into consideration in  proper perspective.

We have gone through the evidence on record and on reappraisal of the evidence we hold that the complainant failed to prove or establish that his father had fallen from slab steps  as a result of which he sustained head injury which resulted in his death for the entitlement of the insurance benefit covered by the policy.  EX. A-2 which is out patient ticket dt.28.1.004 issued in the name of the complainant shows that the patient was brought to hospital by his son Sriniasa Rao and the patient alleged to have fallen from stair and sustained head injury on 28.01.2004. The other  details in it  shows that no external injury was noticed,  however the patient was  asked to be  admitted in the male  surgical ward for further treatment shifting him from emergency ward to the regular inpatient ward. Though the patient was advised to be admitted in the hospital for further treatment he was not  admitted in the inpatient ward. The version of the complainant is that since  the doctors have expressed no hope so he was taken home and on the next day, i.e., on  29.01.2004 he was succumbed to injuries.  The complainant himself was negligent in not admitting the patient in inpatient ward for continuation of treatment and it can be said without any hesitation that patient  was got discharged against medical advise. Ex. A2 medical record shows that there was no head injury as such  it cannot be said that there was nexus of death with that of his fall.  As per the condition No. 2 of policy for entitlement of  the benefit, upon the happenings of any event, i.e.,  the death, injury, disablement of  the insured due to or  arising out of  or directly or indirectly connected with it a notice is to be given within one calendar month giving details of the accident by producing necessary proof and evidence.  It is an admitted fact that Ex. A4 intimation was sent on 5.2.2004 . In Ex. A-4  no proper explanation was given in sending intimation without explaining the  delay though  the accident should be  informed within 30 days of calendar month. Ex. B-5  dated 07.02.2005  is the intimation sent by the OP 1 informing that  claim is to be submitted along with death certificate, original OP ticket 28.1.2004 along with other enclosures. It is also informed that in the absence of PM report and police investigation report the authenticity of the claim is questionable. So in spite of reappraisal of the requirements,   the complainant failed to take appropriate steps to establish that the death of his father was on account of accidental fall from the steps.  When        Ex. A-2 Doctor certificate is contra to the assertion of accidental fall causing injury,  the complainant cannot assert that the death was an accidental one. The District Forum has discussed all these aspects and rightly came to the conclusion that the complainant failed to establish the claim for entitlement of the benefit covered under the policy.  There is no perversity in the order passed by the District Forum.  The appeal is devoid of merits and hence it is liable to be dismissed.

In the result, the appeal  is dismissed confirming the order dated 28.04.2008 passed by the District Forum in CC 205/2007  as justified. No order as to costs. Time for compliance six weeks.

Sd/-MEMBER                                   sd/-MEMBER