BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah , B.Com B.L., President
And
Sri. M.Krishna Reddy , M.Sc., M.Phil., Male Member
Tuesday the 8th day of February , 2011
C.C.No 141/09
Between:
B.G.Nagamani, W/o. Soma Sekhar,
R/o. D.No.19/37, Bramhana Street, Pattikonda, Kurnool District.
…Complainant
-Vs-
1. M/S. Agri Gold Farms Limited Now Called as M/S. Agri Gold Farms
Estate Pvt. Limited, Rep. by its Authorised Person,
D.No.39-2-19/A 10, Surya Estates,Vishnu Vardhan Rao Lane, Pichaiah Street, Labbipet, Vijayawada-10 Pin. 0866 - 2480014.
2. Oriental Insurance Company Limited Rep. by its Divisional Manager,
Siddartha Womens College Road,Post Box No.782, Vijayawada-520 010.
3. B. Obulasu, S/o, Late Sunkanna, Agri Gold Agent,
H.No.19/38-B, Bramhanaveedhi, Pattikonda - 518 380. ……Opposite parties
This complaint is coming on this day for orders in the presence of Sri. Y. Sreenivasulu, Advocate, for complainant, and Sri K. Govind, Advocate for opposite party No.1 and Sri N. Isaiah, Advocate for opposite party No.2 and opposite party No.3 is set exparte upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No. 141/09
1. This complaint is filed under section 12 of C. P. Act, 1986 praying to direct the Opposite party:-
- To pay assured amount of Rs.50,000/- with interest;
- To pay Rs.20,000/- for mental agony and costs of complainant,
- To grant such other relief or reliefs as the honorable Court may deem fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as under:- The complainants husband purchased units in name of his son G.Nikhileswar Naidu from opposite party No.1 by paying Rs.1,000/-. Opposite party No.1 issued receipt. In the said receipt the complainant is shown as the nominee. Opposite party No.1 tied up with opposite party No.2 for the accidents coverage. With the help of opposite party No.3 the units were purchased from opposite party No.1. There is a accident coverage of RS. 50,000/- in case of accidental death of the insured. G.Nikhileswar Naidu died on 05-05-2009 due to dog bite. He was admitted in Government General Hospital, Kurnool. After the death of deceased the complainants husband gave a letter to opposite party No.1 to settle the claim. The complainant also gave a notice to opposite party No.1 informing the death of her son. Opposite party No.1 gave a reply to send all the documents. The complainant accordingly sent the documents through her advocate. Opposite party No.2 rejected the claim stating that there is delay in submitting the details. There is deficiency of service on the part of the opposite party No.1 and 2. Hence the complaint.
3. Opposite Party No.2 and 3 filed written version and opposite party No.3 remained exparte. It is stating by opposite party No.1that the complaint is not maintainable. Units were purchased under the account No. L.S/376669. Opposite party No.1 has got tie up with the opposite party No.2 for group insurance. For the first time the complainant informed about the death of her son through registered notice issued by her advocate. Opposite party No.2 rejected the claim stating that there was delay in intimation of the death of the deceased and also for not submitting the documents like F.I.R., Post Mortem report etc. There is no deficiency of service on the part of opposite party No.1.
Opposite party No.2 also stated that the complainant is not maintainable. It is admitted that opposite party No.1 tied up with opposite party No.2 for the accidental coverage. The complainant has to prove the death and place of death of the deceased. The claim was rejected for the reason that there was abnormal delay in preferring it. There was no immediate death intimation. Opposite party No.2 received the claim of the complainant through opposite party No.1 on 02-06-2009. As there was delay of 24 months in giving death intimation, the claim was rejected. The complainant failed to furnish the documents such as F.I.R., Post Mortem report etc. There is no deficiency of service on the part of the opposite party No.2. The complaint is liable to be dismissed.
4. On behalf of the complainant, Ex.A1 to A10 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties, Ex. B1 to B5 are marked and sworn affidavits of opposite parties 1 and 2 are filed.
5. Both sides filed written arguments.
6. The points that arise for consideration are:-
- Whether there is deficiency of service on the part of the Opposite Parties?
- Whether the complainant is entitled to the reliefs as prayed for?
- To what relief?
7. POINT No.1 & 2 :- It is the case of the complainant that her husband purchased units in the name of their son G.Nikhileswar Naidu by paying RS.1,000/- and that the opposite party No.1 issued Ex.A1 receipt. Opposite party No.1 clearly admitted about the issuance of Ex.A1 receipt in favour of the minor son of the complainant. In Ex.A1 receipt the complainant is shown as nominee. Admittedly opposite party No.1 tied up with opposite party No.2 for the accidental coverage for those who purchased units from opposite party No.1. Ex.B5 is the terms and conditions of the Janata Personal Accident Insurance. It is mentioned in Ex.B5 that the said policy is extended to cover death of the insured. In the present case it is the case of the complainant that the insured who is her son died on 05-05-2009 due to dog bite. She filed Ex.A10 copy of Medical certificate issued by Superintendent, Government General Hospital, Kurnool. It is mentioned in Ex.A.10 that G.Nikhileswar Naidu son of Sekhar of Pattikonda was admitted in Government General Hospital on 03-05-2007 and died on 05-05-2007 with clinical picture of Rabies. It is clearly stated by complainant in her affidavit evidence that her son died due to dog bite on 05-05-2007.
8. After the death of G.Nikhileswar Naidu the complainant submitted her claim to opposite party No.2 through opposite party No.1. The said claim was not admitted by opposite party No.2 stating that intimation of death was delayed more than 24 months and that the claim intimation was received without any supporting documents like F.I.R., Post Mortem report etc. It is argued by the learned counsel appearing for the complainant that as the claim is made basing on the accidental death of the insured, the rejection of the claim is not legal. Ex.B5 contains the terms and conditions of the policy. The condition No.1 is in respect of claim made by the insured. There is no mention in Ex.B5 that the nominee has to give death intimation to the insurer within one calendar month from the date of incident. The condition that notice of the event must be given to the insurer within one month is not applicable in case of claim made by the nominee. The rejection of the claim of the complainant on the ground that she did not intimate the death of the insured within one calendar month is not justified.
9. It is also the case of the opposite party No.2 that the complainant did not submit the necessary documents like F.I.R., Postmortem Certificate along with her claim. It is not the case of the complainant that F.I.R was registered on the death of her son. The insured died on 05-05-2007 due to dog bite is supported by Medical evidence. It is not the case of the complainant that Post Mortem Examination was conducted over the dead body of her son. It is submitted by the learned counsel appearing for the complainant that non submission of documents like F.I.R., Postmortem Examination is not a ground to reject the claim. In a decision reported in (2005) CPJ 199, it is observed that repudiation of the claim due to non filing of F.I.R. and P.M. certificate is not connect when the death certificate issued by the concerned doctor was not rebutted by evidence. In the present case the complainant proved the accidental death of her son due to dog bite by producing the Medical Certificate Ex.A10. The opposite party No.2 ought to have settled the claim of the complainant. Opposite party No.2 rejected the claim of the complainant without valid ground. Admittedly in case of accidental death of the insured, opposite party No.2 under took to pay Rs.50,000/- to the nominee. Opposite party No.2 filed to pay the assured amount to the complainant who is the nominee under Ex.A.1. There is deficiency of service on the part of opposite party No.2.
11. In the result, the opposite party No.2 is directed to pay assured amount of Rs.50,000/- to the complainant along with cost of Rs.500/-within three months from the date of the order. The complaint against opposite party 1 and 3 is dismissed.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 08th day of February, 2011.
Sd/- Sd/-
MALE MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : Nil For the opposite parties : Nill
List of exhibits marked for the complainant:-
Ex.A1 Receipt dt.31-08-2002 issued by OP1.
Ex.A2 Photo copy of death certificate of Deceased.
Ex.A3 Letter dt.20-05-2008 to Agri Gold Forms Limited, Adoni.
Ex.A4 Office copy of legal notice dt.19-12-2008.
Ex.A5 Reply notice of OP1 dt.06-04-2009.
Ex.A6 Office copy of letter dt.19-05-2009.
Ex.A7 Claim ejected by OP1 dt.16-06-2009.
Ex.A8 Claim rejected by OP1 dt.25-06-2009 issued to complainant Advocate.
Ex.A9 Postal Acknowledgements.
Ex.A10 Photo copy of letter dt.15-03-2008 issued by Superintendent, Government General Hospital, Kurnool.
List of exhibits marked for the opposite parties:
Ex.B1 Photo copy of Certificate issued by Registrar of companies, Hyderabad.
.
Ex.B2. Certificate of Minutes of the Meeting of the Board of Directors of Agri Gold Farm Estates India Pvt. Ltd., Hyderabad.
Ex.B3 Photo copy of letter dt.02-06-2009 issued by OP1 to OP2.
Ex.B4 Photo copy of letter dt.16-06-2009 issued by OP2 to OP1.
Ex.B5 Janata personal accident insurance policy terms and conditions.
Sd/- Sd/-
MALE MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
