BEFORE THE DISTRICT CONSUMER FORUM :: WARANGAL
Present : Sri D. Chiranjeevi Babu,
President.
And
Sri Patel Praveen Kumar,
Member.
Monday, the 02nd day of May, 2011.
CONSUMER COMPLAINT NO.179/2008
Between:
Korukoppula Raju, S/o K.Sambaiah,
Age: 25 yrs, Occ: Nil,
R/o Kothagattu Village,
Post Kothagattu Singaram Village of
Athmakur Mandal,
Via Shayampet of Warangal District. (Died)
For L.R.(Mother)
Korukoppula Kattamma,
W/o late Sambaiah,
Age: 55 yrs, Occ: Agricultural Coolie and
Household, R/o Kothagattu Singaram (V),
Atmakur (M), Warangal District.
… Complainant
And
1. The National Insurance Company Limited,
Rep. by its Regional Manager,
Divisional Office-III, Shakespeare Sarani,
6th Floor, Kolkata – 700 071.
2. The Manager,
Golden Multi Services Ltd.,
Division, Warangal, A.P.
H.No.2-5-101, S.B.Arket,
Nakkalagutta, Hanamkonda.
3. Korukoppula Manjula, W/o late Raju, Added as per order
Age:28 yrs, Occ: Housewife, passed in IA 91/10
R/oKothagattu Village, Athmakur Mandal, dated16-07-2010.
Warangal District., presently residing at
Durgampet (V), Athmakur (M),
Warangal District.
… Opposite parties
Counsel for the Complainant :: Sri B.Rajamalla Reddy, Advocate
Counsel for the Opposite party No.1 :: Sri Y. Manohar Rao, Advocate.
Opposite Party No.2 :: Did not appear and has been Exparte.
Counsel for the Opposite party No.3 :: Sri B.Ramesh Goud, Advocate.
This complaint is coming for final hearing before this Forum, the Forum pronounced the following order.
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ORDER
Sri D. Chiranjeevi Babu, President
Originally the complaint was filed by the insured Korukoopula Raju against the opposite parties under section 12 of Consumer Protection Act, 1986 for a direction to pay Rs.1,57,000/- towards the policy amount with interest 24% p.a. and award costs. During the pendency of the case he died. After the death of deceased, his mother filed a petition IA 349/09 to implead her as L.R. of K.Raju, and it was allowed on 23-09-2009 and his mother Korukoopula Kattamma was brought on record i.e, mother of the deceased Raju. Subsequently opposite party NO.3 i.e, wife of the deceased also added as another L.R. of K.Raju as per IA 91/2010 dt.16-07-2010.
The brief averments contained in the complaint filed by the complainant is as follows:
The case of the original complainant is that he has taken Group Insurance Policy from opposite party No.1 through opposite party No.2 vide policy No.100300/42/8200012 for the period from 01-12-2004 to 30-12-2007 for Rs.1,00,000/, for which the wife of the complainant is the nominee. On 11-05-2007 the complainant met with an accident and sustained fractures and injuries. Immediately the complainant was shifted to MGM Hospital, Warangal and underwent treatment and due to which the complainant disabled to an extent of 80% as per disability certificate issued by Regional Medical Board, Warangal. The complainant submitted claim form to opposite party No.2 by enclosing all relevant certificates along with original policy and requested to settle the claim. But the opposite parties did not settle the claim and dodged the matter on one or other pretexts. On 19-05-2008 the opposite party No.2 addressed a letter to opposite party NO.1 to settle the claim of the complainant immediately, but the opposite party No.1 did not settle the claim. The act of opposite parties amounts to deficiency of service. Hence, filed this complaint praying to direct the opposite parties to pay Rs.1,57,000/- under the above said policy with interest and costs.
The opposite party No.1 filed the Written Version stating that the complainant has no locus standi to file this complaint as the contract of insurance is in between opposite party NO.1 and Golden Multi Services Club Limited, Kolkata opposite party No.2 and the complainant is said to be beneficiary only as such the claims if any have to be made by the said club but not the complainant. The said club is only competent to file the complaint, hence, the complaint in the present forum is not maintainable at all.
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Further the opposite party No.1 stated that as per the Condition No.15 of Memorandum of Understanding between the opposite party No.1 and opposite party No.2, the claims have to be submitted by the said Club within 90 days from the date of accident or the cause of claim. There is no waiver clause i.e, to say that the delay if any in submitting the claims will not be condoned under any circumstances and the said club will only liable but not the opposite party NO.1.
Further the said condition in addition to other conditions which are to be complied with by the said club and its beneficiaries as such the claim is not maintainable as per the terms of the contract and MOU signed and agreed by this opposite party and the said club and it is the said club has to answer the claim of the complainant. The said condition No.15 is printed in the policy issued to opposite party No.2 and has printed the same on the reverse side of the certificates issued to the beneficiaries of the same including the complainant. As per the terms and conditions agreed and binding on opposite party No.2 all the disputes with regard to implementation and interpretation of the contract of insurance are to be decided the authorities at Kolkata only, as such this forum has no jurisdiction. The opposite party No.2 has not made the claim as per the terms of MOU as such this opposite party was unable to settle the claims. Opposite party No.1 addressed a letter to the complainant dt.23-10-2008 to submit the documents in support of the claim but the said documents are not submitted on the other hand the complainant is blaming this opposite party for non settlement of the claim and requested this Forum to dismiss this case.
Inspite of publication, opposite party No.2 did not appear before this Forum. Hence, this Forum set it Exparte.
The opposite party No.3 filed the Written Version stating that this case is not maintainable which is liable to be dismissed for want of non-joinder of necessary party to the proceedings at first instance as such this opposite party No.3 came on record in the matter. The opposite party No.3 is the legally wedded wife of the deceased/insured late Korukoppula Raju, who during his life time has taken Group Insurance Policy with opposite party NO.1 vide certificate No.0618118, policy No.100300/42/8200012 for the period from 01-12-2004 to 30-12-2007 for Rs.1,00,000/, for which the wife of the complainant i.e, opposite party No.3 is the nominee. During his life time the deceased met with an accident on 11-05-2007 at about 4.00 pm by
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falling from toddy tree, he sustained fractures and injuries. Immediately the deceased was shifted to MGM Hospital, Warangal and underwent treatment and due to which the deceased disabled to an extent of 80% as per disability certificate issued by Regional Medical Board, Warangal. While the policy is in force on the date of accident, as such the opposite party NO.3 being the nominee is entitled for all the benefits under the policy and on the other hand the complainant is nothing to do with the said claim who has no right or concern with the insurance coverage and entitlement of the policy.
The opposite party No.3 further stated that the mother of the insured i.e, policy holder with malafide intention to cause loss to her and to gain wrongfully from the insurance at first instance did not implead the opposite party No.3 as party to the proceedings, where as the opposite party No.3 being the legally wedded wife and nominee of the above said policy for the period from 1-12-2004 to 30-11-2007 is entitled to get all the benefits on the account of death of the deceased and the complainant is not entitled to get anything and requested this Forum that the claim of the complainant deserves to be dismissed by considering the opposite party No,.3 is entitled for all the benefits under the policy.
The complainant in support of her claim, filed her Affidavit in the form of chief examination and also marked Exs.A-1 to A-20. On behalf of opposite party No.1 M.S. Pasha filed his Affidavit and on behalf of opposite party No.3 Manjula filed her Affidavit in the form of chief examination but not marked any documents.
Now the point for consideration is:
1) Whether there is any deficiency of service on the part of the opposite parties 1 and 2 ?
2) If so whether the wife of the deceased ie, opposite party NO.3 or the mother of the deceased i.e, complainant is entitled to get the policy amount.
Point NO.1:-
After verifying all the documents filed by the complainant and after gone through the contents of complaint, Written Versions and Affidavits of all the parties we are of the opinion that there is deficiency of service on the part of the opposite party No.1.
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It is true as per Ex.A-2 and A-3 it is clear that the deceased Korukoopula Raju has obtained Group Insurance Policy from opposite party No.1 through opposite party No.2 vide policy No.100300/42/8200012 for the period from 01-12-2004 to 30-12-2007 for Rs.1,00,000/, for which the wife of the complainant is the nominee. So for obtaining of Rs.1,00,000/- policy i.e, from Golden Multi Services Ltd, it is an admitted fact that the deceased Korukoopula Raju obtained the same policy. On 11-05-2007 the deceased met with an accident and sustained fracture injuries, immediately the deceased was shifted to MGM Hospital, Warangal and underwent treatment and due to which the deceased disabled to an extent of 80% as per disability certificate issued by Regional Medical Board, Warangal. The complainant submitted claim form to opposite party No.2 by enclosing all relevant certificates along with original policy and requested to settle the claim. But the opposite parties did not settle the claim and dodged the matter then the deceased filed this case before this Forum. Thereafter during the pendency of this case he died. Later the mother of the deceased, subsequently the wife of the deceased added as L.Rs. of the deceased as complainant and opposite party No.3. Further as per Ex.A-1 Panchanama it is clear that Korukoopula Raju met with an accident and sustained injuries. Even though it is Panchanama it clearly goes to show that the offence took place and the deceased sustained fracture injuries. The Panchanama was conducted on 07-06-2007 by Panchadars at Kazipet Police Station. The accident took place on 11-05-2007. It is true as per this document the offence took place on 11-05-2007. So on the basis of Ex.A-1 it is clear that the accident took place on 11-05-2007. When the accident took place on 11-05-2007certainly the deceased is entitled to get compensation because the insurance is in force i.e, from 1-12-2004 to 30-12-2007. Further as per Ex.A-4 it is Disability Certificate, it clearly goes to show that the disabled percentage of disablement is 80%.
Further as per Ex.A-5 the letter from the wife of the deceased i.e, opposite party No.3 addressed a letter to the Regional Manager, National insurance Company Ltd., Kolkata clearly goes to show for early settlement of claim. As per Ex.A-6 case Sheet of the deceased Korukoopula Raju, it clearly goes to show that he sustained injuries. In second page of the case sheet the injuries of the deceased was already mentioned and also whatever the medicines are given to the deceased Korukoopula Raju are already incorporated in the case sheet. So it is clear that there is an accident as per Ex.A-1 to the deceased Korukoopula Raju and he sustained severe injuries to
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his body. For that Ex.A-6 is clearly proved. Ex.A-7 Bill of Jaya Hospital, Hanmkonda, Ex. A-8 to A-12 are the bills of Mahatma Gandhi Medical Stores, Warangal, Ex.A-13 is the M.R.I Scan report of Raju, Ex.A-15 is the death certificate of K.Raju, Ex.A-16 is Dependent Certificate, Ex.A-17 is the First Information Report, Ex.A-18 is the Inquest report and Ex.A-19 is the Postmortem examination report. So as per Ex.A-17, A-18 and A-19 it is clear that the deceased went to tap the toddy on a toddy tree and accidentally he fell from the toddy tree then he received severe injuries. In Ex.A-19 Postmortem examination report it clearly goes to show the cause of death
was due to “Ante Morteum Fracture of Spine and their complications (Multi Organ Failure). When the postmortem report clearly goes to show that the deceased died only due to accident, certainly the opposite party No.1 is liable to pay the policy amount to the opposite party No.3 i.e, wife of the deceased and the complainant i.e, mother of the deceased. Further as per Ex.A-4 Disability Certificate issued by Regional Medical Board, Warangal it clearly goes to show that the deceased got 80% disability. When 80% disability is there certainly the opposite party No.1 is liable to pay the policy amount.
The main contention of the opposite party No.1 is that the deceased K.Raju has not submitted the claim within 90 days from the date of accident and this forum has no jurisdiction to try this matter. For this our answer is that the deceased fell down from the toddy tree, then he immediately shifted to hospital and he got 80% disability. So in not submitting the claim within 90 days is not fatal to this case and it is not at all the ground to repudiate the claim of the deceased. Because of the injuries the deceased K.Raju was unable to attend his caste profession as tapper and there was a coverage of policy under Zanata Personal Accident Insurance Policy for a sum of Rs.1,00,000/-. On 21-06-2007the complainant submitted the claim form by enclosing all the details of the claim and also submitted the original policy, disability certificate and all necessary documents with a fond hope that the claim will be settled in near future through opposite party No.2 for which opposite party No.2 has acknowledge the receipt of the said claim form and original documents which are assigned as P.A. Claim NO.4207829000091 i.e, the complainant submitted all the necessary documents along with claim form, the claim was not yet settled and on the other hand the opposite party No.1 dodged the matter without paying any amount covered under the policy. Since no claim was settled another letter was also submitted to the
CC 179/2008 -- 7--
opposite parties to settle the claim at early date which was duly acknowledged by opposite party No.1 and opposite party No.2. Inspite of forwarding the claim form with documents to opposite party No.1 on 11-07-2007 there was no response from the opposite party No.1 till 19-05-2008.
Except mere denial of complaint allegations there is no other proof to show that the deceased not died due to accident. On the basis of above documents and we have already stated in supra it is clear that the deceased died only due to accident. When the deceased died only due to accident certainly opposite party No.1 is liable to pay compensation to opposite party NO.3 i.e, wife of the deceased and the to the complainant ie., mother of the deceased.
So the wife of the deceased Manjula as per Ex.A-5 she also addressed a letter to the Regional Manager, National Insurance Company and they received the same on 14-05-2008. So anyhow the claim was submitted to the opposite party No.1 on 14-05-2008, it is not a fatal and not intentional. So all the claim documents are submitted to the opposite party No.1, but they have not settled the matter. It is their fault because as per Disability Certificate we already stated in supra that the deceased K.Raju got 80% disablement as per Ex.A-4 because of spinal card problem he was not attended to anywhere and he died on 11-05-07 as per Ex.A-15 Death Certificate. Since the deceased K.Raju died due to spinal card injury and when the insurance policy is in force certainly the opposite party NO.3 and complainant is entitled to get the policy amount from the opposite party NO.1.
The other contention of the opposite party No.1 with regard to condition in column No.15 as well as about the terms and conditions printed on the backside of insurance. With regard to that the deceased K.Raju is an illiterate and he is toddy tapper, he does not know whether any condition is there on the back side of insurance. It is the duty of the insurance that they have to educate with regard to the conditions printed on the back of the insurance policy and they have to obtain the signature on any one of the other paper with regard to the conditions i.e, after explaining the conditions and rules to the deceased Raju they have to obtain signature but they did not do so. They printed the conditions on the next page of the policy, it is not known to the deceased Raju because he is an illiterate and he is only toddy tapper.
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Further the said conditions are printed only by the insurance. At the time of issuing policy it is the duty of the insurance that they have to explain about the conditions and rules and they have to obtain signatures on anyone
of the paper. Without doing anything they are saying there are conditions, it is baseless. So we reject the same and we come to the conclusion that as per Disablement certificate issued by Regional Medical Board, Warangal it is clear that he got 80% disability due to spinal card injury and subsequently he died for that injury only. So on the above factors it is clear that the claim of the deceased is a true claim and genuine.
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For the foregoing reasons given by us we come to the conclusion that there is deficiency of service on the part of the opposite party No.1, when there is deficiency of service on the part of opposite party No.1 certainly the opposite party No.3 and the complainant is entitled to get the policy amount and we answered this point accordingly in favour of the opposite party No.3 and complainant against the opposite party No.1. We are allotting some amount to the complainant only on mercy grounds because she is not the nominee of the policy of the deceased. So the complainant is entitled some amount and opposite party No.3 is entitled major amount.
Point NO.2: To what Relief:- The first point is decided in favour of opposite party No.3 and complainant against the opposite party No.1 this point is also decided in favour of opposite party No.3 and complainant against the opposite party No.1.
In the result the complaint is allowed and we direct the opposite party No.1 to pay an amount of Rs.80,000/- (Rs.Eighty thousand only) to the opposite party No.3 and Rs.20,000/- (Rs.Twenty thousand only) to the complainant along with interest @7.5% p.a. from the date of filing of the complaint i.e, 11-12-2008 till the date of deposit. The opposite party No.1 is also directed to pay Rs.500/- (Rs.Five hundred only) towards costs.
A month’s time is granted to the opposite party No.1 for the compliance of the order.
The claim against opposite party No.2 is dismissed without costs.
(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 02nd May, 2011.)
President Male Member,
District Consumer Forum, Warangal
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APPENDIX OF EVIDENCE
WITNESSES EXAMINED
On behalf of Complainant On behalf of Opposite parties
Affidavit of complainant filed. Affidavits of Opposite parties 1 & 3 filed.
EXHIBITS MARKED
ON BEHALF OF COMPLAINANT
01. Ex.A-1 is the Panchanama.
02. Ex.A-2 is the policy of the deceased issued by opposite party No.2, dt.01-12-2004.
03. Ex.A-3 is the Insurance Policy Claim form of the deceased K.Raju.
04. Ex.A-4 is the Orthopaedically Handicapped Certificate issued by the Chairman, Regional Medical Board, Warangal.
05. Ex.A-5 is the letter from opposite party No.3 to opposite party No.1.
06. Ex.A-6 is the Attested copy Case sheet of the deceased K.Raju.
07. Ex.A-7 is the investigation bill of deceased issued by Jaya Hospital.
08. Ex.A-8 to A-12 are the cash bills of the deceased issued by Mahatma Gandhi Medical Stores, Warangal.
09. Ex.A-13 is the MRI Scan Report of the deceased issued by Jaya Hospitals, Hanamkonda.
10. Ex.A-14 is the letter from opposite party No.2 to opposite party No.1 dt.19-05-2008.
11. Ex.A-15 is the original death certificate of the deceased issued by Medical and Health Department.
12. Ex.A-16 is the Dependent Certificate issued by Revenue Department.
13. Ex.A-17 is the First Information Report.
14. Ex.A-18 is the Inquest.
15. Ex.A-19 is the Report of Post Mortem Examination issued by Department of Forensic Medicine.
16. Ex.A-20 is the Attested Copy of Final Report.
ON BEHALF OF OPPOSITE PARTIES
NIL
PRESIDENT
