This C.C. came before us for final hearing in the presence of Sri.K.Ramesh, Advocate for complainant, and of Sri.G.Seetha Rama Rao, Advocate for opposite party No.1 and of Sri.G.Hareender Reddy, Advocate for opposite parties No.2; upon hearing the arguments and upon perusing the material papers on record, and having stood over for consideration till this day, this Forum passed the following order:
O R D E R
(per Sri. Vijay Kumar, President)
1. This complaint is filed u/s.12 of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of the complainant, late Anjaiah was a member of opposite party No.1 in group personal accident policy bearing NO.GPA 0000120 and certificate No.MC3/HD000002266 for the purpose of personal insurance coverage for a period from 25-3-2003 to 24-3-2004. The opposite party No.1 has tie up with opposite party No.2. Both the opposite parties No.1 and 2 are liable to pay Rs.3,00,000/- in case of accidental death as mentioned in the certificate issued by opposite party No.2, which is mentioned on the reverse of the membership certificate issued to the complainant
2. On 6-6-2003 at about 3-00 hours while the deceased, Ravula Anjaiah sleeping in a open place at his house, a snake bit to his left wrist, on that the deceased, Anjaiah woke up and shouted that a snake bit him, immediately he was shifted to a private hospital of Soma Linga Reddy at Kalluru in an auto and on the advise of the above said doctor, he was shifted to Kothagudem, where he died on 7-6-2003 at about 4 hours. The son of the deceased lodged a complaint on 7-6-2003, at Kalluru P.S., upon which a case is registered in Cr.No.37/2003 u/s.174 Cr.P.C. and investigated the case by conducting inquest over the dead body and the Duty Medical Officer, Govt. Hospital at Penuballi conducted post mortem examination on the dead body of the deceased and opined that the cause of death of the deceased, Anjaiah is due to snake bite. After enquiry, the S.I. of police, Kalluru P.S. has given finale opinion to the Mandal Executive Magistrate of Kalluru referring the case as unnatural death of snake bite. The husband of the complainant had put the name of complainant as nominee in the insurance certificate and as such after the death of the husband, the complainant made a representation, on which the investigator of opposite party No.2 approached and collected all the documents and promised for payment of insurance amount. But the complainant was not paid the amount so far. Since both the opposite parties failed to pay Rs.3,00,000/- and all the efforts made by her became in vain. Therefore, the complainant got issued a legal notice. On receipt of the legal notice, the opposite party No.2 had issued a false reply.
3. Except this insurance claim amount, the other benefits were settled by New India Assurance company Ltd., Khammam by paying Rs.1,00,000/- on 18-1-2005 and also L.I.C. of India by paying Rs.20,000/-, Rs.30,000/- and Rs.39,168/- on the policies of the husband of the complainant. Except this claim, the other death claim benefits of late Anjaiah were settled. Both the opposite parties have failed to pay the insurance amount. Thus, there is sheer negligence on the part of opposite parties in not settling the claim of the complainant. There is deficiency in service on the part of opposite parties. Hence this complaint.
4. Apart from the complaint, the complainant also filed an affidavit reiterating the contents of the complaint.
5. Having received the notice, the opposite party Nos.1 and 2 made appearance through their counsel and filed counter.
6. The opposite party No.1filed its counter and denied all the averments made in the complaint. The opposite party No.1 admits that the complainant is a member of opposite party No.1 in Group Personal Accident Policy bearing No.0000120 vide certificate No.MC3/HD000002266 for the purpose of insurance coverage for a period from 25-3-2003 to 24-3-2004. The opposite party further contended that as per the inquest report the deceased was suffering from blood cancer prior to his death and he died due to snake bite as per the criminal records and the police also filed their final report as unnatural death of snake bite. Immediately after receiving the proposal sent by the complainant to this opposite party, after thorough verification of documents which were sent by the complainant and the same were sent to the opposite party No.2. The role of this opposite party is only to bring awareness among the public with regard to road safety and thereby educate them. The moment a insurance policy is provided its role ends. It has already provided the policy and as such there is no deficiency on the part of opposite party No.1. It is the opposite party No.2 being the insurer responsible to settle the claim. This opposite party acted promptly in sending documents to the insurance company i.e. opposite party No.2.
7. Any dispute in relation to this will be subject to jurisdiction of Chennai courts only, that the complainant is not a consumer as defined under Chapter I Section 2(D) of Consumer Protection Act. As such, this forum is not having any jurisdiction to entertain the complaint and prayed to dismiss the complaint against the opposite party No.1.
8. It is counter of opposite party No.2 that as per the statements given by the deceased’s sons, Mr.R.Rambabu and Mr.R.Krishna to police on 6-6-2003 their father was suffering from cancer before this incident and was under treatment at Khammam and Hyderabad hospitals. Dr.Somalinga Reddy gave a statement to police that he had seen the patient at 4.30 a.m. on 6-6-2003 and advised to shift the patient to Khammam hospital as his condition was critical and also stated in his statement that he was unable to diagnose whether the patient was suffering from snake bite or from any other disease. As per the statement of Dr.Ankamma Chowdary, the patient was brought to his hospital at around 5 p.m. on 6-6-2003 with a delay of 12 hours in shifting the patient from Kalluru to Kothagudem and the police failed to elicit the reasons for this abnormal delay. As per the inquest report, the left wrist of the deceased had no puncture wound, discharge and swelling as has been mentioned in post mortem report conducted by Dr.P.Venkateswarlu. It is further contended in the counter of opposite party No.2 that in cases registered u/s.174 Cr.P.C. generally the viscera would be sent to Forensic Science Laboratory to find out the exact cause of death. But in this case, the doctor has hastily concluded the cause of death without referring the viscera to F.S.L. It is further contended that the deceased woke up at 5-00 a.m. and complained of chest pain and breathlessness. The complainant narrated that her husband while urinating at around 11-00 p.m. on 5-6-2003 some unknown insect bitten him and he complained of pain. It confirms that the deceased was cancer patient. Having known the medical condition, the policy was obtained by not disclosing the material fact. Therefore the present matter requires detailed examination and hence this case ought to be referred to a civil court.
9. It is further case of opposite party No.2 that it is not in dispute that the deceased is a member of opposite party No.1 in Group Personal Accident Policy. It is further contended that as per the claim form submitted by the complainant the cause of death is snake bite. As per the inquest report, the deceased was suffering from blood cancer. Hence, it is clearly established that the deceased obtained policy by suppressing the material fact. The liability of the company is subject to terms and conditions of the policy. Therefore, there is no deficiency in service on the part of opposite party No.2. Hence, prayed to dismiss the complaint.
10. On behalf of the complainant, the following documents are marked
Ex.A.1 - Membership certificate issued by the opposite party No.1 to the husband
of the complainant, dt.25-3-2003
Ex.A.2 - Certificate of insurance issued by the opposite party dt.25-3-2003.
Ex.A.3 - Acknowledgement slip issued by opposite party No.1, dt.25-3-2003.
Ex.A.4 - Attested copy of F.I.R. in Cr.No.37/2003, dt.7-6-2003 of P.S.Kallur
Ex.A.5 - Attested copy of Inquest report of P.S. Kallur
Ex.A.6 - Attested copy of P.M.E. report, issued by Area Hospital, Kothagudem,
dt.7-6-2003.
Ex.A.7 - Death certificate issued by Commissioner, Kothagudem Muncipality,
dt.30-6-2003
Ex.A.8 - Death certificate issued by Padmavathi Nursing Home, Kothagudem
Ex.A.9 - Attested copy of Final report, dt.17-9-2003
Ex.A.10 - Notice send by the complainant, dt.30-3-2005
Ex.A.11 - Postal acknowledgment.
11. On behalf of the opposite party No.2, the following documents are marked
Ex.B.1 - Group Personal Accident Policy
Ex.B.2 - Copy of F.I.R.
Ex.B.3 - Inquest report.
12. On behalf of the complainant and opposite party No.2, written arguments filed. Heard both sides.
13. Perused the oral and documentary evidence placed on the record. Upon which the points that arose for consideration are,
1. Whether the complainant is entitled to amounts covered under
the insurance policy?
2. Whether the complainant is entitled to the damages claimed
in the complaint?
- To what relief?
Points No.1 and 2:
14. The case of the complainant is that her husband, late Anjaiah was a member of opposite party No.1 in Group Personal Accident policy for the purpose of Personal insurance coverage, for a period of one year from 25-3-2003 to 24-3-2004. That on 6-6-2003 at about 3-00 hours, while the husband of the deceased, Anjaiah sleeping in a open place at his house, he woke up and shouted that he was bitten by snake to his left wrist. Immediately, he was shifted to private hospital of Soma Linga Reddy at Kalluru in an auto and on the advise of the doctor he was shifted to Kothagudem, where he died on 7-6-2003 at about 4-00 hours. Basing on the complaint of the son of the complainant, Kalluru police registered the case in Cr.No.37/2003 u/s.174 Cr.P.C. and investigated the case by conducting the inquest over the dead body and the Duty medical officer, Govt. Hospital at Kothagudem conducted P.M.E. and opined that the cause of death of the deceased, Anjaiah was due to snake bite. After enquiry the S.I. of police, Kalluru P.S. has given final opinion to the Executive Magistrate at Kalluru as an unnatural death of snake bite. In support of her contention, the complainant refers to Ex.A.1, membership certificate and also refers to Ex.A.2, insurance policy issued by opposite party No.1 and also refers to Ex.A.3, acknowledgment slip issued by opposite party No.1 with regard to the complaint lodged by the son of the complainant. The complainant refers to Ex.A.4, which is F.I.R. registered in Cr.No.37/2003 by P.S. Kalluru and also refers to Ex.A.5, attested copy of inquest report and also Ex.A.6, copy of P.M.E. report issued by Area Hospital, Kothagudem. Exs.A.4 to A.6 are the crucial and relevant documents and are clinchingly go to establish that the death of the deceased was due to snake bite. Ex.A.6, P.M.E. report is an important piece of evidence to establish the cause of death of the deceased. Apart from this the complainant refers to death certificate of the deceased, Anjaiah issued by Commissioner, Kothagudem Municipality and also death certificate issued by Padmavathi Nursing Home, Kothagudem, which are marked as Exs.A.7 and A.8. Ex.A.9 is the final report filed by the S.I. of police, Ex.A.10 is the notice issued by the complainant and Ex.A.11 is the postal acknowledgment. On the basis of Exs.A.4 to A.9, the complainant substantially proved that her husband, Anjaiah died because of snake bite. On the other hand, it is the case of opposite party No.2 that as per the statements given by the deceased’s sons, R.Rambabu and R.Krishna to police, they stated that their father was suffering from cancer before this accident and was under treatment at Hyderabad hospitals. It is further case of opposite party No.2 that Dr.Soma Linga Reddy stated that he was unable to diagnose whether the patient suffered from snake bite or by any other disease and also it is the case of opposite party No.2 that Dr.Ankamma Chowdary stated that there was delay of 12 hours in shifting the deceased from Kalluru to Kothagudem, in spite of the condition of the patient was being critical and the police had failed to elicit the reasons for this abnormal delay. It is further submitted that as per the inquest report, the left wrist of the deceased had no puncture wound, discharge and swelling as has been mentioned in P.M.E. report. Therefore, it is submitted that all these lacunas can be concluded that having known the medical condition of the patient, the policy was obtained by suppressing the material facts. It is not in dispute that the deceased was a member of the opposite party No.1 for the purpose of insurance coverage. It is a fact that the complainant submitted the claim form by mentioning the cause of death as snake bite, but as per the inquest report, the deceased was suffering from blood cancer. Hence, it is clear case that the deceased obtained policy by suppressing the material fact and filed this case to get compensation wrongfully. On this aspect of the case, the learned counsel for opposite party No.2 made reliance to a decision reported in III (2006) CPJ 199, wherein it was held that the claim repudiated on the ground of death due to snake bite not proved by way of post mortem report. This citation is not helpful to the facts and circumstances of the case. In this case, the post mortem examination report is filed, showing the cause of death as snake bite. Therefore, the facts and circumstances of this case are not helpful to the present case. The learned counsel for the opposite party No.2 refers to another citation reported in III (2006) CPJ 202, wherein it is held that suppression of material facts, fact of being suffering from cancer not disclosed. The L.I.C. entitled to repudiate contract of insurance. But in the present case, the cause of death is not due to cancer, being the clear cause of death due to snake bite. The complainant has filed ample evidence to substantiate that her husband died due to snake bite. Therefore, there is no evidence on record to show that the deceased suppressed the material facts of suffering from cancer. Hence, the citation is not helpful to the facts of the present case. The opposite party No.2 has jumped to hasty conclusion by contending that deceased was suffering with cancer at the time of taking policy and that he suppressed this fact at the time of filing of the proposal. The only basis for opposite party No.2 for coming to this conclusion is as per the line drawn in the inquest report and F.I.R. that late Anjaiah suffered with blood cancer since two months prior to his death. Opposite party No.2 has based its contention on the statement said to have been given to the police. But onus is on opposite party No.2 to establish fact of suffering with cancer prior to his death. Except the verbal statement given to the police, no conclusive proof is overcoming on this aspect of the case. It is not established whether it was diagnosed by any doctor or any treatment is taken by the deceased for blood cancer. Simply basing on the so called verbal statement, it is very difficult to arrive to a just conclusion that the deceased was suffering with cancer. Hence, the arguments by the counsel for opposite party No.2 that insured suffering with blood cancer prior to his death holds no water. This blame cannot be attributable without any basis. In this instant case, the deceased died of snake bite, the complainant has produced ample documentary evidence in this regard. The complainant refers to the complaint given by her son to police and inquest report, held over the dead body of the deceased and the post mortem examination report, which clearly disclose that the cause of death is due to snake bite. All these documents clinchingly go to establish that the deceased died due to snake bite and these documents cannot be silenced. In view of the aforesaid facts and circumstances, the complaint is fit to be allowed.
15. In the result, the complaint is allowed, directing the opposite party No.2 to pay an amount of Rs.3,00,000/- (Rupees three lakhs only) covered under the Group Personal Accident Policy together with interest at 9% P.A. from the date of filing of the complaint till the date of deposit. Further directed to pay an amount of Rs.10,000/- (Rupees ten thousand only) towards compensation for causing mental agony and pain and suffering to the complainant and also Rs.1,000/- (Rupees one thousand only) towards costs of the litigation within a period of one month from the date of this order. So far as the claim against the opposite party No.1 is concerned, it is dismissed on the ground that once insurance company provides the insurance policy, the role of opposite party No.1 comes to an end.
Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum, on this 20th day of February, 2009.
PRESIDENT MEMEBR MEMBER
DISTRICT CONSUMERS FORUM
KHAMMAM
Appendix of Evidence
Witnesses examined for complainant
-None-
Witnesses examined for opposite parties:
-None-
Exhibits marked for complainant:
Ex.A.1 - Membership certificate issued by the opposite party No.1 to the husband
of the complainant, dt.25-3-2003
Ex.A.2 - Certificate of insurance issued by the opposite party dt.25-3-2003.
Ex.A.3 - Acknowledgement slip issued by opposite party No.1, dt.25-3-2003.
Ex.A.4 - Attested copy of F.I.R. in Cr.No.37/2003, dt.7-6-2003 of P.S.Kallur
Ex.A.5 - Attested copy of Inquest report of P.S. Kallur
Ex.A.6 - Attested copy of P.M.E. report, issued by Area Hospital, Kothagudem,
dt.7-6-2003.
Ex.A.7 - Death certificate issued by Commissioner, Kothagudem Muncipality,
dt.30-6-2003
Ex.A.8 - Death certificate issued by Padmavathi Nursing Home, Kothagudem
Ex.A.9 - Attested copy of Final report, dt.17-9-2003
Ex.A.10 - Notice send by the complainant, dt.30-3-2005
Ex.A.11 - Postal acknowledgment.
Exhibits marked for opposite party No.2:
Ex.B.1 - Group Personal Accident Policy
Ex.B.2 - Copy of F.I.R.
Ex.B.3 - Inquest report.
PRESIDENT MEMEBR MEMBER
DISTRICT CONSUMERS FORUM
KHAMMAM
