| Complaint Case No. CC/09/73 |
| | | | 1. Thammisetty Krishna, S/o. Laxmaiah, R/o. H.No.4-51/1, Gudimalla Village, Khammam Town and Mandal, Khammam. | | Gudimalla Village | | Khammam | | Andhra Pradesh |
| ...........Complainant(s) | | Versus | | 1. Road Safety Club Pvt. Ltd., Administrative Office, 2-A, IInd Floor, Prakasham Road, T. Nagar, Chennai - 600 017. | | T. Nagar | | Chennai | | Tamil Nadu State | | 2. Reliance General Insurance Co. Ltd. | | Heavitree, Unit No.1 3rd Floor, Supur Tank Road, Chetpet, | | Chennai | | Tamilnadu | | 3. Reliance General Insurance Co.Ltd., | | Rep. by its Branch Manager, Behind Collectorate, Wyra Road, | | Khammam | | Andhra Pradesh |
| ............Opp.Party(s) |
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| ORDER | | BEFORE THE DISTRICT CONSUMERS FORUM AT KHAMMAM Dated this, the 7th day of December, 2010 CORAM: 1. Sri Vijay Kumar, B.Com., LL.B., President 2. Smt.V.Vijaya Rekha, B.Sc. B.L., Member 3. Sri.R.Kiran Kumar, B.Sc., LL.B., Member C.C.No.73 of 2009 Between: Thammisetty Krishna, S/o Laxmaiah, Age:29years, Occu: Agriculture, R/o.H.No.4-51/1, Gudimalla Village, Khammam Rural Mandal, Khammam District. …Complainant and 1. Road Safety Club Pvt. Ltd., Administrative Office, 2-A, II Floor, Prakasham Road, T.Nagar, CHENNAI – 600 017. 2. Reliance General Insurance Co. Ltd., “HEAVITREE”, Unit No.1, 3rd Floor, Spur Tank Road, Chetpet, CHENNAI – 600 031. 3. Reliance General Insurance Co. Ltd., Rep. by its Branch Manager, behind Collectorate, Wyra Road, KHAMMAM – 507 003. …Opposite parties This C.C. is coming on before this Forum for final hearing in the presence of Sri J. Papa Rao, Advocate for complainant and of Sri. G. Harender Reddy, Advocate for opposite party No.1 and Sri G.Sita Rama Rao, Advocate for opposite parties No.2 & 3; upon perusing the material papers on record; upon hearing the arguments, and having stood over for consideration, till this day, this Forum passed the following:- ORDER (Per Sri.Vijay Kumar, President) This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the complainant is resident of Gudimalla Village in Khammam District. The complainant’s brother Thammisetti Muthyalu and his sister by name Thammisetti Naga Lakshmi, D/o Lakshmaiah obtained policy bearing No.TR.No.3517198, dt.25-09-2007, which is a Group Personal Accident Insurance Policy AMS Classic Special for Rs.2,00,000/-. At the time of taking policy the said Thammisetti Naga Lakshmi mentioned the name of the complainant as her nominee. That on 15-02-2008, the complainant’s sister by name Thammisetty Naga Lakshmi, the policyholder was washing cloths at N.S. Canal, while so abruptly she fell in the water and died. Immediately after the incident, the matter was reported to Secretary, Grampanchayat and police concerned and also informed the death intimation to the opposite party agent. Accordingly the dead body was shifted to Government Head Quarters Hospital, Khammam, the duty Medical Officer conducted Postmortem Examination and gave a report stating the cause of death due to Asphyscda i.e. due to drowning and police personnel also registered the case in crime No.14/2008. The Grampanchayat, Gudimalla issued death certificate on 11-07-2008. After obtaining all the material papers, the complainant submitted them to the opposite parties and according to their advise he approached the Zonal Office, Vijayawada, but the opposite parties instead of settling the claim postponing the same under one pretext or the other. This act on the part of the opposite parties amount to deficiency in service in not releasing the death benefits of the deceased Thammisetty Naga Lakshmi to the complainant. Therefore, the complainant got issued a legal notice on 09-04-2009, after receiving the legal notice the opposite parties gave vague reply denying the payment as in Ex.A2. Hence this complaint. 2. Apart from the complaint, the complainant filed affidavit reiterating the contents of the complaint and also filed the following documents. i) Photo copy of F.I.R. in Crime No.14/2008 of P.S., Khammam Division. ii) Photo copy of Inquest Panchanama iii) Photo copy of P.M.E. Report, dt.16.02.2008 - Ex.A1. iv) Photo copy of Death Certificate, dt.11.07.2008 v) Photo copy of Declaration Certificate, dt.07.07.2008. vi) Photo copy of Membership Certificate. vii) Photo copy of Certificate of Insurance. viii) Postal receipt Nos.5499, 5500 (Nos.2). ix) Acknowledgements (Nos.2) x) Office copy of legal notice, dt.09.04.2009. xi) Reply letter dt.16.04.2009 - Ex.A2. 3. Having received the notice, the opposite parties 1 to 3 appeared through their counsel and filed their counter. 4. In the counter of opposite party No.1, it is admitted that the complaint’s sister i.e. Thammisetty Naga Lakshmi is the member of opposite party No.1’ Club and obtained a certificate PR No.3517198 for insurance cover and she has been given membership card for 6 years. This opposite party No.1 is coordinating for Insurance Company for providing policies to the members. Therefore, this opposite party No.1 cannot be made liable. The role of this opposite party No.1 is only to bring awareness among the public and to educate them to become members of the club and to enable them to get insurance coverage. Once Insurance Company provides the insurance coverage, the role of this opposite party No.1 come to an end. There is no deficiency in service on the part of opposite party No.1 and prayed to dismiss the complaint. 5. Opposite party No.2 and 3 also filed counter. Wherein all the averments made in the complaint are denied in toto. But the opposite parties No.2 and 3 admitted that they issued a Group Personal Accident Policy to opposite party No.1 i.e. Road Safety Club Pvt. Ltd., covering the complainant for the period from 13-05-2007 to 12-05-2008 under a master policy, the liability is subject to various policy terms and conditions. A copy of the policy is filed herewith. It is further admitted in the counter that the opposite party No.2 and 3 received claim intimation from the complainant on 03-04-2008, immediately on receipt of the claim intimation they deputed an independent Investigator to check the veracity of the claim. On detailed verification, the investigator has submitted his report wherein he has clearly stated that the depth of canal is only 3 feet and water comes up to 3 to 3 ½ feet. The deceased fell at the height of 4.6 feet, hence the question of drowning does not arise. The water canal is not a forced flow, it is like a ditch. The place of death is end point of canal and not in main route. On the basis of this report the claim of the complainant has been repudiated by the opposite party No.2 and 3 and rest of the things mentioned in the complaint are denied in toto. 6. On behalf of the opposite party No.1 a letter dt.27-12-2008 is filed wherein it is clearly mentioned about the dispatch of the material documents to opposite party No.2 and 3 for consideration for processing the claim. 7. On behalf of opposite party No.2 and 3 chief affidavit and written arguments filed. Counsel for opposite party No.1 represented to decide the case on merits. Learned counsel for complainant submitted his oral arguments. 8. Perused the oral and documentary evidence, upon which the points that arose for consideration are, 1) Whether the complainant is entitled to the amount covered under the policy? 2) To what relief? Point No.1:- 9. The undisputed facts of the case are that late Thammisetti Naga Lakshmi is a member of opposite party No.1 and membership card was given to her for 6 years. The opposite parties No.2 and 3 issued Personal Accident policy through opposite party No.1 covering the complainant for a period from 13-05-2007 to 12-05-2008. It is also not in dispute that the policyholder Thammisetti Naga Lakshmi had taken a policy through Road Safety Club, which was issued by opposite parties No.2 and 3 under a Master Policy for a sum of Rs.2,00,000/-. It is also not in dispute that the policyholder Thammisetti Naga Lakshmi died on 15-02-2008. It is also not in dispute that immediately after the death of the policyholder, Thammisetti Naga Lakshmi, the same was intimated to the opposite party No.2 and 3 for settlement of the claim. On being given such intimation to opposite parties No.2 and 3 an independent investigator was appointed by opposite parties No.2 and 3 to check the veracity of the claim. A report was submitted by the investigator wherein he has stated in his report that the canal is only 3 feet and water is up to 3 to 3½ feet only. It is not possible for a person sitting at a height of 4.6 feet to be drowned in the canal water. The place of death is end point of canal and not in main route. Hence the question of drowning does not arise. On the basis of this report, the claim of the complainant has been repudiated by the opposite parties No.2 and 3 on the ground that the deceased died due to her own negligence but not due to any accident. Now the dispute is only with regard to the cause of death of the deceased. On this aspect this case is concerned the learned counsel for the complainant refers to a number of documents among which a copy of P.M.E Report dated 16-02-2008 issued by District Head Quarters Hospital, Khammam and it is marked as Ex.A1. In P.M.E. report at relevant column the cause of death is clearly mentioned as the deceased died due to drowning. This is an important piece of evidence, which cannot be brushed aside. On the basis of the opinion of the Doctor, it became clear that the death of Thammisetti Naga Lakshmi is only due to drowning. Therefore it can be safely believed that the deceased died due to fall into the ditch, while washing the cloths near the canal and her death is only because of drowning. Therefore the contention of opposite parties No.2 and 3 that the deceased died due to her own negligence holds no water. This story of negligence is created by the opposite parties No.2 and 3 to cause loss to the complainant. Therefore the action on the part of opposite party No.2 and 3 in repudiating the claim of the complainant is held unjustified. There is any amount of evidence placed to substantiate the claim of the complainant that the deceased died due to drowning. This incident is nothing but an accidental death. Therefore the repudiation of claim on the part of the opposite party No.2 and 3 is untenable. In view of the above facts and circumstances the complaint is fit to be allowed. 10. In the result, the complaint is allowed, directing the opposite parties No.2 and 3 to pay an amount of Rs.2,00,000/- covered under the policy bearing No. TR.No.3517198 together with interest @9% p.a. from the date of repudiation of the claim i.e. 16-04-2009 till the date of deposit. Further ordered to pay an amount of Rs.2000/- towards costs. So far as the claim against opposite party No.1 is concerned, it is dismissed as opposite party No.1 is a proforma party and there is no negligence on the part of opposite No.1. Dictated to the steno, transcribed by her, corrected and pronounced by us in the open forum on this 7th day of December, 2010. PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM Appendix of Evidence Witnesses examined for complainant: - None- Witnesses examined for opposite parties: - None- Exhibits marked for complainant: Ex.A1:- Photo copy of P.M.E. Report, dt.16.02.2008 Ex.A2: - Reply letter dt.16.04.2009 Exhibits marked for opposite parties : - Nil - PRESIDENT MEMBER MEMBER DISTRICT CONSUMERS FORUM KHAMMAM | |
