BEFORE THE DISTRICT CONSUMER FORUM :: WARANGAL
Present : Sri D. Chiranjeevi Babu,
President.
And
Sri.Patel Praveen Kumar,
Male Member.
Wednesday, the 29th day of June, 2011.
CONSUMER COMPLAINT No.56/2010
Between:
1. Jogu Poolamma, W/o.J.Laxmaiah,
Age:38 years, Occu:Housewife
2. Jogu Trimmurthy, S/o.J.Laxmaiah,
Age:20 years, Occu:Student
3. Jogu Saritha, D/o.J.Laxmaiah,
Age:18 years, Occu:Student
4. Jogu Buchamma, W/o.J.Jogaiah,
Age:58 years, Occu:Household
All are R/o.Thativarivempally Village,
Kothaguda Mandal,
Warangal District. …Complainants
And
1. Road Safety Club Pvt.Ltd.,
Rep.by its Manager, 2A, Prakasam Road,
T.Nagar, Chennai – 600 017.
2. Reliance General Insurance Co. Ltd.,
Rep. by Manager, Regd.Office at 19,
Reliance Center, Walchand Harichand Marg,
Ballard Estate, Mumbai – 500 038.
3. Reliance General Insurance Co. Ltd.,
Rep.by its Branch Manager,
Office at J.P.N.Road, Warangal – 506 002. …Opposite Parties
Counsel for the Complainants :: Sri K.Kumaraswamy, Advocate.
Counsel for the Opposite Party No.1 :: Sri Y.Manohar Rao, Advocate.
Counsel for the Opposite Parties 2 & 3 :: Sri T.Ravinder Rao, Advocate.
This complaint is coming for final hearing before this Forum, the Forum pronounced the following order.
ORDER
Sri D. Chiranjeevi Babu, President.
This complaint is filed by the Complainants Jogu Poolamma, Jogu Trimurthy, Jogu Saritha & Jogu Buchamma against the Opposite Parties under section 12 of Consumer Protection Act, 1986 for a direction to pay Rs.2,00,000/- with interest @ 1% per month from the date of death of the deceased i.e. 29-05-2009, award damages of Rs.10,000/- and with costs.
The brief averments contained in the complaint filed by the complainant are as follows:
The case of the complainants is thatthe Complainant No.1 is the wife, Complainant No.2 is the son, Complainant No.3 is the daughter and Complainant No.4 is the mother of deceased Jogu Laxmaiah. The deceased Laxmaiah enrolled as member of Opposite Party No.2 on 10-08-2007 under Road Safety Club Programme vide Membership Certificate No.246135. The Opposite Party No.1 got insured its members with Opposite Party No.2 vide certificate of insurance bearing No.SC6/HA000041181 valid from 01-09-2008 to 31-08-2009, for which the complainant No.1 is made as assignee. As per policy, there is a coverage of accidental death of Rs.2,00,000/-. The said Laxmaiah died on 29-05-2009 due to sun stroke, for which Police, Gudur registered a case in Cr.No.107/09, u/s.174 Cr.P.C. The Complainant No.1 being assignee has submitted her claim form to Opposite Parties and requested to settle the claim, but there was no response from the Opposite Parties. Therefore the complainant got issued legal notice on 29-03-10 demanding the Opposite Parties 1 & 2 to pay policy amount of Rs.2,00,000/- with interest, for which no reply is received. The Opposite Party No.3 has made as party to the proceedings as it is local branch Office. The act of Opposite Parties amounts to deficiency of service. Hence filed this complaint praying to direct the Opposite Parties to pay Rs.2,00,000/- to the complainants covered under the above policy with interest @ 1 % p.m. from 29-05-2009 till realization, to award damages of Rs.10,000/- and costs.
The Opposite Party No.1 has not filed his Written Version, hence this Forum forfeited for filing the Written Version of the Opposite Party No.1.
The Opposite Parties 2 & 3 filed their Written Version stating that this Opposite Parties issued coverage for accidental death to the members of Road Safety Club and that the deceased Jogu Laxmaiah died due to Sun Stroke is admitted. After receiving of the claim intimation from the complainant after three months of the death of the deceased, the Opposite Parties verified the Police documents i.e. PME Report and claim form, wherein it is clearly mentioned that the deceased died due to Sun Stroke. The policy covers only for accidental death and in case the person dies with Sun Stroke the policy does not cover to risk of the deceased. The Opposite Parties in view of the deceased died due to Sun Stroke and it is not any accidental death rightly repudiated the claim of the complainants, since the claim, cannot be entertained and it is nothing but violation of policy conditions and accordingly this Opposite Parties sent a letter of repudiation dt:31-08-2009 to the complainants stating the reasons of repudiation and this Opposite Parties not at all liable for paying of any compensation to the complainants, since the deceased died due to Sun Stroke and the Opposite Parties requested this Forum to dismiss this case.
The complainants in support of their claim, filed the Affidavit of Complainant No.1 in the form of chief examination and also marked Exs.A-1 to A-14. On behalf of Opposite Parties N Mani & Md.Habeeb filed their Affidavits in the form of chief examination and also marked Exs.B-1 to B-5.
Now the point for consideration is:
1) Whether there is any deficiency of service on the part of the Opposite Parties?
2) If so, to what Relief?
Point No.1:-
After arguments of both side counsels, our reasons are like this:
At the time of arguments, the Opposite Party No.1 stated that the Opposite Party No.1 joined in Road Safety Club to get the members they want to contact the members and they were got tag of Insurance i.e. Opposite Parties 2 & 3. Accordingly, the deceased Jogu Laxmaiah got the membership in Road Safety Club i.e. Opposite Party No.1 and the deceased obtained the policy from Opposite Parties 2 & 3 through Opposite Party No.1. Since the deceased Jogu Laxmaiah died due to accidental death, the Opposite Party No.1 is not liable and the Opposite Parties 2 & 3 are liable.
The arguments of the Opposite Parties 2 & 3 are that the deceased died only due to Sun Stroke. So it does not comes under accidental death and also the Sun Stroke has not covered in conditions of the Insurance. So the deceased’s family i.e. L.Rs. are not entitled to get anything from the Opposite Parties 2 & 3.
Now this Forum has to see whether the Sun Stroke comes under the accidental death or natural death. This is the only one point involved in this case.
The complainants filed the Exs.A-1 to A-14. The Opposite Parties filed the Exs.B-1 to B-5, they are all Xerox copies i.e. Ex.B-1 is the Certificate of Insurance, Ex.B-2 is the Repudiation letter by Reliance General Insurance, Ex.B-3 is the First Information Report, Ex.B-4 is the Report of Post Mortem Examination and Ex.B-5 is the Personal Accident Insurance Claim Form of the deceased.
As per Ex.A-1 i.e. Membership Certificate and Ex.B-1 i.e. Certificate of Insurance, it is clear that the deceased Jogu Laxmaiah is the member of Road Safety Club and he obtained the insurance policy from Opposite Parties 2 & 3 through Opposite Party No.1. So the Exs.A-1 & B-1 clearly goes to show that the deceased Jogu Laxmaiah enrolled as member of Opposite Party No.2 on 10-08-2007 under Road Safety Club Programme vide Membership Certificate No.246135 and the Opposite Party No.1 got insured its members with Opposite Party No.2 vide certificate of insurance bearing No.SC6/HA000041181 valid from 01-09-2008 to 31-08-2009, the deceased Laxmaiah died on 29-05-2009 due to Sun Stroke. So at the time of death of the deceased Jogu Laxmaiah the insurance policy obtained by the deceased i is in force.
Ex.A-5 is First Information Report, Ex.A-6 is Inquest Report, Ex.A-7 is Report of Postmortem Examination of the deceased Jogu Laxmaiah and Ex.A-10 & Ex.B-5 are one and the same i.e. the Personal Accident Insurance Claim Form of the deceased, those clearly goes to show that the deceased died due to Sun Stroke. So on the basis of above documents, it is clear that the deceased Jogu Laxmaiah died only due to Sun Stroke.
As per version of the Opposite Parties, the Sun Stroke is not accidental, so they repudiated the claim of the complainants.
On the basis of the Citation in 2008 (1) CPR 96 (NC) filed by the complainant
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
Rita Devi @ Rita Gupta … Petitioner
Vs.
National Insurance Co.Ltd. and Others. … Respondents
Law of Insurance – Meaning of Accident – Whether the death caused by ‘cold wave’ is considered to be an ‘accidental death’ for the purpose of insurance cover? (Yes) Halsbury Laws of England and (2002) 3 BLJ 26, (2003) 2 BLJ 407 relied on.
And in the same Judgment the National Commission clearly stated about the Sun Stroke. Further they stated that the Sun Stroke comes under accidental death. In the same judgment, they held with regard to the Sun Stroke i.e.
Held Further: From the aforesaid law developed in other countries and in this country, it is clear that the injury or death caused by lightning, sun-stroke or earthquake has been held to be accidental. Further, where a man in the course of his work is exposed to excessive heat coming from a boiler and becomes exhausted and death occurs, it would be an accidental death. Similarly, a person working in an icy cold water and thereafter, sustains pneumonia which causes his death, such death is also considered to be an accidental death. Similarly, if the assured is seized by a fit and drowns or falls in front of a train and killed, death is due to external cause and is an accidental death. Death resulting from the threats by miscreants is also considered to be an accidental causes by external violence and visible means. In substance, death which does not occur in the usual course or natural course of events or events/causes which could not be reasonably anticipated is considered to be accidental one. Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect and it is by natural external violent force. Further, ‘cold wave’ is an untoward even which is not expected or designed, and an ordinary man could not expect the occurrence.
So as per the judgment of National Commission, it is clear cut that the Sun Stroke comes under accidental. In the present case also as per the documents filed by the complainants as well as Opposite Parties, it is clear that the deceased died only due to Sun Stroke. So when the deceased died due to Sun Stroke, certainly the Sun Stroke comes under accidental death. When it comes under accidental death, i.e. as per the judgment of National Commission, certainly the Opposite Parties are liable to pay the compensation to the complainants because the deceased died due to Sun Stroke and the Sun Stroke comes under accidental death.
For the foregoing reasons given by us, we come to the conclusion that the Sun Stroke is comes under accidental death. So we already gave reasons with regard to the accidental death of Sun Stroke and the Sun Stroke comes under accidental death. So the Opposite Parties are liable to pay the compensation to the complainants. Since the Opposite Party No.1 is formal Party and the Opposite Party No.1 joined the deceased i.e. Jogu Laxmaiah as member through Opposite Party No.1 only. The deceased Jogu Laxmaiah insured from Opposite Parties 2 & 3, so the Opposite Party No.1 is nothing and the Opposite Party No.1 is not liable to pay anything and accordingly this first point is decided in favour of the complainants against the Opposite Parties 2 & 3.
Point No.2: To what Relief:- The first point is decided in favour of complainants against the Opposite Parties 2 & 3 this point is also decided in favour of complainants against the Opposite Parties 2& 3.
In the result, this complaint is allowed and we direct the Opposite Parties 2 & 3 jointly and severally to pay an amount of Rs.2,00,000/- (Rupees Two lakhs only) to the complainants along with interest @ 7.5% p.a. from the date of filing of the complaint i.e. 17-09-2010 till the date of deposit. The Opposite Parties 2 & 3 are also directed to pay an amount of Rs.500/- (Rupees five hundred only) towards costs. The complainants 1, 2 & 3 are entitled to get an amount of Rs.60,000/- (Rupees sixty thousand) each and the complainant No.4 is entitled to get an amount of Rs.20,000/- (Rupees twenty thousand only).
A month’s time is granted to the Opposite Parties 2 & 3 for the compliance of the order.
The claim against the Opposite Party No.1 is dismissed without costs.
(Dictated to the Stenographer, transcribed by her, corrected and pronounced by us in the open Forum today, the 29th June, 2011).
President Male Member
District Consumer Forum, Warangal
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
On behalf of Complainants On behalf of Opposite Parties
Affidavit of complainant No.1 filed. Affidavits of Opposite Parties filed.
EXHIBITS MARKED
ON BEHALF OF COMPLAINANTS
1. Ex.A-1 is the Original Membership Certificate of Joga Laxmaiah issued by Opposite Party
No.1
2. Ex.A-2 is the Certificate of Insurance of Joga Laxmaiah issued by Opposite Party No.2.
3. Ex.A-3 is the Xerox copy of Certificate of Insurance of Joga Laxmaiah issued by Opposite Party No.2.
4. Ex.A-4 is original Death Certificate of Joga Laxmaiah.
5. Ex.A-5 is the Xerox copy of First Information Report.
6. Ex.A-6 is the Xerox copy of Inquest Report.
7. Ex.A-7 is the Xerox copy of Report of Post Mortem Examination of the deceased
Jogu Laxmaiah.
8. Ex.A-8 is the Xerox copy of Household Card and Telugu News Paper Ad dt:04-06-2009.
9. Ex.A-9 is the Document Checklist issued by Opposite Parties 2 & 3.
10. Ex.A-10 is the Xerox copy of Personal Accident Insurance Claim Form issued by
Opposite Parties 2 & 3.
11. Ex.A-11 is the Medical Certificate.
12. Ex.A-12 is the Legal Notice dt:29-03-2010 issued to the Opposite Parties 1 & 2 from the complainants counsel.
13. Ex.A-13 are the Postal Receipts (3).
14. Ex.A-14 are the Acknowledgements (2).
ON BEHALF OF OPPOSITE PARTIES
1. Ex.B-1 is the Xerox copy of Certificate of Insurance by Opposite Party No.2 along with
Membership Certificate.
2. Ex.B-2 is the letter dt:31-08-2009 to the complainant No.1 from the Opposite Parties 2 & 3.
3. Ex.B-3 is the First Information Report.
4. Ex.B-4 is the Report of Post Mortem Examination of the deceased Jogu Laxmaiah.
5. Ex.B-5 is the Xerox copy of Personal Accident Insurance Claim Form issued by
Opposite Parties 2 & 3.
PRESIDENT
