BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri. T.SundaraRamaiah, B.Com B.L., President

And

Sri. M.Krishna Reddy, M.Sc., M.Phil., Male Member

And

Smt. S.Nazeerunnisa, B.A., B.L., Lady Member

Wednesday the 18^th day of May, 2011

C.C.No.56/10

BETWEEN:

Smt. G.Bhgaya Lakshmi, W/o. Late G.VenkataSwamy Reddy,

H.No.80-36-A3, Krishna Nagar, Kurnool - 518002.   

    …Complainant

                                         -Vs-

1. Senior Divisional Manager, National Insurance Company Limited,

        National Insurance Building, Ground Floor, 8, Indian exchange place, Kolkata.

    2. Managing Director,Golden Multi Services Club Limited,

        S.B.Mansion, 16,         R.N. Mukherjee Road, Kolkatta -700001.

1. Branch In-charge, Golden Multi Services Club Limited,

H.No.40/384, U-con Plaza, Kurnool - 518002.                                

…Opposite Parties

This complaint is coming on this day for orders in the presence of Sri P.SivaSudarshan, Advocate for complainant and Sri D.A.AneesAhamed, Advocate for opposite party No.1 and opposite party No.2 as called absent and Sri M.Azmathulla, Advocate for opposite party No.3 for upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri. M.Krishna Reddy, Male Member)

                                      C.C. No. 56/10 

1.     This complaint is filed by the complainant under section 11 and 12 of C. P. Act, 1986 seeking a direction on opposite parties for the payment of :-

(a)    Insured amount of Rs.1,00,000/- with interest @ 24% P.A.;

1. Rs.20,000/- as compensation for mental agony;

1. Rs.500/-towards the cost of the case;

2.     The complainant’s case is that her deceased husband took a group insurance policy bearing No.100300/42/04/68200012 dated 23/07/2004 covering the period of from 23/07/2004 to 22/07/2014, appointing the complainant as his nominee.  It is the case of the complainant that on the ill-fated date i.e.05/09/2006 at about 22.30hours, the complainant’s husband accidentally had fallen on scattered stones at a building under construction.  As a result of the fall he sustained head injury besides other mute injuries.  He was taken to the Government General Hospital where he was declared brought dead.  The complainant being a nominee approached the opposite parties for the payment of the policy amount.  Despite repeated reminders, the opposite parties did not pay the said amount even though two years had elapsed.  For this reason the complainant approached this Forum for the issue of suitable directions to the opposite parties to comply her just amount.

3.     To substantiate her claim the complainant filed sworn affidavit and certain relevant documents marked in the case as Ex.A1 to A8.

4.     This claim of the complainant is sought to be resisted mainly on the ground that the opposite party is not liable as the insured person had fallen on the stones under the influence of intoxicating liquor.  This debars her claim as per clause 1 (d) of the policy. In support of the cause of death due to the intoxicated condition of the deceased, the opposite party relies on the F.I.R. in Crime No.48/2006 and that being preliminary information which refers to this fact has to be accepted.  For this reason the opposite party No.1 prayed that the complaint is liable to be dismissed.

5.     In support of his version opposite party No.1 filed sworn affidavit and documents marked as Ex.B1 to B7.

6.     Opposite party No.2 and opposite party No.3 are Managing Director and Branch Incharge of Golden Multi Service Club Limited respectively.  The stand taken by them is that they being forwarding organizations have no role either in settlement or repudiation of the claim.  Further they had also sent remainders regarding the claim of the complainant.  And hence rightly no claim is made against them.

7.     Both parties submitted their written arguments. 

8.     Hence the points for consideration are:

a.     Whether the complainant has made out any case to prove the deficiency of service on the part of opposite parties?

b.     Whether the complainant is entitled to the reliefs as prayed for?

c.      To what relief?

9.      POINTS 1 and 2 :-  From the averments made in the claim petition and the denial of entitlement as pleaded by the opposite party No.1, the cause of death assumes Primary importance. The fatal fall of the deceased resulting in his instant death was due to accidental fall or influenced by intoxication of any intoxication inducing substance. There is abundant evidence as manifested from the documents filed by the complainant may be noticed.  The written complainant Ex.A4, given by the son of the deceased clearly refers to the accidental fall as informed to him by the persons who had actually witnessed the fall.  So he is not direct witness to the fatal fall of the deceased.  Ex.A5 the Post Mortem Report which is the Primary document as to the cause of death, does not refer to any trace of intoxication substance in the abdomen or other parts of the body, that clearly establishes that the death was due to accidental fall.  Even the final report Ex.A7, submitted by the S.H.O. based on the P.M.R. (Ex.A5) intimated to the M.R.O. also confirms that the death was “due to accidental fall on the ground”.  The F.I.R., Ex.A3 relied upon by the opposite party No.1 to establish the cause of death due to the fall as induced by intoxication does not find support either from the report of the son of the deceased, on the basis of which F.I.R. was issued or the subsequent important documents such as P.M.R. and the very closure of the report, do not refer to any intoxicated condition.   Thus the F.I.R. does not commend itself as worth of acceptance, as it lacks any factual support either in the report given by the son of the deceased or any other documents.  Hence the Forum is of the opinion that the complainant has established the case of the claim.  In view of the findings reached above, the complainant is entitled for the payments as claimed by her.

10.    POINT No.3:-The claim of insured amount of Rs.1,00,000/- is allowed with interest of 9% P.A. from the date of repudiation of the claim till the date of realization.  The long delay in refusing the claim, despite the repeated reminders sent to opposite party No.1 has caused mental agony.  Suchinstitutional delays have to be frowned up on.

11.    In the result the complaint is allowed directing opposite party No.1 to pay Rs.1,00,000/- with interest at 9% P.A. from the date of rejection of the claim to the date of realization.  Rs.5,000/- as compensation for mental agony and Rs.500/- as cost of the case.  The case against opposite parties 2 and 3 is dismissed.  The time for the compliance is one month from the date of receipt of this order.

Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the day 18^th of May, 2011.

Sd/-                     Sd/-                              Sd/-

MALE MEMBER                      PRESIDENT                   LADY MEMBER

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant : Nil            For the opposite parties:Nill

List of exhibits marked for the complainant:-

Ex.A1                Claim repudiation letter ofopposite party No.1

dated 11-03-2008.

Ex.A2.       Letter of opposite party No.2 dated 30-10-2006.

Ex.A3                Photo copy of FIR NO.48/2006 dated 06-09-2006,

of I Town Police Station Kurnool.

Ex.A4                Photo copy of inquest report dated 06-09-2006.

Ex.A5                Photo copy of Post Mortem report dated 06-09-2006.

Ex.A6        Photo copy of Policy No.100300/42/04/8200012 of

GoldenMulti Services Club Limited, dated 23-07-2004.

Ex.A7                Photo copy of letter issued by Sub-Inspector of Police,

                I Town Police Station Kurnool.

Ex.A8        Proceedings of the Mandal Executive Magistrate and

                Revenue Officer, Kurnool, dated 14-04-2007.

List of exhibits marked for the opposite parties:-

Ex.B1                Photo copy of Memorandum of understanding

dated 02-04-2004 between opposite party No.1 &

opposite party No.2.

Ex.B2                Photo copy of letter dated 17-07-2001 issued by

opposite party No.1.

Ex.B3                Photo copy of Claim Form, dated 19-10-2006.

Ex.B4        Photo copy of Letter dated 30-10-2006 and endorsement of opposite party No.1.

Ex.B5                Photo copy of Reminder letter dated 15-01-2007.

Ex.B6                Photo copy of Reminder letter dated 22-03-2007.

Ex.B7                Photo copy of Reminder letter dated 27-04-2007.

Sd/-                              Sd/-                     Sd/-

MALE MEMBER                      PRESIDENT                 LADY MEMBER

// 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  :

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Copy was dispatched on               :