BEFORE THE DISTRICT CONSUMER FORUM AT NALGONDA
PRESENT: SRI MAMIDI CHRISTOPHER,
PRESIDENT.
SMT.S.SANDHYA RANI,
FEMALE MEMBER.
. . .
TUESDAY, THE SEVENTEENTH DAY OF DECEMBER, 2019
CONSUMER COMPLAINT No. 25 OF 2018
Between:
- Smt. Govinda Rajula Radha Kumari W/o Govinda Rajula Venkata Shobhana Chalapathi Rao Age: 51 years, Occ:Housewife.
- Govinda Rajula Venkata Sai Sree Keerthi D/o Govinda Rajula Venkata Shobhana Chalapathi Rao, Age: 22 years, Occ:Student
Both are R/o Srinagar Colony, Nalgonda Town,
Nalgonda District.
…COMPLAINANTS.
AND
- The Advocates Mutually Aided Cooperative Society Ltd.,
City Civil Court, at Hyderabad.500002, T.S.
Represented by its Authorized Person/The Secretary.
- The United India Insurance Co. Ltd, Corporate Cell, 3rd Floor,1-7-21/1D, Ramalayam, Saroginidevi Road, P.B. No. 1651, Secunderabad, 03.T.S. Represented by its Regional Manager.
- The United India Insurance Co. Ltd, Suryapet Branch,
Door No. 1-4-150, 1st Floor, Near Old Municipal Office,
K.K. Road, Suryapet Town & District.-508213, T.S.
Represented by its Branch Manager.
…OPPOSITE PARTIES.
This complaint coming on before us for final hearing, in the presence of Sri G.Krishna Reddy, Advocate for the Complainants, and Sri M.Shankar, Advocate for the Opposite Parties No.2 and 3, and the Opposite Party No.3 having been called absent, and on perusing the material papers on record, and having stood over for consideration till this day, the Forum passed the following:
ORDER OF THE FORUM DELIVERED
BY SRI MAMIDI CHRISTOPHER, PRESIDENT
1. This complaint is filed by the Complainants, U/S 12 of the Consumer Protection Act, 1986 to direct the Opposite Parties to pay
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insured amount of Rs.10,00,000/- with interest @ 24% p.a. from the date of death of the insured deceased till the date of realization along with costs.
2. The facts of the case as disclosed from the complaint are as follows:
The husband of Complainant No.1 Sri GVS Chalapathi Rao was practicing as Senior Advocate at Hyderabad city and Nalgonda town and he is the Member in the Advocates Mutually Aided Co-operative Society Ltd., Hyderabad. The husband of the Complainant No.1 obtained Group Personal Accident Policy from the Opposite Party No.1 on 03/12/2015 through Opposite Party No.2, vide Policy No.5005004215P110982359 and the said policy was valid from 03/12/2015 to 02/12/2016. As per the Policy, if an Advocate Member dies accidentally, his nominee would be entitled for an amount of Rs.10,00,000/-. The policy was issued to all the Advocates Members of Opposite Party No.1 without taking any health conditions of the insured. The husband of the Complainant No.1 was a good healthy person and he had actively practicing as Senior Advocate in all courts. The husband of the Complainant No.1 Sri GVS Chalapathi Rao died accidentally on 30/06/2016 at Rohini Super Speciality Hospital, Hanamkonda due to sudden heart attack and the same was occurred while he was taken into operation theatre for Spinal Fusion Procedure/Operation at 8-00 a.m., on 30/06/2016. After the death of the deceased, the Complainants submitted the claim form along with all the required papers. Sudden heart attack is also comes under accidental death as per the citation of the Hon’ble National
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Commission, New Delhi, CPJ 2007 (4) NC 355. The Opposite Parties failed to pay the claim amounts under the Group Personal Accident Policy and repudiate the claim of the Complainants on 22/05/2018 on the ground that ‘Sudden Heart Attack not comes under accidental death’. The Complainants got issued legal notice to the Opposite Parties on 06/06/2018 to pay the claim amounts under the above said policy. The brother of Complainant No.1 lodged a complaint before the Police, Nalgonda-II Town, against the doctors and Managing Directors of Rohini Super Speciality Hospital, Hanamkonda on 01/07/2016, stating that the deceased Sri GVS Chalapathi Rao died due to medical negligence. The Police, Nalgonda-II Town, registered a case in Cr.No.192/2016 and conducted inquest and they had sent the viscera of the deceased and got TSFSL Report from the concerned department and later they had issued the FSL Report and PME Report to the Complainants. The said FSL Report also reveals that the death of the deceased life assured was occurred due to sudden heart attack. The Police, Nalgonda-II Town had sent the crime papers to the Police Station, Subedari, Warangal Commissionerate for further enquiry. The Complainants being the legal heirs of the deceased are entitled for an amount of Rs.10,00,000/- with interest from the date of death of the deceased as per the terms and conditions of the policy. The ground on which the repudiation made by the Opposite Parties is a baseless ground and it is not valid. The acts of the Opposite Parties amounts to deficiency of service on their part and as such the Complainants filed this complaint.
3. The Complainant No.1 filed her proof affidavit and marked Exs.A-1 to A-20.
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4. On receiving the notice, the Opposite Party No.1 failed to appear before this Forum and called absent.
5. The Opposite Parties No.2 and 3 filed written version. In their written version, the Opposite Parties No.2 and 3 denied all the averments and allegations made by the complainants in the complaint. The Opposite Parties No.2 and 3 admitted they had had issued Group Personal Accident Policy bearing No.5005004215P110982359 for the period from 03/12/2015 to 02/12/2016 to the Opposite Party No.1 to its members which include Sri G.V.S.Chalapathi Rao, subject to scope, policy terms and conditions in pursuance of proposal form submitted by Opposite Party No.1, which is the basis of contract. The scope of the policy is death due to accident and the definition of accident as per the policy terms and conditions is “an accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means”, but the policy does not cover death due to heart attack. The Opposite Parties No.2 and 3 denied that Sri GVS Chalapathi Rao was well and good healthy person, in fact GVS Chalapathi Rao was suffering from spinal problem. The Opposite Parties No.2 and 3 denied that the said GVS Chalapathi Rao died due to heart attack while he was taken into operation theatre for the purpose of spinal fusion procedure/operation. With regard to the citation in National Commission in CPJ 2007 (4) NC 355 submitted by the Complainants is not good law in view of ruling of Hon’ble Apex Court reported in AIR 1966 SC 1644, AIR 1999 SC 3252, AIR 2004 SC 4794, (2010) 10 SCC 567 and (2016) 3 SCC 49. The death due to mere heart attack is outside the scope of the policy terms and conditions. The Opposite Parties No.2 and 3 denied that the said GVS Chalapathi Rao was well and good healthy person prior to the
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issuance of the policy, but the said averment is contrary to the contents of police complaint, dated 01/07/2016 given by K.V.Janardhan Rao (brother-in-law of GVS Chalapathi Rao) to Police Station, Nalgonda-II Town, which was registered under F.I.R.No.196/2016. In the claim form submitted by the Complainant No.1 and even in the present complaint there is no whisper about cause of death due to external, visible and violent means, and, therefore, the Opposite Party No.2 has rightly repudiated the claim submitted by the Complainant No.1 and it is in consonance with the definition referred to as per the terms and conditions of the policy. There is no deficiency in service on the part of the Opposite Parties No.2 and 3 and they are not liable to pay the amounts as claimed in the complaint. Ultimately, the Opposite Parties No.2 and 3 prayed for the dismissal of the complaint.
6. Smt.Ch.Kalyani, Manager, United India Insurance Co.Ltd., filed her proof affidavit on behalf of the Opposite Parties No.2 and 3 and marked Exs.B-1 and B-2. Written arguments were filed on behalf of the Opposite Parties No.2 and 3.
7. The points for consideration are:
1) Whether there was deficiency in service on the part of the
Opposite Parties No.1 to 3?
2) Whether the Complainants are entitled for the claims
they made in their complaint?
3) If so, to what extent?
8. POINT No.1:
It is not in dispute that the husband of Complainant No.1 Sri GVS Chalapathi Rao was the Member of Opposite Party No.1 and he
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got Group Personal Accident Policy from the Opposite Party No.1 on 03/12/2015 through Opposite Party No.2, vide Policy No.5005004215P110982359 and the said policy was valid from 03/12/2015 to 02/12/2016. As per the Policy, if an Advocate Member dies accidentally, his nominee or nominees would be entitled for an amount of Rs.10,00,000/-. According to the Complainants, the deceased Sri GVS Chalapathi Rao was a good healthy person and he had actively practicing as Senior Advocate in all courts and he died accidentally on 30/06/2016 at Rohini Super Speciality Hospital, Hanamkonda due to sudden heart attack and the same was occurred while he was taken into operation theatre for Spinal Fusion Procedure/Operation at 8-00 a.m., on 30/06/2016. After the death of the deceased, the Complainants submitted the claim form along with all the required papers, that sudden heart attack also comes under accidental death as per the citation of the Hon’ble National Commission, New Delhi, CPJ 2007 (4) NC 355. The Opposite Parties repudiated the claim of the Complainants on 22/05/2018 on the ground that ‘Sudden Heart Attack does not come under accidental death’. The Complainants got issued legal notice to the Opposite Parties on 06/06/2018 to pay the claim amounts as they are entitled for the same. The brother of Complainant No.1 lodged a complaint before the Police, Nalgonda-II Town, against the doctors and Managing Directors of Rohini Super Speciality Hospital, Hanamkonda on 01/07/2016, stating that the deceased Sri GVS Chalapathi Rao died due to medical negligence. The Police, Nalgonda-II Town, registered a case in Cr.No.192/2016 and conducted inquest and they had sent the viscera of the deceased and got TSFSL Report from the concerned department. The said FSL Report also reveals that the death of the
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deceased life assured was occurred due to sudden heart attack. The Complainants being the legal heirs of the deceased are entitled for an amount of Rs.10,00,000/- with interest from the date of death of the deceased under Group Personal Accident Policy.
9. The Opposite Parties No.2 and 3 admitted that the deceased had obtained Group Personal Accident Policy, vide Policy No.5005004215P110982359, which was valid from 03/12/2015 to 02/12/2016. The Opposite Parties No.2 and 3 denied that the deceased Sri GVS Chalapathi Rao died accidentally and submitted that he died due to heart attack while he was taken to operation theatre for the purpose of spinal fusion procedure/operation. According to the Opposite Parties No.2 and 3, the scope of the policy is death due to accident and the definition of accident as per the policy terms and conditions is “an accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means”, but the policy does not cover death due to heart attack. The Opposite Parties No.2 and 3 submitted that the citation in National Commission in CPJ 2007 (4) NC 355 submitted by the Complainants is not good law in view of ruling of Hon’ble Apex Court reported in AIR 1966 SC 1644, AIR 1999 SC 3252, AIR 2004 SC 4794, (2010) 10 SCC 567 and (2016) 3 SCC 49. The Opposite Parties No.2 and 3 submitted that the averments made in the complaint is contrary to the contents of police complaint, dated 01/07/2016 given by K.V.Janardhan Rao (brother-in-law of GVS Chalapathi Rao) to Police Station, Nalgonda-II Town, which was registered under F.I.R.No.196/2016. The Opposite Parties No.2 and 3 submitted that the death due to heart attack is not due to sudden, unforeseen and involuntary event caused by external, visible and
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violent means. The Opposite Parties submitted that the claim form submitted by the Complainant No.1 and even in the present complaint there is no whisper about cause of death due to external, visible and violent means, and, therefore, the Opposite Party No.2 have rightly repudiated the claim submitted by the Complainant No.1, as per the terms and conditions of the policy.
10. Ex.A-3 is the Medical Certificate of Cause of Death, issued by Rohini Super Speciality Hospitals, Hanamkonda, wherein the cause of death was mentioned as ‘sudden cardio respiratory arrest due to hypertension’. Exs.A-8 FSL Report and A-9 PME Report also reveals that the deceased died due to cardiac arrest. Ex.A-12 is the Enquiry Report filed by team of doctors, who conducted enquiry in Cr.No.401/2016 of PS.Subedari, wherein it was stated that ‘there was no negligence on the part of the team of doctors, and the patient died due to sudden cardiac arrest’. Ex.A-13 is the Final Report, wherein the finding given by the doctor reveals that as per Bolan Test as mentioned in the Supreme Court Judgments, gave a finding by way of opinion that the death of the deceased is not on account of the negligence of doctors attended the surgery to the deceased, but the death is only due to cardiac arrest. Ex.B-1 is the Group Personal Accident Policy, and as per the terms and conditions of the said Policy, if any person sustain any bodily injury resulting solely and directly from accident caused by external violent and visible means, then the company shall pay to the insured or his legal personal representatives as the case may be, the sum or sums in respect of any of the insured persons specified in the schedule. Ex.B-2 is the Medical Certificate of Cause of Death, issued by Rohini Super Speciality Hospitals,
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Hanamkonda, wherein the cause of death was mentioned as ‘sudden cardio respiratory arrest due to hypertension’. As per the Exhibits filed by the Complainants and the Opposite Parties No.2 and 3, reveals that there is absolutely no whisper about cause of death of the deceased Sri GVS Chalapathi Rao due to external, visible and violent means, and all the exhibits confirms the death of the deceased only by ‘Cardiac Arrest’, i.e. natural death.
11. In support of the case of the Complainants, the counsel for the Complainants filed the following citations:
1) IV (2007) CPJ 355 (NC)
2) III (2018) CPJ 471 (NC)
3) II (2016) CPJ 364 (NC)
4) IV (2017) CPJ 51 (Punjab State Commission)
5) I (2019) CPJ 441 (NC).
The above citations/findings of the Hon’ble National Commission and Hon’ble Punjab State Commission are not applicable to the case of the Complainants.
12. In a decision reported in Alka Shukla Vs.LIC of India (Supreme Court of India) 67, [Civil Appeal No.3413/2019], the Hon’ble Supreme Court observed that:
Consumer Protection Act, 1986 – Sections 2(1) (g), 23 – Insurance (Life) – Death claim – Heart attack – Accident benefit denied on ground that death was not due to accident – Deficiency in service – District Forum allowed complaint – State Commission Dismissed appeal – National Commission allowed revision – No material on record to indicate that assured sustained specific injuries as a result of a fall from motorcycle or that injuries were caused by
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outward, violent and visible means, which was the sole and proximate cause of his death – No direct nexus or causation between assured suffering a heart attack and injuries sustained in an accident by outward, violent and visible means – Medical evidence on record is itself proof that insured died due to a heart attack and not due to an accident of falling from the motorcycle – Heart attack had a distinc effect of the insured falling off from his motorcycle – Assured died as a result of a heart attack which was not attributable to the accident – Repudiation justified.
13. In the present case, the Complainants have failed to prove that the deceased died accidentally to claim the amounts under Group Personal Accident Policy.
14. In support of their contention, the Opposite Parties No.2 and 3 filed the following citations:
- AIR 1966 SC 1644.
- AIR 1999 SC 3252.
- AIR 2004 SC 4794.
- AIR 2010 SCW 6490.
- AIR 2016 SC 363.
- AIR 2019 SC 2088.
15. POINTS No.2 and 3:
In the light of the findings under Point No.1 and in the light of the findings of the Hon’ble Supreme Court in the above stated citations, the Complainants are not entitled for the claims under Group Personal Accident Policy.
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In the result, the complaint is dismissed without costs.
Dictated to Steno-Typist, transcribed by him, corrected and pronounced by us in the open Forum on this 17th day of December, 2019.
FEMALE MEMBER PRESIDENT
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For Complainants: For Opposite Parties:
Affidavit of the Complainant No.1 Affidavit of the OP.Nos.2 &3.
EXHIBITS MARKED
For Complainants:
Ex.A-1 Dt.27/04/1989 Xerox copy of Certificate, issued by
Bar Council of Andhra Pradesh, Hyderabad.
Ex.A-2 Dt.03/12/2015 Xerox copy of Group Personal Accident
Policy.
Ex.A-3 Dt.30/06/2016 Xerox copy of Medical Certificate of cause of
Death, issued by Rohini Hospitals,
Hanamkonda.
Ex.A-4 Dt.30/06/2016 Xerox copy of Death Report of the insured
GVS.Chalapathi Rao.
Ex.A-5 Dt.12/07/2016 Xerox copy of Death Certificate, issued by
Municipal Corporation, Warangal.
Ex.A-6 Dt.01/07/2016 Xerox copy of F.I.R. in Cr.No.192/2016
of P.S.Nalgonda-II Town.
Ex.A-7 Dt.01/07/2016 Xerox copy of Inquest Report.
Ex.A-8 Dt.28/02/2017 Xerox copy of FSL Report.
Ex.A-9 Dt.01/07/2016 Xerox copy of P.M.E. Report.
Ex.A-10 Dt.08/12/2016 Xerox copy of F.I.R. in Cr.No.401/2016
of PS.Subedari.
Ex.A-11 Dt.09/02/2017 Xerox copy of Letter issued by
Superintendent, MGM Hospital, Warangal
to the Inspector of Police, Subedari P.S.
Ex.A-12 Dt.23/01/2017 Xerox copy of Enquiry Report, issued by
MGM Hospital, Warangal.
Ex.A-13 Dt.16/07/2017 Xerox copy of Final Report in FIR No.401/16
of PS.Subedari.
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Ex.A-14 Dt.16/04/2018 Xerox copy of Claim Form.
Ex.A-15 Dt.22/05/2018 Xerox copy of Repudiation Letter.
Ex.A-16 Dt.06/06/2018 O/c of legal notice issued by the counsel for
the Complainants to the Opposite Parties.
Ex.A-17 Dt.06/06/2018 Bunch of Postal Receipts and
Acknowledgment Cards.
Ex.A-18 Dt.22/12/2016 Xerox copy of Family Members Certificate.
Ex.A-19 Xerox copy of Aadhar Card of the
Complainant No.1.
Ex.A-20 Xerox copy of Aadhar Card of the
Complainant No.2.
For Opposite Parties No.2 & 3:
Ex.B-1 Dt.03/12/2015 Attested copy of Group Personal Accident
Policy bearing No.5005004215P110982359.
Ex.B-2 Dt.30/06/2016 Xerox copy of Medical Certificate of cause of
Death, issued by Rohini Hospitals,
Hanamkonda.
For Opposite Party No.1:
Nil.
PRESIDENT
DISTRICT CONSUMER FORUM
NALGONDA
