BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Monday the 28th day of July, 2008
C.C.No. 102/08
Between:
Smt. P. Janakamma,
W/o. Late Sri. P.Pullaih,
H.No.17-637,
Kranthi Nagar,
Kallu Bhavi Village,
Adoni – 518301
Kurnool District. … Complainant
Versus
The Brach Manager,
The Oriental Insurance Company Limited,
Satheesh Buildings,
12/511, 1st Floor,
P.B.No.6,
Municipal Main Road,
Adoni -518301. … Opposite party
This complaint is coming on this day for orders in the presence of Sri. P. Siva Sudharshan, Advocate, for the complainant, and opposite party is called absent set exparte and upon perusing the material papers on record, the Forum made the following
ORDER
(As per Smt. C. Preethi, Lady Member)
C.C.No.102/08
1. This consumer complaint of the complainant is filed U/s 11 and 12 of C.P.Act, seeking a direction on opposite party to pay a sum of Rs.l lakh towards policy amount with interest, Rs.10,000/- as compensation, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant is the wife of the deceased P.Pullaiah who has taken an Individual Nagarik Suraksha Policy from opposite party and the opposite party also issued a certificate bearing No.2005/191 infavour of the insured . The policy commenced from 2-11-2004 to 1-11-2005 . The complainant husband on 1-6-2005 accidentally fell down from the first floor to ground floor in BJP office and was immediately shifted to Government General Hospital, Adoni and for better treatment shifted to Government General Hospital, Kurnool and on the same day he died due to injuries. The complainant as the wife of the deceased P. Pullaiah informed the death of Pullaiah to opposite party and submitted claim form along with relevant documents . But the opposite party repudiated the claim on 28-6-2006 stating that “the insured died due to chest pain and vomiting, unconscious position resulting to death which is not covered under the policy terms and conditions the policy covers accidental death claim only” the complainant submits that the repudiation by the opposite party is unreasonable and un lawful and the deceased pullaiah died due to accidental death fell down from the building and the said fact was published in all newspapers . The Act of repudiation by the opposite parties constrained the complainant to resorted to the forum for reliefs.
3. In support of her case the complainant relied on the following documents viz., (1) policy copy issued to P.Pullaiah bearing No.2005/191 , (2) death certificate of P.Pullaiah , (3) claim form along with covering letter of Government General Hospital, dated 7-3-2006 and (4) repudiation letter dated 28-6-2006 of opposite party addressed to complainant ,besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex.A1 to A4 for its appreciation in this case and replies to the interrogatories exchanged.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties even after receipt of notice did neither appeared before the forum nor filed any written version. Hence the opposite party was made exparte on 21-7-2008.
5. Hence, the point for consideration is to what relief the complainant is entiled alleging deficiency of service on part of opposite parties.
6. It is the case of the complainant that her husband P.Pullaiah has taken Individual Nagarik Suraksha Policy from opposite party which commenced from 2-12-2004 to 1-11-2005 vide Ex.A1. The Ex.A1 also envisages the total sum insured as Rs.1 lakh and the premium paid was Rs.90/- the policy holder P.Pullaiah died on 1-6-2005 due to fall from first floor to ground floor in BJP office ,Adoni and taken to Government General Hospital , Kurnool for better treatment , where the policy holder died due to injuries. The complainant vide Ex.A3 submitted claim form to opposite parties stating that her husband died due to fall from first floor and made a claim for Rs.1 lakh, along with a covering letter of Government General Hospital where in it was stated that the policy holder P.Pullaiah was brought for treatment on 1-6-2005 and died on 1-6-2005. The claim form in Ex.A3 was filled by Doctor K.B. Vijaya Mohan Reddy, who at Clause No.3 stated that the deceased P.Pullaiah accident fall down from first floor to ground floor and the nature of injury was stated as grievous multiple injuries and died tue to said injuries. Hence, from the above it is clear that the policy holder P.Pullaiah died due to accidental fall only.. The Ex.A4 is a repudiation letter dated 28-6-2006 of opposite party to complainant wherein it repudiated the claim of the complainant stating that the complainant did not submit FIR Post mortem report, Hospital discharge summary sheet which are mandatory for settlement of the claim . But as per the decision of Honorable A.P.State Commission reported in 2000 ALD II Pg.96 wherein it was held that when the death is not of suspicious one obtaining FIR and other documents does not arise , the other decision of our Honorable A.P.State Commission reported in 2004 CPJ Pg.126 wherein it was held that the insured died to house collapse, filling of police complaint is not necessary and the company under the policy is liable to pay insured amount .In the present case, the deceased died due to accidental fall, as the death is not suspicious one, no police complaint was given about the death and no FIR and post mortem certificate was filed. The complainant contends that as the death was accidental there is no necessity to give any police complaint against any body.
7. In the light of the above admitted facts the repudiation by the opposite parties insisting on production of FIR and post mortem certificate appears to be a plea to escape their liability under the policy . To sum up the above discussion and relying on the decision of our State Commission and material on record the complainant is certainly remaining entitled to the policy amount with costs. The main objection of the opposite party is that the deceased death is not accidental but no material is placed to prove the said allegations. Hence the opposite parties cannot escape their liability under the above policy and they are liable to pay the policy amount to the complainant.
8. In the result, the complaint is allowed directing the opposite party to pay to the complainant Rs.1 lakh assured amount under the policy bearing No. 2005/191 along with cost of Rs.1,000/- within one month from the date of receipt of this order. In default the opposite party shall pay the above award with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 28th day of July, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Xerox copy of policy No.2005/191.
Ex.A2. Attested Xerox copy of death certificate.
Ex.A3. Xerox copy of claim form along with covering letter of
Government General Hospital, Kurnool.
Ex.A4. Claim repudiation dated 28-6-2006.
List of exhibits marked for the opposite parties:
-Nil-
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite party.
Copy was made ready on :
Copy was dispatched on :
