BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri. T.Sundara Ramaiah , B.Com B.L., President
And
Sri. M.Krishna Reddy , M.Sc., M.Phil., Male Member
Tuesday the 14th day of September, 2010
C.C.No 12/10
Between:
Bollavaram Leelavathi, W/o Late Bollavaram Keshava Reddy,
R/o Koilkuntla (V) and (M), Kurnool Disrtrict-518 134.
…Complainant
-Vs-
1. The Branch Incharge, M/s. Reliance General Insurance Co., Ltd., ,
Nandyal Branch , Kurnool District - 518 501
2. M/s. Reliance General Insurance Co., Ltd., Rep., by its Deputy Manager for
4th Floor, Sagar Plaza, 4-1-327 to 337, Abids Road, Hyderabad - 500 001. .
…Opposite ParTIES
This complaint is coming on this day for orders in the presence of Sri. A.Prabhakara Reddy, Advocate, for complainant, and Sri. P. Ramanjaneyulu, Advocate for opposite party No.2 and opposite party No.1 is called absent set ex-parte and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No. 12/10
1. This complaint is filed under section 12 of C. P. Act, 1986 praying to direct the OPs
(a) to pay assured sum of Rs.1,00,000/- with accidental benefit ,
and compensation of Rs.10,000/- to the complainant
(b) to grant interest @24% p.a from the date of complaint
( c) to award costs of the complaint and
(e) to grant such other reliefs as the Hon’ble Forum may deem fit and proper in the in the circumstances of the case.
2. The case of the complainant in brief is as follows:- The complainant is the wife of Late. Bollavaram Keshava Reddy who is the member of Primary Agriculture Co-operative Society Limited, Harivaram, Uyyalawada (M), in Kurnool District. The OP insured the life of barrowers of the said society for a sum of Rs.1,00,000/- with accident benefit for the period from 23-02-2003 to 22-03-2009 under the policy bearing No.1811-38-30-11-100003. The complainant is the nominee under the policy. On 05-08-2008 at 1-00 A.M Bollavarm Keshava Reddy husband of the complainant slipped and fell down at his house and received injuries. He died on 12-08-2008 while undergoing treatment. The policy was inforce on the date of the death of the insured. The death intimation was given to OP.No.1. The complainant submitted the claim forms to Ops. The Ops repudiated the claim stating that the death of the insured was caused by insanity. The death of the insured is accidental. The repudiation of the claim is not based on facts. There is deficiency of service on the part of the Ops in repudiating the claim of the complainant . Hence the complaint.
3. OP.No.2 filed written version and the same is adopted by OP.No.1. It is averred in the written version of OP.No.2 that the complaint is not maintainable. It is admitted that the complainant is the wife of the B.Keshava Reddy. It is further admitted that Keshava Reddy was the member of the Primary Co-operative Society Limited, Harivaram. It is admitted that the OP issued a policy to the Kurnool District Co-operative Central Bank , Harivaram. It is admitted that the OP issued a policy to the Kurnool Co-operative Central Bank bearing No. 1811-38-30-11-100003 for the period from 23-02-2003 to 22-03-2009 for the benefit of its members. The deceased Keshava Reddy was suffering from insanity since 3 years prior to his death and he was under going treatment under Psychiatrist doctor by name Dr.Nagi Reddy at Kurnool. He was suffering with severe mental illness and he was unsound mind. The death of the deceased was not by fall. There are no merits in the complaint. The complainant is not entitled to any relief. The complaint is liable to be dismissed.
4. On behalf of the complainant Ex.A1 to A4 are marked and the sworn affidavit of the complainant is filed. On behalf of the opposite parties Ex.B1 to B5 are marked and the sworn affidavit of OP.No.2 is filed.
5. Both parties filed written arguments.
6. The points that arise for consideration are
(i) whether there is deficiency of service on the part of the OP ?
(ii) whether the complainant is entitled to the relief as prayed for?
(iii) To what relief?
7. Points No.1 & 2 :- Admittedly Late B. Keshava Reddy was a member of Primary Agriculture Co-operative Society Limited, Harivaram. The Ops insured the lives of barrowers of the said society with accident benefit under the policy bearing No. 1811-38-30-11-100003 . The said policy was inforce from 23-02-2003 to 22-03-2009. The fact that B. Keshava Reddy died on 12-08-2008 is not under dispute. It is also admitted that after the death of Keshava Reddy his wife submitted claim forms to Ops claiming the benefits under the policy and that her claim was repudiated by Ops on 06-04-2009 under Ex.A4 = B5. It is submitted by the learned counsel appearing for the Ops that the insured is Kurnool District Co-operative Central Bank and that the present complaint by the complainant is not maintainable. In Ex.B5 repudiation letter it is not stated that B. Keshava Reddy was not the barrower. The claim of the complainant was rejected stating that the deceased was mentally ill at the time of the accident. Ex.B1 policy covers Rs.1,30,000/- loanees of several societies. The beneficiary of services is covered by the definition consumer . Consumer means a person who hires or avails of any services for a consideration which has been paid or promised or partly paid and partly promised or under any system of deferred payment and includes any beneficiary of such services other than the person who hires or avails of the services for consideration paid or promised or partly paid and partly promised or under any system of deferred payment, when such services are availed of with approval of the first mentioned person but does not include a person who avails of such services for any commercial purposes. The definition of the consumer also covers the beneficiary of the services. The deceased being a member of the society is a beneficiary under the policy . Admittedly Keshava Reddy the husband of the complainant died on 12-08-2008.
8. It is the case of the complainant that the deceased Keshava Reddy was suffering mentally illness since three years prior to the date of his death and that the Ops are not liable to pay any amount as the deceased died due to mentally illness. The Ops did not place any medical evidence to show that the deceased was mentally insane and that he died due to mental illness. The Ops filed Ex.B2 copy of the inquest report and Ex.B3 proceedings of the Executive Magistrate , Uyyalawada . In Ex.B2 it is mentioned that the deceased was suffering form mental decease and that he was taking treatment under Dr.Nagi Reddy of the said deceased. In Ex.B3 it is also mentioned that the deceased was mentally ill health person and that Keshava Reddy died on 12-08-2008 while undergoing treatment Government Hospital, Kurnool. Basing on the recitals in Ex.B2 and Ex.B3 it cannot be said that the deceased was insane and that his death occurred due to said insanity.
9. It is the specific case of the complainant that her husband slipped and fell down in her house on 05-08-2008 that he received injuries in the said incident and died on 12-08-2008 while under going treatment in Government General Hospital, Kurnool. She filed Ex.A1 copy of the FIR. In Ex.A1 it is clearly mentioned that on 05-08-2008 at about 1-00 AM Keshava Reddy slipped and fell down on a stone and received injuries. In Ex.A3 post mortem report it is clearly mentioned that the cause of the death of the deceased is due to head injury . From the evidence available on record it is very clear that the deceased died due to the injuries received by him by fall accidentally. As per Clause 6 Exceptions mentioned in Ex.B1 policy the company is not liable to pay compensation in respect of death of the insured person if it is caused directly or indirectly by insanity . In the present case as already stated it is not shown by the Ops that the death of the deceased was due to insanity . On the other hand there is material to show that the deceased accidentally fell down on a stone, received injuries and died due to the said injuries on 12-08-2008 while undergoing treatment . The repudiation of the claim by the Ops that the deceased died due to mental illness and that they are not liable to pay compensation is not just and reasonable. The non payment of the assured amount and other benefits to the complainant amounts to deficiency of service. The complainant is entitled to sum of Rs.1 lakh with other benefits under the policy.
10. Point No.3: In the result the complaint is partly allowed directing the Ops to pay assured amount with other benefits with subsequent interest at 9% from the date of the complaint i.e 06-04-2009 till the date of payment along with costs of Rs.500/-.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 14h day of September, 2010.
Sd/- Sd/-
MALE 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. Photo copy of FIR in Cr.No.67/2008 of Uyyalawada, P.S.
Ex.A2. Photo copy of Family member’s certificate dt.22-12-2008.
Ex.A3. Photo copy of postmortem report dt.12-08-2008
Ex.A4 Photo copy repudiation letter dt.06-04-2009.
List of exhibits marked for the opposite parties:
Ex.B1. Attested true copy of Reliance Janata Personal Accident Policy Schedule. Policy No.1811383011100003.
Ex.B2. Photo copy of Inquest report.
Ex.B3. Photo copy of Proceedings of the Mandal Tahasildar and Mandal ExecutiveMagistrate Uyyalawada
Ex.B4. Photo copy of Final Report
Ex.B5. Photo copy of Repudiation letter dt.06-04-2009.
Sd/- Sd/-
MALE 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 parties
Copy was made ready on :
Copy was dispatched on :
