BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Saturday the 29th day of October, 2005
CD No. 113/2005
Smt Y. Siva Narayanamma,
W/o. late Y. Suryanarayana Reddy,
R/o. Perrayapalli (V) & (Post),
Allagadda (M),
Kurnool Dist. . . . Complainant
-Vs-
1. The Branch Manager,
L.I.C of India, Kurnool.
2. The Divisional Manager,
L.I.C of India, Divisional Office,
Cuddapah. . . . Opposite parties
This complaint coming on 20.10.2005 for arguments in the presence of Sri C. Ramana Reddy, Advocate, Kurnool for complainant and Sri A.S. Ummer Javid Ali, Advocate, Kurnool for opposite party No.1 and 2, and stood over for consideration till this day, the Forum made the Following.
O R D E R
(As per Smt C.Preethi, Hon’ble Lady Member)
1. This CD complaint of the complainant is filed under section 12 of C.P. Act, 1986 seeking a direction on the opposite parties to pay Rs. 6,00,000/- towards accidental benefit with bonus and other benefits along with 18 % interest on the said amount from 16.3.2001, interest at 18% per annum on Rs. 6,42,600/- from 16.3.2001 to 28.3.2003 for the delayed period, Rs. 25,000/- towards mental agony, Rs.10,000/- towards costs and any such 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’s husband Y. Suryanarayana Reddy has taken a LIC policy bearing No. 65267277 on 28.1.2001 for Rs.6,00,000/- from opposite party No.1 and opposite party No.2 is the divisional office. As per the policy in case of accidental death of insured the opposite parties has to pay double the assured amount with bonus and other benefits to the nominee and the policy holder nominated the complainant as his nominee. The said policy holder died due to Scorpion bite on 16.3.2001 in Gowri Gopal Hospital, Kurnool which is an accidental death, immediately the complainant submitted claim forms along with required documents.
3. Thereafter, the opposite parties paid Rs. 6,42,600/- (basic amount of Rs.6,00,000/- + interim bonus of Rs.42,600/-) and to consider accidental benefit the opposite party No.1 requested the complainant to submit FIR, PIR, PMR and FPR. As the death occurred due to scorpion bite none of the said documents are available, but the complainant submitted the certificate issued by Gowri Gopal Hospital, Kurnool dated 19.3.2001, which clearly shows the cause of death of the policy holder. The document available with the complainant is the first premium receipt only and informed the opposites parties in April 2003 that the other documents are not available and requested the opposite parties to pay the accidental benefit. There was no response from the opposite parties to the request of the complainant and the above said lapsive conduct of the opposite parties in not paying the accidental benefit to the complainant is amounting to deficiency of service.
4. In support of her case the complainant filed the following document Viz (1) letter dated 28.3.2003 addressed to the complainant by Branch Manager, LIC of India, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and caused interrogatories to opposite parties and the above document is marked as Ex A.1 for its appreciation in this case.
5. In pursuance to the notice of this Forum as to this case of the complainant, the opposite parties made their appears through their standing counsel. The opposite party No.2 filed its written version and opposite party No.1 adopted the written version of opposite party No.2.
6. The written version of opposite parties admits the deceased Y. Surayanarayana Reddy has taken a policy bearing No. 652672777 for assured amount of Rs.6,00,000/- and paid first premium of Rs. 38,585/- and the said policy was issued with accidental benefit and the relevant clause imposed restrictions restricting the accidental benefit upto Rs.5,00,000/- only and the deceased nominated his wife Y. Sivanarayamma as nominee and the said accidental benefit is subject to policy condition 10.2 of the said policy, which says that the additional sum equal to the sum assured in the policy, after the life assured sustained any bodily injury resulting solely and directly from the accident cause by outward, violent, visible means and such injury shall within 120 days of its occurrence solely and directly cause death of life assured and the addition sum payable shall not exceed of Rs.5,00,000/-. On the claim preferred by the complainant the opposite parties settle the claim for basic amount of Rs.6,00,000/- and bonus of Rs. 42,600/- as full and final settlement of the claim and the complainant executed a valid discharge dated 24.3.2003 for Rs.6,42,600/-
7. As the complainant did not submit required documentary evidence such as first information report, postmortem report, police inquest report and final postmortem report for consideration of accidental benefit and there is no documentary evidence to prove to the satisfaction of the opposite parties that the death of the deceased caused solely and directly from accident caused by outward violent and visible means as per the accident benefit clause.
8. The complainant did not produce any satisfactory material to the satisfaction of the opposite parties to consider accidental benefit. Therefore, the complainant cannot claim the said benefit or interest or any other reliefs and seeks for the dismissal of complaint with costs.
9. In substantiation of its case the opposite parties relied on the following documents Viz (1) attested xerox copy of Claim Form A and (2) attested Xerox copy of Claim Form C, besides to the sworn affidavit of opposite party No.1 in reiteration of its written version as defence and the above documents are marked as Ex B.1 and B.2 for its appreciation in this case.
10. Hence the point for consideration is to what relief the complainant is entitle alleging deficiency of service on part of opposite parties:-
11. It may be stated at the out side that the dispute involve in this case centers round the claim of the complainant for Rs.6,00,000/- accidental benefit of her late husband Y. Suryanarayana Reddy and the dispute of the same is raised by the opposite parties by simple putting the complainant to prove the material allegations of the complaint. The material facts that emerged from the pleading, the contents of the documents and the sworn affidavit of the complainant’s that the complainant is the nominee of the said policy holder, who insured his life with opposite parties under policy bearing No. 652672777 for Rs. 6,00,000/- with accidental benefit. The deceased Y. Suryanarayana Reddy died on 16.3.2001 due to Scorpion sting and the complainant, thereafter, submitted claim form for insured amount along with accidental benefit and the opposite parties settled the claim only for basic amount with interest and did not pay the accidental benefit, stating that the required documentary evidence such first information report, postmortem report police inquest report and final police report for consideration of accidental are not submitted by the complainant to claim accidental benefit.
12. The main plank of attack made by the opposite parties is that it did its part of job in paying the basic amount + interim bonus to the complainant and as the complainant failed to produce necessary documents such as FIR postmortem report, police inquest report and final police report, they are not in a position to settle the accidental claim. The counsel for complainant rebutted the said contentions of the opposite parties stating that the death of the insured is not by any suspicion involving any crime. The complainant produced the only documentary evidence that can be produced on the facts of the present case, the learned counsel for the complainant considerably submitted that the opposite parties cannot insist for production of the above said documents in view of the ruling of Hon’ble AP State Commission between LIC of India and other Vs Banavath reported in 2000 ALD II (cons) Pg 96, wherein, it was held that when the cause of death is of Snake bite but not a suspicious one obtaining FIR and other documents does not arise.
13. In the present case also the facts are similar. As such the stand of opposite parties insisting on the production of such documents is held tobe illegal and not valid and untenable. The learned counsel for complainant stressed reiterating that since the death was resulted due to Scorpion bite and as there is no suspicion no question of registering FIR and getting autopsy conducted or inquest conducted does not arise. As such the plea of opposite parties cannot be accepted for production of said documents in the light of the binding and direct ruling of Hon’ble AP State Commission referred supra.
14. It is further seen on carefully scrutiny of the totality of facts and circumstances having due regard to the nature of the claim of the complainant is tobe accepted.
15. As regard to the second relief claimed by the complainant, there is no independent material placed on record by the complainant to sustain her claim for interest, hence, the claim for interest is rejected, but due to non settlement of the claim of the complaint for accidental benefit by the opposite parties though considerable length of time taken the opposite parties are liable to pay interest on the accidental benefit and costs of Rs.5,000/- besides to accidental benefit. The other decision relied by the complainant is that of High Court of Gujarat reported in 1999 ACJ 956, between Ambalal Lallubhai Panchal Vs Life Insurance Corporation of India, wherein, it was held that if the death resulting from an accident caused by outward, violent, visible means is within the meaning of accident benefit clause.
16. In the result, the complaint is allowed directing the opposite parties to pay to the complainant the accidental benefit under the policy bearing No. 652672777 of the deceased Y. Suryanarayana Reddy with 12% interest from the date of the deceased till realization along with Rs.5000/- as costs of the case within one month of receipt of this order.
Dictated to the Stenographer, transcribed by her, corrected and pronounced open court this the 29th day of October, 2005.
Sd/-
PRESIDENT
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MEMBER MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of Exhibits Marked for the complainant:
Ex A.1 Letter dated 28.3.2003 addressed to the complainant by Branch
Manager, LIC of India.
List of Exhibits Marked for the opposite parties:
Ex B.1 Attested xerox copy of Claim Form A.
Ex B.2 Attested xerox copy of Claim Form C.
Sd/-
PRESIDENT
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MEMBER MEMBER
Copy to:-
- Sri C. Ramana Reddy, Advocate, Kurnool.
- Sri A.S. Ummer Javid Ali, Advocate, Kurnool
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
