The Branch Manager, National Insurance Company Ltd., V/S Smt. Laxmi W/o. Thimappa - Consumer Court Case

Karnataka

Raichur

DCFR 35/06

Smt. Laxmi W/o. Thimappa - Complainant(s)

Versus

The Branch Manager, National Insurance Company Ltd., - Opp.Party(s)

Sri. R.Basavaraj

30 Jun 2006

ORDER

DIST. CONSUMER DISPUTES REDRESSAL FORUM
DIST. CONSUMER DISPUTES REDRESSAL FORUM,DC Office Compound, Sath Kacheri
consumer case(CC) No. DCFR 35/06

Smt. Laxmi W/o. Thimappa						...........Appellant(s)
Vs.
The Branch Manager, National Insurance Company Ltd.,						...........Respondent(s)

BEFORE:

Complainant(s)/Appellant(s):

OppositeParty/Respondent(s):

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ORDER

This is a complaint filed U/s. 12 of Consumer Protection Act by the complainant Smt. Laxmi against Respondent- Branch Manager National Insurance Company Ltd., Branch Office Raichur. The brief facts of the complaint are as under:- The complainant is the wife of late Thimappa resident of Maliabad Tq. & Dist. Raichur. During his life time her late husband Thimappa was having Janatha Policy No. 604002/47/3/9600923/2003/ in his name and the complainant is the nominee and his only dependent. On 01-06-04 at about 7-00 AM her husband Thimappa was returning home after completion of his work on his bicycle and when he was near on Maliabad cross, he suddenly fell down due to the skid of his bicycle and he got head injuries and un-conscious, so immediately he was taken to his residence in the village and because of his un-consciousness at about 9-00 AM he lost his breath. As per the policy conditions, it is the duty of the Insurance Company-Respondent to pay the amount of Rs. 1,00,000/-. The complainant has submitted all the documents before Respondent and the Respondent endorsed through his letter by stating that they are not liable for the death claim amount under the policy as the death of the deceased policyholder was under the influence of intoxication of liquor. As per the policy conditions and police report/documents and as per the PME Report and also the letter issued by M.O, PHC the death of the deceased was due to head injury etc., The PME Report and letter issued by the doctor it clearly shows that the deceased has not consumed alcohol. Even then without having sufficient reasons the Respondent straight-away refused to pay the claim amount and endorsed by stating that the complainant is not liable to receive the compensation amount which amounts to negligence and deficiency in service. Hence for all these reasons the complainant has prayed for awarding policy amount of Rs. 1,00,000/- as compensation. 2. The Respondent Insurance Company has filed written version as under:- The deceased Thimappa had never fell down from his bicycle and sustained head injury. As per Medical Report submitted by Medical Officer PHC Gunjahalli, it is very clear that there was no any head injury. In the FSL Report submitted by the Regional Forensic Science Laboratory, Gulbarga it is crystal clear that the deceased Thimappa had consumed alcohol and died under influence of intoxication. Under such circumstances the complaint is not maintainable and liable to be dismissed. As per the policy conditions, if a person dies in an intoxication the policy will not cover the same as per the policy conditions. If a person dies in an influence of intoxication it does not cover. Hence the Respondent has rightly rejected the claim of the complainant as the death is due to influence of intoxication As per PME Report there is no external injury on skull. Brain and membrance found intact and healthy. Therefore Final opinion of Medical Officer, Gunjahalli on cause of death of deceased by concussion of brain due to head injury was totally against the opinion of Chemical Examinations Report. Hence for all these reasons the Respondent has prayed for dismissal of the complaint with heavy cost. 3. During the course of enquiry the complainant has filed her sworn affidavit as evidence and has got marked (12) documents at Ex.P-1 to P-12. The Respondent in-rebuttal has filed his sworn affidavit as his evidence and got marked (4) documents at Ex.R-1 to R-4. 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:- 1. Whether the complainant proves deficiency in service by the Respondent in repudiating her claim as alleged? 2. Whether the complainant is entitled for the reliefs sought for? 5. Our finding on the above points are as under:- 1.In the negative. 2. As per final order for the following: REASONS POINT NO.1:- 6. There is no dispute that late Thimappa the husband of the complainant Laxmi had insured his life under the Group Insurance Policy in-question and the complainant is the nominee. It is the case of the complainant that on 01-06-04 at about 7-00 AM while her late husband was returning to the house on bicycle after his duty he suddenly fell down near Maliabad cross due to skid of bicycle and became un-conscious and got head injury and thereafter he was taken to the house where he lost his breath and died. Thereafter complainant filed claim form with necessary documents but the Respondent Insurance Company repudiated her claim on the ground that her late husband has died due to the influence of intoxication of liquor and so they are not liable to pay the amount. But in-fact her husband died due to fall on the ground due to skid of bicycle and he was not under intoxication of liquor but the Respondents have wrongly repudiated her claim. The Respondent Insurance Company has contended that the deceased died due to intoxication as per the chemical examination report so the Respondent is not liable for the death claim of the policyholder. 7. The complainant has relied on (12) documents at Ex.P-1 to P-12 out of which Ex.P-1 is the repudiation letter, Ex.P-3 is the UDR Report, Ex.P-5 is the Police Statement of the complainant-Laxmi, Ex.P-7 is the Post Mortem Report, Ex.P-9 is the letter of Medical opinion given by the Medical Officer P.H.C. Gunjahalli who conducted Autopsy on the dead body of the policyholder. The Respondent Insurance Corporation has produced (4) documents at Ex.R-1 to R-4 namely Ex.R-1 is the letter of Panel Investigator of the Corporation regarding cause of death of deceased policyholder. Ex.R-2 is the report of FSLR. Ex.R-3 is the Insurance Policy in-question. Ex.R-4 is the conditions of the said policy. 8. Post Mortem Report at Ex.P-7, a perusal of which goes to show that the Medical Officer PHC Gunjahali has conducted the Post Mortem Examination on the dead body of late policyholder of Thimappa. It shows that the cause of death of deceased was kept pending for want of chemical examination report from FSL Gulbarga. It also shows that during Post Mortem Examination, the Medical Officer had preserved whole stomach with its contents along with a portion of small intestine in bottle No.-1, A portion of liver, spleen, kidney heart, lungs, brain in bottle No.-2 and preservative salt used (saturated solution of common salt) in bottle No-3. The FSL Report which is produced by the Respondent at Ex.R-2 goes to show that the said three bottles sent by the Medical Officer, Gunjahalli were examined by FSL Gulbarga and they have opined as under:- The colour test have responded for the presence of alcohol in Exhibits No-1 & 2 but no other poison was detected in all the above stated exhibits. It also shows a note that quantification of alcohol could not be done since the blood sample not collected by the Medical Officer. 9. From FSL Report letter at Ex.R-2 it reveals that the FSL has opined that the colour test have responded for the presence of alcohol in bottles No. 1 & 2 sent by Medical Officer Gunjahalli as referred to above. The learned counsel for the complainant argued that the FSL report cannot be taken as a conclusive since the Medical Officer Gunjahalli who conducted Autopsy has given his final report at Ex.P-9 stating that the death of the deceased was on account of concussion of Brain due to head injury. Further the FSL Report only shows that on colour test they have opined the presence of alcohol and it also shows that the quantification of alcohol could not be done as the blood sample was not corrected by the Medical Officer. On the contrary the learned counsel for the Respondent Corporation submitted that the FSL report shows the presence of alcohol in the contents of bottle No-1 & 2 preserved and sent by the Medical Officer who has conducted Autopsy on the dead body of the deceased policyholder and has opined that the colour test responded the presence of alcohol. So when the colour test itself shows the presence of alcohol then the quantification of alcohol is not a criteria to with-hold the opinion of presence of alcohol. We find considerable force in this argument. Here we are concerned to consider as to whether the cause of death of deceased policyholder was due to influence of intoxication of liquor. The FSL report at Ex.R-2 amply shows the presence of alcohol by examining colour test of the preservation in bottle No-1 & 2 which were sent by the Medical Officer who conducted autopsy. When this is so, as rightly pointed out by the learned counsel for the Respondent Corporation, the quantification of alcohol is not a sole criteria to assail the report of FSL in order to show that the death of the deceased was not due to under the influence of intoxication of liquor. Consequently the final report of Medical Officer at Ex.P-9 that the death of deceased was due to concussion of brain due to head injury will not help the complainant as FSL report is clear enough to show the presence of alcohol in the contents bottle No. 1 & 2 as stated above. In this view of the matter we hold that as per the FSL report the contents of bottle No-1 & 2 which were containing stomach and contents of portion of small intestine and its contents and portion of liver, heart, spleen, kidney and brain which were on colour test found the presence of alcohol then it cannot be said any hesitation that the deceased was under the influence of intoxication of alcohol at the time of his death. Added to this, as rightly pointed out by the learned counsel for the Respondent, the PME report at Ex.P-7 does not show any head injury and on the contrary it shows that it was intact and healthy. Consequently we hold that the Respondent Corporation was right in-repudiating the claim as per the conditions of the policy that the Respondent Corporation is not liable. If the death was due to influence of intoxication liquor or drag. Hence we hold that there is no deficiency in service on the part of the Respondent Corporation in repudiating the claim of the complainant. Therefore Point No.1 is answered in the negative. POINT NO.2:- 10. In view of our discussion and finding on Point No-1, the complainant is not entitled for the reliefs sought for so Point No-2 is answered in the negative. In the result we pass the following order: ORDER The complaint of the complainant being devoid of merits is hereby dismissed. No order as to cost. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum On 30-06-06.) Sd/- Sri. N.H. Savalagi President Dist.Consumer Forum-Raichur. Sd/- Sri.Pampannagouda Member. Dist.Consumer Forum-Raichur. Sd/- Smt.Kavita Patil Member. Dist.Consumer Forum-Raichur.

This is a complaint filed U/s. 12 of Consumer Protection Act by the complainant Smt. Laxmi against Respondent- Branch Manager National Insurance Company Ltd., Branch Office Raichur. The brief facts of the complaint are as under:- The complainant is the wife of late Thimappa resident of Maliabad Tq. & Dist. Raichur. During his life time her late husband Thimappa was having Janatha Policy No. 604002/47/3/9600923/2003/ in his name and the complainant is the nominee and his only dependent. On 01-06-04 at about 7-00 AM her husband Thimappa was returning home after completion of his work on his bicycle and when he was near on Maliabad cross, he suddenly fell down due to the skid of his bicycle and he got head injuries and un-conscious, so immediately he was taken to his residence in the village and because of his un-consciousness at about 9-00 AM he lost his breath. As per the policy conditions, it is the duty of the Insurance Company-Respondent to pay the amount of Rs. 1,00,000/-. The complainant has submitted all the documents before Respondent and the Respondent endorsed through his letter by stating that they are not liable for the death claim amount under the policy as the death of the deceased policyholder was under the influence of intoxication of liquor. As per the policy conditions and police report/documents and as per the PME Report and also the letter issued by M.O, PHC the death of the deceased was due to head injury etc., The PME Report and letter issued by the doctor it clearly shows that the deceased has not consumed alcohol. Even then without having sufficient reasons the Respondent straight-away refused to pay the claim amount and endorsed by stating that the complainant is not liable to receive the compensation amount which amounts to negligence and deficiency in service. Hence for all these reasons the complainant has prayed for awarding policy amount of Rs. 1,00,000/- as compensation. 2. The Respondent Insurance Company has filed written version as under:- The deceased Thimappa had never fell down from his bicycle and sustained head injury. As per Medical Report submitted by Medical Officer PHC Gunjahalli, it is very clear that there was no any head injury. In the FSL Report submitted by the Regional Forensic Science Laboratory, Gulbarga it is crystal clear that the deceased Thimappa had consumed alcohol and died under influence of intoxication. Under such circumstances the complaint is not maintainable and liable to be dismissed. As per the policy conditions, if a person dies in an intoxication the policy will not cover the same as per the policy conditions. If a person dies in an influence of intoxication it does not cover. Hence the Respondent has rightly rejected the claim of the complainant as the death is due to influence of intoxication As per PME Report there is no external injury on skull. Brain and membrance found intact and healthy. Therefore Final opinion of Medical Officer, Gunjahalli on cause of death of deceased by concussion of brain due to head injury was totally against the opinion of Chemical Examinations Report. Hence for all these reasons the Respondent has prayed for dismissal of the complaint with heavy cost. 3. During the course of enquiry the complainant has filed her sworn affidavit as evidence and has got marked (12) documents at Ex.P-1 to P-12. The Respondent in-rebuttal has filed his sworn affidavit as his evidence and got marked (4) documents at Ex.R-1 to R-4. 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:- 1. Whether the complainant proves deficiency in service by the Respondent in repudiating her claim as alleged? 2. Whether the complainant is entitled for the reliefs sought for? 5. Our finding on the above points are as under:- 1.In the negative. 2. As per final order for the following: REASONS POINT NO.1:- 6. There is no dispute that late Thimappa the husband of the complainant Laxmi had insured his life under the Group Insurance Policy in-question and the complainant is the nominee. It is the case of the complainant that on 01-06-04 at about 7-00 AM while her late husband was returning to the house on bicycle after his duty he suddenly fell down near Maliabad cross due to skid of bicycle and became un-conscious and got head injury and thereafter he was taken to the house where he lost his breath and died. Thereafter complainant filed claim form with necessary documents but the Respondent Insurance Company repudiated her claim on the ground that her late husband has died due to the influence of intoxication of liquor and so they are not liable to pay the amount. But in-fact her husband died due to fall on the ground due to skid of bicycle and he was not under intoxication of liquor but the Respondents have wrongly repudiated her claim. The Respondent Insurance Company has contended that the deceased died due to intoxication as per the chemical examination report so the Respondent is not liable for the death claim of the policyholder. 7. The complainant has relied on (12) documents at Ex.P-1 to P-12 out of which Ex.P-1 is the repudiation letter, Ex.P-3 is the UDR Report, Ex.P-5 is the Police Statement of the complainant-Laxmi, Ex.P-7 is the Post Mortem Report, Ex.P-9 is the letter of Medical opinion given by the Medical Officer P.H.C. Gunjahalli who conducted Autopsy on the dead body of the policyholder. The Respondent Insurance Corporation has produced (4) documents at Ex.R-1 to R-4 namely Ex.R-1 is the letter of Panel Investigator of the Corporation regarding cause of death of deceased policyholder. Ex.R-2 is the report of FSLR. Ex.R-3 is the Insurance Policy in-question. Ex.R-4 is the conditions of the said policy. 8. Post Mortem Report at Ex.P-7, a perusal of which goes to show that the Medical Officer PHC Gunjahali has conducted the Post Mortem Examination on the dead body of late policyholder of Thimappa. It shows that the cause of death of deceased was kept pending for want of chemical examination report from FSL Gulbarga. It also shows that during Post Mortem Examination, the Medical Officer had preserved whole stomach with its contents along with a portion of small intestine in bottle No.-1, A portion of liver, spleen, kidney heart, lungs, brain in bottle No.-2 and preservative salt used (saturated solution of common salt) in bottle No-3. The FSL Report which is produced by the Respondent at Ex.R-2 goes to show that the said three bottles sent by the Medical Officer, Gunjahalli were examined by FSL Gulbarga and they have opined as under:- The colour test have responded for the presence of alcohol in Exhibits No-1 & 2 but no other poison was detected in all the above stated exhibits. It also shows a note that quantification of alcohol could not be done since the blood sample not collected by the Medical Officer. 9. From FSL Report letter at Ex.R-2 it reveals that the FSL has opined that the colour test have responded for the presence of alcohol in bottles No. 1 & 2 sent by Medical Officer Gunjahalli as referred to above. The learned counsel for the complainant argued that the FSL report cannot be taken as a conclusive since the Medical Officer Gunjahalli who conducted Autopsy has given his final report at Ex.P-9 stating that the death of the deceased was on account of concussion of Brain due to head injury. Further the FSL Report only shows that on colour test they have opined the presence of alcohol and it also shows that the quantification of alcohol could not be done as the blood sample was not corrected by the Medical Officer. On the contrary the learned counsel for the Respondent Corporation submitted that the FSL report shows the presence of alcohol in the contents of bottle No-1 & 2 preserved and sent by the Medical Officer who has conducted Autopsy on the dead body of the deceased policyholder and has opined that the colour test responded the presence of alcohol. So when the colour test itself shows the presence of alcohol then the quantification of alcohol is not a criteria to with-hold the opinion of presence of alcohol. We find considerable force in this argument. Here we are concerned to consider as to whether the cause of death of deceased policyholder was due to influence of intoxication of liquor. The FSL report at Ex.R-2 amply shows the presence of alcohol by examining colour test of the preservation in bottle No-1 & 2 which were sent by the Medical Officer who conducted autopsy. When this is so, as rightly pointed out by the learned counsel for the Respondent Corporation, the quantification of alcohol is not a sole criteria to assail the report of FSL in order to show that the death of the deceased was not due to under the influence of intoxication of liquor. Consequently the final report of Medical Officer at Ex.P-9 that the death of deceased was due to concussion of brain due to head injury will not help the complainant as FSL report is clear enough to show the presence of alcohol in the contents bottle No. 1 & 2 as stated above. In this view of the matter we hold that as per the FSL report the contents of bottle No-1 & 2 which were containing stomach and contents of portion of small intestine and its contents and portion of liver, heart, spleen, kidney and brain which were on colour test found the presence of alcohol then it cannot be said any hesitation that the deceased was under the influence of intoxication of alcohol at the time of his death. Added to this, as rightly pointed out by the learned counsel for the Respondent, the PME report at Ex.P-7 does not show any head injury and on the contrary it shows that it was intact and healthy. Consequently we hold that the Respondent Corporation was right in-repudiating the claim as per the conditions of the policy that the Respondent Corporation is not liable. If the death was due to influence of intoxication liquor or drag. Hence we hold that there is no deficiency in service on the part of the Respondent Corporation in repudiating the claim of the complainant. Therefore Point No.1 is answered in the negative. POINT NO.2:- 10. In view of our discussion and finding on Point No-1, the complainant is not entitled for the reliefs sought for so Point No-2 is answered in the negative. In the result we pass the following order: ORDER The complaint of the complainant being devoid of merits is hereby dismissed. No order as to cost. (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum On 30-06-06.) Sd/- Sri. N.H. Savalagi President Dist.Consumer Forum-Raichur. Sd/- Sri.Pampannagouda Member. Dist.Consumer Forum-Raichur. Sd/- Smt.Kavita Patil Member. Dist.Consumer Forum-Raichur.