CONSUMER DISPUTES REDRESSAL FORUM,PALAKKAD
Dated this the 15th December, 2014
PRESENT : SMT. SEENA. H, PRESIDENT
: SMT. SUMA. K.P, MEMBER Date of filing : 23/10/2013
CC /180/2013
1. Bagyalakshmi.K,
W/o.Late.Ramanarayanan,
Rashmi Nivas, Panayyur P.O, : Complainants
Athikode, Muthappankudam,
Palakkad – 678 552.
(By Adv.N.Rakhi )
2. Rashmi
D/o.Late. Ramanarayanan,
Rashmi Nivas, Panayyur P.O,
Athikode, Muthappankudam,
Palakkad – 678 552.
(By Adv.N.Rakhi )
3. Seethalakshmi,
D/o.Late.Ramanarayanan,
Rashmi Nivas, Panayyur P.O,
Athikode, Muthappankudam,
Palakkad – 678 552.
(By Adv.N.Rakhi )
Vs
1. Branch Manager,
United India Insurance Company, : Opposite parties
Surya Complex,
Mission School HSS Junction,
Palakkad – 678 014.
(By Adv.A.Nijamudin)
2. Sumesh,
Proprietor,
S.S.Industries, Door No.50/144,
Kavilpad, Olavakkode Main Road,
Palakkad.
O R D E R
By Smt. Suma. K.P, Member,
Brief case of the complaint :-
The complainants are the wife and children of deceased Ramanarayanan who died due to haemorrage followed by an accident on 12/10/2012. Ramanarayanan fell down while he was unloading iron pipes from the lorry at his work place. On the date of accident he did not consult any doctors, instead he purchased some medicines from the medical shop. Ramanarayanan was employed in the 2nd opposite party’s industry namely SS industries. On the next day of the accident he went to Taluk Hospital Chittur for treatment and he was treated as out patient and was prescribed medicines for five days. Later on his condition became worse and he was taken to District Hospital, Palakkad and from there to Medical Mission Hospital, Thrissur and he was treated there as in patient up to 23/10/2012. He passed away on 23/10/2012. The 1st opposite party has issued two insurance policies in favour of 2nd opposite party (The employer of Ramanarayanan) as Janatha Personal Accident (JPA) Policy and Road Safety Policy. After the death of Ramanarayanan the complainant approached 2nd opposite party for availing the insurance claim. The Manager promised her that he will make all the arrangements for availing the insurance claim. The complainant had sent remainders to the 2nd opposite party and had also approached the 1st opposite party. The complainant made an application before the 1st opposite party under Right to Information Act and the 1st opposite party replied that the complainant claim was repudiated since there is no document to prove the accident. Hence the complainant had approached before the forum seeking an order to direct 1st opposite party to grant the insurance amount of Rs.1,50,000/- along with Rs.1,00,000/- as compensation for the mental agony and Rs.10,000/- for the medical expense and cost of Rs.10,000/-.
Notice was issued to the opposite parties in the said complaint. 1st opposite party entered appearance through counsel and filed a detailed version denying all the allegations in the complaint. Notice to the 2nd opposite party was returned stating “not known”. Inspite of repeating notice to the 2nd opposite party in the fresh address he remained absent. Hence 2nd opposite party was called and set exparte.
The 1st opposite party admits that Sri.Ramanarayanan was a worker under the 2nd opposite party as per the insurance issued in his favour. The 1st opposite party has issued two insurance policies in favour of SS Industries as per Policy No:101201/47/12/61/00000103 (JPA) and 101201/48/12/93/00000787 (Road Safety Policy). The coverage of the policy comes only in case its satisfies the conditions mentioned in the policy issued in favour of the insurer. The fact that Ramanarayanan sustained an injury on 12/10/2012 is not admitted by the 1st opposite party. There are no records to show that he had sustained an injury in the course of his employment. There is no police case or post mortem report to show the reason for the death. As per the statement of the complainant itself after the accident the deceased had taken medicine and has gone to his house. Later he went to Taluk Hospital, Chittur for treatment. The treatment records shows that he had vertigo. After that he had gone to Cresent Hospital and from there to Medical College Hospital. From there it is clear that if the injury of such a serious nature was sustained to Ramanarayanan he could not to have walk or take rest for five days. The reason for the death is not known. What happened during 12/10/2012 to 15/10/2012 is not known. Since there are no records to connect the death with the employment, the claim was repudiated by the 1st opposite party. The 1st opposite party had paid the medical expenses covered as per policy. The allegation that the 2nd opposite party had threatened the complainants from filing FIR cannot be believed. This is only a test case to see whether the complainants can claim the insurance amount from the 1st opposite party. The 2nd opposite party is helping the complainants by non appearance and without contesting the matter. He is the person who has got the knowledge of the facts of the case. This is a collusive claim made by the employer and relatives of the deceased employee Sri.Ramanarayanan. The document necessary for 1st opposite party for the settlement of the claim is that Sri.Ramamnarayanan had sustained an employment injury and that in the course of treatment he died. But in the present case there are no records to connect the death with the employment. There is no reports of accident in any of the medical records. The letter forwarded to the employer is returned as not known. The 1st opposite party has repudiated the claim under JPA, since there are no records to show the death was during the course of his employment. It was also submitted that as per the terms and conditions in the policy the liability of the company is limited to Rs.1,00,000/- and Rs.50,000/- only. That is also liable only in cases where the insured satisfies the policy conditions. The claim of Rs.2,70,000/- is baseless. It was submitted that there is no deficiency of service on the part of the 1st opposite party. The complaint is filed without any bonafides and it has to be dismissed.
Complainant as well as 1st Opposite party filed proof affidavit. Ext.A1-A14 was marked from the part of the complainant. Complainant filed application to summon the doctor who had treated the deceased from Taluk Hospital as a witness. The doctor was examined as CW1. Evidence was closed and matter was heard.
The following issues are to be considered.
1. Whether there is any deficiency in service from the part of opposite
parties?
2. If so, what is the relief and cost?
ISSUES 1 & 2
We had perused the documents as well as the evidence adduced from both sides. There is no report of accident in any of the medical records. 1st opposite party had paid a sum of Rs.5,269/- as claim under JPA. There are no records to show the death was during the course of his employment. The cases referred in the petition, and the citations produced from the part of the complainant are in no way connected with the facts of the present case. In the decision referred by the complainant there was supporting documents instead of postmortem records to state the reason for the death. But in the present case there is no records to prove that the complainant had sustained injury as a result of accidents during the course of employment. The witness who was examined as CW1 had deposed that the complainant was suffering from vertebra Basilar insufficiency which may cause due to insufficiency of blood circulation. He had also stated that there was a complaint with regard to the nature of treatment provided to the deceased Ramanarayanan. The reason for death was also not stated by him during examination. The main contention of the complainant was with regard to medical negligence as per the deposition stated by the witness.
From the above facts and evidence on record there is nothing to prove that there was deficiency of service on the part of the opposite parties. In the light of the above observation we find no merits in the complaint and hence the complaint is dismissed.
Pronounced in the open court on this the 15th day of December 2014
Sd/-
Smt. Seena. H
President
Sd/-
Smt. Suma. K.P
Member
A P P E N D I X
Exhibits marked on the side of complainant
Ext.A1- Photocopies of Police Report
Ext.A2-Photocopies of enquiry reports of Thrissur Medical Hospital
Ext.A3- Photocopies of enquiry reports of Director, Health mission director
Ext.A4- Photocopies of Certificates at Chittur Taluk Hospital.
Ext.A5- Photocopies of Certificates at District Hospital, Palakkad.
Ext.A6- Photocopies of Medical Certificates.
Ext.A7- Original Death Certificate of Sri.Ramanarayanan dtd.31/10/2012 issued by Mundathicode Grama Panchayath.
Ext.A8- Photocopy of report written by Proprietor, S.S.Industries.
Ext.A9- To prove the deceased Ramanarayanan’s insurance photocopy
Ext.A10- Reply of 1st opposite party right to information act to the complainant
Ext.A11-Photocopies of Medical bill
Ext.A12- Legal heirship Certificate
Ext.A14- Accident claim form
Exhibits marked on the side of opposite parties
Witness marked on the side of complainant
Nil
Witness examined on the side of opposite parties
CW1-Dr.Rahulvarma
Cost Allowed
No cost allowed.
