This C.C. came on before us for final hearing in the presence of Sri. Gogula Brahmaiah, Advocate for the complainants and of Sri A. Sarath Chander, Advocate for opposite parties No.1 to 3; upon perusing the material papers on record; upon hearing the arguments and having stood over for consideration this forum passed the following:
ORDER
(Per Sri R. Kiran Kumar, FAC President)
This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the complainant No.1, 3 & 4 are the wife and children of the deceased Cherukuri Venkata Siva Ramakrishna Vidhyasagar, S/o late Nageswar Rao and the complainant No.2 is the mother of late Ch.V.S.R.Vidya Sagar. The complainants submitted that late Vidya Sagar had taken the insurance policy on 28-05-2004 through the opposite party No.1 office vide Policy No.687040269. The sum assured was Rs.5,00,000/- under Jeevan Anand Policy, since the date of issuing policy by the opposite party No.1 in favour of deceased Vidya Sagar, he was paying the subscription in half yearly installments. The yearly premium is Rs.28,326/- and the scheme of the policy is 21 years and it will be completed by the year, 2024. The complainants also submitted that the policy covers the risk of the life of the said Vidya Sagar along with accidental benefit and the fact is mentioned in the policy. The complainants also submitted that unfortunately the policy holder i.e. Ch. V.S.R. Vidya Sagar died on 01-10-2009 in Train accident at K.M.No.199/40 on DN Line Moulali yard, Secunderabad and on the complaint of one Ravikanth a case was registered by S.I. Civil SIRP-1004 vide Crime No.514/2009 Under Section 174 Cr.P.C. The complainants also submitted that the Police conducted inquest over the body of the deceased and in the inquest it is mentioned that there are injuries on the head of the deceased and they found the blood on the dead body and the place of offence and after inquest and P.M.E., the complainants took the dead body of the deceased and cremated as per the rites and customs prevailing in the community. The complainants further submitted that the opposite party No.2 Corporation sent a letter to the complainant No.1 along with cheque for Rs.6,38,000/- and mentioned that the basic amount is 5,00,000/- vested bonus is Rs.93,000/- and installment bonus is Rs.45,000/- which comes to Rs.6,38,000/-. The opposite party did not paid the accidental risk which is covered under the policy deliberately, which comes to Rs.5,00,000/- . On 21-01-2010, the complainants requested the opposite parties No.1 & 2 for payment of accidental benefit but the opposite parties informed the complainants that the accidental benefit under the policy has rejected by the competent authority. The complainants approached the opposite party No.3 in the month of March 2010 for the accidental benefit amount and the same was repudiated by the opposite party No.3 through letter dt.21.08.20 10 and the said letter which was mentioned that it is final order. The complainants also submitted that as per the policy, the opposite parties corporation are liable to pay the accidental benefit in addition to the sum assured in case of death occurred in accident and in this case, the deceased Vidya Sagar died with head injury in train accident which is clear by all documents i.e. F.I.R., inquest proceedings issued by police. The complainants further submitted that, they have approached the opposite parties number of times for getting accidental benefits but the opposite parties corporation failed to pay the accidental benefit under the policy, as such the complainants approached the Forum for deficiency of service.
2. On behalf of the complainants, the following documents filed and marked as Exhibits A1 to A13.
Ex.A1:- Photocopy of First Information Report, dt.01-10-2009.
Ex.A2:- Photocopy of letter dt.01-10-2009 from Station Manager, Secunderabad to S.I., Govt. Railway Police Station, Secunderabad.
Ex.A3:- Photocopy of Inquest in Cr. No.514 of 2009, dt.01-10-2009.
Ex.A4:- Photocopy of Post Mortem Examination, dt.03-10-2009.
Ex.A5:- Photocopy of Burial Ground Report Death Information issued by the In-charge of the Burial Ground, Greater Hyderabad Municipal Corporation.
Ex.A6:- Death Certificate by name CH. V. Siva Ramakrishna Vidya Sagar.
Ex.A7:- Photocopy of Income Tax Return Form for the years, 2006-2007.
Ex.A8:- Photocopy of letter dt.21-12-2009 from the opposite party No.2.
Ex.A9:- Photocopy of letter dt.21-01-2010 from the opposite party No.2.
Ex.A10:- Photocopy of death claim application, dt.10-02-2010 filed by the complainant No.1 to the opposite party No.2.
Ex.A11:- Photocopy of letter dt.24-03-2010 from the opposite party No.3 to the complainant No.1.
Ex.A12:- Photocopy of Repudiation letter dt.21-08-2010 sent by opposite party NO.2 to the complainant No.1
Ex.A13:- Photocopy of paper cutting.
3. On receipt of notice, the opposite parties No.1 to 3 appeared through their counsel and filed counter. In their counter, the opposite parties admitted the issuance of policy to the deceased late Ch. V.S.R. Vidya Sagar. The opposite parties submitted that the nominee under the policy Smt. Ch. Rama Devi vide letter dt.06.10.2009 intimated that late Ch. V.S.R. Vidya Sagar expired on 01-10-2009 and clamed the death benefits under the policy. On receipt of death intimation and other requirements, they settled the claim for Basic Sum Assured on 21-12-2009. The opposite parties corporation further submitted that the life assured died under suspicious circumstances, an investigation caused into the cause of death to decide claim for “Accidental Benefit” under the policy and as per the final report of the Police, under FIR No.514/2009, dt.01-10-2009, R.P.S. Secunderabad, the death of life assured occurred while he was trespassing the railway track and was hit by an unknown train. The opposite parties’ corporation also submitted that as per the policy conditions under clause 10 (b) (i) & 10 (b) (iv), the Accident Benefit is excluded for payment in circumstances where death is caused due to “self Injury’ and when there is a ‘Breach of Law’. And also relied on the decision of the Hon’ble National Commission, in R.P.No.2922 of 2006 in LIC Vs Veerabhadraiah, basing on the Supreme Court decision in Oriental Insurance Co. Ltd, Vs Sony Cheriyan (1999) SCC 451 and prayed to dismiss the complaint.
4. On behalf of the opposite parties, no documents filed.
5. Written arguments of complainant filed.
6. Heard oral arguments.
7. Upon perusing the material on record, now the points that arose for consideration are,
- Whether the complainants are entitled for the accident benefit under the policy?
- What relief?
Point No.1:- The case of the complainants are that, the deceased late Ch.V.S.R. Vidya Sagar had taken insurance policy from the opposite party insurance company and the deceased Vidya Sagar died on 01-10-2009 in train accident. On complaint of one Ravi Kanth, a case was registered by S.I. Civil SIRP-1004 vide Crime No.514/2009 Under Section 174 Cr. P.C and thereafter the Police held inquest over the dead body of the deceased Ch. V.S.R. Vidya Sagar and in the inquest it is mentioned that there are injuries on the head of the deceased. According to the complainants, after receiving the documents from the complainants the opposite party No.2 sent a letter to the complainant No.1 along with cheque for Rs.6,38,000/- and the opposite party did not pay the accidental risk benefit which is covered under the policy, and the opposite party informed that the accidental benefit under the policy as rejected by the competent authority. As the opposite party failed to pay the accidental benefit covered under the policy, the complainants approached the Forum for redressal.
From the documents and material available on record, we observed that the issuance of policy is not in dispute. The opposite parties’ corporation has taken objection about the death of the life assured and submitted that the death of the life assured occurred while trespassing the railway track, the death of the life assured is a result of self injury and also breach of law, and the claim was rejected as per the condition No.10 (b) (1) and 10 (b) (iv) of the policy contract. From the above we observed that except taking the objection by the opposite party insurance company, the opposite parties’ corporation failed to produce any material to establish that the death is caused due to self-injury and there is breach of law. The opposite parties’ corporation also failed to produce any documentary evidence to support their contention. The opposite parties’ corporation to support their case, they relied on the judgment of Hon’ble National Commission in R.P. No.2922 of 2006 of LIC Vs Veerabhadraiah and Supreme Court decision in Oriental Insurance Company Ltd. Vs Sony Cheriyan, which facts are not relevant with the present case. As the opposite parties failed to establish their contention, we see that the repudiation by the opposite parties’ corporation shows negligence amounting to deficiency of service on the part of opposite party. As such this point is answered accordingly in favour of the complainant.
Point No.2:-
. In the result, the complaint is allowed in part, directing the opposite parties to pay the accidental benefit covered under the policy No. 687040269 along with interest @9% p.a. from the date of repudiation of the claim i.e. 21-08-2010 till the date of actual payment.
Dictated to steno, transcribed by her, corrected and pronounced by us in the open forum, on this 19th day of July, 2013
FAC PRESIDENT MEMBER
DISTRICT CONSUEMR FORUM, KHAMMAM
APPENDIX OF EVIDENCE
Witnesses examined for complainant: None
Witnesses examined for opposite parties: None
Exhibits marked for Complainant:
Ex.A1:- Photocopy of First Information Report, dt.01-10-2009.
Ex.A2:- Photocopy of letter dt.01-10-2009 from Station Manager, Secunderabad to S.I., Govt. Railway Police Station, Secunderabad.
Ex.A3:- Photocopy of Inquest in Cr. No.514 of 2009, dt.01-10-2009.
Ex.A4:- Photocopy of Post Mortem Examination, dt.03-10-2009.
Ex.A5:- Photocopy of Burial Ground Report Death Information issued by the In-charge of the Burial Ground, Greater Hyderabad Municipal Corporation.
Ex.A6:- Death Certificate by name CH. V. Siva Ramakrishna Vidya Sagar.
Ex.A7:- Photocopy of Income Tax Return Form for the years, 2006-2007.
Ex.A8:- Photocopy of letter dt.21-12-2009 from the opposite party No.2.
Ex.A9:- Photocopy of letter dt.21-01-2010 from the opposite party No.2.
Ex.A10:- Photocopy of death claim application, dt.10-02-2010 filed by the complainant No.1 to the opposite party No.2.
Ex.A11:- Photocopy of letter dt.24-03-2010 from the opposite party No.3 to the complainant No.1.
Ex.A12:- Photocopy of Repudiation letter dt.21-08-2010 sent by opposite party NO.2 to the complainant No.1
Ex.A13:- Photocopy of paper cutting
Exhibits marked for opposite parties:- Nil
FAC PRESIDENT MEMBER
DISTRICT CONSUEMR FORUM, KHAMMAM.
