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
Thursday the 26th day of August, 2010
C.C. No.11/10
Between:
Smt. Dudekula Kullayamma, W/o Late Dudekula Pedda Kullayappa,
H.No.10-807, Gandhi Nagar, Koilakuntla (V) and (M), Kurnool District-518 134.
…Complainant
-Vs-
1. The Branch Manager,United India Insurance Company Ltd.,
2-415B, N.K.Road, Nandyal-518 501.
2. The Divisional Manager,United India Insurance Company Ltd.,
D.No.24, White Road, CHENNAI-6000014.
…Opposite ParTIES
This complaint is coming on this day for orders in the presence of Sri. A.Rama Subba Reddy , Advocate, for complainant, and Sri. G.Madhu Sudhan Reddy , Advocate for opposite party No.1 and opposite party No. 2 is called absent set-exparte and upon perusing the material papers on record the Forum made the following.
ORDER
(As per Sri. T.Sundara Ramaiah, President)
C.C. No.11/10
1. This complaint is filed under section 12 of C. P. Act, 1986 praying to direct the OP
(a) to pay assured sum of Rs.5,00,000/- and compensation of
Rs.10,000/-
(b) to grant interest @ 24% p.a from the date of death.
( c) to grant costs of the complaint,
(d) to grant such other relief or reliefs as the Hon’ble Forum deems fit and proper in the circumstances of the case.
2. The case of the complainant in brief is as follows:- The complainant is the wife of Late D. Pedda Kullayappa . The complainants husband insured his life with the Ops under policy bearing No. 051102/ 47 / 51/11/ 56177 / 98 for Rs.5,00,000/- . The period of insurance policy is from 23-06-1998 to 22-06-2008 and it also covers the accidental death. The complainant is the nominee under the policy. On 10-10-2007 the insured Pedda Kullayappa fell on the gate and received head injury and died on 14-10-2007 at 1-00 P.M while under going treatment in Government Hospital, Kurnool. Subsequently the complainant submitted claim forms to the Ops . The Ops repudiated the claim on the ground that the proximate cause for insured fall is B.P and Sugar. There is deficiency of service on the part of the Ops in repudiating the policy. Hence the complaint.
3. OP.No.2 remained ex-parte. OP.No.1 filed written version stating that the complaint is not maintainable. The Insurance Company repudiated the claim on the ground that the proximate cause for insured fall is B.P and Sugar and not an accident. The complainant made a claim stating that Pedda Kullayappa fell on stair case on 10-10-2007 and sustained fatal injuries leading his death. The police investigated the case gave final report stating that the deceased fell on an iron gate and sustained fatal injuries leading his death . The proximate cause for the insured fall is B.P and Sugar and not accident. The deceased had the history of diabetes and hypertension since 15 years. The said fact was suppressed while obtaining the policy. Hence the claim is repudiated. There is no contractual obligations between the Ops and insured to cover the risk of diabetes and hypertension. The Ops are not liable to pay any amount to the complainant.
4. On behalf of the complainant Ex. A1 to A6 are marked and the sworn affidavit of the complainant is filed. On behalf of the OP no document is marked and sworn affidavit of OP.No.1 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 OP?
(ii) whether the complainant is entitled to any relief ?
- To what relief?
7. Points No.1 & 2 :- Admittedly Sri.D.Pedda Kullayappa obtained Janatha Personal Accident Insurance Policy bearing No. 051102/ 47 / 51/11/ 56177 / 98 - . The validity of the policy is from 23-06-1998 to 22-06-2008. The sum assured under the policy is Rs.5,00,000/- . The complainant who is the wife of the deceased Kullayappa is the nominee under the policy. The case of the complainant is that on 10-10-2007 the deceased Kullayappa fell on the gate , received head injury and died on 14-10-2007 while undergoing treatment in Government Hospital , Kurnool. Ex.A1 is the policy issued by the Ops. The complainant filed Ex.A2 death certificate to show that her husband died on 14-10-2007. Ex.A6 is the post mortem certificate issued by the Medical officer, Kurnool, Medical College, Kurnool. In the said certificate it is mentioned that the Kullayapppa died due to head injury on 14-10-2007. Admittedly the complainant made a claim basing on the policy issued by the Ops. The claim was repudiated on 14-10-2007. Ex.A3 is the repudiation letter where in it is mentioned the proximate cause for the insured fall is B.P and Sugar and hence the Ops are not liable to pay compensation. OP.No.1 also took a plea that the deceased had the history of diabetes and hypertension since 15 years and that he suppressed the said fact while obtaining the policy. No doubt in Ex.A4 copy of the FIR it is mentioned that the deceased was suffering from B.P and sugar since long time and that he fell on the gate on 10-10-2007 due to sugar and B.P. The Ops did not place any evidence on record to show that on the date of Ex.A1 policy the deceased was suffering from diabetes and hypertension. No document is filed by the Ops to show that the deceased had diabetes and hypertension by the date of the Ex.A1 policy. The documents filed by the complainant also do not disclose that he had diabetes and hypertension at the time of obtaining the policy.
8. It is also the case of the Ops that the cause for the insured fall is B.P and Sugar and not accident that the policy does not cover the risk of diabetes and hypertension and that the Ops are not liable to pay any compensation. No doubt the policy issued by the Ops does not cover the risk of diabetes and hypertension. It is not the case of the complainant that the insured died due to diabetes and hypertension. There is material on record to show that on 10-10-2007 the deceased Kullayappa fell on the gate in his house received injury and died on 14-10-2007 while undergoing treatment in Government Hospital, Kurnool. Fall on the gate by Kullayappa is an accidental one. The remote cause for fall of Kullayappa may be diabetes or hypertension. Simply because the deceased Kullayappa was suffering from diabetes and hypertension by 14-10-2007 , the claim of the complainant can not be rejected. Admittedly the policy issued by the Ops was inforce by the date of the death of Kullayappa on 14-10-2007. The death of deceased Kullayappa was accidental . The policy Ex.A1 issued by the Ops covers the accidental death. The Ops are not justifed in repudiating the claim of the complainant who is a nominee under Ex.A1 policy. The Ops without any reasonable cause rejected the claim of the complainant. There is deficiency of service on the part of the Ops .
9. Point No.3: In the result the complaint is partly allowed directing the Ops jointly and severally to pay assured sum of Rs.5,00,000/- with interest at 9% from the date of repudiation of the claim i.e, 14-07-2009 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 26th day of August 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 policy No.051102/47/51/11/56177/98.
Ex.A2. Death Certificate of Late Dudekula Pedda Kulayappa.
Ex.A3. Repudiation Letter dt. 14-07-2009 issued by OP2 to complainant
Ex.A4. F.I.R. in Cr.No.73/2007 Koilakuntla P.S.
Ex.A5. Inquest report of Dudekula Pedda Kulayappa.
Ex.A6. Post Mortem report dt.14-10-2007
List of exhibits marked for the opposite parties: Nil
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:
