Complaint filed on: 22-01-2016
Disposed on: 30-07-2016
BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM,
OLD DC OFFICE COMPOUND, TUMAKURU-572 101
CC.No.14/2016
DATED THIS THE 30th DAY OF JULY 2016
PRESENT
SMT.PRATHIBHA. R.K. BAL, LLM, PRESIDENT,
SRI.D.SHIVAMAHADEVAIAH, B.A, LLB, MEMBER
SMT.GIRIJA, B.A., LADY MEMBER
Complainant: -
M.Bhavana,
D/o. Late Mallikarjunaiah,
Aged about
Pankajanahalli, Shettigere
Hobli, Chikkanayakana Halli Taluk, Tumakuru District.
(By advocate Sri.J.S.Chandrappa)
V/s
Opposite party:-
The Divisional Manager,
United India Insurance Co. Ltd, Branch office, Raghavendra Colony,
BH Road, Tiptur,
Tumakuru District.
(By advocate Sri.H.M.Nagabhushan)
ORDER
SMT.PRATHIBHA. R.K. PRESIDENT
This is a complaint filed by the complainant against the Opposite party, under Section 12 of the Consumer Protection Act. The complainant prays to direct the OP to pay a sum assured personal accident policy claim of Rs.5,00,000=00 along with interest and further pay Rs.2,00,000=00 towards deficiency of service and mental agony and Rs.10,000=00 towards cost of litigation and pass such other relief as deemed fit, in the interest of justice and equity.
2. The brief facts of the complaint is as under.
The complainant submits that, the father of complainant had taken the personal accident policy bearing No.0714024213P108709104 from the OP. On 25-09-2014 the complainant’s father went to their garden to graze the buffalo at Pankajanahalli. While returning from the garden at about 5.30 p.m. the buffalo was jumped and rope of the buffalo surrounded to the deceased Sri.Mallikarjunaiah and he fell down due to which he sustained head injuries. This incident was intimated to the complainant house by the adjacent garden person Sri.Shivaswamy s/o. Lingappa. The complainant along with her family members rushed to the spot and deceased Sri.Mallikarjunaiah was very much tired and immediately they took him to hospital for treatment.
The complainant submitted that, the complainant’s father was succumbed to head injuries near Hutna on the way to KB Cross hospital at about 5.40 p.m. the deceased Sri.Mallikarjunaiah was died on 25-9-2014. Thereafter, the complainant lodged the complaint to the C.N.Halli police station which was registered in UDR16/2014 under Section 174 of CrPC. Thereafter postmortem was done by the Shettikere Primary Health Centre doctor. In the postmortem report of the said doctor, the complainant’s father was died due to head injuries, due to buffalo rope rounded to the deceased Mallikarjunaiah.
The complainant submitted that, after the death of the deceased Sri.Mallikarjunaiah, the complainant has approached the OP for her father’s personal accident insurance policy amount along with necessary documents, but the OP has rejected the claim of complainant as “No Claim” and closed the complainant’s claim. Hence, the complainant got issued a legal notice to OP on 21-10-2015 through RPDA and the same was served on the OP, but the OP did not reply nor settle the claim of the complainant. Hence the complainant has come with the present complaint.
3. After service of the notice, the OP has appeared through his counsel and filed version contending interalia as under:
The OP admitted that, the insured late Mallikarjunaiah had taken the personal accident insurance policy bearing no.071402421P108709104. Further the OP admitted that, the father of complainant died on 25-9-2014 due to head injuries and Shettikere Primary Health Centre doctor has done the postmortem and complaint was lodged before the C.N.Halli police station and registered the case in UDR16/2014 under Section 174 of CrPC.
Further the OP submitted that, the conditions no.3 of the policy. The company shall not be liable to make payment under this policy in respect of any claim if such claim be in any manger fraudulent or supported by any fraudulent statement or device whether by the insured or by any person on behalf of the insured persons”. Further the OP submitted that, the investigation officer has not taken proper steps to investigate the case as per law and has not recorded the statement of the eye witness though the name of the person and his father name and place of his residence is same village. Hence the police have managed to put an end to investigation in collusion with the complainant to claim insurance and created documents to claim the insurance amount. As such those documents will not create any liability to pay compensation to the complainant by OP.
The OP further submitted that, the postmortem report given on the basis of postmortem conducted on 26-9-2014 between 3.45 p.m. to 6.45 p.m. by doctors of Shettikere Primary Health Centre disclose that, time since death was around 12 to 14 hours. But the time since death as per complaint version is more than 24 hours. But as per the inquest report, no wound on the body of the deceased. The cause of death is not perfect but it is a probability, as the death is not due to any accidental cause, the complainant is not entitled to get compensation under the accidental insurance policy. Hence the complainant is not entitled to get the insurance amount, so the complaint is liable to be dismissed with cost.
4. So as to prove the case, the complainant has filed her affidavit by way of evidence and produced documents along with complaint which were marked as Ex-C1 to C10. On the other hand, one R.Govindaraju, who being the Divisional Manager of OP has filed his affidavit by way evidence and no documents are produced on behalf of the OP. We have heard the arguments of both parties and we have gone through the oral and documentary evidence of both sides meticulously.
5. Based on the above materials, the following issues will arise for our consideration.
- Whether there was deficiency in service on the part of the OP as alleged by the complainant?
- What Order?
6. Our findings on the above points are;
Point no.1: In the affirmative.
Point no.2: As per the final order below.
REASONS
7. On perusal of the pleadings, evidence and documents produced by both the parties, it is an undisputed that, the complainant’s father deceased Sri.Mallikarjunaiah has taken Individual Personal Accident Policy bearing No.0714024213P108709104 from the OP, it is marked as Ex-C6 and the same was inforce at the time of death of Sri.Mallikarjunaiah.
8. Further the case of the complainant is that, the complainant’s father while returning from the garden to home dated:25-9-2014 at about 5.30 p.m. The complainant’s father late Sri.Mallikarjunaiah stumbled over the rope tied to the buffalo and the rope strangulated the deceased Mallikarjunaiah and the buffalo dragged late Mallikarjunaiah, due to which, he sustained head injuries; immediately he was shifted to KB Cross for treatment, But the Father of the complainant died near Hutna at about 5.40 p.m. on the way itself and in that regard a complaint was lodged in C.N.Halli police station in UDR No.16/2014 U/s 174 of Cr.P.C. Thereafter the Doctors of Shettikere Primary Health Centre conducted autopsy.
9. To substantiate the above fact, the complainant in her affidavit reiterated the same and also produced charge sheet copy/Ex-C1, FIR copy dated:26-9-2014/Ex-C2, complaint copy dated:26-9-2014 and postmortem report of complainant’s father dated 10-10-2015/Ex-C3. In the postmortem report, it is stated that the cause of death is probably due to “cerebral hemorrhage following fall due to bull gear”.
10. Per-contra, the OP submitted that, the Investigation Officer has not investigated the case as per law and he has not recorded the statement of the eye witness. The name of the persons and their father name and place of residence has not been recorded properly which gives room for doubt, it is alleged that, the eye witness have not seen the incident at all. The OP further submitted that the police have colluded with the complainant and created documents by choosing the complainant’s relatives and friends. Further, the OP submitted that the post-mortem was done on 26-9-2014 between 3-45 p.m. & 6.45 p.m. But the time since death as per complaint version is more than 24 hours.
11. The OP further submitted that, the cause of death is not perfect/beyond reasonable doubt, but it is a probability as the death is not due to any accidental cause. Hence, the complainant is not entitled to get compensation under the accidental insurance policy and it is against the policy conditions.
12. The OP has not produced any investigation report or any evidence to prove that the death of the complainant’s Father is not accidental one, but simply alleged that the complainant colluded with the police and created the documents as per their wish.
13. The OP has not challenged the documents and evidence of the complainant by producing material evidence to show that the death of the father of the complainant is not accidental one.
14. Admittedly after thorough investigation of the case, the police authority have filed detailed charge sheet. In the charge sheet, reason for the death is noted that, the deceased succumbed due to the fall. The Ops have not challenged the charge sheet before any appropriate Forum. This Forum does not have the power and jurisdiction to express any opinion on the chargesheet and the chargesheet has to be accepted. Therefore, in the light of the postmortem report and also the chargesheet, we deem it proper to come to the conclusion that late Sri.Mallikarjunaiah succumbed to the injuries, therefore he is entitled for the policy amount. Hence, the weight of the evidence is on the side of the complainant. Accordingly, we are of the considered opinion that, the complainant has proved deficiency of service on the part of OP and accordingly we answer the point No.1 in the affirmative.
15. Issue No.2: In the result, we pass the following:
ORDER
- The complaint filed by the complainant is partly allowed.
- The OP is directed to pay individual personal accident policy amount of Rs.5,00,000=00 (Policy No.0714024213P108709104) to the complainant along with 9% interest per annum on the said amount from the date of complaint to till the date of realization.
- The OP is further directed to pay Rs.5,000=00 to the complainant towards cost of litigation.
- This order is to be complied by the OP within 30 days from the date of receipt/knowledge of this order.
- Supply free copy of this order to both parties.
(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open forum on this, the 30th day of July 2016).
MEMBER MEMBER PRESIDENT
