Before the District Forum: Kurnool
Sri K.V.H. Prasad, B.A., LL.B., President
And
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B. Com., LL.B., Member
Monday the 28th day of February, 2005
C.D.No. 26/2004
Smt S. Maruthamma,
W/o Late S. Eliya,
Employee in Pro & Excise Office,
Plot No. 66, Banjara Colony,
Kurnool. . . . Complainant represented by his counsel
Sri G. Nagaraju Advocate
-Vs-
The Divisional Manager,
M/s. The New India Assurance
Company Ltd, HDCT Complex,
Railway Station Road,
Kurnool. . . . Opposite party represented by his counsel
C.M.K. Ranjani Advocate
O R D E R
(As per Smt C. Preethi, Hon’ble Lady Member)
1. This CD complaint of the complainant is filed under section 10& 12 of C.P. Act, 1986, seeking a direction on the opposite party to pay assured amount of Rs.1,00,000/- with 18% per annum from the date of intimation of death, Rs.50,000/- as compensation for suffered mental agony, Rs.2,500/- as costs of the complaint and any such other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complaint of the complainant is that the complainant’s husband Late S. Eliya while working in Excise Department obtained a Janata Personal Accident Policy bearing No. 4761150020220 on 20.11.1990 by paying premium amount of Rs.280/- and nominated his wife/ complainant as his nominee. The said policy holder on 10.1.2002 after completion of his duty at Midthur busstop, Nandikotkur slipped and fell down on the road while boarding an Auto and was shifted to Govt. General Hospital, Kurnool next day, while taking treatment at Govt General Hospital the policy holder sccumbed at about 9.45 A.M on 31.1.2002. Immediately the complainant informed the death of the policy holder to the opposite party. The Nandikotkur Police Station has registered a case under Cr. No. 9/2002, under section 174 CRPC and closed the case as accidental death. Inspite of several demands and approaches the opposite party did not settle the claim and on 1.12.2003 through their communication repudiated the complainant’s claim with all false and baseless allegations to avoid payment of policy amount. For the above said lapsive conduct the complainant got issued Lawyer’s notice through her councel on 16.2.2004, after receipt of Lawyers notice the opposite party did not give any reply. Therefore, the repudiation of claim by opposite parties in untenable and amounts to deficiency of service to the complainant.
3. In substantiation of her case the complainant filed the following documents Viz (1) attested Xerox copy of Long Term Janata Personal Accidental Insurance Policy bearing No. 4761150020220 of the deceased S. Eliya (2) attested Xerox copy of FIR No. 9/2002 dt 1.2.2002 of Nandikotkur Police Station (3) attested Xerox copy of inquest report (4) attested Xerox copy of P.M Examination dt 1.2.2002 (5) attested xerox copy of Final Report dt 5.12.2002 (6) Lawyer’s notice dt 16.2.2004 issued by complainant’s counsel to opposite party (7) reply notice dt 1.3.2004 of opposite party’s counsel to complainant’s counsel (8) postal receipt as to the acknowledgement of opposite party for the receipt of Ex A.6 (9) repudiation letter dt 9.12.2003 of opposite party to the complainant and (10) Death Certificate dt 26.2.2002 of S. Eliya issued by Municipal Authorities, Kurnool, besides to the sworn affidavit of complainant in reiteration of her complaint avernments and caused affidavit of complainant in reiteration of her complaint avernments and caused interrogatories to opposite party and third party (Investigator) and suitablely replied to the interrogatories filed by opposite party. The above documents are marked as Ex A.1 to A.10 for its appreciation in this case.
4. In pursuance to the notice of this Forum as to this case of the complainant the opposite party appeared before this Forum through their standing counsel and contested the case by filing written version denying all the complaint avernments and questioning the maintainability of the complainants case either in law or on facts.
5. The written version of opposite party submits that it repudiated the claim of the complainant on 9.12.2003, as the death of the policy holder occurred on 31.1.2002 and the complainant intimated the opposite party as to the death of the policy holder on 29.7.2002 without furnishing any details and after a lapse of 6 months and no explanation was given by the complainant in her letter dt 6.8.2002 to the satisfaction of opposite party. As the death intimation was given on 29.7.2002, as such there is a delay of 6 months, which is clear violation of policy terms and conditions, which says in an event of the death of the policy holder the legal heirs must have intimated the death and caused of death to the Insurance Company within one calendar month after the event, which alone may give rise to make a claim under the policy and further the unreasonable delay of 6 months give rise to legitimate suspicion and latches on their part on the face of case which itself is violation of policy terms and conditions.
6. The opposite party further submits that after receipt of intimation on 29.7.2002 from the complainant as to the demise of policy holder, an investigator was deputed to find out the cause of death of the policy holder. It is learnt by the opposite party that the death of the policy holder S.Eliya was not an accidental, but he died in the hospital due to Paralysis (Quadriplegia) and the Medical Certificate issued by the Govt. General Hospital, Kurnool also confirm the same. In these circumstances the repudiation by opposite party is made after through investigation on two grounds that there is delay in intimation and death is not accidental, therefore, the repudiation is justified and opposite party is not liable to pay the policy amount to the complainant and seeks for the dismissal of complaint with costs.
7. The opposite party in support of its case relied on the following documents Viz (1) Policy certificate bearing No. 4761150020220 of the deceased S. Eliya issued by opposite party (2) Investigation report dt 17.11.2002 by E. Nagendraiah to opposite party and (3) statement dt 8.11.2002 of the complainant, besides to its sworn affidavit in reiteration of their written version as defence and a third party affidavit of E. Nagendraiah and the above documents are marked as Ex B.1 to B.3 for its appreciation in this case. The opposite party caused interrogatories to the complainant and the opposite party and third party replied suitablely to the interrogatories caused by the complainant.
8. Hence the point for consideration is to what relief the complainant is remaining entitled alleging deficiency of service on part of opposite party?:-
9. The replies to the interrogatories are not being in a form of the sworn affidavit as contemplated under Order XI, Rule 8&9 of CPC and Appendix –C Form No.3, they are not remaining worthy of consideration.
10. The Ex A.9 is the letter addressed by the opposite party to the complainant. It dates to 9.12.2003. It repudiates the claim made by S. Marthamma /complainant on 29.7.2002, on two reason that the death of the policy holder was intimated lately on 29.7.2002 after a lapse of 6 months and death of the policy holder is not accidental, by this conduct and from the written version avernments admitting the deceased policy holder has taken a Long Term Janata Personal Accidental Insurance Policy and admitting indirectly the deceased policy holder S. Eliya has taken a policy.
11. The first reason for repudiation of the claim is the delay in intimating the death of the policy holder. The opposite party alleges that the complainant intimated on 29.7.2002 about the demise of the policy holder on 31.1.2002 due to accidental fall when boarding an Auto and there is a delay of six months from the date of demise of policy holder. It further alleges that as per policy terms and condition on demise of policy holder the intimation should be given by the nominee to the Insurance Company within one calendar month. But the opposite party did not file any documentary record to substantiate the supra stated contentions. The opposite party did not file policy terms and conditions binding the complainant and opposite party and there is no default clause mentioned in the policy bond that if there is any delay in intimating the demise of the policy holder, the claim of the nominee will not be entertained and such claimants are not entitled to the policy amounts. While such is so, the complainant intimated the demise of policy holder on 29.7.2002, the claim has been entertained by the opposite party by repudiating her claim and further appointing an investigator to investigate the demise of policy holder, it appears that claim has been entertained by opposite party.
12. In this case the opposite party alleges that claim cannot be entertained as intimation of demise was delayed by 6 months, where as, in Uttar Pradesh State Consumer Disputes Redressal Commission, Lucknow, between LIC of India and Ors Vs Rajendra Singh Gaur, reported in IV (2004) CPJ Pg 53. Where in, it was held that repudiation of LIC on the ground that intimation of death was delayed, is not a good ground and allowed the complaint stating that the policy stood infact for more than 10 years and the complainant alone was the nominee under the said policy, who is entitled to the policy amount. While such is so, with the above case, in the present case the delayed of 6 months intimating the demise of policy holder by the complainant, who was poor and illiterate and unaware of the facts could not made the claim within the stipulated time, which does not appear to be such a grave violation of condition that the complainant should in all events be denied of insured amount of her husband S.Eliya. Therefore the first reason for repudiation is rejected.
13. The second reason for repudiating the claim was that the cause of death of policy holder was due to paralysis and not an accidental death. But the opposite party did not place any material except the so called statement of the complainant, said to have taken by the investigator during his investigation. Ex B.2 is the investigator’s report which envisages that he visited the complainant’s village and contacted the complainant and she stated that her husband suffered from paralysis and died during taking treatment in Govt. General Hospital, Kurnool on 31.1.2002. In support to the said report Ex A.3 is filed. The said statement of complainant in Ex A.3 is denied by the complainant’s sides and no material is placed by the opposite party’s side that said investigator during his investigation has taken the said statement from the complainant. Hence, no credence can be given to the said statement, which the opposite parties relied. Unless expert evidence of the Doctor who has treated the policy holder is produced, such evidence cannot be relied upon and form the basis of a finding that the policy holder was suffering from paralysis at the time of the accident. Merely the proof of documents doesn’t mean the contents there of are necessarily true. Mere assertion or oral testimony in respect of suffered paralysis by the policy holder neither inspires any confidence nor can be acted upon and relied upon.
14. Hence, absolutely there is no material on the record in support of the allegations of opposite party in repudiating the claim. For want of substantiating material in support of opposite party’s allegations, the act of repudiation of the claim of the Insurance by the opposite party as is remaining without any justifiable excuses the said conduct of opposite party is certainly amounting to failure on the part of the opposite party in performing the statutory duty in repudiating the claim and there by amounting to deficiency of service and there by entitling the complainant to the claim as the bonafides of the complainant’s claim are not other wise disturbed.
15. The opposite party relied on the decision of APSCRC between LIC Vs Babu Naidu reported in 2004 (1) ALD (cons) Page 1 wherein it was held that intimation should be give within 90 days of the event, where as the policy holder intimated after one year. Hence, there is no deficiency on part of Insurance Company in repudiating the claim. In the above case it was complainant/policy holder who has to intimate to the insurance and who has entered into an agreement with Insurance Company, but in the present it is the nominee of policy holder has to intimate after happening of the event, as she was poor and illiterates could not inform in time.
16. In the light of the above discussions the decision relied by the opposite party has little relevancy to this case and which can not be relied upon.
17. In the result, and in sum up of the above discussion, the complaint is allowed directing the opposite party to pay the insured amount of Rs.1,00,000/- to the complainant with 12% interest per annum from the date of demise of the policy holder till realization along with Rs.5,000/- as costs of this case, within one month from the date of receipt of this order.
Dictated to the Stenographer, typed to the dictation correct by us pronounced in the Open Court this the 28th day of February, 2005
Sd/-
Sd/- PRESIDENT sd/-
MEMBER MEMBER
