Orissa

Rayagada

CC/354/2016

Smt. M.Gayatri Bai - Complainant(s)

Versus

The Divisional Manager, National Insurance Co. Ltd., - Opp.Party(s)

Sri Gouriswar Rao

20 Feb 2018

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No. 354/ 2016.                                        Date.       20 .2. 2018.

P R E S E N T .

Dr. Aswini  Kumar Mohapatra,                   President

Sri GadadharaSahu, .                               Member.

Smt.  Padmalaya  Mishra,                          Member

Smt. M. Gayatri  Bai, W/O: Late M.UmaSankar, At:  Hukkamba, Po: Hukkamba,          Dist.Rayagada,State:  Odisha.            At present residing  at Co-operative colony, Rayagada.                                                                                                                   …….Complainant

Vrs.

1.The Divisional  Manager,  National Insurance Company Ltd., Division, 38 India Exchange place, Ground floor, Kolkata- 700001    (West Bengal.)

2. The Manager, Golden Trust Financial services 16, R.N.Mukherjee road, Ist. Floor, Kolkata-700 001, West Bengal.                                                            .…..Opp.Parties

Counsel for the parties:                         

For the complainant: - Sri V. Goureswar  Rao, Advocate, Rayagada.

For the O.P No.1 :- Sri P.Ch. Das, Advocate, Rayagada.

For the O.P. 2:- Sri Arun Kumar Lenka, Advocate, Rayagada..

                                J u d g e m e n t.

        The  present disputes emerges out of the complaint petition filed by the above named complainant alleging deficiency in service  against  afore mentioned O.Ps for non payment of insured amount   a sum of  Rs.3,00,000/- towards accidental  death benefits,  The   brief facts of the case are summaried here under.

       1)That the complainant’s husband had deposited money for the insurance policy  under the  O.P.  and the insurance  policy  is covered under Group Janata Personal Accident Insurance.  The complainant’s husband  has been allotted policy vide  No. 100300/47/01/9600022/03/96/30397 and period of coverage under the policy  was  from 15.2.2004 to 14.2.2019.    The  complainant is nominee in the above policy.  The   complainant’s husband and his friend were travelling in a Motor cycle having  No. OD-18-1752, and they were  going  to Rayagada on Dt. 3.9.2014 from their native village Hukkamba to Rayagada.  On the way at village: Parla a  truck  was coming  from Rayagada to Gunupur had dashed the Motor Cycle, so they  fallen there.  The complainant’s husband injured due to the accident and admitted at the Care Hospital, Vishakapatnam(AP) in the following dates i.e on Dt.3.9.2014, Dt.6.2.2015  Dt. 4.3.2015 and discharged on Dt. 25.10.2014, Dt. 21.2.2015 Dt. 14.3.2015 respectively.  The complainant had taken a lot of care for the health of her husband but due to his severe injuries he died on  Dt.30.3.2015 at his residence at Ukkamba village under the Rayagada District. The complainant had sent a letter to the O.P. No.1 on Dt.6.8.2015 claiming the accidental death benefits as per the policy provisions. The complainant had sent all the  papers on  Dt. 25.9.2015   to the   O.P.No.1  to settle her  claim as early as possible. Inspite of repeated correspondence made with the  O.P No.1  till date has not settled legitmate claim. Hence this case. The complainant prays the forum direct the O.P. to pay the accidental death benefits as per the policy provisions  inter alia award compensation  cost and such other relief as the hon’ble forum deems fit and proper for the best interest of justice.

       2)On being noticed the O.P. No.1 filed written version through their learned counsel  and contended that the allegation made in the complaint are not true and correct. The complainant is called up to prove the same which are not admitted here under. That  the averments made in the  petition are  all false, and O.Ps  deny   each and every allegation made in the petition. The O.Ps taking other grounds in the written version   sought to dismiss the complaint as it is not maintainable  under the C.P. Act, 1986.  Hence the O.P No.1   prays the forum to dismiss the case against  them  to meet the ends of justice.

The O.P.No.2 appeared  through their learned  counsel and submitted that according to the  Memorandum of Understanding the   O.P. No.1   empowers  the O.P.  No.2  to extend the insurance coverage to its membersi.e Mr. MediboinaUmasankar (deceased). The policy No. 100300/47/01/9600022/03/96/30397 mentioned therein , was issued by the O.P. No.1 on the facilitation of the O.P. No.2 without however having  any liability with regard to any insurance claim which  is the specific responsibility/liability of  O.P. No.1. Again the O.P.No.2 submitted that settlement and payment of the claim to the complainant by  the O.P. No.1 but not  by the O.P. No.2.  The O.P.No.2 prays the forum kindly  struck down from the petition  of the complaint for the best interest of justice.

The O.Ps appeared and filed their written version.  Heard arguments from the  learned counsel for  the  O.Ps and from the complainant.    Perused the record, documents, written version  filed by the parties. 

The  parties advanced arguments vehemently opposed the complaint touching the points both on the facts  as well as on  law.

                                                         FINDINGS.

On perusal of the record It is not disputed from  both the parties  that Late M.Uma Shankar had taken a Group Janata Personal Accident Insurance Policy bearing No. 1000300/ 47/01/9600022/03/96/30397 for the period from 15.2.2004 to 14.2.2019 and the complainant has mentioned as the nominee  in the above policy. The sum assured in the said policy was Rs.3,00,000/-. It is not disputed that the life assured was died on Dt.30.03.2015.  This policy covers only the accidental death/loss of limbs/permanent total disablement.

The O.Ps in their written version contended that the case is not maintainable before the forum.Prior  to delve in to the merit  of the case on outset  we have to  consider whether the complaint petition  is maintainable   under C.P. Act ?  While answering  the issue  we would like to refer the citation. It is held and reported in  CPC- 1991, page -540 the  Hon’ble  Hariyana State  Commission held that when ever there is any delay or dilatoriness in finalizing  the insurance claim, the same would be tentamount to a  deficiency  in service and thus comes squarely within the  purview of Consumer Forum.  Once it is held that default or negligence in the  settlement of an insurance claim is a deficiency  in service then an arbitrary  or mischievous  rejection  of an insurance claim  would patently  be a default  within its larger  meaning. On principle , it would   seem  some what manifest that the mere repudiation of the insurance claim cannot itself operate  as a  jurisdiction bar for redressel forums under the Act.  This is further  made it clear  it is held and reported  in CPR-1991(2), page No.18  where in  the Hon’ble National Commission  clearly defines  the mere unilateral  rejection of an insured parties  claimed by the insurer does not  per  se  operate as jurisdictional bar to seek redressal before  the forums under the Act. Accordingly answered the issue.   The complaint  petition  is  maintainable  under the C.P. Act.

The  next  point for consideration are :-

Whether there is any deficiency  in service on the part of the O.Ps ?

 “Service” is defined in section 2(1)(o)  of the Act  thus:-

                “Service”means service of any description which is made available  to potential    users and included the provisions  of facilities  in connection with banking,  financing, insurance, transport, processing, supply of  Electrical or other energy, board  or  lodging or both,  entertainment,  amusement or the purveying   of news or information, but does not include the rendering of any service free of charge or under conract or personal service”.

“Insurance” is one of the service  enumerated there and falls  within the ambit of definition.

The O.P. No.1 in written version para No. 3 contended that he has no informationthat complainant’s   husband and his friend were travelling in a Motor Cycle having No. OD-18-1752 to Rayagada on Dt. 3.9.2014 from Ukkamba and on the way to Parala Village a Truck dashed the motor cycle and the rider died at the spot and the complainant’s husband sustained injured due to the accident and admitted at the Care Hospital, Vishakhapatnam (AP) in the following dates i.e on Dt.3.9.2014, Dt.6.2.2015  Dt. 4.3.2015 and discharged on Dt. 25.10.2014, Dt. 21.2.2015 Dt. 14.3.2015 respectively.

       To substantiate the reply to the above questions  the learned counsel for the complainant filed  information which was filled-up by the Dr.N.V.S.Mohan, Neurosurgeon, Care Hospital, Vizag in your claim Proforma   where he was mentioned  in the following dates i.e on Dt.3.9.2014, Dt.6.2.2015  Dt. 4.3.2015 the life assured was admitted  and discharged on Dt. 25.10.2014, Dt. 21.2.2015 Dt. 14.3.2015 respectively. Further  in the above proforma the above Dr. clearly mentioned  the deceased met with an accident  on Dt. 03.09. 2014  at 8.40 A.M. at Parala,Near Ramanaguda and first aid  given  at P.H.C., Ramanaguda and next treatment at Care Hospital, Vizag.  He also clearly mentioned nature of injury i.e. Head, Hydrocephalus, back bone, one eye, one leg injuries.  (copies of the filled up Proforma by the Dr. N.V.S.Mohan is enclosed  in the file which is marked as Annexure-I.

Again in para No.4  the  O.P. No.1  contended that  due to  non submission of the following  documents the  claim  of the complainant is not yet settled.

1. P.M.report nor the treatment papers from 14.3.2015 to 30.3.2015 to know that the husband of the complainant  had  died due to the alleged accident.

To answer the above point the learned counsel for the complainant submitted thatthe deceaseddischarged from theCare Hospital, Vizag on Dt.14.3.2015due to non recovery of of his health condition.TheCare hospital advisedthe complainant to take back her husband to her home and advised her to take care of his health, and also advised her to use medicines as per his prescriptions. The complainant hadtakena lot of care for the health of her husband but due to his severe injuriesin accident he died on Dt.30.3.2015 at his residence at Ukkamba village, in Rayagada District. The death certificate issued by the Medicalofficer, Ramanaguda, C.H.C is enclosed in the filewhich is marked as Annexure-2. Furtherthe learned counsel for the complainant submitted that thoughfrom 15.3.2015 till death i.e. on Dt.30.3.2015the deceased was not under medical treatmentunder any doctorhe wastakingmedicinesas prescribed by theVizag Doctor. So the question of submission of post mortemreportof deceased doesnot arise.

In the above accidentF.I.R. was also filedin the Ramanaguda Police Station, Ramanaguda on Dt. 3.9.2014 vide F.I.R. No. 99 and bearing G.R. case No. 189 of 2014copies ofthe sameare enclosedin the file which ismarked asAnnexure-3 , 4& 5). Final police reportalso filedwhich is marked asAnnexure-6.Againon Dt. 3.9.2014 the Ramanaguda police station, Ramanagudahad sentthe deceased to the Ramanaguda Hospital for his treatment to recoveryofinjuries due to accidentwhich is marked asAnnexure-7.

This forumperused thecitationsimilartype ofcase. It is held and reportedin C.P.R.-2015(1) pageNo.162 in the case of Mrs. Ajmeri Khatun Vrs. National Insurance Co.Ltd where in the Hon’ble National Commission observed- Insurance-Janata Personal Accident policy-Death due to snake bite- Repudiation of death claimon ground postmortem examination is not conducted-There is no justifiable ground to disbelieve police report and doctorreportwhotreated deceased-Order passed by the District forum allowing complaint.

In thepresent case in hand the accident could be proved by doctor’s certificate and the letter issued by the policeauthority to theLocal Hospitalif the postmortem had not been conducted. It is anadmitted fact thatthe deceased had takena Long Term JanataPersonal Accident forthe period from

This forum observed from the date of accident i.e. on dt.3.9.2014till death Dt. 30.3.2015 the deceasedwastreated underdirect supervision of VizagDr. N.V.S.Mohanboth physicaland over phone as per their prescription and medicines. Further there isa certificate on record issued by Dr. N.V.S.Mohan,CareHospital, Vizagthat the deceased was admittedin the above hospital on Dt. 3.9.2014 and expired on Dt. 30.3.2015at his residenceafter 16 days of discharge from Hospital so called on Dt.14.3.2015.

This forum observed there is no justifiableground to disbelieve thepoliceand Doctor report who treated the deceased.

       

In view of the above discussion relating to the above case and  In Res-IPSA-Loquiture  as well as  in the light of the settled legal position  discussed  as above referring citations  which is Aliane Juris. Hence  we allow the above complaint petition  in part.

Hence  to  meet the  ends of justice, the following order is passed.                                                                                                       ORDER.

            In  resultant    the complaint petition is  hereby  allowed  in  part  on  contest against  the O.P.  No.1 and  dismissed against the O.P. No.2.

4.The O.P No.1 is   ordered  to reimburse the accidental death benefit of the insured  amount   as  per the policy provisions bearing  policy No. 100300/47/01/9600022/03/96/30397  under Group Janata Personal Accident Insurance  scheme inter alia   to pay Rs.1,000/- towards litigation expenses  to the complainant.  

The OPs     ordered to make compliance the aforesaid Order within  45 days from the  date of  receipt  of this order      failing which  an interest  @ Rs.9%  per annum  would  accrue on the above  amount  from  the date of  filing  of this case i.e. on Dt.05.11.2016   till  realization.

   Serve the copies of above order to the parties free of cost.

Dictated and corrected by me

Pronounced on this              20 ^th.   Day of  February  ,   2018.

 

Member.                                                             Member.                                                             President