PRESENT: SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT

 

Thursday, 18^th December 2008

1. Bathala Sivanna, S/o B. Pedda Sivaiah, 56 years,

2. Bathala Ramulamma, W/o Sivanna, 53 years.

 

Vs.

 

1. United India Insurance Co. ld., Rep. by its

2. A.P. State Trading Corporation, Rep. by its

           

This complaint coming on this day for final hearing on 16-12-2008 in the presence of Sri V. Eswar Reddy, Advocate for complainant and Sri K. Rama Kondaiah, Advocate for respondents and upon perusing the material papers on record, the Forum made the following:-

 

1.                This is a complaint filed by the complainant under section 12 & 14 R/w Section 2 (1) of C.P. Act seeking directions to the respondents to pay                 Rs. 2,00,000/- towards insurance amount with interest @ 12% p.a. from the date of death of their son, to pay Rs. 20,000/- towards mental agony and deficiency of service and to pay Rs. 5,000/- towards costs of the complaint. 

 

2.                The brief facts of the complaint is as follows:- In the present complaint there are two complainants, complainant No. 1 is the father of the deceased and the complainant No. 2 is the mother of the deceased of the policy holder. The complainants are residing at  P. Venkatapuram Village, Yerraguntla Mandal, Kadapa district. The policy holder B. Veera Siva is the 2^nd son of the complainants who died on 30-4-2007 due to accidental fall from the two storied building. Policy holder B. Veera Siva herein after called the “deceased” was the student of K.S.R.M Engineering College, Kadapa. In the year 2004 at the time of joining in the college he took insurance policy under “Tailor made personal accident scheme” for Engineering students and parents. He paid premium of Rs. 660/- and receipt no. 3067, dt. 12-9-2004 was issued by R1 and the said policy was valid for 4 years of engineering study. The policy covers the risk of accidental death of any student of Rs. 2,00,000/- will be paid to the insured parents / Guardian. In case of death of their parents father or mother the policy holder (student) will receive                         Rs. 2,00,000/- from R1. On 30-4-2007 the policy holder B. Veera Siva accidentally fell down from two stored building which belongs to his paternal uncle at about 9.00 p.m. The said accident was not intimated to the concerned police and no FIR was registered. No inquest was conducted and no doctor conducted post mortem to the dead body. The complainants further sated that the sub-inspector of police, Yerraguntla police station received information through the village Sarpanch one Mr. Kuncham Venakta Subba Reddy of P. Venkatapuram Village, he came to the village and enquired the cause of death of B. Veera Siva. The Sub-inspector of police issued a certificate that in his enquiry he came to know that the deceased died accidentally, but not committed any suicide. 

 

3.                The Village Sarpanch by name Kuncham Venkata Subba Reddy issued a certificate that the policy holder died on 30-4-2004 accidentally falling from two storied building. The policy holder died on the spot and the information of the accident was not given to the concerned police. The Deputy Tashildar issued death certificate on 25-6-2007 stating that the policy holder died accidentally falling from two storied building but not committed any suicide. The complainant No. 1 sent a letter to R1 regarding his sons accidental death and R1 in turn sent a letter to the complainant dt. 6-7-2007 to send the relevant documents. The complainant No. send the documents to R1 and also send the same to Hon’ble Insurance ombudsman at Hyderabad. The complainant received a letter dt.             26-12-2007 that necessary step will be initiate by the Hon’ble Ombudsman to process the claim of the complainant. The complainant No. 1 sent a letter dt.        30-1-2008 to R1 to settle his claim at early. The complainant received a letter from R1 dt. 22-4-2008 no amount will be payable under the said policy.   The complainants further stated that at the time of obtaining the policy the deceased was hale and healthy and at the time of his death the insurance policy was in force and non – settlement of his claim amount of Rs. 2,00,000/- amount to deficiency of service on the part of the respondents. Hence, this complaint. 

 

4.                The R1 filed its counter and the same was adopted by R2 with a memo. The respondent denied all the allegations made by the complainant except issuing of policy to the deceased policy holder. It is true that B. Veera Siva took policy when he was admitted in engineering course in K.S.R.M Engineering College, Kadapa. According to the policy within four years from the date of commencement of the policy whenever, the policy holder or his parents met with an accident and died accidentally this respondent has to pay Rs. 2,00,000/- to the nominee. The policy was in force at the time of death of the deceased policy holder B. Veera Siva. According to the complainants the deceased policy holder died accidentally falling from the top of the two stored building. The nominees of the deceased policy holder approached this respondent for settlement of claim. The respondent further stated that the death of the deceased as stated by the complainants is false and fabricated for purpose of the case. According to the petitioners the deceased died on 30-4-2007. But after three months they sent a letter to this respondents stating that the policy holder died due to fall from the top of the two storied building. According to the policy terms and conditions whenever the policy holder met with an accident the nominees have to intimate the same to the respondents company within one calendar month from the date of death of the policy holder. But in the present case the nominees gave the said information after three months. The complainants violated the terms and conditions of the policy. 

 

5.                The nominees of the deceased policy holder has to submit the FIR, inquest and post mortem certificate regarding the death of the policy holder. In the present case the complainants have not filed any such documents which are mandatory according to the policy to settle the claim. The petitioners simply mentioned that they have no legal knowledge so they have not given any information to the police and no FIR was registered and no post mortem was conducted to the dead body of the deceased policy holder. To settle the claim all the documents are necessary. The respondent took an objection that the complainants filed two documents one is certificate of Sarpanch by name Kuncham Venkata Subba Reddy, in which it is stated that the deceased died accidentally due to fall from the top of the two stored building as his head was broken in to two pieces and died on the spot. Another document which is issued Sub-inspector of police, Yerraguntla stating that he made enquiry and came to know that the deceased policy holder fell down from the top of the 1^st floor and died accidentally and in the said certificate he is not mentioned any date or place, when he has issued the said certificate. The respondent alleged that the two documents filed by the respondents are fabricated for unlawful gain. On their enquiry they came to know that the deceased committed suicide and the Sarpanch who issued the certificate is to help of the complainants. In the said certificate it is mentioned in the first line that the deceased fell down from the top of the two storied building which belongs to his paternal uncle. But in the same certificate in the next following lines he mentioned that the deceased fell down accidentally from the first floor. On perusing the documents filed by the complainant it is clear that the claim of the complainants is not genuine. It is the duty of the complainants to prove their case by submitting all the relevant documents.  The complainants submitted their application before Ombudsman for settling the claim. But after thorough enquiry the Hon’ble Ombudsman held that this respondent is not liable to pay any compensation to the petitioners as the claim is false one. After that the complainants filed the said complaint before Hon’ble Forum by suppressing the facts. The investigator of this respondent on his enquiry, we came to know that the father of the deceased policy holder reprimanded the deceased for his negligent manner in his studies. In the depression mood the deceased committed suicide by hanging. The villagers and parents of the deceased were afraid and they immediately burnt the dead body of the deceased even though it is against their customs.   After two months they came to know about the policy and to grab the policy amount they prepared all the documents and submitted for settlement of the claim. According to the policy there is no coverage to the suicide death and this respondent is not liable to pay any compensation to the complainants and there is no any deficiency of service on the part of the respondents. 

 

6.                On behalf of the complainant Ex. A1 to A12 were marked and on behalf of the respondents Ex. B1 is marked. 

7.                On the basis of the above pleadings the following points are settled for determination.  

i.        Whether the complainants are entitled to receive the policy amount from the respondents?

ii.       Whether there is any deficiency of service on the part of the respondents?

iii.              To what relief?

 

8.                Point Nos. 1 & 2. In the present complaint there are two complainants. Mr. B. Veerasiva, who was the Engineering student of K.S.R.M College, Kaldapa took one policy under “Tailor made personal accidents scheme” which is meant for Engineering students and parents. He paid Rs. 660/- towards premium and receipt was issued under 3067, dt. 12-9-2004 from R1 company.  According to the policy within four years from the date of commencement of the policy whenever the policy holder or his parents meet with an accident and died accidentally, the respondents has to pay Rs. 2,00,000/- to the nominees. While so on 30-4-2007 the policy holder died accidentally due to fall from the top of the two storied building and the two complainants are the nominees of the said policy.  According to the complainants their son that in the policy holder died accidentally due to fall from the top of the two storied building and he died on the spot.  The complainants further stated that their son i.e. the policy holder has not committed any suicide, but died accidentally due to fall from the top of two storied building. 

 

9.                To substantiate their arguments they submitted Ex. A1 to A12. Ex. A1 is the original pamphlet issued by R1. Ex. A2 is the policy copy which was issued to the policy holder by name B. Veera Siva (deceased). Ex. A3 is the certificate issued by the principal of KSRM College, Kadapa. Ex. A4 is the letter head issued by Kuncham Venkata Subba Reddy, Sarpanch, P. Venkatapuram,  Yerraguntla Mandal, Kadapa, dt. 30-4-2007.  Ex. A5 is the certificate issued by Sub-Inspector of police, Yerraguntla police station. Ex. A6 is the Xerox copy of death extract issued by Dy. Tashildar, Yerraguntla. Ex. A7 is the letter from R1 to 1^st complainant dt. 6-7-2007 to furnish the relevant  documents to settle their claim. Ex. A8 is the letter from 1^st complainant to R1 company stating that he submitting claim form copy of the policy etc., to settle the claim of his son. Ex. A9 is the complaint copy filed by the complainant before insurance ombudsman at Hyderabad. Ex. A10 is the letter dt. 26-12-2007 issued by insurance Ombudsman, Hyderabad. Ex. A11 is the letter from complainants to R2 dt. 30-01-2008. Ex. A12 is the repudiation letter from the R2 dt. 22-4-2008. Accoridng to the complainants the deceased died accidentally due to fall from the top of the two storied building and died on the spot and they are liable to receive assured amount from R1 company. The R1 filed its counter and R2 adopted the same. R1 denied all the allegations made by the complainants except issuance of policy to the deceased policy holder B. Veera Siva, Engineering Student of K.S.R.M college of Kadapa. It is true that they issued tailor made personal accident scheme for Engineering Students and the deceased paid Rs. 660/- towards premium and the R1 company issued accidental benefit policy to the deceased. 

 

10.              According to the policy within four years from the date of commencement of the policy whenever the policy holder or his parents met with an accident and died accidentally the respondent has to pay Rs. 2,00,000/- to the nominee. According to the policy the complainants are the nominees of the said policy. To settle the any claim the respondent company need some documents in case of accidental death, they need FIR, Inquest, Post – mortem etc., But in the present case the complainants stated that their sons death is accidental and due to lack of legal knowledge they have not intimated to the concerned police station and no FIR registered and no Post mortem and no inquest was conducted.  In case of accident it is a must to settle the claim of the policy holder not only that in case of death the intimation must be given to R1 company within one calendar month from the date of death. In the present case the complainants gave information to the R1 company after three months. The complainants simply submitted claim form and two certificates issued by Sarpanch of the said village and another certificate issued by Sub-inspector of Police, Yerraguntla. The respondents counsel pointed out that the two certificates which were issued are fabricated for unlawful gain from the R1 company. The counsel for the respondents pointed out that the Ex. A4 which was issued by the Sarpanch by name Kuncham Venkata Subba Reddy issued the certificate on 30-4-2007. According to his own certificate the deceased died on 30-4-2007 at about 9.00 p.m. How the Sarpanch issued the said certificate on the same day. In his certificate the Sarpanch stated that the deceased died accidentally due to fall from the first floor of his paternal uncle house when he was going to have his dinner. He fell down from the top of the house accidentally.  The respondents counsel took server objection but in one certificate he expressed two opinions.   First he stated that the deceased head broken in to two pieces and in the next following lines he mentioned that the deceased fell down accidentally from the top of the first floor and he died with severe head injury. In Ex. A5 certificate issued by the Sub-inspector of police, Yerraguntla stated that the deceased died accidentally due to fall from the first floor and in the said certificate the Sub-inspector of police has not mentioned any date and he has not mentioned when he has conducted the enquiry on whose request he made the enquiry without any FIR. 

 

11.              The respondents counsel questioned the genuine of the two certificates. The respondent counsel further stated that on their survey they came to know that the policy holder committed suicide by hanging. The villagers and family members of the deceased were afraid and immediately burned the dead body of the deceased, even though it is against their customs.   But he has not filed any documents with regard to investigator report. Further he argued that after knowing about the policy the parents of the deceased fabricated the documents and submitted before the respondents for unlawful gain. According to the policy terms and conditions there is no coverage to the suicidal death and the respondents are not liable to pay any compensation to the complainants.  When the claim was repudiated by the respondent the complainants submitted a complaint before the Hon’ble Ombudsman, Hyderabad. The insurance Ombudsman in turn sent the same to the complainants to make a representation to the Regional Office i.e. R2 and wait for reply for a period of one month from the date of their letter.    In case the complainant did not receive any reply from the Regional Office he can inform the same to the Ombudsman for necessary steps.  Ex. A12 issued by the R1 Company stated that there is no need of revision at their end. By suppressing the matter the complainants filed the present complaint before the Hon’ble Forum. Before concluding the order we are of the joint opinion that the two certificates issued by Sarpanch and Sub-inspector of police, Yerraguntla are not genuine and they issued for purpose of settlement of the claim. How those certificates were issued by the concerned authorities  when the matter related to insurance settlement without verifying the facts. The R1 Company is insurance company and in case of any accidental death they are liable to pay compensation to the nominees. But not an all cases.  The money lying with the company is public money. The R1 company cannot distribute to the same to the policy holders and to the nominees without any investigation and proper documents. Ex. A4 which was issued by Sarpanch Mr. Kuncham Venkata Subba Reddy, P. Venkatapuram, Yerraguntla Mandal he has issued the certificate where consisting a party emblem.   How he is entitled to issue a certificate which belongs to a party. The Sarpanch is elected by the villagers and he is not entitled to issue any certificate which belongs to one party symbol. The forum is taken objection with regard to this certificate and in future the Sarpanch need not issue any certificate with the party emblem 

 

12.              On behalf of the complainant Ex. A5 is marked i.e. a certificate issued by Sub-inspector of police, Yerraguntla under the caption “To whom so ever it may concern” in which the Sub-Inspector certified that the deceased accidentally fell down from two storied building on 30-4-2007 at 9.00 p.m. He further certified that per sufficient enquiries made the cause of death was ascertained as only accident and there is no intention of committing suicide by the deceased. This document Ex. A5 is not consist even the place and date at the left side bottom of the certificate is kept blank. Ironically there is no date under his signature. It is not known on what date he visited the spot and made enquiry. Chapter 29 of A.P. Police Manual part – 1, volume – 2 deals with “unnatural death” whenever a cognizable offence particularly with regard to unnatural death is received by the police it is mandatory on the part of the police to issue FIR in terms of section 154 of Cr.P.C. Only after issue of FIR the power of investigation comes to the police. Section 174 to 176 Cr.P.C speaks about the procedure for conducting the inquest. Order 490-1 of A.P. Police Manual reads that the purpose of the inquest is to ascertain the apparent cause of death in case where the police receive information that a person has met with an unnatural death viz., suicide, accident etc., The Cr.P.C and police manual are crystal clear with regards to the part of police in the event of receiving information about the unnatural death. Instead of following the Cr.P.C and procedure laid down in the police Manual, the Sub-Inspector of Police issued Ex. A5 without FIR, inquest etc., without these documents how can he certify the death of the deceased is by accident. Being a Junior Police officer is he empowered to issue such type of certificates like Ex. A5 to the parties, who are interested to claim the insurance. The issuance of Ex. A5 is not accordance with the Cr.P.C  and Police Manual as such needs the attention of Superintendent of Police so that further recurrence of similar nature can be stopped. In view of the above facts and circumstances there is no need of giving weight to Ex. A5 in support of the complainant. This Forum came to conclusion that the deceased committed suicide by hanging. He did not died accidentally due to fall from the top of the two storied building.  By perusing all the documents we came to the conclusion that the documents which were filed by the complainants in support of their son’s death are fabricated one to get unlawful gain from the insurance Company. We are of the opinion that there is no deficiency of service on the part of the respondents and the respondents are not liable to pay any compensation to the complainants. 

 

13.               Point No. 3. In the result the complaint is dismissed without costs.

Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 18^th December 2008

 

                

 

Witnesses examined.

Ex. A1         Original Pamphlet of R1 company. 

Ex. A2         Policy issued by R1 company in favour of the deceased.

Ex. A3         Bonafide certificate issued by KSRM College of Engineering, Kadapa,

dt. 22-8-2007.

Ex. A4         Cerificate issued by Kuncham Venkata Subba Reddy, Sarpanch,

P. Venkatarapuram, dt. 30-4-2007

Ex. A5         Certificate issued by Sub inspector of Police Yerraguntla.

Ex. A6         X/c of death extract issued by Dy. Tahsildar, Yerraguntla.

Ex. A7         Letter from R1 to complainant, dt. 6-7-2007.

Ex. A8         Letter from complainant to R1, dt. 10-9-2007.

Ex. A9         X/c of complaint before the Insurance Ombudsman, Hydeabad.

Ex. A10       Letter from Insurance Ombudsman to complainant, dt. 26-12-2007.

Ex. A11       Letter complainant to R1, dt. 30-1-2008.

Ex. A12       X/c of letter from R1 to complainant, dt. 22-4-2008.

 

Ex. B1         X/c of policy issued by the respondent in favour of the deceased.

1)      Sri V. Eswar Reddy, Advocate. 

 

2) Copy was dispatched on      :

3) Copy of delivered to parties :