Karnataka

Chitradurga

CC/111/2017

Smt. Suvarnamurthy W/o Late B.S. - Complainant(s)

Versus

The Divisional Manager, - Opp.Party(s)

BKG

09 Apr 2018

ORDER

COMPLAINT FILED ON:03/11/2017

DISPOSED      ON:09/04/2018

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

 

CC.NO: 111/2017

 

DATED: 9^th APRIL 2018

PRESENT: - SRI. T.N. SREENIVASAIAH  : PRESIDENT                                   B.A., LL.B.,

                   SRI.N. THIPPESWAMY        : MEMBER

                          B.A., LL.B.,   

……COMPLAINANT/S	1. Smt. Suvarnamurthy W/o Late B.S. Chandrashakarmurthy, Age: 58 Years, R/o Suvarna Nilaya, IUDP 11th Cross, Sri Sai Layout, 4th Main, Chitradurga.   2. Sri. C. Sachin, S/o Late B.S. Chandrashakarmurthy, Age: 32 Years, R/o Suvarna Nilaya, IUDP 11th Cross, Sri Sai Layout, 4th Main, Chitradurga.   (Rep by Sri.B.K. Govardhan, Advocate)
V/S
…..OPPOSITE PARTY	The Divisional Manager, United India Insurance Company Limited, Ramakrishna Complex, Radhika Theatre, Oldkattegudda, Cowl Bazaar, Bellary-583101.   (Rep by Sri.B.M.Ravichandra, Advocate)

ORDER

SRI. T.N. SREENIVASAIAH:   PRESIDENT

The above complaint has been filed by the complainant u/Sec.12 of the C.P. Act, 1986 for the relief to direct the OP to pay a sum of Rs.2,00,000/- along with interest at the rate of 18% p.a, Rs.25,000/- towards mental agony and such other reliefs.

2.      The brief facts of the case of the above complainants are that, the husband of complainant No.1 by name Sri. B.S. Chandrashekaramurthy has obtained PMSBY from OP and paid a sum of Rs.12/- every month and the same has been deducted by the OP from the SB A/c bearing No.10695100000433 of PKGB, IUDP layout Branch, Chitradurga of said B.S. Chandrashekaramurthy.  The sum assured under the policy is Rs.2,00,000/-.  On 15.08.2015, at about 5-30 PM, the said Chandrashekaramurthy was attending his personal work in Ramgiri village and after completion of his work, he was returned to Chitradurga through his Swift Car bearing Reg.No.KA-16 M-9505 along with his driver.  It is further submitted that, when the car moving near Arehalli-Jaipura, near Holalkere Railway Station due to rash and negligent driving of the driver, the said vehicle fell down from the right side of the road and due to the said accident the said B.S. Chandrashekaramurthy was also fell down from the car and he sustained injuries all over the body.  In spite of better treatment taken by him, he did not survive and died on 07.09.2015 at Sunita Nursing Home, Chitradurga.  After the death of said Chandrashekaramurthy, complainants intimated and approached the OP for settlement of personal accident claim by furnishing all the relevant documents pertaining to PMSBY Master Policy No.2411004215P999990021 including the police papers and vehicle records to the OP for the purpose of settlement of claim.  After receiving all the relevant documents instead of settling the matter, the OP has repudiated the claim of the complainants stating that, the complainants have not produced the P.M report.  The cause action for the complaint arose when the OP has issued policy and when the last premium has been collected from the deceased Chandrashekaramurthy and finally, the complainants have issued legal notice on 154.10.2017 which is within the jurisdiction of this Forum.   Therefore, the complainants respectfully prayed before this Forum to allow their complaint with cost. 

3.      On service of notice, OP appeared through Sri. B.M. Ravichandra, Advocate and filed version.  OP has taken a main contention that, the deceased Chandrashekaramurthy has obtain PMSBY policy bearing No.2411004215P999990021 for the period from 01.06.2015 to 31.05.2016 under a capital insured sum of Rs.2,00,000/- per member of insured and also as per the terms and conditions of the policy.  Further it is admitted that, the OP has collected a premium amount of Rs.12/- towards the said policy covers for an amount of Rs.2,00,000/-.  As per the said policy, the personal accident benefits give scope to details of injury and scale of compensation is as under Section B of the said policy.  Further it is admitted that, if such injury shall within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of one eye, or total and irrecoverable loss of use of a hand or a foot, 50% of the capital sum insured stated in the schedule here.  It is further submitted that, the complainants have intimated the death of policy holder B.S. Chandrashekaramurthy to the OP insurance company and the OP insurance company has sought for P.M report of the deceased.  Even inspite of intimation to the complainants, they have not produced the same but on 18.11.2015 the complainant No.1 has given a letter to the Divisional Manager, United India Insurance Company, Bellary Office stating that, her husband B.S. Chandrashekaramurthy was died on 07.09.2015 and admitted to the Hospital as an inpatient as he has sustained injuries in a motor vehicle accident.  In addition to that, the deceased was suffering from kidney disease and he is under dialysis for the past eight months and was suffering from chronic illness, for that PM report was not conducted.  On that basis, the OP Company has written a letter dated 13.06.2016 to the Manager, PKGB stating that, PMSBY claim of the deceased Chandrashekaramurthy is repudiated since they have not produced P.M report which is a compulsory document as per guidelines of the PMSBY scheme.  It is further submitted that, the deceased Chandrashekaramurthy was died on 07.09.2015 and accident took place on 15.08.2015 i.e., after a lapse of nearly one month and the Doctor has given a certificate on 08.11.2015 stating that, the deceased Chandrashekaramurthy was expired on 07.09.2015 due to diabetes mellitus type II, hyper tension, heart disease and end state disease on maintenance bam dialysis,, due to that he has developed massive floral abrasion and his primal dialysis was hampered due to accident and his PM was not conducted as he has multiple chronic problems and his cause of death was known.  As per the terms and conditions of the policy, the P.M report is compulsory.  The complainants never produced P.M report as called for by the OP and hence prayed for dismissal of the complaint. 

         4.       Complainant No.2 has examined as PW-1 by filing affidavit evidence and the documents Ex.A-1 to A-13 were got marked and closed their side. On behalf of OP, one Sri. Surendra Gaonkar, D.M of has examined as DW-1 by filing the affidavit evidence and no documents have been got marked and closed their side.  

 

5.      Arguments of both sides heard.

6.      Now the points that arise for our consideration for decision of above complaints are that;

 

(1)  Whether the complainants prove that the OP has committed deficiency of service for non-settling the claim of the complainants and entitled for the reliefs as prayed for in the above complaint?

              (2) What order?

          7.      Our findings on the above points are as follows:-

          Point No.1:- Partly in Affirmative.

          Point No.2:- As per final order.

REASONS

8.      It is not in dispute that, the husband of complainant No.1 and father of complainant No.2 the deceased B.S. Chandrashekaramurthy has obtained PMSBY policy and has paid Rs.12/- every month through his account from PKGB, IUDP layout, Chitradurga.  On 15.08.2015 at about 5-30 PM, the said Chandrashekaramurthy while he was returning to Chitradurga in his Car bearing Reg.No.KA-16 M-9505, due to rash and negligent driving of the Driver, the car fell down.  Due to the said accident, the deceased Chandrashekaramurthy was also fell down from the car and sustained injuries and inspite of treatment, he died on 07.09.2015 in Sunita Nursing Home, Chitradurga while taking regular treatment.  After the death of the said Chandrashekaramurthy, the complainants have intimated the same to the OP and claimed personal accident benefit under the PMSBY policy taken by the deceased Chandrashekaramurthy for a sum of Rs.2,00,000/-.  By that time, the OP asked some documents from the complainants.  The complainants have produce all the documents along with policy and other relevant documents to the OP.  But, the OP have asked to produce the PM report of the deceased Chandrashekaramurthy. In this case, the deceased Chandrashekaramurthy met with an accident on 15.08.2015 and died on 07.09.2015 i.e., nearly 15 days he has taken treatment from different hospitals.  Finally, he has obtained treatment from Sunita Nursing Home, Chitradurga and died in the said Hospital on 07.09.2015. The Doctors have not conducted any Postmortem on the deceased Chandrashekaramurthy as he was suffering from diabetes mellitus type II, hyper tension, heart disease and end state disease on maintenance bam dialysis,, due to that he has developed massive floral abrasion and his primal dialysis was hampered due to accident and his Postmortem was not conducted as he has multiple chronic problems and his cause of death was known and handed over the body to the complainants.  So, for this reason, the complainants have not produced the PM report. 

9.   We have gone through the entire documents filed by the complainants and OP.  OP never produced any documents to disprove the case of the complainants.  The complainant has produced Ex.A-1 to 13 documents which clearly shows that, the deceased Chandrashekaramurthy was died on 07.09.2015 due to the accident occurred on 15.08.2015.  After the accident, the said Chandrashekaramurthy taken treatment from different Hospitals and finally taken treatment before the Sunita Nursing Home, Chitradurga and after 15 days he died.  For that reason, the Doctors have not conducted Postmortem over the deceased Chandrashekaramurthy.  The OP has taken a contention in its version and affidavit that, the complainants have not produced the PM report, when it called for.  The husband of complainant No.1 has obtained a policy issued by the Government i.e., PMSBY.  Under the said policy, the LR’s of the deceased have got every right to claim compensation.  The OP has no right to ask the PM report and when the OP asked the PM report, the complainants have given explanation about the Doctors have not conducted the Postmortem over the dead body of deceased Chandrashekaramurthy.  As per the documents produced by the complainants, the complainants are the legal heirs of the deceased B.S. Chandrashekaramurthy.  Here, the OPs have not denied that Chandrashekaramurthy has obtained the policy and the said Chandrashekaramurthy has paid Rs.12/- every month to the OP but, the OP has taken a contention that, complainants have not produced the PM report and repudiated the claim.  Whatever the objections raised by the OP is not sustainable under law.  Hence, we come to the conclusion that, there is a deficiency of service on the part of OP/insurance Company.  Accordingly, this Point No.1 is held as partly affirmative to the complainant.          

            10.     Point No.2:- As discussed on the above point and for the reasons stated therein we pass the following:-

ORDER

The complaint filed by the complainant U/s 12 of C.P Act 1986 is partly allowed.

It is ordered that, the OP is hereby directed to pay a sum of Rs.2,00,000/- to the complainants along with interest at the rate of 12% p.a from the date of filing of the complaint till realization.  

It is further ordered that, the OP is hereby directed to pay Rs.10,000/- towards mental agony and Rs.5,000/- towards costs of this proceeding.  

It is further ordered that, the OP is hereby directed to comply the above order within 30 days from the date of this order.

 (This order is made with the consent of Member after the correction of the draft on 09/04/2018 and it is pronounced in the open Court after our signatures)         

 

                                     

 MEMBER                                                   PRESIDENT

-:ANNEXURES:-

 

Witnesses examined on behalf of Complainant:

PW-1:  Complainant No.2 by way of affidavit evidence.

Witnesses examined on behalf of OP:

DW-1:  Sri. Surendra Gaonkar, DM of OP by way of affidavit evidence. 

Documents marked on behalf of Complainants:

01	Ex-A-1:-	Certified Copy of the policy
02	Ex-A-2:-	Letter dated 18.11.2015 of complainant No.1
03	Ex-A-3:-	Claim form
04	Ex-A-4:-	Letter dated 13.06.2016 by the OP to PKGB
05	Ex-A-5:-	Letter dated 08.12.2015 of Sunita Nursing Home, Chitradurga
06	Ex-A-6:-	Legal Notice dated 10.10.2017
07	Ex-A-7:-	Reply notice dated 24.10.2017
08	Ex.A-8:-	Postal receipt
09	Ex.A-9:-	Statement of account for the period from 01.06.2016 to 28.09.2016
10	Ex.A-10:-	Postal receipt and acknowledgement
11	Ex.A-11:-	Charge sheet
12	Ex.A-12:-	FIR
13	Ex.A-13:-	Death Certificate of Chandrashekaramurthy

 

 

Documents marked on behalf of OP:

-Nil-

 

MEMBER                                                            PRESIDENT

Rhr**