BEFORE THE DISTRICT CONSUMER FORUM : MEDAK AT SANGAREDDY
PRESENT: Sri Patil Vithal Rao, B.Sc., LL.B.,President
Smt. Meena Ramanathan, B.Com., Lady Member
Sri G.Sreenivas Rao, M.Sc., B.Ed.,LL.B.,PGADR (NALSAR),Member
Monday, the 15th day of April, 2013
CC. No. 26 of 2012
Between:
Mohan Ramu Pathloth S/o Ramu Harichand Patloth
Age 25 years, Occ: Agricultural,
R/o Venkatapoor (V), Mandal Narayanakhed,
Medak District. ……Complainant
And
- The General Manager,
M/s Oriental Insurance Co. Ltd.,
Rep by it Divisional Manager, OIC., Ltd.,
Ambara Plaza, 2nd Floor,
Ahmed Nagar-M.H. 414001
(Policy No. 16335/47/2010/49951-01/8906003511 valid up to
06.01.2010 to 05.01.2014)
- The Regional Manager,
Oriental Insurance Co.Ltd., T.P. Hub,
Post. Box No. 45, Snehalatha building,
Begumpet, Hyderabad.A.P.
……Opposite parties
This case came up for final hearing before us on 01.04.2013 in the presence of Sri C. Vittal Reddy, Advocate for complainant, opposite party No. 1 set exparte and Sri P. Bal Reddy, Advocate for opposite party No. 2 and heard the arguments of both sides, on perusing the record and having stood over for consideration till this day, this Forum delivered the following:
O R D E R
(Per Se Smt. Meena Ramanathan, Lady Member)
The complainant, who is the son of the deceased Ramu Harichand pathloth approached this Forum by way of the present complaint under Section 12 of the Consumer Protection Act, 1986, claiming Rs. 1,00,000/- the policy amount with costs and interest @ 18% and Rs. 50,000/- towards compensation. His contention, in brief, is that his father Ramu Harichand pathloth, an agriculturist by profession, had subscribed to group insurance policy with Life Line Life Care Limited, for a period of four years. If the policy holder dies or is injured during the enforcement of the policy, the nominees are entitled to the due amount. On 04.10.2010, the father of the complainant was attacked by a buffalo and succumbed to his injuries at Government Hospital, Narayankhed. On 23.11.2011 he filed a requisition with the opposite party to pay the policy amount but they did not respond. Hence he has filed this complaint to seek redressal.
2. Opposite party No. 1 set exparte.
3. Opposite party No. 2 filed their counter, resisting the claim on the grounds – that the deceased has violated the terms and conditions of the policy and that the policy coverage was only for one year and not four years as alleged by the complainant. As such, when the insured Ramu Harichand pathloth, died he was not under the policy coverage. They also further objected by stating that death certificate and legal heir certificate are not filed by the complainant. Post mortem report filed does not show cause of death, and thus this policy is not applicable. They further stated that the death of the insured was not intimated to them and they are not responsible to settle this claim. Hence seek to have the complaint dismissed.
4. Complainant filed his evidence affidavit as PW.1 and evidence affidavit of PW. 2 is also filed. And he relied on the documents A1 to A7 to substantiate his claim.
Opposite party No. 2 filed evidence affidavit of RW.1. Heard the oral arguments and perused the written arguments submitted by the complainant.
5. Now the point for consideration is that whether there is any deficiency of service on the part of the opposite parties in not granting the reliefs in favour of the complainant as prayed for?
Point:
6. It is not in dispute that the deceased Ramu Harichand pathloth took a Janata personal accident policy for himself, his son (complainant) and his wife – Kavita Bai Mohan pathloth. The Janata Personal Accident policy No. 74054/678, 74054/679 and 74054/680 and insurance period is 06.01.2010 to 05.01.201. Ex.A3 is the certificate of insurance and under the deceased’s name, nominee: Mohan Ramu pathloth (complainant) is clearly mentioned. Opposite party No. 1 and Life Line Life Care Limited are the authorized signatories to this policy and it is issued under the aegis of oriental insurance company limited (opposite party No. 2).
7. The period of coverage is from 06.01.2010 to 05.01.2014. The insured died on 04.10.2010 – Ex. A1, the certificate of death is filed to substantiate this. Ex. A2 is the death certificate issued by the Community health center, Narayankhed – and here the civil assistant surgeon has mentioned cause of death due to Haemorrhage shock due to injury to abdomen (Hit by buffalo) and is dated 04.10.2010. It is evident that the insured died with in the period of coverage of the policy and for the opposite parties to dispute this fact is not acceptable.
8. As per Ex. A1 and A2 cause of death is because the insured was attacked by a buffalo. This is further supported by the evidence of PW.2. In his chief examination, PW.2 – namely Karra Chander, states that he was a neighboring farmer and was watering his crop on the morning when Ramu Harichand pathloth was attacked by a buffalo and grievously injured. That the deceased was hale and healthy at the time of the accident. He took the injured to the Government Hospital where he died: Thus this fact is further reiterated by the supporting evidence of PW.2.
9. In the evidence of RW.1 (Executive legal of opposite party No. 2) objections have been raised regarding the complainant not being the nominee or legal heir of the deceased. As per the policy, the complainant is clearly the nominee and filing the legal heir certificate is quite unnecessary and there definitely exists a contract between the complainant (as the nominee) and both respondent no. 1 and respondent no. 2. If RW.1 works (as he claims and states) in the legal department of respondent No. 2, he should be well aware of the terms and conditions of the Janata Personal Accident Policy and the period of coverage. But unfortunately he vehemently denies it.
10. Ex.A3 is the Janata Personal Accident Policy. On reading the conditions mentioned on the rear of the policy, it is clearly evident in Hindi – that for death by accident, there is 100% coverage. Ex. A4 is the membership card given to the deceased by Life Line Life Care Limited. Ex. A5 is the cash receipt from Life Line Life Care Limited for an amount of Rs. 1,600/-. Ex. A6 is the letter addressed to opposite parties to claim the insurance amount.
11. Thus it is clear that the complainant has filed all the material documents to substantiate his claim. No doubt, opposite party No. 2, in the counter, has alleged that the complainant did not file post mortem examination report, but when the death certificate under Ex. A2 duly issued by the medical officer, Government hospital, Narayankhed clearly reveals the cause of death of the insured was on account of ‘attack by buffalo’, the said objection, in our opinion, is devoid of any force.
12. In the given circumstances, it does not lie in the mouth of the opposite parties to contend in the counter, that the death of the insured was not applicable to the policy in question.
13. When the complainant approached opposite party No. 1 by issuing a claim letter Ex. A6, seeking to settle his claim covered by the policy, there was no response which resulted in initiation of the present proceedings. Thus there is a cause of action to file the present case.
14. In view of the aforesaid discussion we hold that the complainant, being the nominee of the insured, is entitled to the policy amount of Rs. 1,00,000/- with reasonable interest @ 9% p.a. Further he is also entitled for a reasonable compensation of Rs. 25,000/-. The point is answered accordingly.
15. In the result, the complaint is allowed directing the opposite parties to pay the policy amount of Rs. 1,00,000/- with interest @ 9% p.a. from the date of death of the insured till realization. Further, they shall also pay Rs. 25,000/- as compensation. Time for compliance: One month.
Dictated to Stenographer, after transcription and correction the order is pronounced by us in the open court today on this the 15th day of April, 2013.
Sd/- Sd/- Sd/-
MALE MEMBER LADY MEMBER PRESIDENT
Copy to:
- The Complainant
- The Opp.parties
- Spare copy
