2. United India Insurance Company Ltd.,

    Rep. by its Branch Manager,

    Door No.6-42-1, P.B.No.30,

    Dr.Vullaki Street, Salipet,

    Tenali   522 201.                                      … Opposite parties

              This complaint coming up before us for final hearing on                      19-07-11 in the presence of Sri G.N.Durga Prasad, advocate for complainant and of Sri P.Sivarama Prasad, advocate for OP1, Sri Paladugu Venkateswarlu, advocate for OP2, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following: 

O R D E R

PER SMT.T.SUNEETHA, LADY MEMBER:  

        This complaint is filed under section 12 of the Consumer Protection Act, 1986 by the complainant seeking directions on opposite parties to pay Rs.1,00,000/- towards Nirbhaya Gold Scheme and also mental agony and compensation for negligence with interest at 24% p.a. from the date of death of the deceased till realization.

2.      The brief facts of complaint are as follows:

                The father of complainant late Panduranga Rao opened SB account bearing No.50140 with 1^st opposite party bank i.e., Chaitanya Grameena Bank.  Subsequently Chaitanya Grameena Bank changed its name to Godavari Grameena Bank and thereby the bank is running smoothly.  The deceased A.Panduranga Rao is having bank account under Nirbaya Gold Scheme.

                The complainant’s father on 19-07-09 while he was proceeding towards Vellatur canal to visit agricultural fields situated at Tippalakatta village, Kollur Mandal due to old age he slipped into the canal and died.  The concerned MRO present and conducted enquiry for the cause of death of deceased Panduranga Rao and at the same time the body cremation was performed by the complainant. The complainant is the legal heir to the deceased Panduranga Rao and he filed representation letter to concerned Bank authorities on 10-09-09 informing about the death of his father and requested opposite parties for grant of insurance claim coverage as per terms and conditions as regulated by opposite parties.  The opposite parties are liable to pay Rs.1,00,000/- towards accidental death of the father of complainant.  The opposite parties received the representation letter of complainant and kept quite.  The complainant on several occasions visited the office of opposite parties to grant claim but invain.  On 11-03-10 complainant got issued legal notice to opposite parties. The opposite parties received the same and kept quite. Hence, the complaint.

3.  The 1^st opposite party filed its version, which is in brief as follows:         

                As per terms and conditions of policy, the policy is in force as on the date of death of the account holder.  The premium for the policy was paid by this opposite party on 31-08-09 and the 2^nd opposite party received the same.  The settlement of claim rests with insurance company i.e., 2^nd opposite party and not with this opposite party.  The same was mentioned in the passbook given to the account holder.  There is no deficiency of service on the part of this opposite party.  Therefore, it is prayed to dismiss the complaint against this opposite party.                   

4.  The 2^nd opposite party filed its version, which is brief as follows:

                The opposite party had issued Group Janatha Personal Accident Insurance Policy bearing No.150804/47/08/61/00000255 to the account holders under Nirbhaya Gold Scheme of 1^st opposite party i.e. Chaitanya Godavari Bank, Donepudi Branch, which is valid from 28-08-08 to 27-08-09. The risk under the said group insurance policy will be covered those who are under the age of 70 years. The deceased is also included in the said group insurance policy. The policy will be issued basing on the bonafide information in good faith furnished by the members of group insurance through 1^st opposite party.

                After the death of deceased Addanki Panduranga Rao the complainant through 1^st opposite party claimed compensation under group insurance policy.  Then this opposite party has appointed investigator by name M.V.Ramana Kumar to make investigation into the claim and to submit his report. The investigator had collected information in several ways and submitted his report on 12-12-09. As per the report of investigator, the deceased was aged 75 years by the date of his death and the same is very manifest from the voter identity card supplied by complainant. Further, it is reliably learnt that the death of deceased was not accidental and it is a case of suicidal death by jumping and drowning into canal water. In case of accidental death, as per policy terms, the complainant shall submit FIR, postmortem certificate, inquest report, charge sheet etc. For the reasons known to complainant, the death was not reported to police and did not submit documents showing the cause of death, which speaks volumes regarding the genuinity of the claim and alleged accidental death. As it is a clear case of suicidal death of deceased, this opposite party is not liable to indemnify the loss covered under the policy. The MRO certificate is nothing but accommodative one. The claim of complainant is false and baseless and it is rightly repudiated by opposite party.  Therefore, there is no deficiency of service on the part of opposite party and hence, the complaint may be dismissed.  

5.             Both parties have filed their respective affidavits.  Ex.A1 to A8 on behalf of complainant and Ex.B1 to B12 on behalf of opposite parties were marked.

6.      Now the points for consideration are

1. Whether the death of the deceased is accidental or not?
2. Whether the age of the deceased is beyond the age specified in terms and conditions of policy?
3. Whether the repudiation of 1^st opposite party is justified or not?
4. Whether there is any deficiency of service on the part of opposite parties and to what relief the complainant is entitled to?

7.      POINT No.1

                The investigation report (Ex.B8) submitted by M.V.Ramana Kumar revealed that the son of deceased said that his father was retrieved from a road side canal with the help of villagers and he thought it may be an accidental fall (it was reported by the investigator that he had collected a photograph taken by the local people when the dead body was retrieved from water and shifted by a cart).  The case was not reported to police.  There were rumors that the deceased due to old age sufferings ended up his life intentionally by jumping into canal water. 

8.             In the conclusions part of report, it was noted that

                ‘No authentic proof was produced by the claimant to conclude the death as accident or any eye witness was produced during my enquiry.  The claimant assumption that his father died due to slip fall in water was not supported by any tangible evidence.’   

9.             The investigator has also written in his report that the deceased Panduranga Rao with sufferings of HTN approached Government Hospital, Tanali on 15-01-09 and after treatment he came back (it was reported by the investigator that he has collected the case record and made enclosed to his report).

10.           The Forum can not come to a conclusion that the deceased committed suicide merely depending upon the investigation report.  We can take it in another view that since he is suffering from hypertension might have felt giddy and have fallen in the canal.  The report itself expressed that there is no eye witness to the death of the deceased.  In this condition, we cannot say that the deceased death is a suicidal death. 

11.    POINT No.2

                The deceased/insured opened saving bank account on          04-09-1998 with 1^st opposite party and obtained Group Janatha Personal Accident policy mentioning his age as 55 years.  Prior to purchasing policy, the deceased obtained voter ID card dt.15-12-1995 (Ex.B10), in which his age was mentioned as 60 years as on                        01-01-1995.  As per this document the deceased must be having 74 years by the time of his death i.e., by 19-07-2009.  The complainant counsel after reserving this case for orders submitted a memo along with photo copy of election card of Mr.Addanki Koteswara Rao stating that he is elder brother of deceased whose age was 50 years as on             01-01-1995 (as per the card) and further stated that the age of deceased is wrongly printed as 60 instead of 50 and his age is about 66 years at the time of death and his age is 55 years at the time of taking policy.   The complainant counsel also filed 3^rd party affidavits of Mr.B.Nageswara Rao and Mr.Venigalla Purnachandra Rao, who were witnesses for opening of account by the deceased Addanki Panduranga Rao on 14-08-1998 at 1^st opposite party bank. They stated in their respective affidavits that at the time of opening of account Addanki Panduranga Rao was aged 55 years and the same was informed to the Bank Manager Sri G.A.S.Prasad and he in turn incorporated the same in the specimen signatures form. 

12.           The election card of Mr.Addanki Koteswara Rao submitted by opposite party saying that he is the elder brother of deceased cannot be relied upon by the Forum since there is no evidence to substantiate whether the person Addanki Koteswara Rao is elder brother to the deceased.  The 3^rd party affidavits also cannot be relied upon by the Forum on question that on what basis they affirmed the age of the deceased.  In these conditions it is appropriate to take into consideration the age of the deceased i.e., 60 years as on 01-01-1995 mentioned in election card issued on 15-12-1995.  The complainant ought to have produced previous election card or any other document to determine the age of deceased.       

13.    POINT No.3

                The opposite party repudiated the claim of complainant on the ground that the age of deceased/insured was 75 years at the time of death, which is more than the maximum age limit of 70 years as specified in the policy conditions and also on the ground that there is no FIR, postmortem report etc, which are to be submitted in case of death claims as mentioned under column No.8 procedure for claims in the agreement. 

14.           The documents produced by complainant to substantiate his submission that his father is aged about 64 years at the time of his death, such as 3^rd party affidavits, election card of brother of deceased are not sufficient to prove the deceased’s age. Ex.B9 election card produced by opposite party dt.15-12-1995 pertaining to the deceased is having more authenticity as earlier in point of time to the litigation and claim.  The complainant ought to have produced earlier voters list of previous elections to disprove Ex.B9.  In view of the age of the insured/deceased at the time of his death does not fall within the age limit prescribed by the terms and conditions of policy, the Forum opines that the repudiation of opposite parties is justified. 

15.           The counsel for complainant relied on following decisions:

1. 2004 IV CPJ 531 between LIC of India Vs. Rajendra Singh Gaur
2. 1997 (II) CPJ 192 between Dukshilal Jaiswad Vs. Branch Manager, LIC of India and another

1. 2006 (1) CPJ 11 between Dharansetty Srinivasa Rao Vs. New India Assurance Company Ltd.

1. 1994 (2) CPJ 400 between United India Insurance Company Ltd. Vs. M/s.Gulzar Cold Storage

1. 1999 (3) CPJ 203 UPSC
2. 2001 (1) CPJ 19

                The above decisions are not applicable to this case as the deceased was not covered by the policy in view of his age.

16.    POINT No.4

                Since the repudiation is justified, there is no deficiency of service on the part of opposite parties. Hence, the opposite parties are not liable to compensate the complainant.

                In the result, the complaint is dismissed without costs.

Typed to my dictation by the Junior Steno, corrected by me and pronounced in the open Forum, this the 28^th day of July, 2011.     

MEMBER                                             PRESIDENT

 APPENDIX OF EVIDENCE

                                        DOCUMENTS MARKED

For Complainant:         

For  opposite parties:

                                                                                             PRESIDENT