O R D E R
(By Sri D.Shankar Rao, Member)
- The brief facts set-out in the complaint are that the husband of complainant Bondla Sayanna @ Sailoo who died accidentally on 28-10-2011 was one of the member in the Group ‘JANATA PERSONAL ACCIDENT POLICY’ from the opposite party No.2 by virtue of having ‘KISHAN CREDIT CARD’ as he used to avail crop loan from the opposite party No.1 bank for agriculture purpose. As per terms & conditions of the policy, the opposite party No.2 has to pay the claim amount of Rs.1,00,000/- in the event of death of a member. Unfortunately on 25-10-2011, the deceased Bondla Sailoo went to his field along with complainant, after attending the work, he had meals and drank the water. After one hour he was getting giddiness and faint. Then the complainant took him under a tree. There he said that he drank water in a tin which was used for spraying pesticides about 10days back. Immediately he was shifted to Government Hospital Yellareddy and there he was referred to higher center at Kamareddy. He was also took to Abhaya Private hospital at Kamareddy for better treatment. But he was died on 28-10-2011 in the morning at 5.00 a.m. on the way while he was taking back to Yellareddy. The death of the deceased was an accidental. The P.S. Yellareddy has registered a case in crime No.108/2011 U/s 174 of Cr. P.C. The police filed final report that the death of deceased was an accidental death.
The complainant submitted all relevant documents to opposite party No.1 with a request to settle the claim. In turn the opposite party No.1 submitted to opposite party No.2 for settlement of claim. The opposite party No.2 addressed a letter dated 19-10-2012 to the complainant, repudiating her claim on the ground that the death was not an accidental.
The repudiation of claim by opposite party No.2 on the ground that the death was not an accidental is illegal unjustified, against law, facts and natural justice. There is an ample evidence to show that the death of the deceased was an accidental. The act of opposite parties in non-settlement of claim and prolonging the matter years together and finally repudiated the claim amounts to gross negligence and deficiency in services for which they are liable to pay damages, and expenditure along with the claim of the policy with interest besides costs.
2. The opposite party No.1 not filed its counter. But the opposite party No.2 filed counter and briefly stated that their insurance company has issued a Group KCC scheme policy and Janata Personal Accident policy bearing No.050700/47/08/43/000001377 covering Group accidental insurance to KCC holders of opposite party No.1 bank. The liability of opposite party No.2 is to be strictly governed by the terms & conditions of the policy. The sum assured under the policy is Rs.50,000/- only. The claim shall be submitted within 30 days from the date of any accident or event. In this case, the FIR, police final report and FSL report are reveals that the deceased consumed water containing Endosulfan. He died due to Endosulfan poisoning. He has not sustained any external injuries as per post mortem report. Hence the deceased died due to his voluntary acts, as such his risk is not covered under the policy as per its terms & conditions. Therefore the opposite party No.2 has rightly repudiated the claim on 19-10-2012. It is totally incorrect to state that the police filed final report as an accidental death. In final report the concerned police opined that “thus it is a clear case of death due to consuming water in a pesticide tin without knowledge and no foul play is suspected by the family members of the deceased”. The complainant is not a nominee in the policy.
The Hon’ble Supreme Court of India in its judgement between ‘General Assurance Society Ltd., V/s Chandumull Jain & another’ reported in (1966) 3 SCR 500 held that ‘in interpreting documents relating to a contract of insurance, the duty of the court is to interpret the words in which the contract is expressed by the parties. In case of Oriental Insurance Company Ltd., V/s Soni Cherian reported in (1999) 6 SCC 451, the court observed that insurance policy between the insurer and insured represents a contract between parties. These principles and propositions have been followed in number of cases like United India Insurance Company Ltd., V/s M/s Harchand Rai Chandanlal (Appeal No.6277/2004) part III CPJ 2006 NC 240. Therefore the Hon’ble Forum has no powers to change the contract of insurance. The complaint is deserves to be dismissed with costs as the complainant is not entitled for any reliefs.
3. During enquiry the complainant filed her evidence affidavit as PW1 and got marked Exs.A1 to A6 documents and closed her evidence. There is no evidence adduced for opposite party No.1 and the evidence of opposite party No.1 was closed on 15-10-2014. The opposite party No.2 filed its evidence affidavit of their Assistant Sri T.Rajendra Sharma as RW1 and got marked Exs.B1 to B14 documents and closed their evidence.
4. Heard Arguments.
5. The points for consideration are:-
- Whether there is any deficiency of Service on the part of opposite parties in repudiation of the claim under the policy?
2) To what relief?
6. Point No. 1: The admitted facts are that the opposite party No.2 insurance company has issued a Group accidental insurance policy bearing No.050700/47/08/43/000001377 covering Kisan Credit Card (KCC) holders of opposite party No.1 bank for a period from 10-45 hours of 02-12-2008 to mid-night of 01-12-2011 in Ex.B2. The husband of complainant Bondla Sayanna @ Sailoo was died on 28-10-2011.
The facts disputed over the Group membership of deceased Bondla Sayanna @ Sailoo in the Group K.C.C. (Kisan Credit Card) policy with sum assured Rs.1,00,000/- and the nominee status of the complainant.
In order to prove the case the complainant has filed her own affidavit as PW1 and relied upon Exs.A1 to A6 documents.
The opposite party No.1 bank has not contested the case, even they have not filed their counter into the case.
The opposite party No.2 insurance company has contested the case and filed the evidence affidavit of their Assistant Sri.T.Rajendra Sharma as RW1 and relied upon Exs.B1 to B14 documents.
We have heard the arguments of counsel for the parties and perused the exhibits on both side and verified the entire case record.
Ex.B6 is issued by opposite party No.1 bank. Showing that the husband of the complainant Bondla Sailu was a Kisan Credit Card account holder bearing No.52169378042 and he was a one of the member in the Kisan Credit Card Group accidental insurance policy bearing No.050700/47/08/43/00001377 for a period from 02-12-2008 to 01-12-2011 issued by opposite party No.2. Exs.B1 & B2 are the Kisan Credit Card scheme policy showing that the sum insured Rs.50,000/- is payable under the policy in the event of accidental death of insured (K.C.C. holder). Ex.B8 is the claim form showing that the name of complainant is mentioned as wife and nominee for the policy holder Bondla Sailoo. Therefore we are of the considered view that the Exs.B1, B2, B6 & B8 are reveals that the deceased Bondla Sailoo was a K.C.C. (Kisan Credit Card) account holder in the opposite party No.1 bank and he was also one of the member in KCC (Kisan Credit Card) Group accidental insurance policy for sum insured Rs.50,000/-. Further reveals that the complainant being wife, she is nominee for the said policy.
Ex.A1 (B9) is the FIR No.108 of 2011 issued by P.S. Yellareddy in respect of the incident occurred and consequently the death of policy holder. Ex.A2 (B10) is the inquest report over the dead body of policy holder. Ex.A3 (B11) is the post mortem report over the dead body of policy holder. Ex.A4 is the final report over the death of policy holder stating that “it is a clear case of death due to consuming water in a pesticide tin without knowledge and NO foul play is suspected by the family members of the deceased”.
The counsel for the opposite party vehemently argued that the deceased policy holder was died due to “Endosulfan Poisoning” which clearly reflecting from the Ex.A3 (B11) post mortem document. The final report in Ex.A4 also disclosing the same and the deceased policy holder died due to his voluntary acts but not an accidental.
The counsel for the complainant has also vehemently argued that the reports in Ex.A3 (B11) and Ex.A4 are the material & crucial documents which are clearly disclosing that the deceased consumed water with empty Endosulfan Tin without having knowledge of consequences. Therefore the death of the deceased Bondla Sailoo be treated it as an accidental death. We have perused and scanned the documents in Ex.(A1) (B9), Ex.A2 (B10), Ex.A3 (B11) and Ex.A4. These documents are ultimately reveals that there is no foul play is suspected by the family members of the deceased. Hence the act of deceased is not an voluntary act within his knowledge of any consequences. Therefore we are of the considered view that the deceased policy holder Bondla Sailoo was died on 28-10-2011 accidently. The complainant being wife and nominee for the policy, she is entitled the sum insured in the policy. Accordingly the point No.1 is answered.
7. Point No. 2: In view of findings in point No.1, the next issue is that to what relief the complainant is entitled.
Ex.B1 & B2 are showing that under K.C.C. (Kisan Credit Card) scheme policy there is sum insured Rs.50,000/- to the K.C.C. (Kisan Credit Card) holders but not Rs.1,00,000/- as pleaded by the complainant. The said insured Rs.50,000/- is payable to the K.C.C. (Kisan Credit Card) holder in the event of his accidental death under the policy.
Therefore we are of the considered view that the opposite party No.2 who being issued Group accidental insurance policy is liable to pay sum insured Rs.50,000/- under the policy in Ex.B2 to the complainant with interest and cost of the complaint. The complaint against opposite party No.1 is dismissed without costs as the bank is being facilitator of the KCC (Kisan Credit Card) Group accidental insurance scheme policy.
The complainant has not filed any record of evidence for other reliefs. Accordingly we also answered in point No.2.
In view of aforementioned findings in point No.1 & 2, the opposite party No.2 is liable to pay sum insured Rs.50,000/- under the policy in Ex.B2 with interest from the date of repudiation i.e. 19-10-2012 to the complainant along with cost of the complaint.
8. IN THE RESULT, the complaint is allowed in part as under:-
- The opposite party No.2 is directed to pay sum insured Rs.50,000/- with 9% interest under the policy in Ex.B2 from the date of repudiation i.e. 19-10-2012 till realisation to the complainant.
- The opposite party No.2 is also further directed to pay Rs.1,000/- to the complainant towards cost of the complaint.
- The complaint is dismissed against opposite party No.1 without costs.
Typed to dictation, corrected and pronounced by the Member in Open Forum on this the 31st day of October 2014.
