BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MANGALORE
Dated this the 29th of October 2010
PRESENT
SMT. ASHA SHETTY : PRESIDENT
SMT.LAVANYA M. RAI : MEMBER
COMPLAINT NO.121/2010
(Admitted on 09.04.2010)
Smt.Komalakshi,
Wo. Late Koosappa Gowda,
Aged about 45 years,
RA. Panjadabailu House,
Pambethady Village, Karikala Post,
Sullia Taluk. …….. COMPLAINANT
(Advocate for the Complainant: Sri.Keshava B.V.)
VERSUS
1. The Manager,
Syndicate Bank Panja,
Panja Post, Sullia Taluk,
Dakshina Kannada.
(Advocate for the Opposite Party No.1: Sri.K.M.Krishna Bhat).
2. The Divisional Manager,
United India Insurance Co. Ltd.,
Bank Assurance Division,
N.R.Square, 2nd Floor, I.M.L. building,
Bangalore – 2. ……. OPPOSITE PARTIES
(Advocate for the Opposite Party No.2: Sri.Diwakar Bangera).
***************
ORDER DELIVERED BY PRESIDENT SMT. ASHA SHETTY:
1. This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Parties claiming certain reliefs.
The brief facts of the case are as under:
It is submitted that, Complainant’s husband late Koosappa Gowda had Savings Bank Account with the Opposite Party No.1 bearing S.B. Account No.017-220-0006492. The Complainant’s husband is insured with the 2nd Opposite Party under Personal Accident Scheme.
It is stated that, on 13.05.2009 at about 6.30 a.m., due to snake bite the husband of the Complainant was died. The same has been informed to the Opposite Parties and the Opposite Party No.2 is liable to pay Rs.1,00,000/- under the Personal Accident Scheme to the Complainant but the 2nd Opposite Party refused to pay the amount which is illegal and amounts to deficiency. Hence the above complaint is filed under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Parties to pay Rs.1,00,000/- and also claimed Rs.25,000/- as compensation and cost of the proceedings.
2. Version notice served to the Opposite Parties by RPAD. Opposite Parties appeared through their counsel filed separate version.
Opposite Party No.1 Syndicate Bank, Panja Branch submitted that, Complainant’s husband late Koosappa Gowda is having S.B. Account No.017-220-0006492 with the Opposite Party. The Complainant’s husband is insured with the 2nd Opposite Party under Personal Accident Scheme. It is stated that, recently the Complainant came to Opposite Party No.1 and informed that her husband was dead due to snake bite and submitted doctor’s certificate to that effect and requested to forward her claim for compensation to Opposite Party No.2. The Opposite Party No.1 immediately forwarded the claim but Opposite Party No.2 refused to honour the claim of the Complainant stating that the claim cannot be entertained, since post mortem report is not submitted to them. It is stated that, there is no contractual relation/liability between the Savings Bank Account holder and 2nd Opposite Party. Hence it is contended that, there is no deficiency and prayed for dismissal of the complaint.
Opposite Party No.2 filed version admitted the policy but it is contended that, the Complainant is not a consumer and this FORA has no jurisdiction to entertain the complaint. And further stated that, the Complainant has failed to produce the relevant records such as FIR, police mahazar to establish the cause of death. That the post mortem report along with the claim form which is the basic requirement to prove the death of Koosappa Gowda was due to an accident. It is submitted that, the Complainant has not produced any of the above mentioned documents to enable the Opposite Party to finalize and settle the claim within the frame of the policy. It is stated that, there is no deficiency and prayed for dismissal of the complaint.
3. In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the Complainant proves that the Opposite Parties committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
- What order?
4. In support of the complaint, Smt.Komalakshi (CW1) filed affidavit reiterating what has been stated in the complaint and answered the interrogatories served on her. Ex C1 to C3 were marked for the Complainant as listed in the annexure. One Sri.P.Venkataprasad (RW1), Administrative Officer of the Opposite Party No.2 and one Sri.V.Parameshwara Navada (RW2) – Manager of the Opposite Party No.1 filed counter affidavits and answered the interrogatories served on them. Ex R1 to R11 were marked for the Opposite Parties as listed in the annexure. Both parties produced notes of arguments.
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before this Forum and answer the points are as follows:
Point No.(i): Affirmative.
Point No.(ii) & (iii): As per the final order.
Reasons
5. Point No. (i) to (iii):
From the outset of the oral as well as documentary evidence available on record, it is admitted that, the Complainant’s husband late Koosappa Gowda was holding Savings Bank Account with the Opposite Party No.1 as per Saving Bank Account No.017-220-0006492. The Complainant’s husband late Koosappa Gowda is insured with the 2nd Opposite Party under Personal Accident Scheme and Rs.10/- is paid to the 2nd Opposite Party from the account of the husband of the Complainant late Koosappa Gowda on 16.08.2008 (as per Ex C1). Under the Personal Accident Scheme, the Insurance Company is liable to pay Rs.1,00,000/- in case of death. The policy issued by the Insurance Company was in force at the time of death of late Koosappa Gowda i.e., the insured on 13.05.2009 (as per Ex R1).
Now the point in dispute between the parties are that, according to the Complainant, her husband late Koosappa Gowda was died on 13.05.2009 due to snake bite (as per Ex R4). As per the policy issued by the Insurance Company under the Personal Accident Scheme, the 2nd Opposite Party is liable to pay Rs.1,00,000/- to the Complainant but the Opposite Party No.2 failed to pay the same. Hence she came up with this complaint.
On the contrary, the 1st Opposite Party i.e., Syndicate Bank, Panja Branch, admitted that the Complainant’s husband late Koosappa Gowda is having S.B. Account No.017-220-0006492 with them and also admitted that, the Complainant’s husband is insured with the 2nd Opposite Party under Personal Accident Scheme and Rs.10/- is paid to the 2nd Opposite Party from the account of the Complainant’s husband. It is also stated that, this Opposite Party informed by the Complainant that her husband was died due to snake bite and submitted the doctor’s certificate and the same has been forwarded to the 2nd Opposite Party. After forwarding the claim of the Complainant, the 2nd Opposite Party refused to honour the claim and replied that the post mortem report is not submitted. The Opposite Party No.1 stated that, there is no deficiency on their part.
Opposite Party No.2, on the other hand contended that, the Complainant has failed to produce the relevant records such as FIR, police mahazar to establish the cause of death and also the Complainant not produced the post mortem report along with the claim form which are the basic requirement to prove the death of Koosappa Gowda to enable the Opposite Party to finalize/settle the claim within the frame of the policy and contended that there is no deficiency.
The Complainant sworn affidavit and produced Ex C1 to C3. Opposite Parties also filed evidence by way of affidavits and produced Ex R1 to R11.
On scrutiny of the oral as well as documentary evidence filed by the parties before this Forum, we find that, the Complainant’s husband late Koosappa Gowda admittedly obtained the Personal Accident Policy from the 2nd Opposite Party bearing policy No.072600/42/08/05/00000101 for the period from 14.08.2008 to 13.08.2009. The said policy is not a motor vehicle accident policy. It is a Bancassurance Co-branded Personal Accident Policy which contains certain terms, conditions, exclusions and definitions.
However, under the above policy, the Company undertakes that –
“If during the period of continuance of the policy, any insured person shall sustain bodily injury resulting solely and directly from accident caused by outward, violent and visible means, then the Company shall pay to the assignee the sum assured under the policy.
PROVISIONS
Provided always that the Company shall not be liable under this policy for:
- Payment of compensation in respect of injury or disablement directly or indirectly arising out of contributed to by or traceable to any disability existing on the date of issue of this policy.
- Payment of compensation in respect of death, injury or disablement of the Insured from (a) intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drugs (c) whilst racing on wheels, hunting big game shooting, mountaineering or whilst engaged in winter sports, skiing and ice hockey (d) directly or indirectly caused by insanity (e) arising or resulting from the insured committing any breach of the law with criminal intent.
- Payment of compensation in respect of death, injury or disablement of the insured due to or arising out of directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, insurrection, mutiny, military or usurped powers, seizure, capture, arrests, restraints and detainments of all kings, princes and people of whatever nation condition or quality so ever.
- Payment of compensation in respect of Death of or bodily injury to the insured directly or indirectly caused by or contributed to be or arising from or traceable to ionizing radiation or contamination by radioactivity from any source whatsoever, or from nuclear weapons material”.
But in the instant case, the insured died due to snake bite. In order to prove the death of the insured, the Complainant produced a certificate issued by Primary Health Centre, Panja, Dakshina Kannada, wherein, Dr.Subrahmanya stated that, the insured Koosappa Gowda died due to snake bite on 13.05.2009 at 6.30 a.m. The above certificate has been marked as Ex R4. The Insurance Company contended that, the Complainant not produced post mortem report or mahazar/FIR. It is a settled position of law that, the post mortem report or mahazar and FIR are the corroborative piece of evidence and not a conclusive piece of evidence. The Complainant produced the certificate issued by the Government Hospital reveals that, the insured died in a snake bite. When that being the case, the option left open to the Opposite Party No.2 to challenge the certificate by summoning the doctor who issued the certificate. No such attempt has been made by the Insurance Company nor any cogent/material evidence produced before this Forum to show that the death caused to the insured is not accidental death or not falls within the purview of the policy issued by them. The snake bite is an accidental death and the said accidental death is covered under the policy and there is no exclusion under the policy issued by the Company.
We have noticed that, the Opposite Party Company just because the Complainant not produced the FIR/post mortem report, not honoured the claim. The Opposite Party Company ought to have considered the certificate issued by the Government Hospital i.e., Primary Health Centre, Panja, Dakshina Kannada i.e., Ex R4 in this case. Repudiation of the claim or not accepting the claim of the Complainant in this case amounts to deficiency.
In view of the above discussions, we hold that, the Opposite Party Insurance Company despite of receiving a proof with regard to the death of the insured not honoured the claim or paid the claim till this date amounts to deficiency as stated supra. Therefore, we direct the Opposite Party No.2 i.e., United India Insurance Company Limited, represented by its Divisional Manager to pay Rs.1,00,000/- to the Complainant along with interest at 9% p.a. from the date of accident till the date of payment and also pay Rs.1,000/- as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
There is no deficiency on the part of the Opposite Party No.1 i.e., Syndicate Bank. Hence the complaint against Opposite Party No.1 is hereby dismissed.
6. In the result, we pass the following:
ORDER
The complaint is partly allowed. Opposite Party No.2 i.e., United India Insurance Company Limited, represented by its Divisional Manager is hereby directed to pay Rs.1,00,000/- (Rupees one lakh only) to the Complainant along with interest at 9% p.a. from the date of accident till the date of payment and also pay Rs.1,000/- (Rupees one thousand only) as cost of the litigation expenses. Payment shall be made within 30 days from the date of this order.
Complaint against Opposite Party No.1 is hereby dismissed.
The copy of this order as per the statutory requirements be forwarded to the parties free of charge and therefore the file be consigned to record.
(Page No.1 to 10 dictated to the Stenographer typed by her, revised and pronounced in the open court on this the 29th day of October 2010.)
PRESIDENT MEMBER
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 – Smt.Komalakshi – Complainant.
Documents produced on behalf of the Complainant:
Ex C1 – : Copy of the bank account issued by the Opposite Party No.1.
Ex C2 – 01.02.2010: Lawyer’s notice issued to the Opposite Parties.
Ex C3 – : Postal acknowledgements (2 in numbers).
Witnesses examined on behalf of the Opposite Parties:
RW1 – Sri.P.Venkataprasad, Administrative Officer of the Opposite Party No.2.
RW2 – Sri.V.Parameshwara Navada – Manager of the Opposite Party No.1.
Documents produced on behalf of the Opposite Parties:
Ex R1 – : Copy of the Tailormade Group Personal Accident Policy issued by the Opposite Party No.2 in favour of Opposite Party No.1.
Ex R2 – 06.07.2009: Copy of the claim form submitted by the Complainant.
Ex R3 – 15.05.2009: Copy of the death certificate of Mr.Koosappa Gowda.
Ex R4 – 02.06.2009: Copy of the doctor’s certificate.
Ex R5 – Same as Ex R2.
Ex R6 – 02.09.2009: Letter of the Complainant to the Opposite Party No.1.
Ex R7 – 16.09.2009: Letter of the Opposite Party No.1 to the Opposite Party No.2.
Ex R8 – 14.10.2009: Letter of the Opposite Party No.1 to the Opposite Party No.2.
Ex R9 – 11.01.2010: Letter of the Opposite Party No.2 to the Opposite Party No.1.
Ex R10 – 10.03.2010: Reply of the Opposite Party.
Ex R11 – Same as Ex R1.
Dated:29.10.2010 PRESIDENT
