BEFORE THE DISTRICT FORUM: KURNOOL

Present: Sri. T.SundaraRamaiah, B.Com B.L., President

And

Sri.M.Krishna Reddy, M.Sc., M.Phil., Male Member

And

Smt. S.Nazeerunnisa, B.A., B.L., Lady Member

Wednesday the 25^th day of May, 2011

C.C.No 37/2007

BETWEEN:

J.Rama Krishna,

S/o J.Ch.VenkataSwamy,

Resident of Rudravaram Village,

PamulapaduMandal,

Kurnool District.                             …Complainant

-Vs-

1.   National Insurance Company Limited,

Represented by its Divisional Manager,

        Division-III, ShakesphereSarani,

        6^th Floor, Kolkatta.                      

2.   National Insurance Company Limited,

Represented by its Branch Manager,                     

        Tula Complex,Gandhi Nagar,

        Kurnool.

3.   Golden Multi Services Club Limited,

Represented by its Director,

        S.B.Monsoon, 16, R.N.Mukherjee Road,

        Kolkatta-700001.

4.   Golden Multi Services Club Limited,

Represented by its Branch In-Charge,

U-Con Plaza, III-Floor,

Kurnool.                             …Opposite Parties

This complaint is coming on this day for orders in the presence of Sri.P.Chandra Sekhar, Advocate for complainant and Sri D.A.Anees Ahamed, Advocate for opposite parties 1 and 2 and Sri M.Azmathulla, Advocate, for opposite parties 3 and 4 for upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri.T.SundaraRamaiah, President)

CC. No. 37/2007

1. This complaint is filed under section 12 of C. P. Act, 1986 praying:-

(a)    To direct the opposite parties to pay Rs.5,00,000/- towards insurance amount;           

(b)    To pay compensation of Rs.1,00,000/- towards compensation for damages, mental agony and hardship;

1. To pay costs of the complaint;

1. To pay interest at the rate of 18% per annum from the date of death of the deceased;

 And

 (e)   To grant such other relief or reliefs as the Hon’ble Forum may deems fit and proper under the circumstance of the case.

2.     The case of the complainant in brief is as under:- The complainant is the husband of JalaSarada who died on 25-01-2006 due to  accidental drowning.  JalaSarada who is the wife of the complainant joined as a member under opposite party No.3.  She obtained Group Janata Personal Accident Insurance Policy bearing No.100300/47/01/9600022/04/96/30022. The said policy was issued by opposite party No.1.   The sum assured under the policy is Rs.5,00,000/-. The policy was in force from 15-04-2004 to 14-04-2009.  The complainant is the nominee under the said policy.  The complainants wife died due to accidental drowning on 25-01-2006 while the policy was in force.  After the death of JalaSarada the complainant who is the nominee under the policy submitted F.I.R., Inquest, Post Mortem Certificate, Death Certificate and the copy of the policy to opposite party No.2.  On 29-03-2006 opposite party No.2 returned the said documents to the complainant.  Again on 04-04-2006 and on 16-05-2996 the complainant

sent all the documents to opposite party No.1.  Thereis no response from opposite party No.1 on 01-09-2006 the complainant got issued legal notice to opposite party No.1.  Opposite party No.1 received the said notice and kept quiet.  There is deficiency of service on the part of the opposite parties. Hence the complaint.

3.     Opposite party No.2 filed written version and the same is adopted by opposite party No.1.  It is stated in the written version of opposite party No.1 that the complaint is not maintainable.  There is no cause of action against opposite parties 1 and 2 as the deceased did not pay the premium to opposite parties 1 and 2. The complainant has to prove the policy by filing theoriginal.  The JPA policy is the contract between the                                                                          parties.  The attested copy of the policy is not admissible.  Opposite party No.3 has not submitted the claim form and original bond.  Opposite party No.1 not received claim form directly from the complainant.  The complainant is not maintainable and it is liable to be dismissed as the alleged death of the deceased JalaSarada does not fall within the scope of the policy.  The drowning of JalaSarada in water drum is due to the fits disease.  The death of deceased is not resulted solely and directly from the accident caused by external visible and violent means.  There is no evidence of injuries present over the dead body of the deceased. The death of JalaSaradais suspicious in nature.  In order to gain wrong fully the complainant filed the present complaint.  There is no deficiency of service on the part of the opposite parties 1 and 2.

        Opposite party No.4 filed written version and it is adopted by opposite party No.3.  It is stated in the written version that the complaint is not maintainable.  Janata Personal Accident Insurance Policy was issued by opposite party No.1 covering the risk of the members of Golden Multi Services Club of Golden Trust Financial Services.  There is a memorandum of understanding between opposite party No.1and Golden Multi Services Club of Golden Trust Financial Services. As per the memorandum of understanding opposite party No.1 Company agreed to accident insurance coverage to the members of Golden Multi Services Club of Golden Trust Financial Services.  The complainant wife as a member of Golden Multi Services Club of Golden Trust Financial Services obtained a Group Janata Personal Accident Insurance policy for Rs.5,00,000/-.  The complainant is the nominee under the said policy.  As per the terms and conditions of the policy opposite parties 1 and 2 have exclusive authority to settle the claim.  Opposite parties 3 and 4 are not concerned regarding the settlement of the claim of the complainant.  There is no deficiency of service on the part of opposite parties 3 and 4 and the complaint is liable to be dismissed against opposite parties 3 and 4.

4.     On behalf of the complainant Ex.A1 to A10 are marked and sworn affidavit of the complainant is filed.  On behalf of the opposite parties Ex.B1 to B4 are marked and sworn affidavit of opposite party No.2 is filed.

5.     Both sides filed written arguments.

6.     The points that arise for consideration are:

1. Whether there is deficiency of service on the part of the opposite parties?

1. Whether the complainant is entitled to the reliefs as prayed for?

1. To what relief?

7.     POINTS 1 and 2:- It is the case of the complainant that his wife JalaSarada was a member of Golden Multi Services Club of Golden Trust Financial Services and that opposite party No.1 issued Janata Personal Accidental Insurance Policy covering the risk of members of Golden Multi Services Club of Golden Trust Financial Services.  Opposite parties 1 and 2 denied issuance of policy in favour of the complainants wife.  The complainant inhis sworn affidavit clearly stated that his wife JalaSarada was a member of Golden Multi Services Club of Golden Trust Financial Servicesand that opposite party No.1issued the policy Ex.A1. As seen from Ex.A1 it is very clear that JalaSarada was a member of Golden Multi Services Club of Golden Trust Financial Services.  It is mentioned in Ex.A1 that the Group Janata Personal Accidental Insurance Policy was in force from 15-04-2004 to 14-04-2009 and that JalaSarada is the insured person. It is also mentioned in Ex.A1 that sum insured under the policy is Rs.5,00,000/-.  Opposite party No.4 in its written version admitted that JalaSarada joined as a member of Golden Multi Services Club of Golden Trust Financial Services and that opposite party No.1 issued the policy.  From the affidavit evidence of the complainant and Ex.A1 it is very clear that the complainants wife JalaSarada is the insured person and that the policy was in force from 15-04-2004 to 14-04-2009.

8.     It is the case of the complainant that this wife died accidentally on              25-01-2006 by drowning and that he intimated the same to opposite party No.1 who issued Ex.A1 policy.  The complainant to show that his wife died on 25-01-2006 relied on Exs.A2 to A5.    Ex.A2 is the death certificate of JalaSarada issued by Panchayat secretary RudravaramPolice Station.  In Ex.A3 copy of the F.I.R and Ex.A4 copy of Inquest report also there is mention that JalaSarada died on 25-01-2006 by drowning in the water drum.  The complainant could able to establish that his wife died on 25-01-2006 by drowning in water drum.

9.     It is the case of the opposite parties 1 and 2 that the death of JalaSarada is not accidental and that the complainant is not at all entitled to the relief claimed.  It is mentioned in Ex.A2 death certificate that JalaSarada died on 25-01-2006 by fall into the water drum.  On the report given by the complainant a case in crime No.06/2006 was registered by Pamulapadu Police Station.  In the F.I.Rit is mentioned that on25-01-2006 the complainant came to know that his wife had fallen in water drum due to fits and died.In Ex.A4 inquest report also the inquest Panchayatdars came to the conclusion that the complainants wife JalaSarada died due to fall in water drum due to fits.  In Ex.A6 proceedings of the Sub Divisional Police of the Atmakur it is mentioned that no foul play was suspected over the death of JalaSarada.  As seen from the documentary evidence it is very clear that Sarada died on 25-01-2006 due to fall in water drum due to fits.

10.    It is the case of the opposite parties 1 and 2 that they are not liable to pay any amount to the complainant as the death of the deceased does not fall within the scope of the policy.  According to the opposite parties 1 and 2 that accidental drowning in the water drum is due to the fits disease and that the death of JalaSarada is not resulted solely and directly from accident caused by external visible and violent means.  There is no evidence   on record to show that JalaSarada died due to fits disease.  She had fallen in water drum accidentally.  Merely because no external injuries are found on the body of the disease it cannot be said that the death of JalaSarada is not accidental.   There is a clear mention in Ex.A1 inquest report that JalaSaradahad fallen into water drum accidentally.  Merely because the deceased had fits disease the opposite parties 1 and 2 cannot escape their liability.  The death of JalaSaradais not suicidal.  As the death of JalaSaradaoccurred accidentally the opposite parties are liable to pay the insured amount to the complainant who is the nominee. 

11.    It is the case of the opposite party No.1 that no claim form was received from the complainant along with documents and that the complainant is not entitled to any amount under the policy.  According to the complainant he sent the claim to oppositeparty No.2 and the same was returned by the opposite party No.2 on 25-03-2006.  Ex.A7 is the letter addressed to the complainant by opposite party No.2 with request to correspond with opposite party No.1.  After receiving Ex.A7 the complainant sent the documents to opposite party No.1 on 04-04-2006 and on 16-05-2006 as evidenced by Exs.A9 and A10 respectively. Opposite party No.1 having received the documents sent by the complainant in the year 2006 did not choose to give reply.  Thecomplainant gave legal notice Ex.A8 dated 01-09-2006 requesting opposite party No.1 to settle the claim.  The acknowledgements attached to Ex.A8 go to show that opposite party No.1 received the original of Ex.A8 on 08-09-2006.  Having received Ex.A8 legal notice, opposite party No.1 did not choose to give any reply.  Thecontention of the opposite parties 1 and 2 that no claim was preferred by the complainant is not correct.  As the claim of the complainant was not settled he filed the present complaint.  There is deficiency of service on the part of opposite party No.1.  Opposite party No.1 is liable to pay the assured amount to the complainant who is the nominee under the policy Ex.A1 issued by opposite party No.1.

12.    In the result the complaint is partly allowed directing opposite party No.1 to pay to the complainant the insured amount under the policy bearing No.100300/47/01/9600022/04/96/30022along with cost of Rs.500/- with interest at 9% from the date of the complaint i.e. 21-03-2007 till the date of payment.  The complaint against opposite parties 2 to4 is dismissed.

Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the day 25^thof May, 2011.

Sd/-                                                 Sd/-                              Sd/-

MALE MEMBER                         PRESIDENT                         LADY MEMBER

APPENDIX OF EVIDENCE

     Witnesses Examined

For the complainant :Nill                     For the opposite parties:Nill

List of exhibits marked for the complainant:-

Ex.A1        Attested Xerox of Janata Personal Accident Insurance Policy bearing No. 100300/47/01/9600022/04/96/30022.

Ex.A2.       Attested Xerox of Death Certificate.

Ex.A3                Attested Xerox of FIR of Pamulapadu (Police Station) in

Crime No.6/2006 along with letter.

Ex.A4        Attested Xerox of Inquest Report.

Ex.A5                Attested Xerox of Post Morten Report.

Ex.A6        Attested Xerox of Proceedings of Sub Divisional police Officer, Atmakur.

Ex.A7        Letter dated 29-03-2006 of opposite party No.2 addressed to complainant.

Ex.A8        Officer Copy of legal notice dated 01-09-2006 along with postal Receipts and acknowledgement.

Ex.A9        Photo copy of letter issued by complainant to

Opposite party No.1 dated 04-04-2006 along with postal

Receipt and acknowledgement.

Ex.A10       Photo copy of letter issued by complainant to

Opposite party No.1 dated 16-05-2006 along with postal

Receipt and acknowledgement.

List of exhibits marked for the opposite parties:-

Ex.B1        Letter dated 17-07-2001 addressed by opposite party No.1 to opposite party No.3.

Ex.B2        Letter dated 17-07-2001 addressed by opposite party No.1 to opposite party No.3.

Ex.B3        Communication of opposite party dated 17-07-2001.

Ex.B4        Attested Xerox of Memorandum of understanding between opposite party No.1 and opposite party No.3.

Sd/-                                                 Sd/-                              Sd/-

MALE MEMBER                           PRESIDENT                      LADY MEMBER

// Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties  :

Copy was made ready on             :

Copy was dispatched on               :