BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt C.Preethi, M.A., LL.B., Member
Monday the 14th day of May, 2007
C.C. No.11/2007
M. Jareena Bee, W/o Late Momin Abubakkar Siddiq,
H.No. 25/35, Kothapeta Street, Atmakur, Kurnool District. ... COMPLAINANT
Verses
The Oriental Insurance Company Limited,Represented by its Divisional Manger,
Kurnool. ... OPPOSITE PARTY
This complaint coming on this day for hearing in the presence of Sri.K.Ravi Kumar, Advocate, Kurnool for Complainant and Sri.Y.Jaya Raju, Advocate, Kurnool for Opposite Party upon the perusing the material papers on record, the Forum made the following:
ORDER
(As per Smt. C. Preethi, Member)
1. This consumer complaint of the Complainant is filed U/S 12 of C.P. Act., 1986 seeking a direction on the Opposite Party to pay Rs. 1,00,000/- with 12% interest to the Complainant, Rs. 50,000/- towards damages, costs of the complaint and any other relief or reliefs which the Complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the Complainant’s husband during his life time insured his life with Opposite Party under Individual Janta Personal Accidental Insurance Policy bearing No. 2005/239 for Rs. 1,00,000/- for a period from a period from 05-08-2004 to 04-08-2009 and the Complainant was nominated as nominee. While the policy was in force the Complainant’s husband Momin Abubakkar Siddiq died on 02-06-2005 due to accidental fall from the top of the tomato loaded lorry bearing No. AP21-W-1191. On the claim preferred by the Complainant it was repudiated stating that FIR Panchanama, Postmortem are not submitted by the Complainant. Hence the Complainant resorted to the Forum for redressal.
3. In substantiation of their case the Complainant relied on the following documents viz; (1) Attested xerox of death certificate (2) Repudiation letter dated 29-12-2005 and (3) Attested xerox of letter of Dr. Gowrinath, besides to the sworn affidavit of the Complainant in reiteration of her complaint avernments and the above documents are marked as Ex.A1 to A3 for its appreciation in this case. The Complainant caused interrogatories to Opposite Party and replied suitablely to the interrogatories caused by Opposite Party.
4. In pursuance to the notice of this Forum as to this case of the Complainant the Opposite Party appeared through their standing counsel and contested the case by filling written version.
5. The written version of Opposite Party admits that the Complainant’s husband Momin Abubakkar Siddiq was covered under the policy issued by the Opposite Party for accidental death for assured sum of Rs. 1,00,000/- and the policy holder died on 02-06-2005. It submits that the accidental fall from the tomato lorry by the policy holder is not proved and the certificate issued by Doctor is fabricated one. Moreover immediately after the claim form is received by the Opposite Party, it requested the Complainant to furnish FIR, Inquest and Panchanama certificates but the Complainant failed to furnish and further failed furnish full particulars of death of the policy holder with in stipulated time and no complaint was given to the police, no inquest was done and postmortem was not conducted. Hence the claim of the Complainant is created and fabricated to get wrongful gain from the Opposite Party and there is no deficiency of service on part of Opposite Party and seeks for the dismissal of complaint with costs.
6. In support of their case the Opposite Party relied on the following documents viz (1) Janta Personnel Accident Insurance Policy with terms and conditions (2) Office copy of letter dated 28-09-2005 of Opposite Party to the Complainant (3) Postal acknowledgment as to the receipt of Ex.B2 by the Complainant and (4) Claim form of the Complainant dated 14-10-2005 besides to the sworn affidavit of the Complainant in reiteration of his written version avernments and the above documents are marked as Ex.B1 to B4 for its appreciation in this case. The Opposite Party caused interrogatories and replied to the interrogatories caused by Complainant.
7. Hence, the point for consideration is to what relief the Complainant is entitled alleging deficiency of service on part of Opposite Parties?
8. It is the case of the Complainant that her husband Momin Abubakkar Siddiq died on 02-06-2005 due to accidental fall from top of the tomato loaded lorry bearing No. AP21-W-1191 and the Momin Abubakkar Siddiq was covered under the Individual Janta Personnel Accident Insurance Policy issued by Opposite Party. A claim vide Ex.B4 was submitted by the Complainant to the Opposite Party, and the Opposite Party repudiated the claim of the Complainant vide Ex.A2. The Ex.A2 dates to 29-12-2005, it repudiates the claim of the Complainant on the grounds that full particulars of death was not intimated to Opposite Party within the stipulated time and the Complainant failed to submit FIR, Police Panchanama and Postmortem report etc., to consider the claim and the Opposite Party in his written version avernments submits that the alleged accident cannot be treated as accident.
9. Therefore, the first contention of Opposite Party is that as per condition No.1 full particulars which may give rise to a claim should be submitted within one month from the date of accident and alleges the particulars in this case are not submitted within the stipulated period. Admittedly claim intimation letter was addressed to Opposite Party on 26-09-2005, and it was received by Opposite Party and inturn addressed a letter dated 28-09-2005 to the Complainant requesting the Complainant to fill up the claim form duly signed and return the claim form along with original, FIR, Police Panchanama, Postmortem report, Death Certificate, Legal Heir Certificate, Doctors Certificates who has given treatment to the deceased etc., for settlement. At the first instance the intimation letter was received belatedly by the Opposite Party then there is no necessary for the Opposite Party to request the Complainant to submit above documents for settlement of claim when there is delay in intimation isself then the Opposite Party should not have requested the Complainant to submit claim form along with necessary documents. Therefore when the Opposite Party requested the Complainant to submit necessary documents for settlement of claim by accepting the delay intimation letter now can not repudiate the Complainant’s claim on delay of intimation. Hence, the above plea of Opposite Party is rejected.
10. The second contention of the Opposite Party is that the Complainant did not submit required documents such as FIR, Police Panchanama, Postmortem report etc. The said contention of the Opposite Party is repelled by placing reliance on the decision of Honourable A.P. State Commission reported in 2000 ALD (Cons) page 96, where in it was held that unless a death is of suspicious nature in question registering FIR, conducting postmortem or inquest does not rise. As such the stand of Opposite Party insisting on the production of such documents is held to be illegal and not valid and untenable. In this case the Complainant relied on Ex.A3 certificate issued by Dr.D.P. Gowrinath of Saranya Clinic dated 02-06-2005, it says that a patient by name Siddiq was brought to his clinic at about 07:00 PM with head injuries alleged to have caused due to fall from top of a tomato lorry while examining he died at 7:05 PM. The Opposite Party in Ex.B2 at Sl.No. 5 asked the Complainant to produce doctors certificate and the Complainant brought on record the said certificate and marked it as Ex.A3. The Opposite Party submitted that no relevant documents are submitted and the Complainant’s claim is false and relied on decision of Uttaranchal State Commission reported in I (2007) CJP 354, wherein the Complainant’s claim was falsified for not lodging FIR and there are no sigh of splitting of petrol even in the photographs taken soon after the accident. But in this present case of the Complainant, Doctors certificate (Ex.A3) is on record to prove that the deceased died due to injuries while examining. In the Uttaranchal State Commission case there is no piece of evidence to show that petrol was spilled and hence the Complainant’s claim was treated as false claim. In the present case the Ex.A3 is supporting the claim of the Complainant. Hence the plea taken by the Opposite Party remains as plea for plea sake without any substantiation.
11. The third contention of the Opposite Party is that the fall from the tomato lorry cannot be treated as accident. The perusal of dictionary meaning of accident it will be clear that any event which happens without any cause or is not expected to be caused in normal circumstances is covered under it. It is also an unfortunate event causing physical harm or damage by some unintentional act. Thus the event which happened in the present case was merely an accident. It is not routine or a normal cause that the deceased fallen from top of a tomato loaded lorry. It does not occur in normal course of life. Thus the event which occurred in the present case is merely by chance and is covered by the word ‘accident’. The word is to given its normal meaning by which it is understood by common man. Even a common man will say that if such an event happens it is by chance accident and not a phenomenon occurring so often. Thus the non payment of assured amount to the Complainant on this ground is total baseless and devoide of any reasoning which has been adopted by the Opposite Party.
12. To sum up the Opposite Party miserablely failed to substantiate their contention by placing any rebuttal evidence and it can not be held that the insured person has not met with accident and the Complainant filed this false case. The Complainant is certainly remaining entitled to claims made in the complaint and in not paying the said amount the Opposite Party is at deficiency of service.
13. In the result, the complaint is allowed directing the Opposite Party to pay to the Complainant the assured amount under the policy bearing No. 2005/239 with 9% interest from the date of filling of the case i.e., 12-01-2007 till realization along with costs of Rs. 500/- within a month of receipt of this order.
Dictated to the Computer Operator transcribed by him, corrected and pronounced in the Open bench on this the 14th day of May, 2007.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite party: Nil
List of exhibits marked for the complainant:-
Ex.A1 Attested xerox of death certificate.
Ex.A2 Repudiation letter dated 29-12-2005.
Ex.A3 Attested xerox of letter dated 02-06-2005 of Dr. D.P. Gowrinath.
List of exhibits marked for the opposite party:-
Ex.B1 Janta Personnel Accident Insurance Policy with terms and conditions.
Ex.B2 Office copy of letter dated 28-09-2005 of Opposite Party to the
Complainant
Ex.B3 Postal acknowledgment as to the receipt of Ex.B2 by the Complainant.
Ex.B4 Claim form of the Complainant dated 14-10-2005.
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1. Sri. K. Ravi Kumar, Advocate, Kurnool.
2. Sri. Y. Jayaraju, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
