-Vs-

1.  The Oriental Insurance Company,

    Rep.by its Regional Manager, Snehalatha’               6-3-871, Green lands Road,

    Post Box -45, Begampeta,Hyderabad-16.

2. The Oriental Insurance Company,

   Rep.by By  Branch Manager,

      1^st Floor P.B.No6,

   H.No.12-511,Muncipal Main Road,

   Adoni, Kurnool -518001.

3. The Oriental Insurance Company,

   Rep.by Divisional Manager,

   Bhupal Complex, Post Box No.33,

   Kurnool (AP)-518001.                          …Opposite Parties

  This complaint is coming on this day for orders in the presence  of  Sri. S. Lakshmi Narayana ,  Advocate, for complainant and Sri D.Srinivasulu , Advocate for the opposite party No. 3 and opposite party No. 1 and 2 is called absent set ex-parte and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Sri. T.Sundara Ramiah, President)

C.C. No.205/08

1.     This complaint is filed under section 11 and 12 of the C. P. Act, 1986 praying 

a)     to direct the opposite parties No. 1 to 3 to pay assured sum of Rs.3,00,000/-with bonus and compensation of Rs.25,000/- to the complainant for the mental agony.  

b)     to grant interest @ 24% p.a from the date of death of insured

c)     to grant costs of the complaint.

d)     to grant such other reliefs or reliefs as the Hon’ble Forum may deem fit proper in the circumstances of the case.

2. The case of the complainant in brief is as follows:- The complainant’s husband K.Bhaskar Reddy took Nagrik Surakash Policy bearing No.2006/326 from the opposite parties . The complainant is the nominee of the said policy . The complainant’s husband  Bhaskar Reddy died on 25-05-2008  when the policy was in force . The complainants husband was riding his motor bike on 25-05-2008 .He fell down  on the road  while driving motor bike and received sever head injury.              After the accident Bhaskar Reddy was shifted to A.P. Vaidhay Vidaan Parshid Community Hospital , Yemmiganur . The civil surgeon  attached to Community Hospital , Yemmiganur referred Bhaskar Reddy to Government Hospital , Kurnool. While he was shifting to the Government Hospital  , Kurnool in an vehicle he died on the way . Due to depression  and shock the deceased not got subjected to  postmortem . The complainant informed about the death of her husband to opposite party No. 2 . Subsequently  he also made a claim with a request  to settle the claim . Opposite party No. 2  did not settle the claim of the complainant.  Inspite of legal notice there was deficiency of service on the part of the  opposite parties  . Hence the complaint.

3.     The opposite parties  1 and 2 remained ex-parte. Opposite party No. 3 filed written version that the  complainant is not maintainable .It is admitted that Bhaskar Reddy took Nagrik Surakash Policy bearing No.2006/326  . Opposite parties 1 and 2 are not necessary parties to the  complainant and they are unnecessarily added.  Opposite parties  denied that Bhaskar Reddy died due to the injures  received by him in the  accident on 25-05-2008. For the legal notice  got issued by the complainant  a suitable reply  was issued by the opposite parties. It is true that the  complainant intimated about the death of her husband to opposite party No. 2. After receiving the  death intimation opposite party No. 2 issued claim form to the complainant  and asked her to submit the claim form along with necessary documents to settle the claim but the complainant  failed to submit the  documents such as FIR , post mortem certificate and other documents   . Inpsite of demands by opposite party No. 2  the complainant failed  to submit necessary forms to settle the claim. In the present case there was false case reported about the alleged accidental  death of the insured. The complainant failed to submit the  necessary documents to process her claim.  There was neither negligence nor deficiency of service on the part of the opposite parties.  The complainant is not  entitled for any relief as sought for.

4.     On behalf of the complainant Ex. A1 to A8 are marked  and PW.1 is examined . On behalf of the opposite parties Ex.B1 to B3 are marked.  

5.     On the basis of the above pleadings the points that arise for consideration are     

(i) whether there is any deficiency of service on the part of the

respondents/ opposite parties ?

(ii) Whether the complainant is entitled to the relief as prayed

for?

(iii) To what relief?

6.     Point No.1 & 2: Admittedly Sri. K. Bhaskar Reddy husband of the complainant took Nagarik Surakash Policy bearing No.2006/326 from the opposite parties.  The complainant is the nominee  under the said policy.  It is also  admitted that the  complainant informed about the  death of her husband  to opposite party No. 2 and  also submitted claim form for payment of the amount due  under  the policy. It is   the specific case of the   complainant  that  her  husband  died  on   25-05-2008  due to the injuries received by him  in the road accident. The opposite party No. 3 disputes that K.Bhaskar Reddy met with an accident  on 25-05-2008. The complainant to show  that her husband met with a road accident on 25-05-2008  got examined P.W1 , medical officer attached to Community Health Centre, Yemmiganur . It is stated by P.W.1 in his evidence that on 25-04-2008 at 3.05 P.M he examined male  person  by name K.Bhaskar Reddy and found injuries 

on him . He also stated that the said injuries were sustained on account of accidental fall from a running two wheeler  near electric sub-station at Errakota (V)  of yemmiganur (M). It is further  stated by him he referred the patient to Government Hospital , Kurnool for further treatment  on account of critical condition of injury  . He identified Ex.A1 as the case sheet of Bhaskar Reddy and Ex.A2 as the medical certificate issued by him . As seen from Ex.A1 and A2 it is very clear that Bhaskar Reddy met with motor accident on 25-05-2008 and that P.W.1 gave first aid . In Ex.A1 case sheet also there is clear  mention that Bhaskar Reddy met with an accident on 25-05-2008.

7.     The complainant filed Ex.A4 death certificate evidencing her husband died on 25-05-2008 . According to the complainant  that her husband died on the way to Government Hospital , Kurnool .It is in the evidence of P.W.1 that he referred the patient at Government Hospital , Kurnool on 25-05-2008. There is no serious dispute about the death of Bhaskar Reddy on 25-05-2008. It is the main contention of the opposite party No. 3 that the complainant did not produce the necessary  documents like FIR , post mortem  certificate etc., to settle the claim.  It is not the case of the complainant  that a report was given regarding the road accident that took place on 25-05-2008. It is also not the case of the complainant  that post mortem examination was conducted on the dead body of her husband Bhaskar Reddy. Merely because  the FIR  and post mortem report are not filed it can not be said that there was no accident. The medical officer who is examined as P.W.1 in his evidence stated that Bhaskar Reddy received injuries accidentally. There is clear mention in the case sheet Ex.A1 also about the accident. In a decision  reported IV (2008) CPJ 312 it is observed that “Non  furnishing of the FIR , post mortem report would not  mean that no accident took place ”.

8.     In the present  case on hand the complainant is able to establish that her husband sustained injuries  in the road accident that place  on   25-05-2008 and died on the way to Kurnool  hospital. Admittedly prior to the  filling of the complainant she got issued a demand notice to opposite party No. 2. Opposite party No. 2 gave a reply directing the complainant  to produce   FIR, post mortem examination  etc., . The demand for post mortem examination report by the opposite parties is unwarranted . The complainant  could able to  establish that her husband met with a motor accident and that he died on 25-05-2008. It is not the case of the opposite parties  that they are not  liable to pay the amount to the complainant. Complainant is the nominee under the policy. There is deficiency of service on the part of the opposite parties and they are liable to pay the assured sum of Rs. 3,00,000/- with other benefits to the complainant .    

9.Point No.3:-In the result the complainant is partly allowed directing the opposite parties 1 to 3  jointly and severally  to pay Rs.3,00,000/- along with other benefits with subsequent interest at 9% p.a  from the date of the complaint i.e, 10-12-2008 till the date of payment along with costs of Rs.500/-.

Dictated to the stenographer, transcribed by her , corrected and pronounced by us in the open bench on this the 26^th day of April, 2010.

        Sd/-                                                                  Sd/-

MALE MEMBER                                                            PRESIDENT

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :                For the opposite parties :Nil

P.W.1        Deposition of  P.W.1

(Dr.M.Rajappa, ) dt:06-04-2009.

List of exhibits marked for the complainant:-

Ex.A1.       Marked in PW.1 evidence.

Ex.A2.       Marked in PW.1 evidence.

Ex.A3.       Xerox of Nagrik Suraksha Policy with terms and conditions       

Ex.A4.       Death certificate dated 07-06-2008.

Ex.A5.       Xerox copy of family member certificate.

Ex.A6.       Attested Xerox copy of driving license of Bhaskar Reddy

Ex.A7.       Attested Xerox copy of house hold card.

Ex.A8.       Office copy of legal notice dated 21-11-2008 along with

                three courier receipts.    

List of exhibits marked for the opposite parties:  

Ex.B1.       Letter dated 29-09-2008 of OP.No.2 to the complainant .

Ex.B2.       Xerox copy of the terms and conditions pertaining to Nagrik

                Suraksha Policy.

Ex.B3.       Office copy of legal notice dated 08-12-2008.

       Sd/-                                                           Sd/-

 MEMBER                                                            PRESIDENT

// 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