Per Sri A. Hazarath Rao,  President:-

        The complainant filed this complaint u/s 12 of the Consumer Protection Act seeking the insured amount and bonus of Rs.4,05,000/- and interest of Rs.1,91,700/- from 12-01-08 and Rs.50,000/- as damages for delay and mental agony besides for costs. 

 2.   In short the averments of the complaint are hereunder:

        One Medatati Krishna Rao husband of the complainant obtained personal accident policy bearing No.550507/742/04/6100000324 from the opposite party in 2003 and was renewing the same till his death. The said Krishna Rao died on 12-01-08 in railway accident near Nidubrolu Railway Station. The Tenali Railway police registered the said incident as Cr.No.4/08 after it came to its notice.  After investigation the said police issued final report on 10-06-08 treating the death of the said Krishna Rao as accidental.   The complainant being nominee of the said policy is entitled to receive the benefits. The complainant submitted the claim form along with relevant documents within few days.   The opposite party did not settle the claim on some pretext or other and thereby caused untold mental agony to the complainant.   The complainant got issued legal notice on 05-11-11.  The opposite party though received notice neither settled the claim nor gave reply.   On 15-09-10 also the opposite party still required the complainant for some information/documents.   The inaction and inordinate delay by the opposite party in not settling the claim amounted to deficiency of service.  The opposite party is liable to pay interest @12% p.a., The complaint therefore be allowed.

3.   The contention of the opposite party in nutshell is hereunder:

The complaint is barred by time, as the insured died on                   12-01-08.  The opposite party on 18-03-08 received death intimation of the insured from Smt M. Vasanthi with a request to send claim form.   While sending the claim form the opposite party requested the complainant to send FIR, Final Investigation report, Inquest report, Death Certificate and Post Mortem Certificate etc.  The opposite party by its letters dated 19-08-10, 27-08-10, 15-09-10 and 20-10-10 required the complainant to send completed claim form, SSC certificate of the insured, forensic report to find out the real cause of death.   The complainant did not submit the completed claim form and the documents sought by the opposite party.   The opposite party on 31-12-10 closed the matter as no claim for want of information.   The opposite party did not commit any deficiency of service.   The complaint suppressed material facts and approached this Forum with false allegations.   The complaint therefore be dismissed.

4.   Exs.A-1 to A-12 and Exs.B-1 to B-12 on behalf of the complainant and opposite party were marked respectively.                   

5.     Now the points that arose for consideration are:

1. Whether the complaint is barred by time?
2. Whether the opposite party committed deficiency of service?
3. Whether the complainant is entitled to compensation?
4. To what relief?

6.  POINT No.1:-        Relying on the judgment of Supreme Court rendered in Kandimalla Raghavaiah and company vs. National Insurance Company Limited 2009 CTJ 950 (SC) the National Consumer Disputes Redressal Commission IN Lakshmi Bhai and others vs. ICICI Lombard General Insurance Company Limited and others 2011 (4) CPR 64 (NC) held 

          “13.    The cases where such payment is not made,                  would fall in one of the following categories—

1).  Where no claim is made either with nodal officer or the Insurance Company, within 2 years of date of death such claims shall be barred by limitation.

2).  Cases where claim is made to nodal officer or nodal officer has forwarded the claim to Insurance Company or claim has been directly filed with Insurance Company within 2 years of the death and the claim has remained undecided. In such a case the cause of action will continue till the day the Respondent/insurance Company pays or rejects the claim.

3). In a case where the Respondent/insurance company rejects the claim, the cause of action arises again from the date of such rejection.

7.     In this case the insured died on 12-01-08 in GGH, Guntur             (Ex.A-5).  Even according to opposite party also the complainant informed the death of her husband on 18-03-08 (Ex.B-2).   The opposite party treated the claim as closed on 31-12-10 contending no response from the complainant.   The complainant filed this case on 21-12-11.   We therefore opine that the complaint is well in time.   We therefore answer this point in favour of the complainant.

8.  POINT No.2:-     The insured taking Personal Accident Policy on            31-01-07 (Ex.A-8=B-1) and the validity of the said policy till midnight of 30-01-08 are not in dispute.   At 1^st instance the SHO, Tenali RPS registered a complaint u/s 174 Cr.P.C. on 13-01-08 on the intimation given by CMO, GGH, Guntur regarding the death of an unknown person as seen from Ex.A-1.   The police conducted inquest on 14-01-08 in GGH, Guntur on the corps of the deceased covered by Ex.A-1 where blood relatives of the deceased identified the deceased as insured as seen from Ex.A-2.   

9.     Ex.A-3 post mortem report revealed that Medatati Venkata Krishna Rao died due to multiple injuries.   Ex.A-3 further revealed that the injuries mentioned therein were anti-mortem in nature.    Basing on Ex.A-3 only the authorities of GGH informed the death of the deceased Venkata Krishna Rao to the Registrar of Births and Deaths, Municipal Corporation, Guntur who in turn issued Ex.A-5.    Thus the identity of the insured was established.   The SHO, RPS, Tenali issued final report on 10-06-08 dropping further action as the death was accidental.  

10.   The main contention of the opposite party is that the complainant did not submit required documents in spite of repeated reminders (Exs.B-5 to B-11).  The complainant refuted the said contention relying on Ex.B-4.   Ex.B-4 dated 29-06-10 is extracted below for better appreciation:

        “

11.   The person who obtained Ex.B-4 on behalf of the opposite party did not mention the documents received by him.   Exs.B-7 to B-11 are subsequent to Ex.B-4.   When the opposite party did not mention the documents received by it under Ex.B-4 in our considered opinion Exs.B-7 to B-11 lost its significance.    The opposite party appointed a surveyor who in turn submitted a report on 21-07-10 (Ex.B-12).              A perusal of Ex.B-12 disclosed that the insured died due to accidental fall from a running train. 

12.   The other contention of the opposite party is that the complainant did not furnish forensic report and relied on an observation made in Ex.A-2 inquest report.   In column No.23 of              Ex.A-2 it was mentioned that the corps was sent to Professor of Forensic Medicine, GGH, Guntur to ascertain the cause of death.  There were over writings in Ex.A-2 regarding the date of holding inquest i.e., 15-01-08 was corrected as 14-01-08.   While undergoing treatment, the insured (deceased) succumbed to injuries in GGH, Guntur as seen from Column No.IV of Ex.A-2.  Post mortem was conducted on 15-01-08 at GGH, Guntur from 10.45 a.m. to 11.45 a.m.  The doctor who conducted post mortem did not preserve any material to be sent for Forensic Laboratory/tests.   Under those circumstances, the observation made in column XXIII of Ex.A-2 has no evidentiary value in our considered opinion.    The opposite party did not sought SSC certificate of the deceased in Exs.B-5 and B-6.   The opposite party cannot go on insisting documents one by one at its convenience either from the insured or his nominees.  

13.   If a person commits suicide by jumping from a running train or accidentally falls from a running train either death or grievous injuries will result as rightly contended by the complainant.   The parties to the policy are covered by terms and conditions enumerated in the policy.  One such condition prescribed under personal accident (insurance individual policy) is extracted below:

            ‘Upon the happening of any event which may give rise to claim under this policy written notice with full particulars must be given to the company immediately in case of death written notice also of the death must unless reasonable cause is shown be given before interment/cremation and in any case within one calendar month after the death and in the event of loss of sight or amputation of limbs written notice there must also be given within one calendar months after such loss of sight or amputation’.  

14.   The complainant did not mention the date when she gave written intimation to the opposite party regarding the death of her husband.   The complainant sought claim form on 18-03-08 and 22-05-08 (Ex.B-2 and B-3).  By that time the cremation was also over.  In view of           Exs.A-1 to A-3 the delay if any is there is not fatal in our considered opinion.   The opposite party seeking document one after another from the complainant and finally closing the claim in our considered opinion amounted to deficiency of service.   The opposite party is therefore in our considered opinion is liable to pay the insured amount together with bonus.  

15.   There were latches also on behalf of the complainant in not submitting the required documents in time till 29-06-10.   Under those circumstances, awarding interest from 01-01-11 will meet ends of justice.   We therefore answer this point in favour of the complainant.

16.  POINT No.3:-    As already observed the complainant is also guilty of committing certain latches.   Under those circumstances, we opine that the complainant is not entitled to any compensation.   We therefore answer this point against the complainant.

17.  POINT No.4:-  In view of above findings, in the result the complaint is partly allowed as indicted below:

1. The opposite party is directed to pay Rs.4,05,000/- (inclusive of bonus) together with interest @9% p.a., from 01-01-11 till the date of payment to the complainant.
2. The opposite party is directed to pay Rs.2,000/- towards costs to the complainant.
3. The opposite party is directed to deposit the amounts mentioned above within six weeks.

          Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 20^th day of July, 2012.

MEMBER                                             MEMBER                                         PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:

                                                                                                                        PRESIDENT