This C.C. is coming on before us for final hearing in the presence of           Sri. Gollapudi Rama Rao, Advocate for complainant; and of Sri. G. Sita Rama Rao, Advocate for opposite party No. 1; and of Sri. Malladi Vasudev, Advocate for opposite party No. 2; upon perusing the material papers on record and upon hearing and having stood over for consideration, this Forum passed the following order;

O R D E R

(Per Sri R.Kiran Kumar, Member)

          This complaint is filed u/s.12-A of Consumer Protection Act, 1986. 

2.       The averments made in the complaint are that the husband of the complainant Lala Pradeep Kumar, is the policy holder by virtue of Abhaya Gold Account in Andhra Bank, Main Road, Yellandu Branch, he had taken an account Abhaya Gold savings vide account No.055310100071421, and the name of the complainant was mentioned as nominee.  The complainant submitted that her husband died on 20-09-2012 due to injuries sustained in a road accident, the accident was registered as crime No.21/2012 on 31-01-2012 of P.S. Yellandu.  The complainant also submitted that originally the crime was registered under section 337 of IPC and the injuries are grievous in nature to the inner organs of the deceased.  The complainant further submitted that immediately after death of her husband the complainant approached the opposite party No.2 and submitted relevant papers seeking payment of amount of Rs.1,00,000/- which is assured amount to the Abhaya Gold savings account holders on their death, even after the approach the opposite party no.2 failed to pay the amount and stated that they sent claim papers to the insurer i.e. opposite party No.1 and as soon as the amount deposited by the opposite party No.1 they will pay the amount to the complainant.  The complainant further submitted that the opposite party No.1 erroneously, without any valid and tenable grounds refused the claim of the complainant and the opposite party No.2 advised the complainant to approach the Forum.  Hence the complainant filed this complaint.

3.       On behalf of the complainant, the following documents were filed and marked as Exhibits A1 to A6:-

Ex.A1:-Photocopy of letter addressed to the opposite party No.2 by the opposite party No.1 by denying the claim of the complainant.

Ex.A2:-Photocopy of Bank pass book of the deceased.

Ex.A3:-Photocopy of FIR in Crime No.21/2012, dt. 31-01-2012 along with charge sheet.

Ex.A4:-Photocopy of Letter given to P.S. Yellandu to order the section of law.

Ex.A5:-Photocopy of Death Certificate of deceased issued by Municipal Authority, Yellandu.

Ex.A6:-Photocopy of Discharge Summary of the deceased Lala Pradeep Kumar.

4.       On receipt of notices, the opposite parties appeared through their counsel and filed counter.   In the counter opposite party No. 1 submitted that the insurance policy between the insurer and the insured represents a contract between the parties, since the insurer undertakes to compensate the laws suffered by the insured on account of risk covered by the insurance policy, the terms of agreement have to be strict construed to determine the extent of the liability of the insurer.  The opposite party No.1 also submitted that the insurance is a contract Act of indemnity and it has to be viewed as a normal contract as per the Indian contract, any violation of the contract by the parties to the contract of insurance, the contract become void and in such an event the insurance company would not be liable to answer the claim of the other party.  The opposite party no.1 also submitted that they have not rendered any deficiency of service by declining the claim of the complainant and the complainant is not entitled for any of the claim as prayed.  The opposite party No.1 also submitted that as per the version of the complainant, she has not submitted her claim with the opposite party No.1, she is not entitled for damages, as such she cannot claim deficiency of service against opposite party No.1, this complaint is not maintainable and prayed to dismiss the complaint.

          The opposite party No.2 in their counter submitted that they are not admitting the narration made in para No.3 of the complaint relating to the death of husband of the complainant as alleged by the complainant, evidently there is no deficiency of service on the part of opposite party No.2, they sent all the relevant papers furnished by the complainant to the opposite party No.1, who is bound to pay the amount in respect of Abhaya Gold Savings account as such the complainant has no cause of action to file this complaint against the opposite party No.2, the opposite party No.2 denied the damages as prayed by the complainant, there is no deficiency of service on their part and prayed to dismiss the complaint against them.

5.       On behalf of the opposite party No.1 the following documents filed and marked as exhibits B1 to B3.

Ex.B1:- Policy copy was bearing No.050400/47/11/61/00000003, dt.31-10-2011.

Ex.B2:- Photocopy of the Memorandum of understanding between opposite party No.1 and 2.

Ex.B3:-  Investigation Report.

6.       Written Arguments of complainant and Opposite party No.1 filed.

7.       Heard oral arguments from both sides.

8.       Upon perusing the material paper on record, upon hearing the arguments, the points that arose for consideration are,

i) Whether the complainant is entitled for claim?

ii) To What Relief?

Point:- i)               In this case the husband of the complainant had taken Abhaya Savings account no.055310100071421 with opposite party No.2 branch, and the complainant being the wife, her name was mentioned as nominee.  The husband of the complainant met with a road accident, and the same was registered as crime no.21/2012 on 31-01-2012 of P.s. Yellandu and he died on 20-09-2012 due to injuries.  After death of her husband, the complainant submitted relevant papers to the opposite party no.2 for seeking payment of Rs.1,00,000/- which is assured amount to the Abhaya Gold Savings account holders.  According to the complainant, the opposite party No.2 stated that they sent the claim papers to their insurer i.e. opposite party No.1 and after deposited the amount by the opposite party No.1 they will pay the amount and thereafter, opposite party No.2 handed over a letter said to have been received by opposite party No.1.  in the above letter the opposite party No.1 erroneously without valid and tenable grounds refused the claim of the complainant as such the complainant approached the Forum.

          From the documents and material available on record, we observed that the husband of the complainant is the account holder of Abhaya Gold savings account with opposite party No.2 branch and the same was admitted by the opposite parties.  According to the opposite party No.1 as per the terms and conditions of the policy the complainant must produce the following documents such as bank certificate, FIR, Post Mortem Report, Inquest Report, Final Report of the charge sheet, Death Certificate in original and the above said documents are not submitted by the complainant and on their investigation report the accident occurred on 28-01-2012 and the insured died on 20-09-2012 and also Post Mortem Examination was not conducted and also the same was not informed to the police.  According to the opposite party No.1 as per the insurance act, the conditions of the policy must be complied by the complainant. 

From the documents submitted by the complainant and as per (Exhibit A3) the charge sheet, Leela Pradeep Pasi sustained injuries over his head, he was shifted to government hospital, Yellandu for treatment, subsequently he was referred to khammam and Hyderabad for better treatment and he is still unconscious at the time of filing of charge sheet.  And also we observed that the as per Exhibit A4, dt. 22-09-2012, the brother of the deceased had given death intimation to the S.H.O. Yellandu and requested to alter the section of 337 IPC to 304A of IPC.  To support her case the complainant filed Photocopy of Discharge summary wherein the doctors observed that the patient found to have severe head injury (DAI with left base frontal contusion and ACF Fracture).  After explaining the risk, benefit and outcome of the patient condition to the attendees, he underwent left frontal de-compressive craniotomy with ACF carpeting on 29-01-2012. The patient underwent tracheotomy for prolonged ventilation and patient being discharged to get admitted for local hospital for further management. 

And also we observed that in the investigation report Exhibit B3 done by the Investigator of opposite party No.1 company, he observed in his findings that the police orally confirmed the death of the deceased due to road accident and from the accident the deceased continuously under Coma till death, insured family members not conducted PME of dead body of the deceased hence the police charge sheet was not filed under section 304A of IPC, already the police filed charge sheet under section 337 & 338 of IPC basing on wound certificates.  And also observed that the village people, neighbour’s confirmed the road accident and death of the insured is due to road accident only, and he observed the accident spot and confirmed that it is purely accidental death and there is no foul play suspected and he collected the written statements from them.  From the above findings of the investigator we are of the opinion that it is a clear case that the husband of the complainant died due to the accident dt. 28-01-2012. When the death is due to the accident, we are on the opinion that the opposite party No.1 insurance acting in unreasonable manner to avoid payment of bonafide claim.  In Puspha giri Vs. New India Assurance company Ltd., III (2013) CPJ 14B (CN) (MP) wherein the Hon’ble State Commission observed that CT Scan report shows the insured suffered from head injury, hemorrhagic contusions were present in frontal region.  Insured fell from cycle and hit his head resulting in contusion which ultimately leads to death.  Accidental death established and the absence of FIR and Post Mortem Report cannot be fatal to this claim and insurance company acting in unreasonable manner to avoid payment of bonafide claim and compensation awarded.

In the aforesaid circumstances, on the basis of the record submitted by the complainant, we consider that as the opposite party no.1 failed to pay the amount to the complainant, it amounts to deficiency of service on the part of opposite party No.1 therefore the complainant is entitled for the claim against opposite party No.1.  As such this point is answered accordingly in favour of the complainant. From the record we also observed that the opposite party No.2 submitted the claim to opposite party no.1, we cannot attribute any deficiency on the part of Op.No.2, therefore, the complaint is liable to dismissed against the opposite party no.2

Point No:-ii)

In the result the complainant is allowed in part directing the opposite parties No.1 to pay Accident Insurance Cover of Rs.1,00,000/- with interest @ 9% per annum from the date of complaint (i.e. from 04-06-2013) to till the date of actual payment and also directed to pay an amount of Rs.3,000/- towards costs of the litigation.  The complaint against opposite party No.2 is dismissed.

          Typed to dictation, corrected and pronounced by us in the open forum, on this the 27^th day of March, 2015.

  Member                  FAC President             

District Consumer Forum, Khammam

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                     For Opposite party:-   

            -None-                                                                    -None-

DOCUMENTS MARKED:-

For Complainant:-                                                     For Opposite party:-   

  Member                  FAC President             

District Consumer Forum, Khammam