BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT MANGALORE
Dated this the 9th August 2010
COMPLAINT NO.115/2010
(Admitted on 09.04.2010)
PRESENT: 1. Smt. Asha Shetty, President
2.Smt.Lavanya M. Rai, Member
BETWEEN:
Smt.Poornima,
Wo Praveen,
Aged about 40 years,
Mundappa Compound, Nangigudda,
III Cross Road, Jeppu Bappal,
Kankanady P.O., Mangalore 2. …….. COMPLAINANT
(Advocate for the Complainant: Sri K.Mahabala Shetty)
VERSUS
The United India Insurance Company Ltd.,
Represented by the Authorized signatory,
Bridge Road, Balmatta,
Mangalore 575 001. ……. OPPOSITE PARTIES
(Advocate for the Opposite Party: Sri K.Arun Kumar)
***************
ORDER DELIVERED BY PRESIDENT SMT. ASHA SHETTY:
1. The facts of the complaint in brief are as follows:
This complaint is filed under Section 12 of the Consumer Protection Act alleging deficiency in service against the Opposite Party claiming certain reliefs.
The Complainant submits that, her brother late M.K.Harischandra Kulal S/o. M.Koragappa had obtained an Insurance Policy bearing No.370803/47/98/51/00000166 with the Opposite Party for a sum of Rs.1,00,000/-. It is stated that, the aforesaid policy holder expired on 15.02.2009 at Fr. Muller’s Medical College Hospital, Mangalore who was a bachelor, survived by legal heir, sister, i.e., the Complainant. It is stated that, during his life time the insured had nominated the Complainant as his nominee.
It is submitted that, the Complainant approached the Opposite Party with a view to get the insured amount covered under the policy but the Opposite Party refused to pay the amount. Thereafter the Complainant issued a legal notice dated 16.12.2009 calling upon the Opposite Party to pay the same. Inspite of that, the Opposite Party not paid the same and hence the Complainant filed the above Complaint before this Forum under Section 12 of the Consumer Protection Act 1986 (herein after referred to as ‘the Act’) seeking direction from this Forum to the Opposite Party to pay a sum of Rs.1,00,000/- towards the insured amount stands in the name of late M.K. Harischandra Kulal under policy No.370803/47/98/51/00000/66 to the Complainant and also claimed compensation and cost of the proceedings.
2. Version notice served to the Opposite Party by RPAD. Opposite Party appeared through their counsel filed version admitted the policy but it is stated that, late M.K. Harischandra Kulal had died due to liver failure arising out of heavy drinking alcohol and the cause of death was natural and not due to any accident. The Opposite Party submits that, the Complainant not produced the original policy, medical certificate issued by the hospital where the deceased was admitted or treated, case history, cause of death, death certificate, post mortem report etc. which are the basis requirements to prove that the death was due to an accident. Since the death is not due to any accident, the Opposite Party is not liable to pay any compensation under the Individual Janatha Personal Accident Policy issued by them and contended that there is no deficiency and prayed for dismissal of the Complaint.
3. In view of the above said facts, the points now that arise for our consideration in this case are as under:
- Whether the Complainant proves that the Opposite Party has committed deficiency in service?
- If so, whether the Complainant is entitled for the reliefs claimed?
-
- What order?
4. In support of the complaint, Smt.Poornima (CW1) filed her affidavit reiterating what has been stated in the complaint and answered the interrogatories served on her. Ex.C1 to C7 were marked for the Complainant as listed in the annexure. One Sri.P.Venkataprasad (RW1), Administrative officer of Opposite Party filed counter affidavit and answered the interrogatories served on him. Ex.R1 to R7 were marked for the Opposite Party as listed in the annexure. Opposite Party produced written notes of arguments.
We have considered the notes/oral arguments submitted by the learned counsels and also considered the materials that was placed before the Hon'ble Forum and answer the points are as follows:
Point No.(i): Negative.
Point No.(ii) & (iii): As per the final order.
Reasons
5. Point No. (i) to (iii):
The facts which are not in dispute is that, the deceased M.K. Harischandra Kulal, S/o. M.Koragappa who was a resident of Mangalore had obtained an Individual Janatha Personal Accident Policy bearing No.370803/47/98/51/00000166 from the Opposite Party for a sum of Rs.1,00,000/-, the said policy is valid from 10.10.2008 to midnight of 09.10.2009 (as per Ex C2).
Now the point in dispute before this Forum is that, the Complainant expired on 15.02.2009 during the subsistence of the policy at Fr. Muller’s Medical College Hospital, who was a bachelor, survived by legal heir, sister, i.e., the Complainant in this case. It is stated by the Complainant that, after the death of the insured she has lodged a claim with the Opposite Party and the Opposite Party not honoured the claim, hence this Complaint.
The Opposite Party on the contrary admitted the policy but took a contention that, the cause of the death of M.K. Harischandra Kulal i.e., the insured was a natural death and it is not an accidental death and the same is not covered under the Individual Janatha Personal Accident Policy.
We have perused the entire evidence on record and also perused the policy produced before this Forum. The policy i.e., Ex C2 and R3 placed before this Forum clearly shows that, the policy one which issued by the Opposite Party in this case is an Individual Janatha Personal Accident Policy not the Mediclaim Policy. Admittedly, the case summary and the discharge record issued by the Fr. Muller’s Medical College Hospital Mangalore clearly reveals that, the insured died on 15.02.2009 due to ‘Sepsis d/t pneumonia chronic liver disease with portal hypertension in hepatic encephalopathy’.
The observation made in the policy is very clear that under the policy if the insured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means then the Company shall pay to the insured the sum of herein after set worth i.e., to say –
- If such injury shall within 12 calendar months of its occurrence be the sole and direct cause of death the insured the capital sum insured stated in the schedule. The amount payable under this clause shall be paid to the assignee shown in the schedule.
- If such injury shall within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of site of both eyes, or total and irrecoverable loss of use of two feet, or use of two hands or one hand and one foot, or one such loss of site of one eye and such loss of hand or of one foot the capital sum insured stated in the schedule herein.
- If such injury shall within 12 calendar months of is occurrence be the sole and direct cause of the total and irrecoverable loss of site of one eye, or total and irrecoverable loss of use of a hand or a foot, fifty percent (50%) of the capital sum insured stated in schedule herein.
- If such injury shall within 12 calendar months of its occurrence be the sole and direct cause of permanently totally and absolutely disabling the insured from engaging in being occupied with or giving attention to any employment or occupation of any description whatsoever the capital sum insured stated in the schedule.
It is a settled law that, the terms of the Insurance contract have to be strictly read and natural meaning given to them. No outside aid should be saw unless the meaning is ambiguous. In the instant case, admittedly the Complainant obtained Individual Janatha Personal Accident Policy not the Mediclaim Policy and the hospital records clearly reveals that he died due to chronic liver disease which is not covered under the policy in this case. The terms and conditions under the above policy is very clear that, the policy one which obtained by the insured is not a mediclaim policy, it is a policy covers personal accident as stated supra.
In view of the above discussion, we hold that there is no deficiency on the part of the Opposite Party Company hence the Complaint has no merits, deserves to be dismissed. No order as to costs.
6. In the result, we pass the following:
ORDER
The complaint is dismissed. No order as to costs.
The copy of this order as per the statutory requirements be forwarded to the parties free of charge and therefore the file be consigned to record.
(Page No.1 to 6 dictated to the Stenographer typed by her, revised and pronounced in the open court on this the 9th day of August 2010.)
PRESIDENT MEMBER
ANNEXURE
Witnesses examined on behalf of the Complainant:
CW1 – Smt.Poornima – Complainant.
Documents produced on behalf of the Complainant:
Ex C1 – 16.12.2009: Office copy of the Lawyer’s notice issued on behalf of the Complainant to the Opposite Party.
Ex C2 – 10.10.2008 to 9.10.2009 :Insurance Policy.
Ex C3 – :Intimation renewed of policy.
Ex C4 – 30.9.2008: Receipt issued by Opposite Party.
Ex C5 – 4.3.2009: Death Certificate relating to the death of
Mr.Harischandra.
Ex C6 – 10.10.2003 to 9.10.2004 : Policy issued to MR.Harischandra.
Ex C7 – 10.10.2004 to 9.10.2005 : Policy issued to MR.Harischandra.
Witnesses examined on behalf of the Opposite Party:
RW-1 : Sri.P.Venkataprasad, Administrative officer of Opposite Party.
Documents produced on behalf of the Opposite Party:
Ex R1 – 16.12.2009: Original letter received from Mr.K.Mahabala Shetty.
Ex R2 – 18.12.2009: Reply sent by the Opposite Party to the Advocates’s letter dated 16.12.2009:
Ex R3 – 10.10.2008 to 9.10.2009: Certified copy of the Individual Janatha Personal Accident Policy No.070803/ 47/08/51/00000166 issued by the Opposite Party.
Ex R4 –26.4.2010: Investigation Report of Mr.S.P.Hegde, Investigator of Insurance Claims regarding the death of the insured person.
Ex R5 – 12.2.2009: Admission/discharge record No.MR-10 and No.278182 of Fr.Muller’s Medical College Hospital, Kankanady, Mangalore; pertaining to M.K.Harishchandra Kulal.
Ex R6 – History and Physical examination certificate No.MR-14 (3 sheets) pertaining to the treatment of M.K.Harishchandra Kulal; Issue by Fr. Muller’s Medical college Hospital, Kankanady, Mangalore.
Ex R7 – Case summery and Discharge Record No.MR-84 pertaining to M.K.Harishchandra Kulal issued by Fr.Muller’s Medical College Hospital, Kankanady, Mangalore.
Dated:09.08.2010 PRESIDENT
