BEFORE THE DISTRICT CONSUMER FORUM : WARANGAL
Present: Sri D.Chiranjeevi Babu
President.
Sri N.J.Mohan Rao,
Member.
AND
Smt. V.J. Praveena,
Member.
Thursday the 26th June, 2008
CONSUMER COMPLAINT No. 63/2007
Between:
Kodam Sarojana,
W/o.Late Satyanarayana,
Age: 38 yrs., Occu.: Housewife,
C/o.Swapna Photo Studio,
Main Road, Mulugu,
Warangal District.
… Complainant
A N D
United India Insurance Co.,Ltd.,
Represented by its Branch Manager,
15-1-315, Vishnu Priya Complex,
Rangampet,
Warangal District.
… Opposite Party
Counsel for the Complainant :: Sri. K.Rajeshwar, Advocate.
Counsel for the Opposite Party :: Sri. M.Sharath Kumar, Advocate
:: ORDER ::
Sri D.Chiranjeevi Babu President
This is a complaint filed by the complainant i.e.Kodam Sarojana against the opposite party under section 12 of Consumer Protection Act, 1986 for a direction to (a) Pay the claim amount of Rs.1,00,000/- to the complainant, (b) pay interest @ 24% p.a. from 15-01-2006 till full realisation of the claim amount, (c) Pay Rs.1,00,000/- towards compensation and damages, (d) Award of Rs.2,000/- towards costs and (e) such other relief or relives.
The brief averments contained in the complaint filed by the complainant are as follows:
The case of the complainant is that the complainant’s husband Late Satyanarayana on 15-12-2005 at about 11.60 a.m. has gone to purchase medicines at Pallavi Medical Stores, Mulugu and while returning back he has accidentally slipped from the steps of the said Medical Stores and sustained grievous injury to his head and died while shifting to Hospital. On information the complainant gave petition and the Police Mulugu have booked a case with Crime No.176/2005. The Police have conducted Panchanama and the complainant’s husband dead body was sent for post-mortem at Community Health Centre, Mulugu, where after conducting post-mortem on the deceased Satyanarayana a report was issued i.e. P.M.E., after investigation made a final report. In this case the complainant further stated that the complainant is the nominee and beneficiary of the Insurance Claim from opposite party and on his accidental death of deceased Satyanarayana the Janata Personal Accident Policy and the opposite party issue has to benefit of the claim of Rs.1,00,000/- in future. The complainant’s husband Late Satyanarayana taken policy No.050601/47/05/00662 for the period 22-09-2005 to 21-09-2007. After the death of the said Satyanarayana, the complainant who is nominee and legal heir of Policy had informed husband of complainant i.e. late Satyanarayana to opposite party for claiming insurance coverage as per the policy issued by opposite party. The complainant has submitted claim form, medical certificate and all relevant papers to the opposite party, but the opposite party without any basis and proper reasoning have bluntly repudiated the claim and informed through their letter 050601/47/JPA/271/2007, dt.:19-01-2007. Thereafter the complainant filed this case before this Forum directing the opposite party to pay an amount of Rs.1,00,000/- etc., as prayed in her complaint.
Opposite Party filed the Written Version contending in brief as follows:
The opposite party filed his Written Version stating that the Investigator appointed by the Insurance i.e. who has conducted detailed enquiry by observing the scene and also examined the complainant, K.Saraiah, Gumastha in Pallavi Medicals & Generals, S.Narasimha Rao, Proprietor of Medical Stores and after Dr.Raghu recorded the statement the above declarance which have been filed and as per the Doctor Statement the death is due to “Massive Myocardial Infarction” (Heart-Attack) leading to unconsciousness to death and subsequent fall on Road or from the steps. Thus it is stated that the death is natural as such no claim is maintainable and the repudiated the claim of the complainant as there is no deficiency of service and requested to this Forum to dismiss the case.
The complainant in support of her claim filed her Affidavit in the form of chief examination and marked Exs.A-01 to A-07. On behalf of opposite party filed his Affidavit in the form of chief examination and marked Exs.B-1 to B-6.
Now the point for consideration whether the complainant is entitled to get an amount of Rs.1,00,000/- from the opposite party with interest @ 24% per annum and also he entitled to pay an amount of Rs.1,00,000/- towards compensation and damages and Rs.200/- towards costs.
05. After arguments of the both side counsels our reasons are like this. In this case this Forum has to see whether the death of the deceased is natural or not, for this our answer is that the deceased death is accidental one. Because as per the Post Mortem Certificate i.e. Ex.A-2 in page No.5 its clearly goes to show that the cause of death of the deceased is due to Injury to the Vital Organ – Brain – Death – Due to Head Injury, so this is covered under the policy, the death is unnatural one and it is comes under accident. But the death of the deceased was not committed with his own hands and it is accidentally done, when the death is accidental the insurance is liable to pay the policy amount to the complainant, because the death of the deceased is only due to Head Injury. When the death of the deceased is due to head injury and not natural and insurance is liable to pay the policy amount. The Ex.B-1 to Ex.B-6 they are only the statements those statements do not help to the case of the insurance i.e. opposite party side. In final report i.e. Ex.A-3 in it, it is clearly mentioned that the death of the deceased was only due to head injury. The death of the deceased is on 15-12-2005 and the case is not barred by limitation, when the case is not barred by limitation, accidental death was covered under the policy conditions, certainly the complainant is entitled to get the amount from the opposite party under Janata Personal Accident Policy i.e. an amount of Rs.1,00,000/- under the Policy No.050601/47/05/00662 for the period 22-09-2005 to 21-09-2007 and the date of death the deceased i.e. Satyanarayana is 15-12-2005 the insurance is in force when the insurance is in force, certainly the complainant is entitled to get back her policy amount by the opposite party. When the Post Mortem Certificate i.e. Ex.A-2 clearly goes to show that the death of the deceased is due to Head Injury when it is an unnatural one, we have no hesitation to believe that the death of the deceased is only accidental death and it is covered under the policy conditions. Mere repudiation of the opposite party is like no water in the lake, certainly the opposite party is liable to pay the premium amount of the deceased to the complainant. So certainly the complainant is entitled for the policy amount when there is no point for opposite party to reject or repudiated the claim of the complainant.
For the foregoing reasons given by us, we come to the conclusion that the death is unnatural covered under the policy conditions and also the case is filed within time i.e. in period of 2 (two) years. The complainant is entitled to get her policy amount from the opposite party. Hence we answered this point accordingly in favour of the complainant against the opposite party.
POINT No.2 WHAT RELIEF:- The main point is decided in favour of the complainant against the opposite party, this point is also decided in favour of the complainant against the opposite party.
In the result, this complaint is allowed and we direct the opposite party to pay an amount of Rs.1,00,000/- (Rupees One Lakh Only) to the complainant with interest @ 7.5% from the date of filing of this complaint (i.e.14-08-2007) till the date of realisation of the policy amount and we award an amount of Rs.500/- (Rupees Five Hundred Only) towards costs and we are not granting any amount towards compensation and damages.
A month’s time is granted to the opposite party to compliance of the order).
(Dictated to the Stenographer transcribed by him corrected and pronounced by us in the open Forum today i.e. 26th June, 2008).
Sd/- Sd/- Sd/-
Member Member President,
District Consumer Forum, Warangal.
APPENDIX OF EVIDNECE
WITNESSES EXAMINED
ON BEHALF OF O.P.
1. Affidavit in Chief Examination of PW-1 Affidavit in Chief Examination of RW-1
2. Affidavit in Chief Examination of PW-2
3. Affidavit in Chief Examination of PW-3
EXHIBITS MARKED
ON BEHALFOF COMPLAINANT
- Ex.A-1 is the Xerox copy of First Information Report, dated 15-12-05.
- Ex.A-2 is the Xerox copy of Report of Post Mortem Examination, dated 15-12-2005.
- Ex.A-3 is the Final Report in Cr.No.176/05 U/Sec.174 Cr.P.C. of P.S.Mulugu,
- Ex.A-4 is the Xerox copy of Certificate of Death.
- Ex.A-5 is the Repudiation of J.P.A.Claim of Late Sri K.Satyanarayana Policy No.0506014705000662.
- Ex.A-6 is the Xerox copy of proposer name sent by the United India insurance Company Limited.
- Ex.A-7 is the Xerox copy of Telugu Vaartha Paper Publication.
ON BEHALF OF Opposite partY
- Ex.B-1 is the Xerox copy of Death investigation Report, Date of Death 15-12-2005.
- Ex.B-2 is the Original Statement of Smt.Kodam Sarojana recorded by Investigator i.e. G.Ramchander, dated 26-12-2006.
- Ex.B-3 is the Original Statement of Sri Korra Saraiah recorded by Investigator i.e. G.Ramchander, dated 05-01-2007.
- Ex.B-4 is the original Statement of Sri Sukhavasi Narsimha Rao recorded by Investigator i.e. G.Ramchander, dated 26-12-2006.
- Ex.B-5 is the Original Statement of Dr.P.Raghu recorded by Investigator i.e. G.Ramchander, dated 28-12-2006.
- Ex.B-6 is the Showing the plan.
Sd/-
PRESIDENT.
