Sri.D.Krishnappa,<br /> President<br /> <br /> 1. The Complainants have come up with this complaint under section 12 of the Consumer Protection Act, 1986 claiming that one K.P.Manoharan husband of complainant no.1 and father of complainants no.2 and 3 had taken a Janatha Personal Accident Insurance Policy from the Opposite party for a sum assured at Rs.1,00,000/-. That K.P.Manoharan met with a road accident on 27.05.2004 at Mangalore and succumbed to the injuries on 16.07.2004 leaving behind them as his sole heirs. Thereafter, they made a claim to the Opposite party by submitting all the original papers to settle the insurance claim, but the Opposite party refused to settle it. Then they caused a legal notice on 30.06.2005 and therefore have prayed for directing the Opposite party to pay the policy amount, compensation of Rs.50,000/- with interest and cost as prayed.<br /> 2. The Opposite party has filed version denying it’s knowledge about the relationship of the complainants with the insured and contended that the complainants have not furnished the office code of the said policy and other particulars, therefore it is not in a position to settle the claim. Further denying it’s liability has contended that in case of allowing the complaint, rate of interest should not exceed 6% p.a. under terms and conditions of the policy.<br /> 3. During the enquiry, 1st complainant has filed her affidavit evidence reiterating the complaint averments and produced copies of certain correspondences and the insurance policy. On behalf of the Opposite party, the Administrative Officer has filed his affidavit evidence narrating the same contention raised in the version.<br /> 4. Heard the counsel for both the parties and perused the records.<br /> 5. On the above contentions, following points determination arise:-<br /> 1. Whether the Complainants prove that there is deficiency in the service of the Opposite party in not settling the insurance claim of the deceased K.P.Manoharan?<br /> 2. To what relief the complainants are entitled?<br /> 6. Our findings are as under:-<br /> Point no.1 : In the negative.<br /> Point no.2 : See the final order.<br /> <br /> REASONS<br /> <br /> 7. Point no. 1:- On perusal of the contentions of both the parties and letters that were exchanged between the parties, it emerges that the complainants who claimed as the surviving heirs of the insured K.P.Manoharan on his death due to a road accident, though made a claim with the Opposite party, they did not furnish the required particulars including the Agency code and the policy details to enable the Opposite party to take necessary action in the matter. It appears that on 16.09.2005, the complainants got issued a legal notice to the Opposite party besides having got issued another legal notice on 30.06.2005. Even thereafter it is found from the copy of the letter relied upon by the Opposite party dated 07.07.2005, the Opposite party requested the 1st Complainant to furnish the policy details and the office, where the claim lodged to enable them to take suitable action. Thereafter, it is not brought to our notice any reply given to that letter or in having furnished the details to the Opposite party. It is only on 16.09.2005, the counsel for the Complainant found to have furnished certain details to the Opposite party for considering their claim. Thereafter, the Opposite party appears to have not made any other endeavor to settle the claim of the complainants nor sought any further details from the complainants, as such the claim of the Complainants appears to had been left at rest. <br /> 8. The learned counsel representing the Opposite party during the course of enquiry of this Complaint submitted that the complainants had not furnished any documents regarding cause of death of the deceased. Therefore, in the absence of it, the Opposite party could not settle the claim. At this stage, during the enquiry of this Complaint, the complainants filed a copy of the FIR and medical certificates of two hospitals namely Citi Hospital Research Diagnostic Centre, Mangalore and B.M.Hospital, Mysore. On perusal of the copy of the FIR, it is evident that Sri.K.P.Manoharan met with a road traffic accident on 27.05.2004 and a criminal case came to be registered for the offences punishable under section 279 and 377 of IPC. Further, hospital records reveal that the injured / insured was admitted as an inpatient to Citi Hospital Research Diagnostic Centre, Mangalore on the same day that is on 27.05.2004 for multiple injuries he suffered in the accident. He was under treatment till 02.07.2004 and appears to had been discharged with advice for attending review after 6 weeks, but the hospital records of Basappa Memorial Hospital reveal that injured with further complication was admitted to that hospital at Mysore on 15.07.2004 and he expired on 16.07.2004 at 5.20 p.m. and the death is shown as due to acute, SDH with multiple occipital contusion and resulted in DARDIO respiratory arrest. In this documents produced and relied upon by the complainants are not denied by the Opposite party. Therefore, on perusal of the copy of the FIR and hospital records make it manifest that the insured K.P.Manoharan met with a road accident on 27.05.2004 and he succumbed to injuries on 16.07.2004 and there is nexus between the accident and a death of the insured. Therefore, there cannot be any doubt to hold that insured died due to injuries he suffered in a road traffic accident and that clearly falls in the inclusive clauses of the Janatha Personal Accident Insurance Policy issued by the Opposite party and therefore, the Opposite party is liable to pay the insured amount to the complainants who claimed to be the heirs of the deceased insured. <br /> 9. The complainants have not denied that they had not produced the death certificate to the Opposite party till they produced it before this Forum to enable the Opposite party to examine the claim of the complainants to settle the claim under the terms and conditions of the policy. Therefore, when there is lapse on the part of the complainants in not furnishing the required documents, they cannot complain of any deficiency on the part of the Opposite party. However, the required materials are now produced before this Forum and the complainants have proved their entitlement for the insured amount with other benefits, but not to other components of the compensation they have claimed in the Complaint. With these, we answer point no.1 in the negative and answer point no.2 as under and pass the following order:- <br /> ORDER<br /> <br /> 1. The Complaint is allowed in part.<br /> 2. The Opposite party is directed to pay the amount of Rs.1 lakh insured in the name of K.P.Manoharan under Janatha Personal Accident Insurance Policy with other statutory benefits to the complainants within 3 months from the date of receipt of this order, failing which they shall pay interest at 10% p.a. after the expiry of 3 months till the date of payment.<br /> 3. Each party to bear their own costs.<br /> 4. Give a copy of this order to each party according to Rules.<br />