State Consumer Disputes Redressal Commission
Duggireddy Naga Lakshumma, Kadapa vs Duggireddy Naga Lakshumma, Kadapa And ... on 11 October, 2012
BEFORE THE A BEFORE THE CIRCUIT BENCH OF A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT TIRUPATHI. FA.No.199/2011 against C.C.No.70/2010 District Consumer Forum, Kadapa YSR District. Between: Duggireddy Naga Lakshumma, W/o.late Duggireddy Venkata Reddy, Aged about 49 years, Hindu, Occ: Housewife, R/o.K.Sunkesula Village, Khajipeta Mandal, Kadapa Dist. Appellant/Complainant. And 1.The Dealer, Castrol India Ltd. Korrapadu Road, Opp.Rama Maharshi School, Door No.7/1401, Proddatur Town, Kadapa District. 2.The Oriental Insurance Co. Ltd. Vivekananda Cloth Market, Proddatur, rep. by its Branch Manager. 3.The Oriental Insurance Co. Ltd. Broker Divisional Office, 4th Floor, Oriental House, 7J Tata Road, Church Gate, Mumbai 400 020, Rep. by its Sr. Divisional Manager. Respondents/Opp. parties. Counsel for the Appellant : M/s. V.Gourisankara Rao. Counsel for the Respondents : Notice of R.1 served. M/s. P. Bhaskar Poluri (for R.2 and R.3). QUORUM: THE HONBLE JUSTICE SRI D.APPA RAO, PRESIDENT, AND SRI T. ASHOK KUMAR, HONBLE MEMBER.
THURSDAY, THE ELEVENTH DAY OF OCTOBER, TWO THOUSAND TWELVE.
Oral Order (Per Honble Justice Sri D.Appa Rao, President) *******
1. The appellant is an unsuccessful complainant.
The case of the complainant in brief is that her husband, Duggireddy Venkata Reddy was the owner of the Tractor bearing No.AP-04-U-4648 with trolley No.4647 and by virtue of the Scheme floated by O.P.No.1, a personal accident policy was issued for a sum of Rs.2,00,000/- covering the period from 31.03.2009 to 30.03.2010.
While so, on 10.09.2009 while he was carrying a cement pole it slipped and fell down into the canal and as a result of which he sustained head injury as it fell on his head and consequently fell unconsciousness. Immediately, he was taken to RIMS Hospital, Kadapa for treatment, and on the very same day he was taken to SVIMS, Tirupathi for better treatment and was discharged on 24.09.2009 and after he was brought to his house he died on 04.10.2009. When she submitted the claim along with death certificate, etc. followed by a legal notice, there was no reply from the Insurance Company.
Alleging deficiency in service, she filed the complaint claiming Rs.2,00,000/-, the amount covered under the policy, together with interest at 18% per annum, Rs.50,000/- towards compensation and Rs.1,000/- towards costs.
2. O.P.1, the Dealer of Castrol India Limited, and O.P.3, the Senior Divisional Manager of Oriental Insurance Company Limited did not choose to contest the matter, and therefore, they were set exparte.
3. O.P.2, the Branch Manager of Oriental Insurance Company Limited resisted the case. It alleged that the complainant had suppressed the fact that it had directed her to submit the claim form by duly filling it up along with police report, post mortem certificate, etc. Since she did not respond to it, a reminder was also issued on 27.07.2010 for which there was also no response. There was no discharge summary relating to the treatment taken at RIMS or SVIMS. No complaint was registered with the Police. There was no record to show that he had taken treatment. Since the complainant did not mention the particulars in the claim form, the claim is not maintainable. It prayed for dismissal of the complaint.
4. The complainant in proof of her case filed her affidavit evidence and got the documents marked as Exs.A.1 to A.14, while the Insurance Company filed Exs.B.1 and B.2.
5. The District Forum after considering the evidence placed on record opined that the name of the complainants husband was mentioned as D.Venkata Reddy, while the hospital record shows his name as D.S.Venkat Reddy. The complainant had suppressed receipt of Ex.B.1 and B.2, the letters sent by the Insurance Company requiring documents to be submitted, and therefore opined that there was no deficiency in service on the part of the Insurance Company and accordingly dismissed the complaint, however without costs.
6. Aggrieved by the said order, the complainant preferred the appeal contending that the District Forum did not appreciate either the facts or law in correct perspective. It ought to have seen that the very policy was issued in the name of D.Venkata Reddy, vide Ex.A.1 Personal Accident Insurance Certificate. The Accident Register, vide Ex.A.2, and O.P. cards, vide Exs.A.3 and A.4 disclose that the deceased was none else than the assured. In fact there is no proof that the Insurance Company had sent Ex.B.1 and B.2, and therefore, she prayed that the appeal be allowed.
7. The point for consideration is whether the order of the District Forum is vitiated by mis-appreciation of facts or law in this regard?
8. It is an undisputed fact that the Insurance Company, O.P.2 and 3 have issued Ex.A.1 policy under the name and style of Personal Accident Insurance Certificate in the name of D.Venkata Reddy, S/o.Venkata Reddy with the following address: K.Sunkesula (V), Kajipeta (M), Kadapa (Dist.), wherein the name of the complainant was shown as nominee.
The period of insurance was from 31/3/2009 to 30/03/2010. The complainant alleges that on 10.09.2009 her husband went to their agricultural fields, and while carrying a cement pole slipped from the ridge of a canal and fell down into the canal and sustained head injury when the cement pole fell on his head.
9. In order to prove the said fact, she filed Ex.A.2 Accident Register maintained by RIMS, Kadapa wherein it was mentioned fall of cement pole over head at 7.00 A.M. at Shankaraya Kotala at his fields on 10/9/09. It mentioned two injuries namely 1. A laceration of 10x5 cm over rt side of frontal region of skull, and
2. Contusion of rt eye of size 4x6 cm.
Ex.A.3 was an Out Patient Ticket maintained by the Government General Hospital. The complainant alleges that immediately he was taken to SVIMS at Tirupathi, where the very same injuries were made a mention. Ex.A.4, Out Patient Card maintained by SVIMS shows that he was admitted on 10/9/09 and the surgical operation was conducted on 10/9/09 and was discharged on 24/9/09. In the said card his name was mentioned as D.S.Venkat Reddy. Later D.S. was substituted with DUGGI REDDY. The complainant alleges that after his discharge he was taken to their house, where he succumbed to the injuries and died on 04.10.2009, vide EX.A.7 Death Certificate wherein the particulars of the assured were mentioned.
10. Immediately, she has issued a notice under Ex.A.8 for which the Insurance Company did not give any reply.
The fact that the deceased was assured is evident from the certificate issued by the Registration Authority marked as Ex.A.11. Since he died in the house and as there was no FIR she filed Ex.A.12 certificate issued by the Medical Superintendent, RIMS General Hospital, Kadapa wherein the hospital authorities have categorically mentioned that they have intimated to the police as emergency case. Since the Out Patient Card mentioned his name as D.S.Venkat Reddy a correction was made as D.Venkat Reddy. A certificate was issued to that effect by none else than the Medical Superintendent, vide Ex.A.12. The complainant has issued yet another notice, Ex.A.13 directing the Insurance Company to pay the claim amount. The said notice was served on the Insurance Company. The complainant filed Ex.A.14 cash refund receipt to show that her husband had taken treatment in SVIMS, at Tirupathi. It is not the case of the Insurance Company that they did not receive the notice sent by the complainant. What all it alleges was that it had sent two letters, namely Ex.B.1 and B.2 to the complainant to hasten up the process of the claim, but she did not submit the same.
The fact that the issuance of those two notices is not evidenced by any acknowledgement though it was mentioned as Regd A/D. Neither a receipt was filed, nor the acknowledgement was filed. Simply because the Insurance Company raises a plea that it had sent two notices requesting the complainant to submit relevant documents, it cannot be said that the plea raised by it is true unless there is documentary evidence to substantiate the said plea. The complainant could file all the relevant documents to prove that she had submitted her claim by way of registered notices which we have already adverted to. The Insurance Company not even replied to those notices. It did not dispute the receipt of the notices. An adverse inference is to be drawn against its version. Equally, the opinion of the District Forum that the name does not tally with the hospital record cannot be countenanced. In fact a close perusal of it indicates that the name of the deceased and the address particulars do tally with the particulars mentioned in Ex.A.1.
It is not the case of the Insurance Company that after receipt of the claim, it had appointed an investigator to find out whether the deceased was altogether a different person. She filed the Death Certificate, wherein all those particulars namely, name and address, date of death, etc were noted. The entries therein have been made in regular course of business. They had to be believed by invoking Provision under/Sec 114 (f) of the Evidence Act.
When the policy itself indicates that the coverage is for the death of the assured and the complainant having proved that the death was due to accident, undoubtedly she being a nominee under the policy she would be entitled to the claim amount. We do not agree with the opinion expressed by the District Forum in this regard. From a stray entry in medical record namely D.S.Venkat Reddy instead of D.Venkat Reddy, the case of the complainant cannot be thrown out when the entire record consistently shows that the deceased was none other than the insured. The Insurance Company having issued Ex.A.1 policy covering the risk of the life of the deceased, the Insurance Company is liable to pay the amount to the complainant, she being a nominee under the policy.
11. In the result, the appeal is allowed and the order of the District Forum is set aside.
Consequently, the complaint is allowed.
The Insurance Company is directed to pay Rs.2,00,000/-, the amount covered under the policy, to the complainant together with interest at 9% per annum from the date of complaint i.e. 19.06.2010 till the date of payment together with costs of Rs.5,000/-. Time for compliance one month.
________________________ PRESIDENT ________________________ MEMBER 11/10/2012.
Vvr.