State Consumer Disputes Redressal Commission
Df vs Df on 28 March, 2012
BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE. DATED THIS THE 28th DAY OF MARCH 2012 PRESENT THE HONBLE MR.JUSTICE K.RAMANNA : PRESIDENT SMT.RAMA ANANTH : MEMBER Appeal No.1375/2004 Opposite Party before the DF .Appellant/s -Versus- Complainant before the DF .Respondent/s O R D E R
HONBLE JUSTICE MR.K. RAMANNA : PRESIDENT This appeal is filed under Section 15 of the C.P Act, 1986 by the Opposite Party to set aside the order dated 08.10.2011 passed by the DF, Belgaum in Complaint No.214/2000 whereby the complaint filed by the respondent/complainant came to be allowed directing this appellant/Opposite Party to pay a sum of Rs. 5,00,000/- the insured sum to the complainant with interest at 8% p.a from the date of repudiation of the claim i.e., 20.03.2000 till realization with litigation expenses of Rs. 3,000/-. Further directed to comply the order within two months from the date of the order. Assailing the same, the Opposite Party has come up with this appeal on various grounds.
2. The appellant also filed an application under Section 5 of the Limitation Act to condone the delay of 112 days caused in preferring this appeal supported by an affidavit of its Senior Divisional Manager, Sri. S.M.D. Rao explaining the delay caused.
3. After service of notice, the respondent appeared through counsel and filed objections to I.A. I and II that is to condone the delay and to stay the operation and execution of the impugned order under challenge. When the matter posted for hearing on I.A. I and II, though the advocate for respondent appeared but none represents on behalf of the appellant. Therefore, hearing of I.A. I and II was deferred and that is ordered to go along with main.
4. We have heard the arguments of the LC for the appellant and respondent and perused the records.
5. In view of the above said facts, the points that arise for our consideration are:
1. Whether the appellant has shown sufficient and reasonable grounds to condone the delay of 112 days in preferring this appeal?
2. Whether the DF is justified in allowing the complaint filed by the respondent?
3. If so, what order?
6. Point No.1:- The appellants officer has filed the affidavit explaining the reasons for the delay in preferring the appeal of about 112 days. The appellant has narrated some administrative difficulties in preferring the appeal in time. We have gone through the reasons assigned and satisfied and therefore the delay in filing the appeal is condoned by allowing I.A.No.I.
7. Point No. 2:- The case of the respondent/complainant is that, one Sri. Dutta Ram Ananth Shinde had obtained a janata personal accident insurance policy from the appellant/Opposite Party and the policy was in force in between 02.08.1998 to 01.09.2008 and the respondent/complainant is none other than the brother of the insured and he nominated him as a nominee. The sum assured was Rs. 5 lakhs. According to the respondent/complainant, his brother died as a result of the fall in front of his house on 14.03.1999 and as a result of the said fall he sustained cerebral hemorrhage and died in the hospital within one year from the date of taking policy. Therefore, he submitted claim form with documents to the appellant.
Claim form submitted by him is without FIR and PM report to prove the cause of death. But the appellant repudiated the claim on that ground only, therefore the respondent filed a complaint to direct the appellant/Opposite Party to pay sum assured with other accrued benefits from the policy.
8. Of course, the appellant herein who appeared through counsel and denied all the allegations and also the allegations of deficiency of service on its part. Of course the respondent/complainant has produced two affidavits dated 18.08.2002 and 22.07.2003 of Dr. Vijay Desai as well as of the witnesses dated 04.07.2003 of one Deepak and another Rama and also documents were produced and the interrogatories were answered. Initially the DF has allowed the complaint filed by the respondent by an order dated 23.08.2006 which has been challenged by the respondent before this Commission in Appeal No. 2187/2006 and after considering the grounds urged the appeal was allowed by setting aside the order passed by the DF and remanded the matter to dispose of the complaint afresh keeping in mind the observations made by this Commission. Of course, after remand one more affidavit evidence of the same Doctor dated 11.08.2008 has been filed by the respondent and Doctor answered the interrogatories of the appellant/Opposite Party and certain documents were got summoned by the respondent/complainant from the hospital. But the appellant herein has examined one Dharmendrarao, Divisional Manager by filing affidavit evidence. There is no dispute with regard to the janata personal accident policy issued in favour of Dattu Ram Ananth Shinde vide accident policy No. 4751/06408/181/98 for Rs. 5 lakhs for a period of 10 years commencing from 02.08.1998 to 01.09.2008 by paying premium of Rs. 1,250/- which has been admitted by the appellant. According to the respondent, on 14.03.1999 at about 8-10 PM, his brother late Dattaram Ananth Shindhe accidentally stumbled in front of the house and due to fall, sustained severe head injuries who was taken to Prabha Hospital run by Dr. Vijay Desai wherein he succumbed to the injuries within one and half hours of fall.
9. Of course, no complaint has been lodged with the police and the Post Mortem was also not conducted. According to the respondent, his family members were not aware of the policy taken by the deceased. They came to know only in the month of June-2009 and claim was made. Of course, the appellant herein who has taken a contention before the DF in its version that claim form along with necessary documents should be submitted to the appellant within one month time.
Moreover there is no FIR and the PM report. Of course, the learned counsel for the appellant vehemently argued that, in order to prove that the cause of death is only an accidental one and the material documents like FIR and the P.M report are very much required. If a policy was taken by a person without informing his family members or a nominee, if he dies suddenly in an accident, delay if any caused in submitting the claim form cannot be a ground to repudiate and denying the sum assured from the appellant. Of course, the respondent has produced affidavits of three persons.
The DF has rightly accepted and believed the affidavit evidence of three witnesses amongst them is one Doctor who treated the patient in his Prabha Hosptial but, the injuries were fatal in nature, this could not be survived. Two independent witnesses have also stated in their affidavit that the insured fall in front of the yard of the house and sustained severe injuries and died while undergoing treatment in the hospital. In some families if a person met with an unnatural or accidental death they will bury the dead body without lodging any complaint on the apprehension that the body will be subjected for P.M examination. Therefore, the evidence of Doctor who has treated the deceased immediately after the fall has opined that the injuries sustained by the deceased on account of fall are of severe in nature. So in this behalf the learned counsel for the respondent vehemently argued that the DF is right in allowing the complaint. The non lodging of FIR and non-conducting of the P.M report are not fatal to the case. Information to the company delayed as the complainant did not know about the policy is not a criteria to deny the rights of the nominee or the legal heirs of the insured. When once the appellant/insurance company accepts the issuance of the policy, if insured died on account of accident, it is bound to pay the sum assured. The learned counsel for the appellant rightly relied on a decision in Narendra Singh Bhasin Vs. National Insurance Company Ltd., reported in I (2005) CPJ 523 wherein it has been held that, Non lodging of FIR and not conducting post mortem not fatal for case of the complainant.
Information to the company delayed as complainant did not know about policy since the respondent who is a nominee under the policy was not knowing that his late brother had taken personal accident policy from the appellant and the nominee is not shown in that policy is not a ground to deny the legitimate rights of the nominee.
10. Therefore, in our opinion we dont see any good reasons to reverse the order that is to set aside the order under challenge. Accordingly, we pass the following:
O R D E R Appeal is dismissed confirming the order passed by the DF, Belgaum in Complaint No. 214/2000 dated 08.10.2011. No order as to costs.
The amount deposited by the appellant in this appeal shall be transferred to the District Forum to enable the District Forum to pay the same to the respective complainant after due notice to him.
PRESIDENT MEMBER Rhr*