Penumala Gangadhar, S/o Gangulaiah,

38 years, Y.S. Rajareddynagar, Vempally,

Kadapa District. ….. Complainant.

Vs.



1. Sriram Life Insurance Co. Ltd., 3-6-478, Anand Estates,

3rd floor, Liberty Road, Himayat Nagar, Hyderabad – 500 029,

Rep. by its Manager.

2. Sri Ram Life Insurance Co. Ltd., Branch office,

Kadapa 7/107-3, Obulreddy Complex, jayanagar colony,

Kadapa Rep. by its Branch Manager, ….. Respondents.

O R D E R


2. The brief facts of the complaint is as follows:- The complainant was husband of Chitte Obulamma, who had one insurance policy bearing No. NP 080700070964 from O.P. No. 2. The complainant’s wife died on 24-8-2007 while taking treatment as inpatient in SVRR Govt. General Hospital, Tirupati due to snake bite. The death was accidental and the policy was in force at the time of death. In case of natural death the opposite parties should pay Rs. 1,00,000/- and in case of accidental death the opposite parties should pay Rs. 3,00,000/-. The complainant was husband and nominee of the deceased claimed Rs. 2,00,000/- towards accidental benefit by submitting all the relevant documents. The opposite party No. 1 on 23-5-2008 requested the complainant to send a joint photograph of the complainant and his wife. It was sent but there was no response. At last the present complaint was filed for Rs. 3,00,000/- towards accidental benefit together with interest from the date of complaint till the date of payment and Rs. 20,000/- towards mental agony and Rs. 1,000/- towards costs.



3. The O.P. No. 1 filed a counter that the cause of death was in dispute including the identity of the complainant, as nominee of the deceased policy holder. It could not be decided in summary proceedings. Chitte Obulamma took a policy for Rs. 1,00,000/- with rider benefits for a period of 20 years term along with half yearly premium and nominated her husband P. Gangadhar.

The policy was ‘Sri Raksha’ Policy bearing No. NP 080700070964 commenced from 28-3-2007. P. Gangadhar addressed a letter with abnormal delay stating that the policy holder died on 24-8-2007 at SVRR Govt. General Hospital, Tirupati during treatment of snake bite. On 17-12-2007 the complainant was supplied the claim forms but they were not sent immediately. On 19-1-2008 the O.P. No. 1 sent a reminder and later Gangadhar submitted the claim forms. The O.P. No. 1 conducted an investigation through Sri M.A. Sajid, Hyderabad, who submitted a report dt. 13-5-2008 that after the death of the policy holder her husband Gangadhar left the village and married again and living separately and his whereabouts were not known. Further the original nominee Gangadhar was not available and as per information the present claim was pressed into service by the family members of the deceased Obulamma through one of the relatives with the name of Gangadhar showing as nominee.

Therefore, the company suspected the identification of the nominee and hence, a letter dt. 23-5-2008 was sent to Gangadhar requesting to submit the particulars of the nominee and joint photo of himself and Obulamma. There was no response even to reminder dt. 11-6-2008. The opposite party sent another letter dt. 28-6-2008 stating that no claim would be considered in view of the lack of identification. In the month of July a joint photograph without any enclosures was received by the company. The photograph created suspicion that it was a morphed one. The company requested to send the particulars relating to nominee vide letter dt. 22-7-2008. There was no response. On 28-8-2008 the company sent another reminder. On 4-10-2008 the company sent another reminder letter. But there was no response to any of the reminders. Thus, it was treated “no claim” and same was intimated to Gangadhar vide letter dt. 15-12-2008. On 17-4-2009 the present complaint was filed by Gangadhar as fictitious person by impersonation.

A complaint was sent to the Superintendent of Police, Kadapa on 8-8-2009 regarding the identification and impersonation. There was no information received from the Superintendent of Police, Kadapa. Unless and until the identification would be settled the claim could not be decided and settled. In the intimation letter dt. 24-8-2007 sent by Gangadhar it was mentioned that Obulamma died while availing treatment at SVRR Govt. General Hospital, Tirupati due to snake bite. It showed that she had a snake bite on the early hours on 24-8-2007 and then she was admitted in SVRR Govt. General Hospital, Tirupati and on the same day she died. In the claim form-B under column No. 5 ( c ) it was mentioned as 3 days and she was suffering from the disease since 3 days before death. In Column No. 5 (e) in claim form – B the symptoms of illness was since 3 days prior to 24-8-2007. At the bottom of the claim form – B the month November was corrected and under the signature of Medical attendant the month 11 was corrected as 12. It could be seen to naked eye. The claim form –C disclosed that on 24-8-2007 at 6.00 p.m the dead body was buried. But she died around 11.00 a.m at Tirupati on 24-8-2007.



4. The investigators report revealed that Obulamma the mother of the deceased had informed on 22-8-2007 that her daughter had a snake bite and then she came back to home and attended her daily work. A person who had a snake bite could not attend daily work. She informed that on 23-8-2007 she had fever and on 24-8-2007 she became unconscious and so she was taken to Tirupati for treatment where she expired. The neighbors informed that she was in the hospital of Gangi Reddy, Pulivendula. The investigator came to know that the insured was brought to the hospital at Tirupati on 24-8-2007. She was not admitted in the hospital and she was declared dead at 11.00 a.m on the same day. The attendants of the deceased did not accept for post mortem over the dead body. Post mortem examination was not conducted. Snake bite could not be decided without post mortem examination. Therefore, the cause of death was not established and there was no proper proof. Thus the complaint may be dismissed with costs.



5. The O.P. No. 2 filed a counter denying that the wife of the complainant purchased a policy. She got the policy from O.P. No. 1 directly for which the O.p. no. 2 did a transit business between them. Either the complainant or the complainant’s wife had no direct access with O.P. No. 2. When it was purchased from O.P. No. 1 it was delivered to her to O.P. No. 2. The O.P. No. 2 was not a necessary party. The O.P. No. 2 was added for the reason that the branch office of O.P. No. 1 was at Kadapa. There was no service offered by the complainant after death of the policy holder from O.P. No. 2. They did not disclose whether the concerned papers were received by the O.P. No. 2. There was no relationship in between O.P. No. 2 and the complainant. The involvement of O.P. No. 2 in purchasing the policy by the complainant was not the concern of O.P. No. 2. Thus there was no deficiency of service and hence, the complaint may be dismissed with costs.



6. On the basis of the above pleadings the following points are settled for determination.

i. Whether there is any negligence and deficiency of service on the part of the Opposite parties?

ii. Whether the complainant is entitled to the relief as prayed for?

iii. To what relief?



7. On behalf of the complainant Ex. A1 to A8 were marked and on behalf of the respondents Ex. B1 to B18 were marked.



8. Point No. 1 & 2 The complainant filed a complaint as the husband of one Chitte Obulamma, who had ‘Sri Raksha’ (participating) policy bearing No. NP 080700070964 for Rs. 1,00,000/- commenced on 28-3-2007 from O.P. No. 2. The Xerox copy of policy was Ex. A1. Under Ex. A1 in case of natural death of the policy holder the O.P’s should pay Rs. 1,00,000/- to the nominee and Rs. 2,00,000/- in case of accidental death. Obulamma died on 24-8-2007 while taking treatment as inpatient in SVRR Govt. General Hospital, Tirupati due to snake bite. Ex. A8 was Xerox copy of death certificate of Obulamma.



9. After the death of Obulamma the complainant submitted claim application to O.P. No. 2 as he was her husband to claim the accidental benefit of Rs. 3,00,000/- from Opposite parties. The Xerox copy of claim forms-A, B and C were Ex. A2 to A4. The claim form-A under Ex. A2 was claimant statement i.e. the statement of the complainant and claim form – B, under Ex. A3 was medical attendant’s certificate issued by Dr. G. Kishore Babu, SVRR Govt. General Hospital, Tirupati, dt. 28-12-2007. The said doctor in Ex. A3 at first noted the month as November 2007 in words and corrected as December 2007 and similarly under the signature the same doctor noted the month as 12 by correcting from 11. In Ex. A3 the primary cause of death was snake bite and secondary cause was cellulites. The deceased was suffering from the diseases since 3 days.

She was admitted in the hospital at Tirupati on 24-8-2007 and death occurred on the same day due to snake bite and blebs with ulcer over right leg and loss of consciousness. Three days prior to the death of her disease would mean it was from 22-8-2007. If really the death occurred due to snake bite it would be on 22-8-2007. But the complaint and medical attendant’s certificate showed that she was suffering from the disease of snake bite and cellulites on 24-8-2007. So there was no scope of snake bite on 21-8-2007 i.e. 3 days prior to death. If really Obulamma had snake bite on 21-8-2007 i.e. 3 days prior to giving treatment on 24-8-2007, there was no scope of survival for three days with snake bite i.e. poison with cellulites. More over in Ex. A3 it was mentioned a Post Graduate surgeon also attended to her. But his name was not disclosed. Even though the case sheet was prepared but it was not filed. Ex. A4 was certificate of identity and burial or cremation at 6.00 p.m on 24-8-2007.



10. The O.P. No. 1 addressed a letter on 23-5-2008 to the complainant requesting to send a joint photo of himself and Obulamma for the sake of identity of nominee. The Xerox copy of letter was Ex. A5. Ex. A6, A7 were Xerox copies of prescription and medical certificate issued by Dr. G. Kishore Babu, Tirupati. In Ex. A6 he prescribed 1) I.V. fluids, 2) Decadran injection, 3) deriphylline injection and 4) 02 Inhalalion. It was mentioned in Ex. A6 that the deceased was suffering from snake bite since 3 days and blebs and ulcer over right leg since 2 days and loss of consciousness since one day. In view of Ex. A6 it was very clear that she had snake bite on 22-8-2007. As already discussed earlier, if really there was a snake bite 3 days prior to 24-8-2007 i.e. on 22-8-2007 there was no scope of survival for 3 days with snake bite till 24-8-2007 and died on 24-8-2007. Thus the death of Obulamma was not due to snake bite. It was not at all accidental death. The doctor issued the medical certificate under Ex. A7 without examining the patient properly.



11. The Opposite parties filed Ex. B1 a Xerox copy of death intimation given by the complainant. On 17-12-2007 the Opposite parties requested the complainant to submit claim forms-A, B & C and original policy and medical reports for treatment taken for snake bite from SVRR Govt. General Hospital, Tirupati.

The Xerox copy of the letter was Ex. B2. Ex. B3 was first reminder dt. 19-1-2008. Ex. B4 was a letter dt. 11-6-2008 requesting to submit joint photograph. Ex. B5 another letter dt. 28-6-2008 addressed by the Opposite parties that the complainant failed to submit the required evidence and hence, the claim could not be considered. Ex. B6 was postal acknowledgement. Ex. B7 was Xerox copy of another letter from the Opposite parties dt. 22-7-2008 to submit joint marriage photo, M.R.O certificate of marriage and marriage certificate. Ex. B8 was Xerox copy of certificate of posting to Ex. B7. Ex. B9 was Xerox copy of letter dt. 28-8-2008 requesting to submit joint photos, marriage certificates. Ex. B10 was Xerox copy of certificate of posting. Ex. B11 was another letter dt. 4-10-2008 requesting to submit the same marriage certificate and joint photo. Ex. B12 was Xerox copy of certificate of posting. Ex. B13 was Xerox copy of letter dt. 15-12-2008 that particulars of nominee have not been submitted. Therefore, the claim would not be considered. Ex. B14 was Xerox copy of certificate of posting. Ex. B15 was Xerox copy of joint photo.

On perusal with naked eye it appeared that the photo of the deceased was clubbed and joined to the photo of the complainant. It was not a joint photo but two photos were joined to make it as joint photo for purpose of claim. Ex. B16 was Xerox copy of complaint given by the Opposite parties to the Superintendent of Police, Kadapa on 8-8-2009 regarding dispute about nominee and the joint photograph appeared to be morphed one. Ex. B17 was a Xerox copy of postal acknowledgement. Ex. B18 was a Xerox copy of Investigators report dt. 13-5-2008. The investigator under Ex. B18 opined that actual person did not prefer claim but another person claimed as if he was the nominee and the death of the insured was not due to snake bite.

On seeing from any angle the claim was not a genuine claim and the complainant had not submitted the required documents sought for by the Opposite parties regarding his marriage and joint photos and the death was not due to snake bite. Thus it was not an accidental death and hence, the complainant is not entitled to any relief.

12. The complainant filed family members certificate dt. 8-10-2009 issued by Tahsildar, Vempalli which disclosed that Obulamma died on 24-8-2007 leaving behind her husband Penumala Gangadhar and son Penumala Ramanjaneyulu. The certificate could not serve any purpose to the complainant because the Opposite parties disputed the nominee of the deceased policy holder and also disputed that the complainant was not the nominee of the deceased and he was another person claimed, as if he was the husband of Obulamma by impersonation. Hence, the points are answered accordingly.



13. Point No. 3 In the result, the complaint is dismissed without costs.

Vikas Talwar aged 35 years s/o Sh. M.L. Talwar, r/o 29/77, Fatehgarh Road, Near Old Octroi Post, Hoshiarpur.
........ Complainant
versus
1.
Shriram General Insurance Co. Ltd., SCO-2 Iind Floor, Puda Complex, Ladowal Road, Near Dainik Bhaskar Office, Jalandhar, through its Sr. Divisional Manager.
2.

Sh. Sukhbir Singh r/o VPO: Hariana, Distt. Hoshiarpur, Authorized Agent of Shriram General Insurance Co. Ltd., at Hoshiarpur.

.......... Opposite Parties


Complaint u/S 12 of the Consumer Protection Act, 1986.


Quorum: Sh. P.D. Goel, President,

Sh. A.S. Jauhar, Member,

Mrs. Vandna Chowdhary, Member.


Present: Sh. Manu Kaushal, Counsel for the complainant.

Sh. D.K. Behl, Counsel for OP No. 1.

OP No. 2 already ex-parte.


PER P.D. GOEL, PRESIDENT:


1.

The complainant namely Vikas Talwar has filed the present complaint, under Section 12 of the Consumer Protection Act, 1986 (as amended upto date) “hereinafter referred as the Act”. Put briefly, the facts of the case are that the complainant purchased comprehensive insurance policy through OP No. 2, the authorized agent of OP No. 1 for his car bearing registration No. CH-03V-8842, valid from 26.2.2009 to 25.2.2010 and paid the premium of Rs. 10,172/-.
2.

It is the case of the complainant that the terms and conditions were neither supplied nor explained to him at the time of purchase of the policy or thereafter. That risk of third party was duly covered.
3.

It is further the case of the complainant that on 10.5.2009, the said car met with an accident at Chandigarh. That DDR No. 36 dated 10.5.2009 was also recorded at PS, Industrial Area, Chandigarh. One Harjinder Kumar received injuries in the accident who agreed to get treatment at the expense of the complainant. The complainant took said Harjinder Kumar to Chawla Nursing Home and got his treatment done. The amount of Rs. 15,000/- was spent on the treatment of Harjinder Kumar. That as per terms and conditions of the policy, the complainant was entitled to get reimbursement of the amount of Rs. 15,000/- and as such, filed the claim with OP No. 1 through OP No. 2 and also submitted all the bills for Rs. 15,000/- alongwith discharge certificate. The complainant gave several reminders and also visited personally the office of OP No. 1, but of no consequences. The complainant also served a legal notice dated 1.6.2009 upon the Ops, but no action has been taken, as such the delay in settlement of the claim amounts to deficiency in service, hence this complaint.
4.

The OP No. 1 filed the reply. The preliminary objections vis-a-vis maintainability, locus-standi, cause of action, concealment of facts, estoppel and jurisdiction were raised. On merits, the claim put forth by the complainant has been denied. It is replied that the claim of the complainant for the damage to the vehicle was settled to the sum of Rs. 14,025/- and the amount of Rs. 14,025/- has already been received by the complainant by way of full and final settlement of the claim, per terms and conditions of the insurance policy. However, it is admitted that the complainant got insured his car from the replying OP after payment of the premium of Rs. 10,172/- and thereafter, the insurance policy alongwith terms and conditions was sent to him. It is also admitted that the car of the complainant got damaged in the accident. The complainant is not entitled to any claim on account of the treatment of the injured namely Harjinder Kumar.
5.

The OP No. 2 was proceeded against ex-parte on 27.8.2009.
6.

In order to prove the case, the complainant tendered in evidence his affidavit – Ex. C-1, detail of expenses – Mark C-2, hospital slip – Mark C-3, copy of DDR – Mark C-4, copy of insurance policy – Mark C-5, copy of legal notice – Mark C-6 and closed the evidence.
7.

In rebuttal, the opposite party No. 1 tendered in evidence affidavit of Raj Kumar – Ex. OP-1, insurance policy – Ex. OP-2 (2 pages), claim form – Ex. OP-3 (2 pages), cheque of Rs. 14,029/- - Ex. OP-4, terms and conditions – Ex. OP-5, survey report – Ex. OP-6 (6 sheets) and closed the evidence.
8.

The learned counsel for the complainant and OP No. 1 filed written arguments. We have gone through the written submissions and record of the file minutely.
9.

The opposite party No. 1 had raised the defence that the claim of the complainant for damage to the vehicle was settled to the sum of Rs. 14,025/-. That the amount of Rs. 14,025/- has already been received by the complainant by way of full and final settlement of the claim. The insurance company has raised the plea that the complainant is not entitled to any claim on account of the treatment of the injured namely Harjinder Kumar, whereas the case of the complainant is that the risk of third party was duly covered. One Harjinder Kumar received injuries in the accident. The amount of Rs. 15,000/- was spent on the treatment of Harjinder Kumar. That as per terms and conditions of the policy, the complainant was entitled to get reimbursement of the amount of Rs. 15,000/-,but the insurance company has failed to settle the claim of Rs. 15,000/-.
10.

It is an admitted fact that the car bearing registration No. CH-03V-8842, was insured with opposite party No. 1. The said car met with an accident at Chandigarh and one Harjinder Kumar received injuries in the accident. It is also an admitted fact that the claim of the complainant for the damage to the vehicle was settled to the sum of Rs. 14,025/- and the complainant has already received the amount of Rs. 14,025/- by way of full and final settlement of the claim. The insurance company-OP No. 1 has specifically pleaded that the complainant is not entitled to any claim on account of the treatment of the injured namely Harjinder Kumar, as per law and also as per terms and conditions of the insurance policy.
11.

The Motor Vehicle Act, 1988 is a complete code in itself, which provides as who, how and in what manner compensation is payable by the insurer, resulting from accident.
12.

The complainant has claimed the amount of Rs. 15,000/-. The insurance policy is Mark C-5 – Ex. OP-2. The close scrutiny of the insurance policy makes it clear that there is no such clause which entitles the complainant to claim the amount, which he has incurred on the treatment of the injured. More-so, the complainant submitted the Claim Form – Ex. OP-3 duly signed by him and at page No. 3, Column No. 5, “TP claims Details”, the complainant has specifically stated that “No Third Party Claim will be availed”.
13.

Section 147 of the Motor Vehicle Act, 1988 limits the liability of the insurer and cover injury to any person under Section (1) (b)(i) and Section 166 of the Act provides as who can file the application for compensation. Section (1)(b) is clear which provides by the person who has sustained the injuries. The present complaint has not been filed by the third party – injured. Moreover, the third party can file the case regarding the injuries sustained in the accident before the MACT Tribunal and the Consumer Court has got no jurisdiction. Reliance placed on 2009 CTJ 878 (CP) (NCDRC), New India Assurance Company Ltd. Versus Bolem Rama Devi and others, wherein it has been held that “no court or any other tribunal including the consumer forums except the Motor Accidents Claims Tribunal has the jurisdiction to entertain a claim in respect of accidents involving the death of, or bodily injury to, persons arising out of the use of motor vehicles.
14.

As a result of the above discussion, it is held that neither the present complaint is maintainable nor the complainant has the locus-standi to file the present complaint, consequently the complaint is dismissed. No order as to costs. Copy of the order be sent to the parties free of cost. File be consigned to the record room.