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Golden Multi Services Club 
Submit Complaint..
Polamarasetty Ramana, S/o Ramana, Hindu, aged 55 years, R/o Gavarla Anakapalle Village, Munagapaka Mandal, Visakhapatnam District.
… Complainant
1. M/s Golden Multi Services Club Limited, rep. by its authorised signatory, having its office at S.B. Mansion, 16, R.N. Mukherjee Road, Kolkata – 700 001.
2. M/s National Insurance Co. Ltd., rep. by its Divisional Manager, Seethampeta Road, Dwarakanagar, Visakhapatnam.
... Opposite Parties
: O R D E R :
1. The complainant is the father of Polamarasetty Kumari, who took Group Personal Accident Insurance Policy from the opposite parties valid from 18-08-2004 to 07-08-2005. The insured policy amount was Rs.4,00,000/- . On 07-09-2004, it is claimed that the said Polamarasetty Kumari, while getting down accidentally fallen from train at Tuni Railway Station and received severe injuries and shifted to Railway Hospital, Tuni and from there to King George Hospital, Visakhapatnam.
Further she was taken back to home on the advise of the doctors, where she succumbed to the injuries on 13-11-2004. As the death was not informed to the police no case was registered and consequently no postmortem was conducted. Due to the lack of knowledge, the complainant could not inform the death of his daughter to the opposite party as policy was misplaced.
After tracing of the policy the 1st opposite party was informed and at their request a claim was submitted on 30-11-2006 to the 2nd opposite party . The claim was not settled by the opposite parties. Hence this complaint alleging deficiency in service against the opposite parties 1 and 2 and pleading direction to make payment of policy amount of Rs.4,00,000/- with interest @ 24% from 30-11-2006 from the date of submission of claim and Rs.25,000/- towards damages for mental agony and another Rs.25,000/- for committing breach of agreement.
2. 2nd opposite party the insurer filed a counter admitting the issue of policy. It is pleaded that there is no evidence placed by the complainant to show the nature of injury sustained in that alleged accident, no postmortem was conducted even though the death was said to be due to accident. If the death was due to Railway Accident the claim should have been made before Railway Claims Tribunal, but the complainant is silent on that aspect. So in these circumstances it is doubtful whether the complainant received injury in that accident and she died due to the same injuries.
The death was in the month of November 2004, while the claim made on 30-11-2006. Moreover in and around Anakapalli area, the people who obtained Group Personal Accident Insurance Policy are dying naturally and making claim as an accidental death after long period. There are number of claims on similar grounds and the investigation is pending by CBI. In these circumstances there is no deficiency of service on the part of the opposite party and the complaint is liable to be dismissed.
3. The 1st opposite party took a plea that it is only a facilitator in obtaining policy for the deceased from 2nd opposite party and hence cannot be mulcted with any liability.
4. At the time of enquiry the complainant filed his affidavit and marked Ex.A.1 to Ex.A.9. The opposite parties filed documents, marked as Ex.B.1 to Ex.B.5. Both the counsels were heard, who naturally reiterated their respective contentions. In the light of the pleas taken and the contentions raised the point that would arise for determination is:
Whether there is any deficiency in service on the part of the opposite parties and complainant is entitled for the reliefs claimed against them?
5. The complainant’s daughter, Polamarasetty Kumari, aged 23 years was issued Group Personal Accident Insurance Policy, by 2nd opposite party through 1st opposite party, covering period from 08-08-2004 to 07-08-2005 for an amount of Rs.4,00,000/- is not in dispute. It is the case of the complainant that his daughter Polamarasetty Kumari, while getting down from the train at Tuni in the early hour of 07-09-2004 accidentally fallen from the train and received injuries.
Further pleads that she was taken to Tuni Hospital at first instance and there to King George Hospital, Visakhapatnam, and on the advise of the Doctors he took away her to the house and ultimately she died on 13-11-2004, due to the above said injuries sustained in the accident. This claim of accident and the consequential death is disputed by the opposite parties. Unless it is shown to be an accidental death the opposite parties cannot be fastened with any liability. So how far the evidence on record would establish this claim of the complainant is to be seen.
6. The victim was evidently taken to Railway Hospital at Tuni, as can be seen from Ex.A.2. Where first aid appears to have been given. Ex.A.2 would show notes of the Doctor that the patient alleged to have fallen from 472 passenger train and brought to Tuni by Pushkaram Special. Doctors did not find external injuries except mild swelling at Nap of Neck on left side and movement of left arm mildly painful. He also noted that there was pain around interior service of scapula. As per the complainant’s version she was taken to King George Hospital, Visakhapatnam. Ex.A.3 is the OP chit of the same date, which bears endorsement by the Doctor that there was head injury with bleeding.
It does not further show anything. Ex.A.9 case sheet shows that admission into hospital was made on 27-10-2004 for treatment of head injury as an the old MLC. Evidently, the victim after getting checked up in King George Hospital on 07-09-2004, she was taken back home and only when symptoms of illness appeared, later one month thereafter, she was again brought back to King George Hospital.
As a matter of fact, there is a discrepancy in the injuries noted soon after the incident in Ex.A.2 which does not show any head injury, but subsequent treatment in King George Hospital was for head injury. Even if the head injury was taken as suffered in another incident, but not at the time when fall from train accident occurred in the month of September 2004, still in our view the incident would be covered in the policy as consequential death of the victim was due to the head injury, inspite of taking treatment in King George Hospital.
So whether this injury sustained at the time of accident at Railway station or later at home, it is quite evident that the victim that the daughter of the complainant died of injuries but not a natural one. Such being the case, under the policy the complainant being nominee would be entitled for the policy amount. In between the opposite parties, 1st opposite party counsel has rightly contended that he is only a facilitator in obtaining the policy from 2nd opposite party and hence cannot be mulcted with any liability.
7. Inspite of proper claim has been made, the 2nd opposite party did not choose to either settle the claim or repudiate the same and in our view it amounts to deficiency in service on the part of the 2nd opposite party. Hence 2nd opposite party besides liability to pay the policy amount of Rs.4,00,000/- to the complainant, would also liable to pay compensation of Rs.20,000/- for failure to settle the claim without any justifiable grounds resulting in mental agony. The complainant would naturally be entitled for interest @9% p.a., from 15th December 2006 till the date of payment.
8. In the result, the complaint is allowed, directing the 2nd opposite party to pay Rs.4,00,000/- (Rupees four lakhs only), being the policy amount with interest @ 9% p.a., from 15th December 2006 till realization and make another payment of Rs.20,000/- (Rupees twenty thousand only) towards compensation to the complainant and costs of Rs.5,000/-. Claim against 1st opposite party is dismissed but without costs. Advocate fee Rs.2,000/-.
