BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM ::
KADAPA Y.S.R DISTRICT
PRESENT SRI V.C. GUNNAIAH, B.Com., M.L., PRESIDENT
SMT. K. SIREESHA, LADY MEMBER
SRI M.V.R. SHARMA, MEMBER
Tuesday, 22nd September 2015
CONSUMER COMPLAINT No. 01 / 2015
Yankatapuram Tuppada Jayalakshmi, age 43 years,
W/o Late Y.T. Hanumanthu, Hindu, aged 43 years,
Widow, R/at D.No. 2/658, Postal colony,
Adoni Post – 518 301, Kurnool District, Andhra Pradesh. ….. Complainant.
Vs.
1. The Chief Manager, Andhra Pragathi Grameena Bank,
Head Office, P.B. No. 65, Near Krishna Hall,
Beside Bollineni Diagnosis Center, Kadapa.
2. The Senior Divisional Manager,
United India Insurance Co. Ltd., Divisional Office,
D.No. 2/194 (2), Ground, Opp. Officers Club,
Laxmi Ranga Road, Kadapa city. ….. Respondents
This complaint coming on this day for final hearing on 14-9-2015 in the presence of Sri K. Vijaya Krishna, Advocate for complainant and Sri A. Raja Reddy, Advocate for R1 and Sri K. Rama Kondaiah, Advocate for R2 and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Smt. K. Sireesha, Member),
1. Complaint filed under section 12 of the C.P. Act 1986.
2. The brief facts of the complaint are as follows:- It is humbly submitted that the husband of the complainant namely Y.T. Hanumanthu, was working as Scale – 1 officer in A.P.G.B. Adoni Branch, Kurnool District vide E.No. 1378.
3. It is further submitted that the R1 and R2 have decided to introduce a scheme to provide insurance coverage to the individual persons opened Savings Bank Accounts individually / severally / jointly with R1 bank through “Group personal Accident Policy”. Accordingly the R1 and R2 have entered into an agreement on 30-3-2009 according to the terms and conditions of the agreement, the period of master policy is one year from the date of issuance of the policy renewed for the same period subject to premium change. The sum insured under the master policy is Rs. 1,00,000/- in respect of each S.B. Account holder of the bank and in case of multiple accounts, the coverage would be restricted to a maximum of Rs. 2,50,000/- per individual. The risk coverage is in the event of the death due to the accident, the insurance company is liable to pay the sum assured to the nominee of the deceased. In case of injury due to the accident, risk would be covered if death occurs within 6 months from the date of accident provided sole and direct cause of death is related to the accident.
4. The 2nd respondent company has issued Group Personal Accident Policy to R1 vide policy bearing No. 050900/42/11/05/00000001 covering the period in respect of S.B. Account holders of R1 by receiving a total premium amount. The deceased Y.T Hanumanthu is holder of multiple accounts in APGB vide (1) S.B. Account No. 19110528458 at Hebattam branch, (2) 19155064763 at Adoni branch and (3) 19099525843 at Tennakal Branch and included in the said group personal accident policy. The complainant being wife of the deceas3ed is nominated as beneficiary of the said policy. The said policy was being renewed from time to time and its relevant tenure is from 01-4-2011 to 31-3-2012.
5. It is further submitted that on 3-10-2011 at 6 a.m the said Y.T Hanumanthu, accidentally fallen in his house from the cot so also in bathroom of his house as a result he fell on the water pot, which is in the bathroom whereby he sustained internal brain injury due to the result of the said accidental fall. Consequently, the nerves relating to his eyes were damaged. On the same day, he was taken to Sri Sai Krishna Eye Hospital where Dr. O.M. Krishna Murthy, M.S. DO gave Medical treatment. Despite the medical treatment, the impact of the said head injury is such that as to badly affecting the vision of his two eyes. Resultantly, by 16-10-2011, the said Y.T Hanumanthu became totally blind having lost his both eyes vision which was occasioned due to the internal brain injury following the accidental fallen only. As the health condition of the said Y.T Hanumanthu was critical, he was taken to A.P. government area Hospital, Adoni, on 16-10-2011 and admitted there as inpatient. From there he was referred to Kurnool General Hospital for better management. However, he was taken to Head and Brain Center, Kurnool and admitted there at 2.20 midnight vide admission No. 1458/2011. Unfortunately, while undergoing treatment, he breathed his last at 4.00 a.m the total loss of blindness and consequent death of the deceased Y.T Hanumanthu is a corollary of his accidental fallen only. As the fallen of the deceased Y.T Hanumanthu is an accidental one which resulted into losing his both eyes vision, no FIR was registered no inquest and no postmortem was conducted. However, the complainant gave a compliant to the Adoni III town P.S. by narrating the incident happened to her husband by registered post on 31-10-2011 but the same was returned as unserved.
6. It is further submitted that the complainant being wife and nominee of the said policy became entitled to the Sum Insured amount of Rs. 2,50,000/-from the R2 consequent upon the demise of her husband during the currency of the policy.
7. Accordingly the complainant claimed personal accident insurance benefit from R2 through the R1q by giving intimation on 24-10-2011. The complainant also furnished all necessary documents which she had to the respondents. However, after completion of more than one year and two months the utter surprise and shock to the complainant the R2 addressed a letter dt. 24-12-2012 repudiating the claim of complainant without any valid and just cause but on paltry reasons that the complainant has failed to produce certain vital documents viz., FIR, P.M. Report etc., and that the claim of the complainant cannot be entertained and thus the claim was repudiated and files are closed.
8. Again the complainant sent a letter dt. 12-1-2013 seeking for reviewing her claim for which in reply thereto the R2 addressed a letter dt. 30-12-2013 saying that the husband of the complainant died due to “HTN, CAD T ALCHOLIC” which is not covered under the policy conditions which finding is totally arbitrary, unfounded and baseless and without any supportive material. The complainant again sent a letter dt. 9-2-2013 which met the same fate of repudiation in reiteration of its earlier decision by R2 vide letter dt. 14-2-2013. In the meanwhile, the complainant personally visited the claims Review Committee of the R2 situated in Chennai on 4-2-2013 and gave a representation to look into her claim and pay the policy amount. The complainant persuaded the C.R.C. Chennai on many occasions over phone for which the concerned authority used to prolong the matter saying that the decision is not yet taken and that the decision would be intimated soon. At last a reply dt. 19-2-2013 came from the UNI Customer care Department of the R2 saying that the claim of the complainant cannot be considered as the death of the member insured is due to consumption of alcohol which is an exclusion under the policy. The said letter dt. 19-2-2013 does not contain the signature of the concerned authority and the same was not written in the concerned postal ledger of the company.
9. It is further humbly submitted that the R2 had not evaluated the claim of the complainant in its proper perspective. As per the terms of the policy, in case of injury due to accident, risk would be covered if death occurs within six months from the date of accident provided sole and direct cause of death is related to the accident. The case of the complainant exactly falls into this category i.e. death consequent upon internal brain injury due to accidental fallen in the house. Admittedly, the deceased Y.T Hanumanthu was hale and healthy and he had no any disease like sugar glaucoma etc., It is significant to note at this juncture that Dr. O.M. Krishna Murthy, M.S.D.O., who had firstly treated the deceased had categorically certified under certificate dt. 16-10-2011 that the deceased came to him on 3-10-2011 for painless loss of vision of both eyes and he gave the history of accidental fall from the cot facing to floor and again in the bathroom sustained head injury facing back and he referred the patient to Kurnool Heart and Brain Center for consultation of Dr. Narsasaram on 16-10-2011 Civil Assistant Surgeon, Area Hospital, Adoni, had also given a certificate certifying that the deceased Y.T Hanumanthu came to area Hospital at 10.00 p.m on 16-10-2011 when he was on duty with history of sudden fall in the bathroom and he was complained of unable to see. One Sri Y. Anand, LIC agent Adoni, had given a statement declaring that the deceased Y.T Hanumanthu was hale and healthy but died of accidentally and consequently while undergoing treatment and that the complainant being wife of the deceased is entitled for benefits under the policy. Thus, all these facts clinchingly show that the deceased Y.T Hanumanthu had sustained loss of vision of both eyes by accidentally falling in his house due to the injury over his head and so the complainant being nominee is entitled to get benefits of the policy. However, the fact retains is that the R2 has not at all honoured its part of the contract in considering the claim of the complainant and arbitrarily repudiated the claim of the complainant without any just cause on paltry reasons, which is neither tenable nor justified either in law or on facts of the case. Hence, the acts of the R2 in repudiating the claim of the complainant would clearly amount to deficiency of service for which the complainant had to suffer mentally physically and financially. Hence, the complainant is constrained to file this complaint.
10. It is therefore, prayed that the Hon’ble Forum may be pleased to (a) direct the respondents jointly and severally to pay an amount of Rs. 2,50,000/- being the claim amount covered under the subject matter policy with interest @ 18% p.a. from the date of making the claim i.e. 24-10-2011 until realization, (b) direct the respondents to pay an amount of Rs. 50,000/- towards deficiency of service in not honouring the claim of the complainant, (c) direct the respondents to pay an amount of Rs. 50,000/- towards mental agony caused to the complainant on account of their deficiency of service (d) direct the respondents to pay an amount of Rs. 10,000/- towards costs of this complaint incurred by the complainant and (e) Grant such other reliefs or reliefs as the Hon’ble forum deems fit and proper in the circumstances of the case in the interest of justice.
11. Counter filed by respondent No. 1 that the complaint is not maintainable either in law or on facts of the case. The complainant put to strict proof of all the facts except that are specifically admitted by this respondent bank.
12. It is submitted that the R1 bank is a Regional Rural Bank constituted under the Regional Rural Banks Act 1976. The RRBs Act 1976 is an act of Parliament enacted to provide for the incorporation, regulating and winding up of Regional Rural Banks with a view to developing the rural economy by providing for the purpose of development of Agriculture, trade, commerce, industry and other productive activities in the rural areas, credit and other facilities particularly to the small and marginal farmers, agricultural labourers, artisans and small entrepreneurs and for matters connected there with and incidental thereto. The share capital of the RRB i.e respondent Bank is being shared by Central Government, Sponsor Bank and state Government in the ratio of 50:35:15 respectively. It is respectfully submitted that, in exercise of powers conferred by sub section (1)of section 23 A of the Regional Rural Banks Act 1976 (21 of 1976) the Central Government of by Notification dt. 01-6-2006 have amalgamated Rayalaseema Grameena Bank, Sree Anantha Grameena Bank and Pinakini Grameena Bank sponsored by Syndicate bank in the state of Andhra Pradesh in to a single Regional Rural Bank called Andhra Pragathi Grameena Bank and the said bank came into existence from the date of notification i.e. 01-6-2006
13. With reference to para – 1 it is respectfully submitted that the husband of the complainant late Mr. Y.T.Hanumanthu initially appointed as Junior Clerk cum Cashier on 5-12-1988 in the erstwhgile Rayalaseema Grameena Bank and he was promoted to the cadre of officer scale – I w.e.f 6-9-2011 and worked at different branches and lastly worked as APFSCS Ltd., Harivanam Society from 26-7-2011 to till his date of death i.e. 17-10-2011.
14. With reference to para – 2 & 3, it is respectfully submitted that the R1 bank had introduced as scheme called “personal Accident Insurance Scheme to the Savings Bank Account Holders of the Bank” to offer several add on facilities to the existing as well as new savings bank account holders of the respondent bank and taken master policy from the united India insurance Co. Ltd., Divisional office, Kadapa and the said scheme is came into existence w.e.f 01-4-2009 since then renewing the said master policy by paying premium annually and renewing in every year. The said master policy covers all individual savings bank account holders who attained the age of 10 years and have not completed the age of 70 years, provided a balance of Rs. 22/- over and above the requisite minimum balance is available in the savings bank account against the accidental death.
15. The Important features of the personal accidental insurance scheme to cover the savings bank account holders of the bank are given below.
- All individual savings bank account hodlers who attained the age of 10 years and have not completed the age of 70 years are eligible to be covered under the policy, provided a balance of Rs. 22/- (as on renewal date of 1-4-2011) over and above the requisite minimum balance is available in the account. All staff members, ex-staff members are also covered.
- The premium chargeable is @ Rs. 22/- per account holder per annum for a sum insurance of Rs. 1,00,000/-
- The risk covered is death due to accident only.
- Multiple accounts of an account holder will be covered p to a maximum sum of Rs. 2,50,000/- under the proposed policy.
- In respect of joint accounts, insurance cover would be available to joint account holders in proportion to the sum assured depending up on the number of account holders.
- Risk coverage:- The insurance cover is available only on the death of the SB Account holder / depositor due to accident. The risk covers death due to accident in road, rail, air, fire bomb blast, house collapse, electrification, earthquake biting of insects etc., in the event of death due to accident United India Insurance Co. Ltd., will pay a sum of Rs. 1,00,000/- to the nominee of the deceased. In case of injury due to accidental cause, the risk would be covered, if death happens within six months from the date of accident, provided sole and direct cause of death is related to the accident. However, normal death due to sickness or any other normal cause will not be covered. Death due to commitment of suicide is not covered under the scheme.
It is correct to say that the R1 bank and the R2 had entered an agreement on 30-3-2009 on above scheme. The premium will change from renewal date initially it was Rs. 10/- and it is enhanced to Rs. 22/- from the renewal date 01-4-2011. Late Mr. Y.T. Hanumanth was the holder of S.B. Accounts 1) Sb A/c No. 19110528458 at Hebatam Branch, 2) BS A/c No. 19155064763 at Adoni Branch and 3) SB A/c No. 19099525843 at Ternekal Branch. The respondent bank had renewed the Group Personal Accident policy bearing No. 050900/42/11/05/00000001 covering the period from 01-4-2011 to 31-3-2012 by paying premium of Rs. 1,39,37,182/-.
16. With reference to para – 4 & 5 respectfully submitted that the husband of the complainant Late Y.T. Hanumanth, Ex.Managing Director of APFSCS Ltd., deceased on 17-10-2011. The complainant had sent a claim form in the last week of December 2011 to R1 through the Manager, Hebbatam Branch, Kurnool district requesting the settle the insurance amount under personal Accident insurance master policy and the Head Office of the respondent bank had forwarded the said claim form along with all required documents to the R2 i.e. the Senior Divisional Manager, M/s United India Insurance Co. Ltd., Divisional Office, Kadapa on 9-01-2012. The claim form and the documents like death certificate, family members certificate of Hospital treatment and medical attendance certificate and Notarized affidavit received from the complainant were forwarded to the Senior Divisional Manager, M/s United India Insurance Co. Ltd., Divisional Office, Kadapa through our letter dt. 9-01-2012. Then the United India Insurance Co. Ltd., Divisional Office, Kadapa vide letter dt. 01-11-2012 had advised to submit the following documents.
a. FIR duly attested by concerned police authorities.
b. Inquest report duly attested by concerned policy authorities.
c. Post mortem report duly attested by concerned police authorities
d. Final report / charge sheet duly attested by concerned policy authorities.
e. Ration card / Voter card.
d. Paper publication etc.,
Immediately after receipt of R1 letter dt. 01-11-2012, the R1 vide his letter No. 1191/STF/1378/PAIS/2012, dt. 01-11-2012 advised the complainant to submit the said documents to forward the same to United India Insurance Co.Ltd., the complainant had forwarded only ration card. Again the R1 remained the complainant vide his letter ref No. 1191/STF/1378/PAIS/2012, dt. 01-11-2012, but the complainant had not submitted said document.
17. With reference para – 6 & 7 it is respectfully submitted that the United India Insurance Co. Ltd., Divisional Office, Kadapa vide the letter ref No. 050900/SB Claims/2012 file SB122/2012, dt. 24-12-2012 had informed the complainant that she had not complied with required procedure nor she is in position to do so at this juncture. Further the United India Insurance Co. Ltd., had informed that in the absence of vital documents required the claim under Personal Accident policy cannot be entertained and finally informed that the claim of the complainant was repudiated and the files are closed under copies to the R1 bank and Hebbatam branch of the respondent bank. Again United India Insurance Co. Ltd., the R2 vide its letter ref No. 050900/SB Claims/2012 file SB122/2012, dt. 24-12-2012 had informed to the complainant that the complainant’s husband was died due to “HTN, CAD T AlCHOLIC which is not covered under policy conditions” and further informed that her husband died due to consumption of ALCHOHOL and the same is not covered under SB A/c holders Personal Accident claim and also under Group P.a. Staff. Moreover it is also informed in said letter that the essential documents are also not submitted. Hence, the complainant’s claim is not entertained and claim files are closed by the R2. Again on the representation dt. 9-2-2013 of the complainant the R2 once again informed vide letter ref No. 050900/SB claims/2012 file SB122/2013 dt. 14-2-2013 that he has examined the matter in its totality and found that there is no change in the decision of “repudiation” communicated to the complainant vide letter dt. 31-01-2013.
18. It is respectfully submitted that it is under stood from the copy of the letter 19-2-2013 of United India Insurance Co. Ltd., Head Office, Chennai that the complaint under reference No. DG0009942012, dt. 6-2-2013 of the complainant was registered and the United India Insurance Co. Ltd., Head office, Chennai had informed in the said letter that after through deliberations the members of grievance committee had opined that the complainant claims cannot be considered as the death of the member insured is due to consumption of alcohol which is an exclusion under the personal accident policy.
19. With reference to para – 8 it is respectfully submitted that there is no negligence on the part of the R1 bank attracting the element of deficiency in service in not settling the insurance amount claimed by the complainant under Personal Accident Insurance Policy as it has to be considered and settled by the United India Insurance Co. Ltd., Kadapa the R1 acted timely at every stage and communicated the requirem4ents required by the insurance company to the complainant to facilitate the complainant to comply the requirement to settle the claim. It is respectfully submitted that the only duty of the R1 is only to forward the claim received from the insured members / legal heirs of insured members. The R1 bank is no way concerned to pay the insurance amount and interest on it, as it is the responsibility of the R2 United India Insurance Co. Ltd., as it is accepted the premium and insured the members covered under the policy.
20. It is submitted that there is no deficiency in service on the part of R1 bank hence, the R1 need not pay any amounts towards deficiency service, ,mental agony, costs etc., it is therefore, prayed that the Hon’ble forum may be pleased to dismiss the complaint in the interest of justice.
21. Counter field by R2 that the complaint is not maintainable either in law or on facts of the case. Except the allegations which are admitted herein to be true and correct, rest of the allegations are denied by this respondent as false and incorrect.
22. According to the complainant her husband Y.T. Hanumanth was working at APGB, Adoni Branch. The deceased Y.T. Hanumanth, obtained a S.B. Account holder personal accident policy from this respondent through R1. Accordingly, this respondent company issued a personal accident policy to the S.B. Account holder who are employers under the R1. As per the terms of the policy, whoever, covered under the policy, whenever they met with an accident, with that effect bodily injured with that effect if he died or personally disabled, they will be covered under the policy. According to the complainant, it is alleged that her husband who is covered under the policy who is employee of R1, on 3-10-2011 at about 6.00 a.m he was fell on the floor from the cot and also fell in bathroom at his house as a result he lost his eye sight and he died due to the impact of the accidental fallen from the cot and in bathroom.
23. It is submitted that this respondent insurance co. repudiated the claim made by the petitioner stating that the complainant has not produced any documentary which are necessary to comply the claim those are FIR inquest, P.M. Certificate, charge sheet or final report in support of her version, that her husband was died due to the impact of the accidental fallen from the cot and it the bathroom and also this respondent company repudiated the claim stating that the said Y.T. Hanumanth, who is employee of R1 died due to HTN, CAD T alcoholic which is not covered under the policy conditions. It is further submitted that the petitioner repeatedly approached the respondent company and also made a representation to the customer grievance cell, Chennai of the main branch. The customer grievance cell of this respondent company clearly informed to the complainant that the company could not accept her claim due to the above circumstances only.
24. It is further submitted that the petitioner approached the insurance Ombudsman for settlement of another claim under the group personal accident policy bearing No. 050900/42/11/03/0000003 which was obtained by the deceased Y.T Hanumanth, as employee of R1, and submitted her version for settlement of that claim. The ombudsman passed an order against the complainant by observing the plea taken by this respondent company. But the petitioner purposefully suppressed the said fact and she filed a petition before the Hon’ble forum stating the same facts. The said petition also numbered as C.C. No. 5/2014 and the same is pending before this Hon’ble forum.
25. It is further submitted that according to the complainant, her husband Y.T. Hanumanthu was hale and healthy prior to the accidental fall from the cot and fell in bath room on 3-10-2011. But on that day according to her he fell from the cot and in bath room, he was shifted to the hospital on 16-10-2011. It is submitted that after the alleged accidental fall of Y.T. Hanumanthu, he went to the hospital for treatment after 13 days. So if he lost his eyesight and he died due to the impact of fallen from the cot or in bathroom, he might have received some external injuries on his head. But there is no iota of evidence regarding to that injuries or if he taken any treatment in that period of 13 days. So, it is crystal clearly establishes that he has not received any injuries which may leads to loss of eyesight or death of the insured. The Ombudsman also observed this aspect.
26. It is further submitted that the document filed by the complainant that she went to the Sai Krishna Eye hospital, Adoni, the doctor, who issued the certificate, he also clearly mentioned that the Y.T. Hanumanthu came to the hospital with painless loss of vision of both eyes. But even the said doctor has not notified any injuries sustained by the Y.T. Hanumanthu, he issued a certificate stating that his visible acquit was only CF 1 mt and fundus was normal. The doctor suspected cortical blindness and he referred him to the Kurnool Heart and Brain Center. So according to the doctor of Y.M. Krishna Murthy, there is no whisper that the Y.T. Hanumanthu lost his eyes due to any injuries. According to the complainant, she shifted her husband to the Govt. Area Hospital, Adoni on 16-10-2011 from there he was shifted to Kurnool Brain and Heart center, on 17-10-2011, where he died on 17-10-2011 while undergoing treatment. Immediately his dead body was buried.
27. After 13 days demise of her husband she sent a report to the police station by registered post and the same was returned on 31-10-2011 with endorsement of unserved. It is unbelievable version of the petitioner because she might have resided with a distance of 1 ½ k.m from the police station. If she wants to give a complaint to the police, she might have gone to the Police station and give a complaint and she do not need to send a complaint by registered post. So this aspect shows that the complainant willfully acted like this. If any complaints or registered postal covers went to the police station if the addressee is correct, it will never returned as unserved. So this aspect clearly shows the falsehoodnes of the petitioner.
28. It is submitted that the out post card issued by the A.P.V. Vidhana Parishat Area Hospital, Adoni wherein the deceased Y.T. Hanumanthu admitted on 16-10-2011, it is clearly mentioned that the loss of vision and past history was recorded therein as hypertension, CAD with chronic alcoholism. It is submitted that his above fact is supported by the affidavit given by the petitioner stating that her husband had in the habit of taking alcohol. So the loss of the eyesight of Y.T. Hanumanth and subsequent death of his is due to chronic alcohol attitude only but not any accidental result.
29 It is further submitted that the policy issued by the insurer, there is a specific exemption is that the insurance company shall not be liable to pay any amount if the disability or death of the life assured shall one be caused a) by intentional self-injury, b) suicide or attempt to suicide, c) whilst under the influence of intoxicating liquor or drugs and d) while engaging in aviation. So the policy crystal clearly stated that the coverage of the risk under the policy and exemption. According to the outpatient card issued by the A.PO. Area Hospital, Adoni and the affidavit given by the petitioner, it is clearly shows that the deceased Y.T. Hanumanthu might have lost his eye sight and his breath due to alcoholic influence but not accidental. So this respondent company is not liable to pay any compensation to the petitioner. This aspect clearly explained to the petitioner but even then she filed a complaint before the Hon’ble forum with false allegations.
30. It is further submitted that whenever any claim has to be decided, the proper documents must be produced by the claimant to the insurance company. According to the policy issued by this respondent the risk covered only when the life assure shall sustain any bodily injury resulting solely and directly from the accident caused by external violent and visible means and such injury shall within the 360 days of its occurrence solely directly and independently and all other causes result in the death of the life assured.
31. It is submitted that to elicit that the deceased / assured was got disability or died due to the accident, it must be supported by the documentary evidence i.e. FIR, inquest, P.M. Certificate, charge sheet or final report. Those are authenticated documents to prove that the deceased was died due to the accident but in this case there is no such documents to show that the Y.T. Hanumanthu last his breath due to the accidental fallen. So this respondent requested the petitioner to produce the same but she failed to produce these documents so that only the company repudiated the claim.
32. It is further submitted that before filing this application before this Hon’ble forum the petitioner approached Ombudsman for settlement of Group personal Accidental policy bearing No. 050900/42/11/03/00000003. The Hon’ble Ombudsman also observed the above objections raised by the respondent company and dismissed the claim petition filed by the petitioner. But the petitioner filed a complaint before this Hon’ble forum by suppressing all the facts and that the complaint was also numbered as C.C. No. 5/2014 and the same is pending before this Hon’ble forum. It is submitted that this respondent replied whenever the petitioner approached to the company and specifically stated that to her why the company repudiated the claim. So the question of insufficient services on the part of this respondent does not arise.
33. This respondent reserves it right to file additional counter if necessary. It is therefore, prayed that the Hon’ble court may be pleased to dismiss the complaint with costs in the interest of justice.
34. On the basis of the above pleadings the following points are settled for determination.
- Whether the complainant is eligible for compensation or not?
ii. Whether there is negligence or deficiency of service on the
part of the Respondents or not?
iii. To what relief?
35. On behalf of complainant Exs. A1 to A21 were marked and behalf of the R1 Exs. B1 to B16 were marked and R2 Ex. B17 & 18 were marked.
36. Point Nos. 1 & 2. It is a fact that the complainant was working with R1 and he had insurance coverage with R2 company i.e. Group Personal Accidental Policy, it is clear from Ex. A1 & A2. Ex. A3 also proves the same. As seen from the documents and complaint filed by the complainant and evidence given by PW1 i.e. complainant, it is very clear that the deceased life assured Y.T. Hanumanthu was in habit of consuming alcohol. Ex. A5 clearly proves that the deceased Y.T. Hanumanthu was suffering from HTN, CAD and he was in the habit of alcoholism. Ex. A6 also proves the same. When the complainant approached the respondents 1 & 2 asked to her to produce the relevant documents like FIR, Inquest report, Post Mortem Certificate and Final report, Ration card and paper publication etc., for the accidental death of her deceased husband Y.T. Hanumanthu. But the complainant did not furnished the same documents. So, R2 company repudiated the claim as false claim, and as per complaint itself the complainant had taken the deceased Y.T. Hanumanthu to the hospital for treatment after 13 days, if there is severe and serious injuries to the brain or head of the complainant why delayed in taking her husband to the hospital. It creates lot of suspicion on the part of the complainant. At the same time there is no external injury to the deceased Y.T. Hanumanthu. If the deceased lost vision by falling either from cot or in the bathroom to what prevented to go to the hospital immediately. There is no doctor certificate that the deceased Y.T. Hanumanthu lost his eye sight due to injuries sustained by falling. What prevented the complainant to give police complaint immediately after fallen in the house? All these creates lot of suspicion on the part of the complainant. Ex. A5 is the out post card issued by the Area Hospital, Adoni, dt. 16-10-2011, there is previous history of hypertension chronic alcoholism. All these proves the death of the deceased is due to several reasons but not accidental death. The complainant utterly failed to prove her case. The complainant approached the R2 Ombudsman also and there also they have repudiated the claim. The Exs. Filed by the complainant did not support her case, at the same time they creates some suspicion. It is an accidental death there must and should be a police complaint. So all these did not support the case of the complainant at the same time there is no responsibility or liability on the part of the R1 and R2 as there is no negligence or deficiency of service on the part of the respondents 1 & 2. Under these circumstances the complaint is dismissed as the complainant is not liable for any compensation as prayed by her.
37. Point No. 3. In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open Forum, this the 22nd September 2015.
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant : NIL For Respondents : NIL
Exhibits marked for Complainant: -
Ex:A1 P/c of Agreement between the R1 & R2, Dt.30-3-2009.
Ex:A2 P/c of Brief contract issued by the 2nd respondent.
Ex:A3 P/c of Claim form for P.A. policy for SB A/c Holders.
Ex:A4 P/c of prescription given by Sri Sai Krishna Eye hospital relating to
medical treatment given firstly to the deceased Y.T. Hanumanthu,
Dt.16-10-11
Ex:A5 P/c of inpatient ticket issued b y Area Hospital, Adoni, stating about admission on 16-10-2011 at night and referring the case to Kurnool and discharge particulars at 11-30 night.
Ex:A6 P/c of Certificate issued by Civil Assistant Surgeon, Government Hospital, Adoni, about total loss of vision of late Y.T. Hanumanthu, Dt. 13-12-2011.
Ex:A7 P/c of C.T. Brain plain study issued by Shanthiniketan Diagnostic Centre (P) Ltd., Kurnool, Dt. 17-10-2011.
Ex:A8 P/c of Certificate issued by Kurnool Heart and Brain Hospital Centre, about demise of the deceased Y.T. Hanumanthu on 17-10-2011 at 4-00. a.m.
Ex:A9 P/c of Certificate of death issued by Registrar of Births and Deaths, Kurnool Municipal Corporation, Dt. 24-10-2011.
Ex:A10 P/c of Registered letter sent to S.H.O. P.S. No.III, Adoni and the returned cover thereof, Dt. 31-10-2011.
Ex:A11 P/c of letter given by the complainant to Chairman, A.P.G.B. Bank, Kadapa, regrading intimation of the demise of her husband.
Ex:A12 P/c of Statement given by the agent of the respondent stating that the deceased late Y.T. hanumanthu was hale and healthy but became totally blind due to the accident, DT. 18-11-2011.
Ex:A13 P/c of Letter sent by the chief Manager, A.P.G.B. Kadapa to the complainant seeking requirements for claiming the personal accident insurance benefit, Dt. 1-11-2012.
Ex:A14 P/c of Family member certificate issued by Tahsildar, Adoni,
Dt.12-12-2011
Ex:A15 P/c of Letter sent by the respondent no.2 to the complainant repudiating the claim of complainant, Dt. 24-12-2012.
Ex:A16 P/c of letter sent by the respondent no.2 to the complainant closing the claim file of the complainant, 30-1-2013.
Ex:A17 P/c of Requisition sent to the Chairman, Claims Review Committee, U.I.I. Co., Ltd., Chennai, seeking to review the decision of repudiation, Dt. 4-2-2013.
Ex:A18 P/c of Letter sent by the S.D.M. of the respondent to the complainant about no change in the decision of repudiation which contains no signature of the concerned authority and not written in the postal ledger, Dt. 14-2-2013.
Ex:A19 P/c of letter sent by the respondent company to the complainant about not considering the claim of the complainant, Dt. 19-2-2013.
Ex:A20 Certified copy of deposition of PW1 in C.C. No.5/2014.
Ex:A21 Certified copy of Handwritten and typed deposition of PW2 in
C.c. No.5/2014.
Exhibits marked on behalf of the Respondent. No.1.
Ex:B1 P/c of Bank Cir. No.44/2009-BC-PDD.Dt. 4-3-2009 pertaining to Personal Accident Insurance Scheme to the savings bank account holders of the bank.
Ex:B2 P/c of Bank Cir. No.67/2011-BC-PDD.Dt. 15-3-2011 pertaining to Personal Accident Insurance Scheme to the savings bank account holders of the bank.
Ex:B3 Agreement Dt. 30-3-2009 on Personnel Accident Insurance Policy to
SB A/c holders of APGB.
Ex:B4 Group Personal Accident Scheme with UII Co., Ltd., Policy
No.050900/42/11/05/00000001.
Ex:B5 S.B.A/c No.19110528458 of Y.T. Hanumanthu at Hebbatam Branch.
Ex:B6 S.B. A/c No.19155064763 of Mr. Y.T. Hanumanthu at adoni Branch.
Ex:B7 S.B. A/c No.19099525843 of Mr. Y.T. Hanumanthu at Ternekal Branch.
Ex:B8 Bank Letter dated 9-1-2012 forwarding the claim form of Mrs. Y.T.
Jayalakshmi.
Ex:B9 Claim form for P.A. policy for SBA/c holders along with all documents
Ex:B10 Notarized Affidavit of Y.T. Jayalakshmi.
Ex:B11 UII Co., Ltd., letter no. 050900/Staff Group P.A./2011, Dt. 1-11-2012.
Ex:B12 Letter No.1191/ST/1378/PAIS/2012, Dt. 1-11-2012 of APGB, H.O.
Kadapa.
Ex:B13 UII Co., Lr. No.050900/S.B. claims/2012-File: SB122/2012, Dt.
24-12-2012 addressed to Y.T. Jayalakshmi.
Ex:B14 UII Co., Lr. No.050900/S.B. claims/2012-File: SB122/2012, Dt. 30-1-2013 addressed to Y.T. Jayalakshmi.
Ex:B15 UII Co., Lr. No.050900/S.B. claims/2012-File: SB122/2012, Dt. 14-02-2013 addressed to Y.T. Jayalakshmi.
Ex:B16 UII Co., Lr. No.050900/ Group P.A./2013, dt. 10-7-2013 addressed
to APGB.
Exhibits marked on behalf of the Respondent. No.2.
Ex:B17 P/c of Out patient ticket issued by Area Hospital, Adoni,
Kurnool District.
Ex:B18 Case Record ( Case sheet).
MEMBER MEMBER PRESIDENT
Copy to :-
- Sri K. vijaya Krishna, Advocate for complainant.
- Sri A. Raja Reddy, Advocate for respondent No. 1.
- Sri K. Rama Kondaiah, Advocate for Respondent No. 2.
B.V.P.
