Death due to accidental fall from upstairs - No proof - claim repudiated =
Death due to accidental fall from upstairs - no medical report, no police report and to say negative the report submitted does not belong to deceased as evidenced by reply of M.R.O. - No supporting affidavit who witnessed the incident filed - District consumer forum and state consumer forum orders are set aside =
To prove the death by accident, either police report or hospital records confirming the death as accidental were to be produced. In this case, no such reports were submitted. A copy of the statement of some of the villagers of the deceased life assured which were signed by the panchayat Secretary and MandalRevenue Officer from the alleged records of MRO, Chittamur vide LD NO. 413/ 2003 dated 06.04.2003 only was produced. But MRO Chittamur vide letter RCA 148/2004 dated 02.04.2004, in reply to the Senior Divisional Manager, United India Insurance Co. Ltd., Nellore LD NO. 413/ 2003 has dealt with the correspondence of the fire accident subject related to Mettu village and honorarium paid in favour of Shri SK Ramthu Sahab son of Khader Saheb of Mettu village but it does not relate the alleged accidental death of N Sarasamma of Molakalapudi village. Hence, the accidental death has not been proved to the satisfactory of the insurer.=
In the absence of any records, the respondent has failed to give any affidavit of any person who was present at the time of accident or death.
Even the panchanama report given by the Panchayat Secretary merely says what was given in the complaint that N Sarasamma had fallen down from the stairs and she was taken to Nellore by road and she died on the way. In fact, this fact has not been mentioned in the complaint.
There is no other information with regard to the injuries sustained and when the death occurred.
This report has been allegedly signed by the Mandal Revenue Officer, Chittamur, though, later he has stated as mentioned earlier, that the incident bearing no. L Dis 413/ 2003 dated 12.05.2003 does not pertain to N Sarasamma.
We are of the view that the respondent has failed to prove that the death was caused was due to accident. No evidence has been placed on record by the respondent to establish the same. Hence, the revision petition is allowed and the orders of the State Commission and the District Forum are set aside and the complaint is dismissed, with no order as to cost.
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION
NEW DELHI
REVISION PETITION No. 3869 of 2008
(From the order dated 09.06.2008 of the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad in Appeal no. 661 of 2008)
Life Insurance Corporation of India
Branch Manager
Naidupetta Branch
Nellore District Petitioner
Through
Assistant Secretary
Northern Zonal Office
Jeevan Bharti, Cannaught Circus
New Delhi
Versus
N Shanker Reddy
Son of Late Sarasamma
Resident of Malakalapudi Village Respondent
Chittamuru Mandal
District Nellore, Andhra Pradesh
BEFORE:
HON’BLE MR JUSTICE V B GUPTA PRESIDING MEMBER
HON’BLE MRS REKHA GUPTA MEMBER
For the Petitioner Mr Ashok Kashyap, Advocate
For the Respondent Mrs R Radha, Advocate
Pronounced on 10th October 2013
ORDER
REKHA GUPTA
Revision petition no. 3869 of 2008 has been filed under section 21 (b) Consumer Protection Act, 1986 by the petitioner/ Opposite party against the order dated 09.06.2008 in Appeal no. 661 of 2008 passed by the Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (‘the State Commission’).
The brief facts of the case as per the respondent/ complainant are that the respondent is the son of a policy holder N Sarasamma. The said Sarasammatook two policies bearing no. 650696766 and 840116947 with accident benefits. Subsequently she died on 05.04.2003 by accidental slip from upstairs.
Respondent submitted a claim form to the LIC herein, requesting to pay the accident benefit also. Instead of settling the claim under accident benefit, the LIC settled the claim only for the policy amount and paid Rs.14,510/- vide cheque dated 17.06.2003 for policy no. 840116947 and Rs.75,640/- vide cheque dated 27.06.2003 for policy no. 650696766.
Admittedly it was an accidental death as per the statements recorded by the sarpanch, village Secretary and Mandal Revenue Officer, Chittamur. As it was an accidental death, LIC was liable to pay another sum of Rs.14,510/- and Rs.75,640/- under the above said two policies which was an accidental benefit as per the terms of the policy. But the respondent failed to do so. Thus, there was a clear deficiency of service on the part of the LIC in not settling the claim under the accident benefit scheme though it was confirmed that it was an accidental death. Hence, this complaint.
Respondent/ complainant has prayed before this Commission to direct the LIC to settle the claim under the accident benefit scheme in the policies referred to above, i.e., to pay Rs.14,510/- and Rs.75,640/- along with interest from the date of the claim; grant cost of this complaint; to pay damages of Rs.10,000/- to the respondent; and grant such other and further reliefs.
In the counter filed by the petitioner/ opposite party (LIC), they have admitted that it was true that two policies were issued on the life of N Sarasammawith policy no. 650696766 and 840116947 for sum assured of Rs.40,000/- and Rs.10,000/- with date of commencement of risk as 11.09.1990 and 28.07.1996 respectively. Both the policies were issued with accidental benefit facility.
As per the conditions and privileges of the policy bond, condition no. 10-2 under the caption “Accident Benefit” an additional sum equal to the sum assured would be paid if the life assured should sustain bodily injuries resulting solely and directly from the accident which result into the death of the life assured and the same was proved to the satisfaction of the corporation.
To prove the death by accident, either police report or hospital records confirming the death as accidental were to be produced. In this case, no such reports were submitted. A copy of the statement of some of the villagers of the deceased life assured which were signed by the panchayat Secretary and MandalRevenue Officer from the alleged records of MRO, Chittamur vide LD NO. 413/ 2003 dated 06.04.2003 only was produced. But MRO Chittamur vide letter RCA 148/2004 dated 02.04.2004, in reply to the Senior Divisional Manager, United India Insurance Co. Ltd., Nellore LD NO. 413/ 2003 has dealt with the correspondence of the fire accident subject related to Mettu village and honorarium paid in favour of Shri SK Ramthu Sahab son of Khader Saheb of Mettu village but it does not relate the alleged accidental death of N Sarasamma of Molakalapudi village. Hence, the accidental death has not been proved to the satisfactory of the insurer.
Hence, nothing was payable towards accident claim. No costs, no damages as further reliefs were payable as accidental death was not properly established. Hence, the CD should be dismissed with heavy costs.
District Consumer Disputes Redressal Commission, Nellore, (“the District Forum’) vide order dated 07.03.2008 while holding that “it is not in dispute that the respondent/ complainant’s mother N Sarasamma obtained two policies with accidental benefits. As per exhibit A 4 the deceased life assured N Sarasammadied in an accident while the policy was inforce. The nominee is also entitled the accidental benefits. It is also not in dispute that the respondent/ complainant is a nominee for the said two policies. So under these circumstances, the opposite party – LIC only paid Rs.75,640/- and Rs.14,510/- under two policies. But the opposite party did not pay the accidental benefits under two policies. So non-payment of the accidental benefits to the nominee who is the complainant/ respondent herein amounts to the deficiency of service on the part of the opposite party. So the affidavit of the complainant coupled with Ex A1 to Ex A6 clearly established the guilt of deficiency of service on the part of the opposite party. The complainant established the deficiency of service on the part of the opposite party. Accordingly, this point is answered in favour of the complainant against the opposite party.
The District Forum ordered that the complaint is partly allowed with cost of Rs.2,000/- and directing the opposite party to pay an amounts of Rs.14,510/- and Rs.75,640/- under the two policies to the complainant together with interest per annum on 14,510/- and Rs.75,640/- from the date of filing of this complaint i.e., from 23.02.2004 till the date of realisation and the opposite party is directed to deposit the above said amount within one mother from the date of receipt of this order”.
Aggrieved by the order of the District Forum the petitioner - LIC filed an appeal before the State Commission. Vide order dated 09.06.2008, the State Commission came to the conclusion that “we have her clinching evidence that the death is accidental. We have already given our opinion as per it. Coming to the facts the complainant proved that the death of his mother is an accidental death. The District Forum has correctly came to the finding holding that it is an accidental death and the complainant is entitled to the double accidental benefits as provided on the policy. It is a well-considered order. There are no grounds to interfere with the order of the District Forum.
In the result the appeal is dismissed at the admission stage”.
Hence this present revision petition.
The main grounds for the revision petition are that:
· Both the Fora below have failed to see that there was no averment in the pleading or evidence placed on record to show that the life assured had fallen from the staircase and died due to the said fall.
· Both the Fora below have failed to see that there is no evidence like police report, post-mortem report, Doctor’s certificate showing the cause of death due to accident.
· Both the Fora below have failed to see that the complainant did not mention under what circumstances she fell from the staircase and what injuries she suffered due to alleged fall and the complainant failed to establish that the death of her mother was due to fall from staircase.
· Both the Fora below have failed that the principle laid down by the Kerala High Court reported in AIR 1986 Kerala 201 (DB) that “in such contracts as one party is in very strong position to know the material facts and the other is in very weak position to discover them. The former is under duty not only to abstain from making false representations of material facts but also to disclose, in good faith, such materials facts as are within the knowledge of other party”.
· Both the Fora below have committed material irregularity and illegality and have exceeded their jurisdiction by allowing the accident Benefit. Moreover, even if the case of accident benefit is made out, it is only an equal sum of the policy amount is to be paid and no bonus and interest can be granted under the terms of the policy.
We have heard the learned counsel for the petitioner as well as the respondents and have gone through the records of the case carefully.
It is an undisputed fact that the respondent’s mother had taken two policies bearing no. 650696766 and 840116947.
Thereafter, as per the respondent she died on 05.04.2003 by accidental slip from ‘upstairs’.
The respondent has nowhere mentioned in the complaint as to when the accident took place and the circumstances of the accident.
He has also not mentioned the injuries sustained and what action was taken after the accident.
The respondent has also not mentioned who discovered his mother after she fell down and what action was taken for getting hermedical aid.
It was also not clear from the complaint as to when she fell and when she died. The respondent has filed the claim for insurance which has been repudiated by the petitioner as there are no documents to prove that the incident of death was by accident.
There is no police report, no death certificate, no post mortem report and no certificate by any Doctor certifying the cause of death.
The only proof given is the statement made by the villagers of the deceased life insured and the Panchayat Secretary and MRO from the alleged records of the MRO Chittamur village LDO no. 413/ 2003 dated 06.04.2003.
The petitioner has placed on record the letter from MRO Chittamurdated 02.04.2004 which reads as follows:
“Subject: Issue of public copy of file bearing no. L Dis. 413/2003-dt.Reg
Reference: Senior Divisional Manager, Lr. Dt. 02.04.2004.
With reference to the letter cited it is informed that this office file bearing no. L Dis. 413/2003 dated 12.05.2003 dealt with the correspondence of fire accident subject relates to Mettu village. Honorarium paid in favour of Sri S K M Saheb son of Khadar Saheb of Mattu village, but it does not relate the alleged accidental death of N Sarasamma of Melakalapudi village.
Yours faithfully,
Mandal Revenue Officer
Chittamur”
The District Forum surprisingly allowed the complaint on the ground that the burden “lies on the opposite party to establish the death of N Sarasamma is a natural one”…………. When the OP took the plea that the death of Nemalapudi Sarasamma is a natural one. But to prove no scrap of paper was filed to show that N Sarasamma death is a natural one”.
It further held that “it is the case of the complainant that the complainant’s mother N Sarasamma died due to falling from the staircase and that they did not give any report to the police about the death of N Sarasamma as it was an accidental one. So the police reports and other records were not available. The production of police reports and other records is not required”.
It is not known and on what basis the State Commission has held that “as per the complainant after the insured fell down accidentally from the upstairs she died while taking to the hospital. The matter was not reported to the police. When the matter itself is not reported to the police, registering the case by police and conducting inquest and post mortem on the deceased does not arise. When death occur by accidental slip etc., nobody would report to the police. It is not an offence. She cannot complain against herself for slipping from the steps. The appellant intends that every accidental death should be equated to a death like a death by motor vehicle accident. We believe that the appellants are in confusion over the expression ‘accident’. She must not have anticipated slip from the steps would result in her death nor her family members. In such cases, there will not be any report to any authority. The District Forum has elaborately discussed and gave finding”.
In the absence of any records, the respondent has failed to give any affidavit of any person who was present at the time of accident or death.
Even the panchanama report given by the Panchayat Secretary merely says what was given in the complaint that N Sarasamma had fallen down from the stairs and she was taken to Nellore by road and she died on the way. In fact, this fact has not been mentioned in the complaint.
There is no other information with regard to the injuries sustained and when the death occurred.
This report has been allegedly signed by the Mandal Revenue Officer, Chittamur, though, later he has stated as mentioned earlier, that the incident bearing no. L Dis 413/ 2003 dated 12.05.2003 does not pertain to N Sarasamma.
We are of the view that the respondent has failed to prove that the death was caused was due to accident. No evidence has been placed on record by the respondent to establish the same. Hence, the revision petition is allowed and the orders of the State Commission and the District Forum are set aside and the complaint is dismissed, with no order as to cost.
Sd/-
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[ V B Gupta, J.]
Sd/-
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[Rekha Gupta]
Satish
