UNITED INDIA INSURACE CO LTD Vs. KONETI MANJU

JUDGEMENT

(1.) This revision petition has been filed under Section 21(b) of the Consumer Protection Act, 1985 against the order dated 7.9.2011 passed in first appeal No. 551 of 2009 by Andhra Pradesh State Consumer Disputes Redressal Commission, Hyderabad (in short, 'the State Commission') whereby the appeal of the complainant was allowed and the insurance company was directed to pay Rs. 5 lakhs with interest @9% per annum from the date of complaint.

(2.) The complainant, Koneti Manju's husband, K. Yedukondalu (since deceased) was an employee of M/s Rashtriya Ispat Nigam Limited/OP-1. He was covered under Janata Personal Accident Policy issued by the United India Insurance Co. Ltd. (op-2) for the accidental sum and in the event of death in an accident, a sum of Rs. 5 lakh was agreed to be paid. Unfortunately, on 3.11.2002, he slipped in the bathroom and was immediately taken to General Hospital, Visakapatnam Steel Plant where he was declared death. The post mortem was performed wherein it was found that the cause of death was head injury. The police registered crime. The wife i.e. the complainant, Koneti Manju submitted the relevant documents to the insurance company for the accidental death claim alongwith sum assured in the policy, but it was repudiated by the OP 2 as "No Claim". Therefore, aggrieved by the unlawful repudiation, the complainant filed a complaint before the District Consumer Disputes Redressal Forum, Visakhpatnam.

(3.) Op-1 resisted the complaint. OP-1 submitted that the deceased was an employee of their organization and it has acted only as a facilitator. There was no financial commitment towards the settlement of claim as per the insurance policy. The claim was not honored because the complainant's husband died due to heart attack and not by any accident. On the basis of medical record on 3.11.2002 at 10.00 p.m., deceased fell unconscious after vomiting at once and he was taken to the hospital at 00.00 hours on 4.11.2002 in dead condition. The PM report revealed the "cause of death of the deceased appeared to have died of injury to the brain due to head injury'. The OP appointed an investigator to find out the cause of death wherein, he found that the death of insured was due to heart attack and not due to head injury. Therefore, the proximate cause of death was heart attack and not due to head injury, hence, the complaint deserves to be dismissed.