BRANCH MANAGER NEW INDIA ASSURANCE CO LTD Vs. P SULOCHANA
LAWS(KERCDRC)-2009-12-3
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Decided on December 02,2009

BRANCH MANAGER NEW INDIA ASSURANCE CO LTD Appellant
VERSUS
P Sulochana Respondents


Referred Judgements :-

COL. BHIM SINGH V. REGIONAL MANAGER,NATIONAL INSURANCE CO. LTD. AND ANR. [REFERRED TO]
MORINDA COOP SUGAR MILLS LTD VS. NEW INDIA ASSURANCE CO LTD [REFERRED TO]
SRI JAYAJOTHI AND CO LTD VS. ORIENTAL INSURANCE CO LTD [REFERRED TO]


JUDGEMENT

- (1.)THE appellant is the opposite party/New India Assurance Company Ltd., in OP No. 508/02 in the file of CDRF, Thiruvananthapuram. The appellant is under orders to pay a sum of Rs. 5,00,000/ - within two months and if not with interest at 9% and also to pay Rs. 5,000/ - as compensation and Rs. 1,000/ - as cost.
(2.)IT is the case of the complainant that her husband who was working as a mason in Sharjah, U.A.E was the holder of the Pravasi Suraksha PS II Insurance Policy of the opposite parties. The sum assured was Rs. 10,00,000/ - for the period from 1/5/02 to 30/4/05. On 4/5/00 he sustained the serious injury due to the penetration of a nail on his right eye while working at a place called 'Dhaid' in Sharjah. He was taken to the Indian Eye Clinic at Dhaid wherein he underwent preliminary operations to the right eye. On 8/5/00 he was referred to Zulekha Hospital, Sharjah and treated therein till 15/ 5/00. On 8/5/00 he was subjected to ophthalmic ultrasound scan at Zulekha hospital. The result of the scanning is as follows.
The right orbital globe contour is markedly distorted with AP diameter of approximately 24.0 mm.

Organised vitreous haemorrhage is seen associated with posterior vitreous detachment and sub -vitreous haemorrhage. The right optic nerve is poorly visualized. The right retina is obscured by the sub -vitreous haemorrhage. The right lens could not be visualized.

Left orbital globe appears normal and measures 24.0 mm in the AP axis.

The left lens with the iris is normal in location.

The extra ocular structures, retro -orbital spaces are distorted on the right side suggesting a retro -orbital component as well.

Opinion: Organised vitreous haemorrhage with posterior vitreous detachment and sub -vitreous haemorrhage on the right side with compressed optic head. Due to the sub -vitreous haemorrhage it is hard to comment on the retinal status at present.

Corneo scleral wound (Sutured), aphasia and amaurosis of right eye were diagnosed at Zulekha Hospital. He was discharged with the direction that he should be released from visual and physical work for six weeks. For getting better treatment he arranged journey to India on 18/5/00. But he died o n 17/ 5/00. His body was brought to. Thiruvananthapuram on 23/5/00. In the death certificate issued from the Ministry of Health, Department of Preventive Medicine, U.A.E. brought along with the dead body, the leading cause of death and actual cause of death are mentioned as unknown. The relatives, in order to ascertain the actual cause of death reported the matter to the Vattappara Police Station within the jurisdiction of which the family was residing. Vattappara Police registered Crime No. 88/00 and as per requisition dated 23/5/00 postmortem was conducted at Medical College Hospital. Thruvananthapuram. In the post -mortem report dated 23/5/00 the cause of death was reserved awaiting the report of laboratory investigations. Subsequently on 28/8/00 the doctor of the Department of Forensic Medicine has noted the final opinion as to cause of death based on postmortems and results of laboratory examinations as death was due was due to interstitial Pneumonia following injury sustained to right eye. The complainant who is the widow of the assured submitted the claim but the same was protracted by the opposite parties seeking documents one after another. The policy was issued from Dubai, U.A.E. Even after the lapse of one year the claim was not settled. So the complainant petitioned to the Chief Minister and other Ministers of the Government of Kerala including Minister for information, Parliamentary Affairs and Non Reside -1 Keralites Affairs Department. Vide letter dated 04 -10 -2001 the opposite parties forwarded a voucher for Rs. 5 lakhs directing to return the same duly signed in full and final settlement. It is stated therein that the amount of Rs. 5 lakhs is for complete loss of vision of the right eye due to the reported accident as per Clause 1 (3) of the policy. It is also mentioned that the cause of death is not attributable to the eye injury sustained in the accident and as such the death claim is not admissible. The complainant accepted the cheque on 13 -10 -2001 i.e. after a lapse of nearly IV2 years from the date of death of her husband. Her husband had pledged his house and borrowed money from various persons for going abroad. The deceased had left two unmarried daughters. Due to pressing necessity for money the complainant accepted the above said amount for the total loss of vision and not for death of her husband. The opposite parties have misled the complainant and her unmarried daughters. The marriage took place immediately after release of the amount. It is contended that the death was squarely caused due to injuries sustained to the right eye. Hence the claim release of further assured amount of Rs. 5 lakhs.

(3.)OPPOSITE parties have filed version contending that the petition is not maintainable as the complainant has accepted Rs. 5 lakhs in full and final settlement of her claims and executed the discharge voucher dated 18 -10 -2001. The claim was submitted on 01 -09 -2000. It is after considering the records submitted by the complainant and other reports, considering the close proximity of the claim as the policy commenced on 01/05/2000 and the accident occurred on 04/ 5/2000 an investigation abroad was arranged. M/s Cormiche Loss adjustors (LLC), Dubai was appointed as Investigators. The Investigators reported as per report dated 18/02/ 2001 that there is no clinic by name Indian Eye Clinic in U.A.E and there are no eye clinics in Dhaid. It is also mentioned that on 17 -05 -2000 when his roommate alerted him in the morning around 06.00 hours to take medicine, he was found dead. He had booked flight ticket to Thiruvananthapuram on 17 -05 -2000. It was found that the deceased was not experiencing any fever during the night on 16 -05 -2000. It is further reported that he was not having any other problems except the eye injury. There was no symptoms of pneumonia. The direct cause of death in the death certificate is mentioned as cardio respiratory arrest. The eye injury has no connection with his death. It is at the influence and connivance of the complainant and her relatives that a crime was registered by the Vattappara Police Station authorities and postmortem conducted. The opinion rendered as the result of the postmortem is without any basis and without considering the medical report obtained from Zulekha Hospital, U.A.E. The above report and other relevant records were forwarded by the opposite party to (1) Dr. V.Sahasranamam, Assistant Professor, Regional Institute of Ophthalmology, Thiruvananthapuram. (2) Dr. Suseela B. Nair, Director, Regional Institute of Ophthalmology, Thiruvananthapuram and (3) Dr. K.P. Paulose, retired Professor and Head, Department of medicine, Medical College, Thiruvananthapuram. The reports of the above doctors produced would establish that it was not on account of the eye injury or the consequence of the same that the husband of the complainant died. It has been specifically mentioned in the letter sent to the complainant dated 04/01/2001 that the death claim is not admissible. It is not mentioned in the medical records issued from Zulekha Hospital on 15.05/2000 that the husband of the complainant required further treatment. The above person decided to come to India only as the doctors at Zulekha Hospital directed that he should not engage in visual and physical work for 6 weeks. The delay in setting the claim was caused only due to the delay in submitting the requisite records.
The evidence adduced consisted of the testimony of Ext.Pl to P15, Dl to D15 and the proof affidavits of the respective parties.



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