BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION: HYDERABAD.

F.A. No.860 OF 2022 AGAINST ORDERS IN CC.No.380 OF 2019 DISTRICT CONSUMER COMMISSION-II, HYDERABAD Between:

The Divisional Manager, National Insurance Company Limited, Divisional Office, IV, Kumarakrupa Road, Shivananda Circle, Bangalore-560 001.

…. Appellant/Opposite party No.2 And

1. Cirasanagandle Rajitha, W/o. Late Thirupathi Rao, Aged: 45 years, Occ: Housewife, R/o. H.No.17-83/4, Srinagar Colony, Near Anjana Function Hall, Dilsukhnagar, Hyderabad-500 036.

…Respondent No.1/Complainant

2. The Commissioner of Labour, Government of Telangana, T Anjaiah Bhavan, RTC “X” Roads, Hyderabad-500 020.

……...Respondent No.2/Opposite party No.1 Counsel for the Appellant/Opposite party No.2: M/s. TMH Sudhakar For the Respondent No.1/ Complainant: Paper Publication filed For the Respondent No.2/Opposite party No.1: Notice served :QUORUM:

HON’BLE SMT JUSTICE DR.G. RADHA RANI, PRESIDENT &

HON’BLE SMT R.S. RAJESHREE- MEMBER (NON-JUDICIAL)

MONDAY, THE 16^th DAY OF MARCH TWO THOUSAND TWENTY-SIX ORDER: (HON’BLE SMT. R.S. RAJESHREE, MEMBER, NON-JUDICIAL)

01. This appeal is filed U/s.41 of the Consumer Protection Act, 2019, by appellant/opposite party No.2 praying this Commission to set aside the order dated 01.07.2022 in CC No.380 of 2019 on the file of District Commission-II, Hyderabad, by allowing the appeal with costs throughout in the interest of justice.

02. For the sake of convenience, the parties are described as complainant and opposite party as arrayed in the complaint.

03. The case of the complainant is that the Government has introduced a Social Security Scheme in the year 2015 for transport driver and non-transport auto driver, home guards and journalist. That the Telangana Government provided a group personal accident insurance scheme to the members of the said scheme and had taken a master policy from OP No.2 and as per the policy the sum assured amount is Rs.5,00,000/- to each member. That the complainant’s husband C. Thirupathi Rao was the member of the said scheme. That on 20.03.2017 he was admitted to Osmania Hospital as he was suffering from fever, that on the same day, while undergoing treatment in hospital he accidently fell down in Electrical Bus Bar Room of OP Block and died due to Head Injury. That the police have registered a case and after investigation filed a final report, concluding that the death was caused due to Head Injury. That the complainant being the wife and nominee of the deceased assured had made a claim by submitting all the documents to opposite party No.1. The Opposite party No.1 in turn had forwarded the said claim of the complainant to opposite party No.2, but however the opposite party No.2 after a gap of 09 months had repudiated the claim on the ground that the deceased died due to fits and not due to any accident. As such the claim was not considered by the opposite party No.2. This act of repudiation of claim amounts to deficiency of service. As such a complaint was filed before the District Commission seeking Insurance amounts apart from compensation and costs.

04. The opposite party No.1 filed its written version while admitting that, it is the master policy holder under the social security scheme introduced by the Government; that immediately after receiving a claim from the complainant the same was processed and forwarded to E-Med Life Brokering Services through online on 10.08.2017, upon which the E-Med Life Brokering Services had forwarded the same to opposite party No.2 by E-Med Life Brokering Services. On 11.12.2017, the opposite party No.2 had rejected the claim on the ground that the deceased was suffering from fits and died due to a fall in the Osmania General Hospital. Upon which this opposite party had sent a reply on 21.12.2017 stating that as per the post-mortem report the death has occurred due to Head Injury and the death was caused due to said accident. Upon which the E-Med Life Brokering Services had sent a mail on