BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
OF 2009 AGAINST C.C.NO.335 OF 2008 DISTRICT CONSUMER FORUM-II VISAKHAPATNAM
Between
Shri Malla Bhaskara Athchiyya Naidu
S/o late Appala Naidu, aged 28 years
D.No.1-73, Thimmarajupeta
Munagapaka Mandal, Visakhapatnam
Appellant/complainant
A N D
1. M/s Reliance General Insurance Co., Ltd.,
rep. by its authorized signatory
403, 3rd floor, Eswar Paradise, Dwarakanagar
Main Road, Visakhapatnam-016
2. M/s Reliance General Insurance Company Ltd.,
rep. by its authorized signatory, 4th floor
Sagar Plaza, 4-1-327, Abids Road,
Hyderabad-001
Respondents/opposite parties
Counsel for the Appellant Smt P.Leelavathi
Counsel for the Respondents Sri K.S.N.Murthy
QUORUM: SRI SYED ABDULLAH, HON’BLE MEMBER
&
SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER
FRIDAY THE TWELFTH DAY OF NOVEMBER
TWO THOUSAND TEN
Oral Order ( As per R.Lakshminarsimha Rao, Member)
***
1. The unsuccessful complainant is the appellant.
2. The appeal is directed against the order of the District Forum in C.C.No.335 of 2008 whereby the complaint was dismissed on the premise that the complainant failed to prove that the insured died of an accidental death and that his claim was repudiated on unsustainable grounds.
3. The facts of the case are that the father of the complainant Malla Appala Naidu during his life time insured his life under policy bearing No.1802-2913-00003-06 on 6.9.2006 for Rs.3 lakh for a period of one year commencing from 6.9.2006 to 5.9.2007. The complainant has submitted that his father was bitten by a snake on 6.12.2006 and he was shifted to Sri Shiridi Hospital, Anakapalli where he died while undergoing treatment. The complainant has contended that he was not aware of the insurance policy obtained by his father till the month of January 2008 and on 8.1.2008 immediately after finding the insurance policy he addressed letter intimating the death of his father to the opposte party no.1 along with an enclosure thereto i.e., death certificate pertaining to his father and copy of insurance policy. The opposite party no.2 addressed letter dated 9.4.2008 stating that no documents such as police report panchanama, report of postmortem examination were submitted. Therefore, the claim was repudiated.
4. The second opposite party contested the case on the ground that the father of the complainant had not died due to snake bite and the claim was not lodged within the prescribed time.
5. The complainant has filed his affidavit and documents Exs.A1 to A5. On behalf of the opposite parties Exs.B1 and B2 had been marked.
6. The complainant filed his written arguments.
7. The point for consideration is whether the complainant is entitled to the amount as sought for?
8. The father of the complainant during his life time obtained insurance policy is not disputed. The complainant has claimed the proceeds under insurance policy contending that his father died due to snake bite on 6.12.2006 while undergoing treatment in Sri Shiridi Sai Hospital Anakapalli. The opposite party refuted the charge on the premise that the father of the complainant met with natural death as also that the claim was not filed within the limitation period.
9. Admittedly, the complainant has not filed any documents except the death certificate issued by Grampanchayat, Timmarajupeta Munugapaka Mandal and copy of prescription dated 6.12.2006 issued by Dr.Prasad Rao of Shri Shiridi Sai Hospital Woodapet Anakapalli. In the copy of the prescription it is mentioned that Malla Appalanaidu reported with snake bite on his left foot. TT ASV IV Drip were administered and he was referred to KGH, Visakhapatnam for further management. As seen from the prescription no ante venom and no saline was given by Dr.Prasad Rao in Shri Shiridi Sai Hospital. The investigator appointed by the opposite party has submitted his report marked as Ex.B2 stating that he had verified the records of Grampanchayat Timmarajupeta and enquired about the death certificate of the insured and he was informed that the cause of death and the age of deceased were not noted in the records and as such the panchayat Secretary has expressed his inability as to whether the death of the insured was accidental or normal. On enquiry Dr.Prasad Rao of Shri Shiridi Sai Hospital Anakapalli informed him that generally the snake bite case will be treated as Medico Legal Case and they would not deal with such cases and that without looking into the prescription he could not say whether he had treated the deceased or not. The investigator has concluded that local people informed him that the insured died due to ill health. Relying upon the investigator’s report, the opposite parties repudiated the claim.
10. The investigator has not conducted a comprehensive investigation and he had come to a blind conclusion that the insured died a natural death only basing on enquiry stated to have been conducted even without noting down the names of the persons or the villagers who informed him that the deceased died a natural death. The report if taken on its face value does not support an iota of contention of the opposite party that the deceased met with natural death. It is settled principle of law that the repudiation of the claim should not on arbitrary grounds or imaginary ideas. The investigator’s report if does not support the contention of the case of the opposite party, there is no other evidence brought on record by the opposite party to the effect that the deceased died due to a natural cause.
11. It is pertinent to note that the observation of the investigator cannot be given any credence that Dr.Prasad Rao had told him that he could not recollect without looking into the prescription whether he had treated the patient or not. The doctor in the course of time comes into contact and treats number of patients and to infer that he was not able to say whether the treatment was given or not without looking into the prescription would not mean that he had not treated the patient is not sustainable. The investigator has not stated the names of the persons as to who informed him that the father of the complainant met with natural death. He has just clearly stated that local people informed him that the father of the complainant had not died due to snake bite. The insurance company has the obligation to prove the ground for repudiation of the claim. The investigator’s report sans any basis the conclusion that the diseased had not died due to snake bite. Therefore, insofar as the burden of proof rested on the insurance company is concerned, has not been discharged by the opposite parties resultantly the complainant’s contention held sustainable that his father died due to snake bite which has been supported by the certificate issued by Dr.Prasad Rao.
12. The learned counsel for the opposite parties has contended that the claim was not lodged within the stipulated period. They relied upon the decision of the Hon’ble Supreme Court in HP State Forest Company Limited Vs United India Insurance Company Limited, reported in 2008 TLPRE-0-2049 wherein clause 6(II) of the insurance policy fixing period of limitation at 12 months against the period of limitation of three years u/s 44 of the Limitation Act was held valid. In the case on hand the complainant informed the opposite parties about the death of his father on 8.1.2008. The complainant’s father died on 6.12.2006. The complainant has submitted that he had no knowledge of the policy till 8.1.2008 on which date while white washing the house he could know about the existence of the insurance policy obtained by his father whereunder he was appointed as nominee of his father. Ex.B1 is the insurance policy filed by the opposite parties. The opposite parties relied upon condition no.1, 2 and 3 of the policy. The conditions for the sake of discussion have been extracted hereunder:
1) Upon the happening of any event which may give rise to a claim under this policy, written notice with full particulars must be given to the company immediately. In case of death written notice of death must, unless reasonable cause is shown, be so given before internment/cremation, and in any case, within one calendar month after the death, and in the event of loss of sight or amputation of limb(s), written notice thereof must be given within one calendar month after such loss of sight or amputation.
2) Proof, satisfactory to the company shall be furnished on all matters upon which a claim is based. Any medical or other agent of the company shall be allowed to examine the insured person on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the complainant and in the event of death to make a postmortem examination of the body of the insured. Such evidence as the company may from time to time require shall be furnished and a postmortem report, if necessary, be furnished within the space of 14 days after demand in writing and in the event of a claim in respect of loss of sight the insured person shall undergo at insured’s expense such operation or treatments as company may reasonably been desirable. Provided that all sums payable hereunder shall be payable in the case of
i) Death or permanent total disablement, only after deleting an endorsement the name of the insured person in respect of whom such sum shall become payable without any refund of premium.
ii) ………
iii) ……..
3) The company shall not be liable to make any payment under this policy in respect of any claim, if such claim be in any manner fraudulent or supported by any fraudulent statement or device, whether by the insured or anyone acting on insured’s behalf.
13. The opposite parties had not pressed into service condition no.1 as seen from the repudiation letter dated 9.4.005 wherein the condition no.2 which deals with the furnishing of relevant documents. The relevant para in the letter reads as under:
“ We would like to draw your attention with reference to the above claim. Based on condition no.5.5 of the policy which is given below for your reference.
5.5 The insured person shall obtain and furnish to the company all original bills, receipts and other documents upon which a claim is based and shall also given the company such additional information and assistance as the company may require for dealing with the claim.
We wish to inform you that as per the service provider report that there are no substantiating documents to support the claim i.e., claim is not reported to the police, no panchanama and postmortem report. As per above lines, we therefore, express our inability to proceed further with the claim and are treating this “no claim”.
14. Therefore, the only condition that was invoked by the opposite parties is in regard to the relevant documents sought to be furnished by the complainant. We have already held the aspect of death of the insured due to snake bite in the above mentioned paragraphs of the order.
15. The contention of the opposite parties at the appellate stage that the claim was not subjected to arbitration or litigation within 12 months from the date of cause of action is not borne out by any records mubh less the terms and conditions of the policy. In the circumstances, the decision of the Hon’ble Supreme Court has no application to the facts of the case. The opposite parties rendered deficient service by not settling the claim. The investigator’s report reveal that the mother and wife of the insured are left behind him. Therefore, the complainant alone cannot claim the sum assured. For the latches on the part of the complainant, there cannot be any interest or compensation on the sum assured. The complainant being one of the legal heirs and not being appointed the nominee of the insured, cannot claim the entire amount under the insurance policy.
16. In the result the appeal is allowed. The order of the District Forum is set aside. The complaint is partly allowed. The opposite party directed to pay a sum of `1,00,000/- to the complainant. There shall be no order as to costs.
Sd/-
MEMBER
Sd/-
MEMBER
Dt.12.11.2010
KMK*
