FA  114/2008  in   C C  273/2007   on the file of the

District Forum, Prakasam at Ongole

Between :

United India Insurance Company Ltd

Rep. by its Divisional Manager,

H. No. 206 and 207, Saptagiri Towers,

Begumpet, Hyderabad  - 16                                 .. Appellant/opp. Party

And

Thugunta Naga Chandrika,

D/o Srimannarayana, 18 years

R/o Santhanuthalapadu Village and Mandal,

Prakasam District                                             … Respondent/complainant

Counsel for the Appellant            :           Mr. V. Sambasiva Rao

Counsel for the Respondent      :           Mr.  S. Venkateswarlu

Coram           ;           Sri Syed Abdullah              …        Hon’ble Member

And

Sri R. Lakshminarasimha Rao…      Hon’ble Member

Friday, the Sixteenth  Day of July, Two Thousand Ten

Oral Order : ( As per Sri Syed Abdullah,  Hon’ble Member )

*******

Being aggrieved by the order passed in C. C. 273/2007 by the District Forum, Prakasam District  at Ongole directing the opposite party to pay a sum of Rs.3 lakhs with interest at 9% p.a. from the date of repudiation letter dated 16.05.2007 till the date of realization and directing  to reimburse the hostel fee and tuition fee for the period of study subsequent to the death of the  deceased in terms and conditions of the policy and with a further direction  to pay additional compensation of Rs.1000/- and costs of Rs.1000/-.   The impugned order is assailed as erroneous and contrary to the facts and evidence under law.

The facts of the case disclose that  the complainant had taken a policy under Tailor made PA Scheme for Engineering Student Policy bearing  No. 052000/42/000733 dated 25.10.2004.  Subsequent to the issuance of the policy, the complainant’s father died due to snake bite on 08.01.2006.  He was taken to RNR Hospital, Santhanuthalapadu  for treatment where he was admitted for treatment. But on the advice of the doctor,  he was  shifted to Government hospital, Ongole but on the way he succumbed to it and thereby he was taken back to his house  and cremated. Due to sudden death of the complainant’s father, the entire family was suffering and hence no post mortem and panchanama was  done on the dead body. The Village Secretary gave certificate stating that the death of the deceased Srimannarayana was due to snake bite. The complainant got issued a legal notice claiming insurance amount  but the opposite party rejected the same which is attributed as deficiency in service. 

The opposite party in its version has taken the stand that upon happening of any event giving raise to claim under the policy, a written notice with full particulars must be given to the company immediately  and in case of death, written notice also of the death must be given before internment cremation  and in any case within one calendar month  after the death as per the policy condition but the intimation was received by the insurance company after six months of the death as there is a violation of policy condition.   In fact on 09.08.2006, the opposite party requested the complainant  to submit claim papers along with FIR, PM Report, Panchanama etc.   but the same were not furnished except addressing a letter dated 15.11.2006 by the mother of the complainant stating  that her husband died  due to snake bite and she came to know about the existence of the policy only in the month of September, 2006  which is a clear contradiction  to the claim intimation letter dated  22.07.2006 submitted  by the complainant which was received by the opposite party on 09.08.2006.  The company’s investigator submitted his report  which reveals that the deceased was suffering from diabetes  for the last five years  and there are no physical injuries over the body of the deceased and that the deceased felt un-easiness on 08.01.2006 at about 7.00 PM and contacted Medical Officer at Santhanuthalapadu who referred him to go to Ongole and on the way the deceased breathed his last.   Death took place naturally  but not by snake bite.  Condition no. 2 of the policy requires proof for making a claim, as such, cause of death is not established properly. So the Insurance company is justified in repudiating the claim.

During enquiry, on the side of the complainant   Ex. A-1 to A-7 along with evidence affidavit and similarly, Ex. B-1 to B-4 along with evidence affidavit fled by the respective parties.

As there is  no dispute with regard to the issuance of Ex. A-1 insurance policy which is a Tailor made PA Scheme for Engineering Student Policy and that the insured had died  which was certified by the Gram Panchayat Secretary covered by Ex. A-2  and it was corroborated by the Doctor’s certificate under Ex.A-3 which was issued initially to the effect that it was a case of snake bite and that there was an exchange of correspondence between the parties, the District Forum came to the conclusion that the complainant has established  that her father died due to snake bite  and non-payment of insurance claim   amounts to breach of policy conditions.

Point for consideration is,  whether the impugned order suffers from any factual and legal infirmity ?

Undisputedly, the policy was issued which has laid down certain terms and conditions.  Conditions of Ex. A-1 are relevant  to appreciate  the contentions of the parties.

1.         Upon the  happening of any event which may give  rise to claim under this insurance,  written notice with full particulars must be given to the company immediately.  In case of death, written notice also of the death must, unless reasonable cause is shown, be so given before internment cremation,   and in any case,  within one calendar month after the death

2.         Satisfactory proof of the company shall be furnished of all mattes upon which a claim is based.  Any Medical  or other agent of the company shall be allowed to examine the person of  the insured on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the company  and in the event of death to make a post-mortem examination of the body of the insured.  Such evidence  as the company may from time to time requires shall be furnished and a post-mortem examination report, if necessary, be furnished within the space of fourteen days after demand in writing.  Providing that in case of claims by death all sums payable hereunder shall be payable only on the delivery of this policy for cancellation and discharge.  “ No sum payable under this policy shall carry interest “.

The dates are very much relevant  to accept the version of the complainant. The policy was issued on 25.10.2004 covering the educational study period of four years up to 25.10.2008.  The policy covers personal accident scheme for engineering students and parent in the event of death of any of those persons to have the benefit, i.e., the complainant is entitled to the benefits of the policy in the event of accidental death.  Even according to the complainant, her father was taken to RNR hospital, Santhanuthalapadu for treatment where he was admitted for treatment but the doctor advised to shift the patient to Government Hospital, Ongole. So in the said process on the way he succumbed to it  and thereby  he was taken to his home and performed the obsequities .  Ex. A-3 is the photo copy of the letter dated 08.01.2006 addressed by the Managing Director of  RNR Hospitals Private Limited , Santhanuthalapadu on his letter head addressed to Duty Medical Officer, Government Hospital,  Ongole expressing his opinion  that it is a case of snake bite of one T. Srimannarayana who is referred to Government hospital for treatment.  On the face of record Ex. A3 appears to be a fabrication subsequently. In case of admission in any hospital, whether it is private or Government  the name of the patient will be registered in casualty register  noting down the details.  It is not known why  the complainant has not produced the record pertaining to the admission in the hospital.  Except Ex. A-3 a requisition said to have been issued to the Government hospital, Ongole, in which, there is a mention that the person had snake bite.  Ex. A-2 is the death certificate  issued by the Sarpanch which counter signed by the Village Secretary of the village stating that the villagers by name T. Srimannarayana , S/o Venkateswarlu, who had gone to calls of nature  in the fields  and that he became a victim of snake bite which caused his death. Death certificate cannot be issued by the sarpanch or panchayat secretary. On the intimation sent  by the village officers, the concerned Registrar of Births and Deaths will record the information and then will issue a certificate.  Significantly, in Ex. A-3  there is no mention  when the deceased family members have given intimation that the said person was  the victim of snake bite as alleged.  Though the incident had taken place  on 08.01.2006, a registered notice Ex. A-7 was sent to OP on 08.05.2007 after lapse of 16 months, for which,  the opposite party insurance company sent a reply dated 16.50.2007 stating that on receiving the claim intimation letter  on 09.08.2006 claims forms were sent advising to furnish relevant papers substantiating the cause of death and that the claim forms and a letter dated 15.11.2006 was received but it is not enclosed by FIR or post mortem certificate  and on that an investigator  was appointed who submitted a report  on 21.11.2006 and on analyzing  the entire set of facts they opined that the cause of death was not due to snake bite and therefore repudiated the claim.  when condition no. 1 of Ex. A-1 policy is very clear that in case of death written notice also of the death is to be informed  within a period of one calendar month.  It cannot be said that the complainant is an illiterate or innocent person as such  she could not bring it to the notice of the opposite party/insurance company.  When she is able to contact the sarpanch and village secretary, it is not known why she had delayed to send the intimation to the Insurance company at an earliest point of time. Unless the fact of the death is proved by producing necessary evidence, the insurance company cannot entertain the claim automatically.  Condition nos. 1 and 2 are to be complied with.  The District Forum relying on a decision of National Commission reported in 2006 (1) CPC page 230 held that  “ death of the insured by snake bite, post mortem report not required – doctor certificate sufficient”.   There is no dispute with regard to the legal proposition. In this case, the death certificate is not obtained or produced.  Ex. A-3 is only a requisition said to have been given by the private doctor to the Government hospital expressing that the person had snake bite which cannot be considered as an authentic certificate  issued by the Medical officer.  The concerned doctor’s affidavit evidence is also not produced. Ex. A-3 throws  any amount of doubt when it is not accompanied with the details of the admission of the hospital and treatment given there.  When condition no. 1 imposes contractual  obligation on the beneficiary to inform full particulars of cause of death immediately or in case of death written notice is to be sent within one calendar year  after the death,  the claim was sent on 09.08.2006 after lapse of 7 months.  At least, the complainant could have given a report to the police bringing it  to their notice as the death was not natural one.  In all cases of un-natural deaths, the  police are necessarily to be informed  to register a crime so as to  submit its report U/s. 174 Cr. P. C.  The post mortem certificate is not essential if death is confirmed.  But the lodging of FIR by the police is essential even after the incident.   There is no reason why the investigators  report is to be dis-believed.  Investigator  is expected  to make enquiry and submit his report.  After going through the factual aspects and evidence on record, we are of the considered opinion that the order of the District Forum  is not sustainable  and it is liable to be set aside.

In the result,  the appeal is allowed setting aside the order dated 14.12.2007 in CC No. 273/2007 on the file of the District Forum, Prakasam at Ongole.  Consequently,  the complaint is dismissed. But no costs in the appeal.

Sd/-MEMBER

                                                                                                                                                                  SD/-MEMBER

                                                                                                                                                                  DATED : 16.07.2010