Rajasthan

StateCommission

A/368/2018

Kamlesh Kumar Meena s/o Lat. Ramji Lal Meena - Complainant(s)

Versus

Star Health and Allied Ins. Co. Ltd. - Opp.Party(s)

Gopal Shastri

05 Mar 2019

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 368/2018

 

Kamlesh Kumar Meena s/o Late Ramjilal Meena r/o village Dhani Jagala Chhareda Tehsil Nagal Rajavatan Distt. Dausa.

Vs.

Star Health & Allied Insurance Co. Ltd. through MD, regd office 1, New Tonk Street, Valuever Kotam High Road, Nungabakam, Chennai & ors.

 

Date of Order 5.3.2019

Before:

Hon'ble Mrs. Justice Nisha Gupta- President

Mrs. Meena Mehta -Member

 

Mr. Gopal Shastri counsel for the appellant

Mr.S.S.Khandelwal counsel for the respondents

 

BY THE STATE COMMISSION ( PER HON'BLE MRS. JUSTICE NISHA GUPTA,PRESIDENT):

 

2

 

This appeal is filed against the order of the learned District Forum, Jaipur 4^th dated 1.6.2018 whereby the Forum below has directed the Insurance Company to decide the claim on merits within two months.

 

The contention of the appellant is that his father has died due to snake bite, an accidental death. Visceras were never taken and sent for analysis report hence, he was not in a position to submit chemical report of the viscera and the claim should have been allowed.

 

Per contra the contention of the respondent is that death was not accidental. As per the certificate of Secretary Gram Panchayat Chhareda the death was natural and the claim should have been dismissed.

 

Heard the counsel for the parties and perused the impugned judgment as well as original record of the case.

 

The contention of the respondent before the Forum below was that the viscera report of the deceased has not been

 

3

 

submitted but as per the statement of the doctor who has conducted the postmortem report it is more than clear that visceras were never taken and sent for chemical examination. Per contra as per postmortem report the deceased has died due to snake bite. The panchnama of the body was prepared immediately and all the participants of the panchnama were of the opinion that the death has caused due to snake bite and on right foot the sign of snake bite was found. Claim has been submitted showing the death due to snake bite. The Insurance Company has appointed investigator. The investigator has relied upon the certificate of Secretary Gram Panchayat Chhareda but this certificate has been obtained on 9.1.2016 whereas the death has caused on 11.4.2015. No reason has been shown that what occasion has arisen for the investigator to obtain such certificate from the Secretary and even Secretary is not competent to issue the certificate as regard to cause of death. Investigating report also recites that number of persons have stated that the cause of death was long illness but no documentary evidence for illness is being collected and even the statement of the concerned persons from whom the investigation has been done were not placed on record with the investigation report. Per contra the police has investigated

4

 

u/s 174 CrPC and it was found that it was a case of snake bite hence, it is more than clear that the deceased has died due to snake bite, an accidental death.

 

The contention of the Insurance Company is that investigation is pending against the doctor in another case. Be that may be the case the postmortem report which has not been questioned by the Insurance Company should have been relied.

 

The other contention of the insurance company is that the claim has been filed with delay. This issue has already been dealt by the Forum below and the insurance company has not preferred any appeal objecting the same.

 

The other contention of the appellant is that the complainant is not only heir of the deceased but there is no dispute about the fact that the complainant is the nominee in the policy and this fact has also been verified by the investigator. Hence, the claim should have been allowed.

 

The counsel for the appellant has rightly relied upon the judgment passed by this Commission in First Appeal No.

5

 

179/2018 Ramesh Chand Saini Vs. HDFCI RGO General Insurance Co. where in the similar issue the Commission has allowed the claim.

 

Here in the present case the only contention of the insurance company is that death is not accidental but as considered above the death has been caused by snake bite. It was accidental death hence, the claim should have been allowed.

 

In view of the above, the appeal is allowed. The appellant is entitled to get Rs. 15 lakhs sum assured alongwith 9% interest from the date of presentation of the claim. The appellant is further entitled to get Rs. 25,000/- as cost of proceedings.

 

(Meena Mehta) (Nisha Gupta)

Member President

 

nm