This is a complaint filed U/s. 12 of Consumer Protection Act by K.Veeraraghavalu against the Respondent-United Insurance Company Ltd., Branch Sindhanoor. The brief facts of the complaint are as under:-<br /> <br /> The complainant’s father K.Veeraraghavalu had insured his life under Janatha Personal Accident Insurance Policy for a period of (10) years from 23-11-1998 to 22-11-2008 under policy No. 618/98 for a sum of Rs. 5,00,000/- with the Respondent Insurance Company. His father K.Veeraraghavalu died on 04-05-05 due to snake-bite at Venkatagiri Camp. Immediately thereafter the victim was shifted to local hospital of Registered Medical Practitioner in the camp for treatment and the victim died in the hospital on the same day due to snake-bite. The dead body of his father was cremated as per the customs prevailing in the community and within a period of one week from the date of death of his father, his mother also died on 10-05-05 as such the complainant suffered great mental shock and agony due to immediate and ultimately death of his parents.<br /> <br /> His late father K.Veeraraghavalu during his life time was looking after all the family affairs of the family as Karta. As such the complainant has no knowledge about the Insurance policy taken by his late-father during his life time. Due to this lack of knowledge the complainant has no knowledge about the terms and conditions of the policy and due to this bonafide reason no complaint was filed reporting the death of his father to the concerned authority and no Post Mortem Examination of the dead body of his father was conducted. The complainant is the only surviving member and legal heir of his deceased father K. Veeraraghavalu.<br /> <br /> The complainant has submitted application along with relevant records to the Respondent on 24-01-06 for the settlement of policy amount but the Respondent has not at all settled the matter and prolonged on one or other pre-text. The complainant has also produced Medical Certificate and other records to show that his father died due to snake-bite. In-spite of furnishing all the relevant records the Respondent prolonged the matter and without enquiry threatening the complainant to close the file as “No Claim” through letter dt. 09-03-06. This attitude of the Respondent shows deficiency in service by the Respondent. Hence for all these reasons the complainant has sought for direction to the Respondent to make payment of policy amount of Rs. 5,00,000/- with 12% interest from 04-05-05 the date of death of his father till realization along with Rs. 10,000/- towards damages.<br /> <br /> 2. The Respondent Insurance Company has filed written statement contending that there is no cause of action to file the complaint, as there is no deficiency of service by the Respondent. It is falsely contended that the father of the complainant by name K.Veeraraghavalu died due to snake-bite and was treated by R.M.P. doctor and later he died in the hospital on the same day and without the knowledge of existence of policy his body was cremated without conducting Post Mortem Examination on the dead body. The complainant has not produced necessary documents for settlement of claim which are required to prove the death due to snake-bite and also other required documents demanded by the Respondent and so there is violation of policy in-question. It is not within the knowledge of this Respondent that the complainant is only the legal heir. The amount of compensation claimed is excessive, exorbitant and out of proportion and without documentary proof. Hence for all these reasons the Respondent Insurance Company has sought for dismissal of the complaint.<br /> <br /> 3 During the course of enquiry the complainant has filed his sworn affidavit and the affidavits of witness-B.Satyanarayana and Dr. K.Shivaram krishna prasad by way of examination-in-chief as PW-1,2,& 3 and got marked (17) documents at Ex.P-1 to P-17. In-rebuttal the Respondent Insurance Company has filed sworn affidavit of Divisional Manager of Respondent Company as evidence and got marked (5) documents at Ex.R-1 to R-5.<br /> <br /> 4. Heard the arguments of both sides and perused the records. The following points arise for our consideration and determination:<br /> 1. Whether the complainant proves deficiency in service by the Respondents in not settling his claim under insurance policy, as alleged.?<br /> <br /> 2. Whether the complainant is entitled for the reliefs sought <br /> for?<br /> <br /> 5. Our finding on the above points are as under:-<br /> <br /> 1. In the affirmative. 2. As per final order for the following.<br /> <br /> REASONS<br /> POINT NO.1:-<br /> <br /> 6. There is no dispute that late K.Raghavalu the father of complainant had insured his life under Janatha Personal Accident Insurance Policy for a period (10) years from 23-11-1998 to 22-11-2008 under policy No. 618/98 for a sum of Rs. 5,00,000/- with the Respondent Insurance Company. There is also no dispute that this insured K.Veeraraghavalu died on 04-05-05. But the bone of contention between the parties is according to the complainant his father K.Veeraraghavalu died on 04-05-05 due to snake-bite which has been disputed by the Respondent Insurance Company. It is also contended by the Respondents that the complainant has failed to produce necessary and relevant documents to show that his father died due to snake-bite and all other required documents demanded by the Respondent. So the claim of the complainant was closed as “No Claim”.<br /> <br /> 7. The complainant has produced (17) documents at Ex.P-1 to P-17. Out of which Ex.P-3 is the Death Certificate of K.Veeraraghavalu. Ex.P-4 is the Death Certificate of K.Chandravathi W/o. K.Veeraraghavalu. Ex.P-5 is the affidavit of the complainant filed with the Respondent. Ex.P-6 is the attested copy of Medical Certificate dt. 10-01-06 issued by Dr. K.S.R.K. Prasad. Ex.P-7 is the Medical prescription dt. 04-05-05. Ex.P-11 to P-14 are the letter/correspondence made by the Respondent with the complainant on different dates regarding death claim of late K.Veeraghavalu. Ex.P-15 is the letter of the complainant dt. 09-01-06 to the Respondent requesting for early settlement of death claim of his father. Ex.P-16 is the Family Pedigree of late K.Veeraraghavalu issued by Village Accountant, Rowdu Kunda. Ex.P-17 is the Medical Certificate dt. 10-01-06 issued by Dr. K.S.R.K. Prasad. The attested True copy of which is already marked as Ex.P-6.<br /> <br /> The Respondent has produced (5) documents at Ex.R-1 to R-5 namely: Ex.R-1 to R-4 are the letters of the Respondent addressed to the complainant on four different dates. Ex.R-5 is the copy of Janatha Personal Accident Insurance Policy.<br /> <br /> 8. As seen above Ex.P-11 to P-14 are the letters/correspondence made by the Respondent to the complainant on different dates for producing required documents like Post Mortem Examination Report and FIR/Panchanama since as per the policy conditions in the event of death claim Post Mortem Report by the Government Hospital is mandatory. Through the last letter dt. 24-03-06 at Ex.P-14 the Respondent informed that in-spite of correspondence, the complainant has not submitted required documents hence as per the terms and conditions of the policy non-submission of required documents, the claim is not admissible and so the claim is not payable. <br /> <br /> 9. The learned counsel for the Respondent Company argued that in-spite of correspondence made by the Respondent, the complainant failed to produce required documents like Post Mortem Examination Report of the dead body of his deceased father FIR/panchanama so on the failure of the complainant in producing these documents the Respondent Company had no other go than to close the file as “No Claim” and hence there is no deficiency in service by the Respondent. <br /> On the other hand the learned counsel for the complainant argued that immediately after the snake-bite the insured/victim K.Veeraraghavalu was shifted to local hospital of Registered Medical Practitioner in the Camp for treatment where he died on the same day i.e, on 04-05-05 due to snake-bite. Further the complainant had no knowledge about the insurance policy taken by his late father insured as such the dead body of his father was cremated as per custom in their community and so due to bonafide reasons no complaint was filed reporting the death of his father to the concerned authority and no Post Mortem Examination was conducted on the dead body of his father. Under these circumstances the complainant has not produced Post Mortem Examination Report and FIR. But however the complainant has filed Medical Certificate at Ex.P-6 and Medical Prescriptions at Ex.P-7 to show that his late father K.Veeraraghavalu died due to snake-bite. The Respondent Insurance Company could have given attention to these documents and could have released the policy amount but instead of that, Respondent went on making repeated correspondence asking to produce Post Mortem Examination and FIR/Panchanama and in-spite of furnishing the relevant records the Respondent without enquiry has closed the file as “No Claim” through letter dt. 09-03-06. This attitude of Respondent discloses deficiency in service by the Respondent. In-support of his argument the learned counsel has relied on decision reported in (1) III (2006) CPJ 199 of Rajasthan State Commission Head Note. (2) 2001 CPR Page 32 by State Commission Lucknow-Head Note. (3) 2001(2) KCCR 1034 Karnataka High Court Head Note. (4) III (2002) CPJ 134 National Commission Head Note and (5) 2006 (i) CPR Page 327 (NC) Head Note.<br /> <br /> 10. The First ruling of Rajasthan State Commission reported in III (2006) CPJ 199 Head Note reads as under:<br /> “Consumer Protection Act, 1986__ Section 2(1) (g)__ Insurance__Group insurance policy__Death of insured due to snake bite__Certificate issued by doctor to such effect__ Claim repudiated on ground, fact of death due to snake bite not proved by way of post-mortem report__Certificate of doctor appeared genuine and reliable__ illegality committed by Forum in relying upon same__Also, in case of snake bite, post-mortem report not necessary, same could be certified or proved by doctor__Absence of post-mortem report not makes certificate of doctor unreliable__ Repudiation unjustified__Insurer liable.”<br /> <br /> In para- 12 of this judgment the Hon’ble State Commission Rajasthan has observed a supporting decision of Hon’ble National Commission reported in Dharmisetty Srinivas Rao V/s. New India Assurance Co. Ltd., reported in I (2006) CPJ II (NC) wherein the Hon’ble National commission has held as under:<br /> “In case of snake-bite, post mortem report is not necessary and the fact that the death had taken place due to snake-bite could be certified or proved by the doctor.”<br /> <br /> and further observed in Para-13 as under:-<br /> “When this being the position of law, in the present case if the fact of death by snake-bite had been established by the doctor’s certificate, therefore, if post-mortem of the body of the deceased was not got conducted and no post mortem report is available, it would not make the doctor’s certificate unreliable.”<br /> <br /> <br /> The Second ruling of State Commission Lucknow reported in 2000 (i) CPR 32 <br /> Head Note reads as under:<br /> “Consumer Protection Act, 1986__ Section 14(1) (d)__Insurance claim__Compensation__Accident__Meaning of__Deceased took accident and disability policy in her name__ Deceased sitting on a Motor Cycle fell down__Died after a month__complainant lodged claim__Repudiated__ Contention that there is no evidence that accident took place in the public place and neither any FIR lodged nor any post-mortem examination done on the insured__Contentions held, not tenable__Appeal dismissed.”<br /> <br /> In para-9 it is observed that:<br /> “Non furnishing of First Information Report and Post-Mortem examination report will not mean that no accident has taken place. In such cases when there was no collusion between the two vehicles or an incident of this nature. No offence was committed under the provisions of Indian Penal Code or any other enactment. Therefore, there was no necessity of lodging any FIR and getting post-mortem examination done.”<br /> <br /> The last ruling of Hon’ble National Commission reported in 2006(i) CPR 327 (NC) Head Note reads as under:<br /> “Consumer Protection Act, 1986__ Section 21 (b)__Revision petition against concurrent finding of deficiency in insurance service__Personal Accident Policy__Accident due to fall at borewell__Due to poverty, injured was not taken to hospital and died__Supported by affidavits of sarpanch__Insurance Co. repudiated claim on belated report of its investigator that death was due to malaria__Consumer Fora found this rejection perverse__Whether can be disturbed in revision? (No)__Revision dismissed.”<br /> <br /> 11. Bearing in-mind the principles laid-down in the above said Rulings it is clear that absence of Post Mortem Examination Report not makes certificate of doctor unreliable. In the instant case according to the complaint and his affidavit-evidence it clearly shows that immediately after snake-bite on 04-05-05 the victim/insured K.Veeraraghavalu was shifted to local Registered Medical Practitioner in the camp (Venkatagiri camp) for treatment and he died in the hospital on the same day. This contention of the complainant has been supported by the Medical Certificate issued by Dr. KSRK Prasad RMP doctor at Venkatagiri Camp vide Ex.P-6 and the treatment given by this doctor by prescribed injections at Ex.P-7. The Medical Certificate at Ex.P-6 and Medical-Prescriptions at Ex.P-7 go to show that the victim/insured K.Veeraraghavalu was admitted in the hospital of Dr. KSRK Prasad at 6-00 PM on 04-05-05 and he died at 6-15 PM due to snake bite and was discharged at 6-30 PM.<br /> <br /> 12. The Respondent Insurance Company have not disputed or produced any rebuttal evidence to contravert the geniuses of the Medical Certificate at Ex.P-6. Hence having regard to the dictum laid-down in the first ruling of Rajasthan State Commission referred to above which is based on the decision of Hon’ble National Commission reported in Dharmisetty Srinivas Rao V/s. New India Assurance Co. Ltd., reported in I (2006) CPJ-II (N.C) the absence of Post Mortem Examination Report not makes certificate of doctor unreliable regarding death due to snake-bite. Under these circumstances the Respondent Insurance Company was not right in repudiating the claim of the complainant for non-production of Post Mortem Examination Report and FIR/Panchanama. Therefore we hold that the complainant has proved deficiency in service by the Respondent in not settling his claim. So Point NO-1 is answered in the affirmative.<br /> <br /> POINT NO.2:-<br /> <br /> 13. The complainant has sought for direction for payment of policy amount of Rs. 5,00,000/- with interest of 12% p.a. from the date of death of his father/ insured till realization along with damages of Rs. 10,000/-. In-view of our finding on point No-1 and having regard to the facts and circumstances of the case we pass the following order:<br /> <br /> ORDER<br /> <br /> The complaint of the complainant is allowed in part.<br /> <br /> The Respondent shall pay policy amount of Rs. 5,00,000/- to the complainant along with a global compensation of Rs. 5,000/- under both heads as claimed.<br /> <br /> The Respondent shall comply this order within six weeks from the date of receipt of copy of this order.<br /> <br /> Office to furnish certified copy of this order to both the parties forth with free of cost.<br /> <br /> (Dictated to the Stenographer, typed, corrected and then pronounced in the open Forum on 22-02-07)<br /> <br /> Sd/-<br /> Sri. N.H. Savalagi,<br /> President,<br /> District Forum-Raichur.<br /> <br /> Sd/-<br /> Sri. Pampannagouda, <br /> Member<br /> District Forum-Raichur.<br /> <br /> <br /> On leave. <br /> Smt.Kavita Patil, <br /> Member. <br /> District Forum-Raichur<br /> <br />