BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
and
Smt.C.Preethi, Hon’ble Lady Member
Friday the 13th day of October, 2006
C.C.No.71/2006.
Sri. Chittu Baliza Govindu,
S/o. Smt. C.B. Erramma,
H.No:1-6, Yenugubala Village,
Yemmiganur Mandal,
Kurnool District. …Complainant
-Vs-
1. The Manager,
National Insurance Company Limited.,
Regd. Office:3 Middleton Street,
Kolkatta – 700 071.
2. The Manager,
National Insurance Company Limited.,
Gandhi Nagar,Kurnool. …Opposite parties
This complaint coming on this day for Orders in the presence of Sri. A.Prabhakara Reddy, Advocate, Kurnool for Complainant, Sri. L.Harihara Natha Reddy, Advocate, Kurnool for Opposite Parties No.1 & 2 , and stood over for consideration till this day, the Forum made the following:-
C.C.No.71/06
As per Smt. C.Preethi, Honb’ble Lady Member
1. This consumer complaint of the complainant is filed under section 12 of C.P. Act, 1986 seeking a direction on opposite No.1 to pay Rs.1,00,000/- assured amount to the complainant with 12% interest per annum, Rs.20,000/- towards compensation, Rs.2,000/- towards costs and any other relief are reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s daughter Chitu Baliza Erramma was a member of Golden Multi Services Club Limited, who has taken a Janata Personal Accident policy from opposite party No.1 covering its members. The opposite party No.1 issued a policy bond in favour of the deceased Erramma after receiving premium of Rs.357/-. The said policy commenced from 15.07.2004 to 14.07.2009 and nominated the complainant as her nominee. The policy holder on 13.10.2004 died due to Snake bite while doing agricultural operations, and immediately admitted in Primary Health Centre, Divamdinne, for treatment but she died on the same day. A Medical Certificate was issued by the Medical Officer, Primary Health Centre Divamdinne, as to the cause of Death of the policy holder as Snake bite. The complainant on 28.01.2005 submitted claim form along with relevant documents for assured sum but to the dismay of the complainant opposite party No.1 rejected the claim through its letter dated 08.03.2006. Therefore, there is deficiency of service on part of opposite party No.1 for not paying assured amount to the complainant and the complainant resorted to the Forum for Redressal.
3. In support of his case the complainant relied on the following documents Viz.(1)Attested Xerox copy of policy bearing No.100300/42/04/8200012 issued to the deceased Erramma (2)Office copy of letter dated 05.04.2005 issued by complainant’s counsel to opposite party 1(3)Attested Xerox copy of death certificate issued by Mandal Revenue Officer dated 20.11.04 (4) Attested Xerox of certificate issued by Primary Health Centre.(5)Repudiation letter dated 08.03.2006 issued opposite party No.1 to the complainant.(6)Attested Xerox copy of claim form dated 01.02.2005, besides to the Sworn of Affidavit of the complainant in reiteration of his complainant averments and the above documents are marked as Ex.A1 to A6 for its appreciation in this case. The complainant caused interrogatories to opposite party and suitablely replied to the interrogatories caused by the opposite party.
4. In pursuation to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case by filing denial written version.
5. The written version of opposite parties denies the complaint allegations as not maintainable either in law or on facts and admits the complainant’s daughter Erramma has taken policy, bearing No.100300/42/04/8200012 dated 15.07.2004 for Rs.1,00,000/-. The death of the policy holder was intimated by submitting the claim form after 7 months 10 days. The complainant alleged that his daughter died due to Snake bite but did not produce F.I.R., Postmortem report and final investigation report of concerned police to prove that the deceased death is due to Snake bite and no case is registered with the police which itself shows that the complainant filed false claim with an intention to get wrongful gain. The opposite parties further submits that upon happening of any event which may give rise to a claim under the policy issued by opposite party written notice with all particulars must be given to the company immediately. In case of death written notice must be given within one calendar month after the death and the claim should be given within thirty days by the claimant to the opposite party. With regard to the claim form it should be submitted with all necessary supporting documents within 90 days from the happening of the accident and any claims submitted after 90 days shall not be entertained as per terms and conditions of the policy. The complainant intimated the death of the policy holder after 7 months 10 days and claim form is submitted of 7 months 10 days, it is clear violation of terms and conditions of the policy. Hence, the opposite party No.1 is not able to entertain the claim of the complainant and treated the claim as “No Claim”. Hence there is no deficiency of service on part of opposite party No.1 in treating the claim as no claim and seeks for the dismissal of the complaint with costs.
6. In support of their case the opposite parties relied on the following document i.e., (i)attested Xerox copy of policy along with terms and conditions, besides to the Sworn Affidavit of opposite party No.2 and the above document is marked as Ex.B1. The opposite party No.2 caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
7. Hence the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite party:?
8. It may be stated at the out set that the dispute involved in this case centers round the claim of the complainant for Rs.1,00,000/- policy amount and the dispute of the same is raised by the opposite party by simply putting the complainant to strictly prove the material allegations of the complaint. The material facts that emerge from the pleadings, contents of the documents and the Sworn Affidavit of the complainant etc., that the complainant is a nominee of the deceased Erramma, who insured with opposite party No.1 for Rs.1,00,000/- by paying premium amount of Rs.357/- on 15.07.2004 and a policy was issued Vide Ex.A1 and the same was valid from 15.07.2004 to 14.07.2009. The deceased Erramma died on 13.10.2004 due to Snake bite and the complainant informed and sent required documents to opposite party No.1 to settle the claim, however the opposite party No.1 repudiated the claim of the complainant as the complainant did not file F.I.R., Postmortem report and the death intimation was given by the complainant belatedly i.e., after 7 months 10 days. The complainant’s produced Ex.A3 and A4 attested Xerox copies of death certificate dated 20.10.04 and 20.11.04 where in it was mentioned the cause of death of deceased Erramma was due to Snake bite.
9. The opposite parties No.1 pleaded that the claim of the complainant cannot be settled as the complainant did not file documents like F.I.R., Postmortem report, final report of police etc., and the death intimation was given belatedly and the complainant’s has to strictly prove that the said Erramma death is due to Snake bite.
10. While the sheet anchor objections of the opposite parties that the complainant failed to produce F.I.R. Postmortem etc., is untenable as asserted by the learned counsel for the complainant. It is pertinent to note that in the Ex.A3 and A4 the cause of death of Erramma, was a cleanly mentioned as due to Snake bite, and such it remains clear in the light of Ex.A3, and A4 that the cause of death of Erramma was due to snake bite and the opposite party No.1 cannot rejected the claim or escape their liability by insisting on production of F.I.R., postmortem report, final report of police etc. The learned counsel for the complainant strongly submitted that the opposite party No.1 cannot insist for F.I.R. Postmortem report in view of ruling of Hon’ble A.P. State Commission reported in the 2000 A.L.D (II) page No.96, where in it was held that when the cause of death of the policy holder is due to snake bite but not a suspicious one, obtaining F.I.R. and other documents does not arise, the other decision relied by the complainant is Hon’ble Rajasthan State Commission reported in 2005(I) C.P.J page 119, it was held that, if the insured died due to snake bite and the insurance company repudiated the claim for not filing F.I.R. and postmortem report where as the death certificate issued by concerned Doctor shows that death was due to snake bite and the same is not rebutted by opposite parties by placing any evidence, hence it is proved that the death is due to snake bite and the insurance company is liable to pay assured amount.
11. To sum up of the above discussion and following the above decisions of A.P. State Commission and Rajasthan State Commission and the material available on record shows in the opposite party No.1 (Insurance company) cannot escape there liability from settling the claim as the death certificate in Ex.A3 and A4 clearly certified that the deceased was brought to the hospital on 13.10.2004 AM the body colour changed into black and expired on the same day as a result of snake bite. The above certificate of the concerned Doctor was not rebutted by opposite parties by placing any cogent relevant evidence, hence it is conclusively establish that the deceased death was due to snake bite.
12. The other plea of the opposite parties is that the complainant intimated the death of the policy holder belatedly but the complainant relied on the decision of Hon’ble Uttar Pradesh State Commission between L.I.C. of India and others Vs Rajendra Singh your reported in IV (2004) page 531, wherein it was held that when intimation of death was delayed but the policy stood in tact and the nominee alone is entitled for the policy amount under the policy of the deceased, hence repudiation by insurance company was held unjustified and insurance company was held liable to pay policy amount to the complainant.
13 To conclude the above discussions and following the above mentioned citation the complainant is perfectly remaining entitled for the assured amount of deceased Erramma. As regards to the claim for compensation for mental agony in the absence of any evidence placed by the complainant, therefore the said claim is rejected.
14. In the result, the complaint is allowed directing the opposite parties jointly and severally to pay to the complainant the assured amount under policy bearing No.100300/42/04/8200012 with 12% interest per annum from the date of filing of this complaint till realization along with Rs.2000/- as costs, within a month of receipt of this order.
Dictation to the Stenographer, transcribed by him, corrected and pronounced in the Open Forum this the 13th day of October, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties: Nil
List of Exhibits marked for the Complainant:
Ex.A1 Attested Xerox of the policy No.100300/42/04/8200012 sum of
Rs.1,00,000/-.
Ex.A2 Office copy of the letter dated:05.04.2005.
Ex.A3 Attested xerox of Death Certificate dated:20.11.2004.
Ex.A4 Attested xerox copy of Death certificated dated:20.11.2004. issued by
Doctor as to cause of death.
Ex.A5 Repudiation letter dated:08.03.2006.
Ex.A6 Attested xerox copy of claiming form dated:01.02.2005.
List of Exhibits marked for the Opposite parties:
Ex.B1 Attested xerox copy of policy along with terms and conditions.
MEMBER PRESIDENT.
Copy to:
Sri. A. Prabhakara Reddy Advocate, Kurnool.
Sri. L. Harihara Natha Reddy, Advocate Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
