DATE OF FILING- 2.12.2011
DATE OF DISPOSAL-11.12.2013
O R D E R
Miss S.L.Pattnaik,President
The case of the complainant in a nutshell is that his wife Smt.Kuni Sahu had opened one S.B.Account with the Opposite Party No.1,Rushikulya Gramya Bank,Hatiota Branch( now the bank’s new name is Utkal Grameen Bank) bearing Accont No.1466 on dated 29.5.2009. The said account was having coverage of insurance of Rs.1,00,000/-(Rupees one lakh) under Surakhya Scheme of the bank. The Opposite Party No.2, the Oriental Fire and General is to
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indemnify the account holder under the scheme viz.Janata Personal Accident Insurance Scheme. The complainant alleges that his wife while going to take bath to his village tank ghat, on 1..6.2010 at about 7 .00 P.m.was bitten by a poisonous snake and as a result she died . Subsequently, the complainant approached to Opposite Party No.2 with an application dt. 4.6.2010 requesting for settlement of the claim. The Opposite Party No.2 supplied the claim form on the letter of Opposite Party No.1 and the complainant submitted the form, duly filled in, alongwith death certificate. But the Opposite Party No.2 did not settle the claim and the complainant finding no other alternative but to file this case praying therein for settlement of claim amount of Rs.1,00,000/- and compensation for harassment and mental agony caused to him due to deficiency in service of the Opposite Parties.
2- The Opposite Parties entered their appearance through learned counsels and filed their written version separately. The Opposite Party No.1 in its written version has not disputed that Smt.Kuni Sahu was having valid S.B.Account No.1466 and the same carries insurance benefit of Rs.1,00,000/-. It is further stated that on the approach of the complainant, the bank wrote to O.P.No.2 for supply of claim form vide letter dated 8.6.2010 and 10.7.2010 and on 12.1.2013 the O.P.NO.2 was requested to settle the claim of the complainant. However, it is clarified that the Insurance Company(O.P.No.2) is to settle the claim as they received insurance premium against the concerned account.
The Opposite Party No.2 in its written version has, inter-alia, stated that the complainant has not furnished the relevant papers i.e. legal heir certificate, medical report in support of the claim despite several reminders as a result the claim of the complainant was not settled. However, the Opposite Party No.2 raised objection regarding maintainability of the case on the ground of limitation, jurisdiction and non-joinder of necessary parties and prayed for dismissal of the case.
We have gone through the case in detail, perused the documents relied on and written arguments filed by both the parities. Heard the case from both the sides at a length. It is not disputed that the deceased Kuni Sahu had opened a S.B.Account No.1466 in the bank of the Opposite Party No.1. It is also an admitted fact that she was covered with group insurance scheme of the Opposite Party No.2 for the insured sum of Rs.1,00,000/-. It is the case of the complainant that his wife Kuni Sahu died due to snake bite on 1.6.2010 and he has obtained a copy of the entry made in the P.H.C.,Kabisuryanagar under Serial No.266 on dated 11.6.2010(Annexxure-3). He has also obtained the certificate of the Sarapanch of Kaniary Gram Panchayat regarding the death of Kuni Sahu due to snake bite in the village on 1.6.2010. It is
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pleaded by the learned counsel for the complainant that the deceased was bite by a poisonous snake while going to take her bath in village tank. Subsequently, as per Hindu custom ritual was made in presence of the village people. According to the complainant, when the claim was filed the Opposite Parties did not pay the amount which amounted to deficiency in service.
On the other hand, Opposite Party No.1 contended that the claim has to be settled only by the insurance company i.e. O.P.No.2 and their duty is to facilitate the arrangement of insurance cover and otherwise there is no responsibility, that they have no role except to forward the claim application. So they have not committed any deficiency of service for which they would be liable to answer the claim of the complainant.
The learned counsel for the Opposite Party No.2 urged that as demanded by the insurance company, necessary documents like police report or post mortem report, medical report, etc. were not produced, and, therefore, they were unable to settle the claim, which can not be described as deficiency of service.
It is not the case of the complainant that his wife met with a road accident for which a case was required to be registered, followed by investigation, in which postmortem involved, etc. It is the specific case of the complainant, that his wife while going to take bath in her village tank, met with an accident viz. snake bite, for which despite initial treatment given there, died and then ritual was made in their village as per Hindu custom. The above facts so pleaded, are not seriously disputed. Even in the written version also, we are unable to find any specific plea, such as the complainant’s wife ,did not die due to snake bite or this kind of death will not cover or come under the Insurance Policy obtained by the deceased, which is the subject matter. Snake bite is not a crime and no F.I.R. can be lodged against snake. Therefore, without understanding the nature of death insistence of the Police papers or postmortem report and other connected documents by the insurance company should be held as negligent act and deficiency in service. When postmortem was not admittedly conducted, and when the complainant has repeatedly said that her ritual was made as per Hindu customs, we do not understand the logic of the insurance company, insisting postmortem certificate as well as police intimation, etc. Rather, the Opposite Party No.2 should have deputed their Agent to make confirmation about the cause of death from the village to settle the claim.
Therefore, when a claim was lodged by the legal heir of the deceased, serving the purpose of the Group Insurance Scheme, would have served properly and they should not have evaded their responsibility, insisting to do certain impossible things for which no documents were available admittedly. Since the claim was not settled, insisting the documents, which can
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not be in existence, the act of the Opposite Party No.2 should be construed , not only as negligent but also deficiency in service. Hence, this order.
In view of the above findings and considered to the circumstance of the case, we allow the case of the complainant. We direct the Opposite Party No.2 to pay Rs.1,00,000/-(Rupees one lakh) the insured amount against insurance cover of Kuni Sahu to the complainant within 30 days from the date of receipt of this order. In the event of non-compliance of the order within the specified period as above, the Opposite Party No.2 is liable to pay interest on the insured amount of Rs.1,00,000/- at the rate of 6 per cent per annum from the date of order till actual payment.
The case is disposed of accordingly with an order of Rs.2000/-(Rupees two thousand) towards cost of litigation to be paid by the Opposite Party No.2 to the complainant within the period as specified above.
Copy of the order be furnished to the parties free of cost.
Dictated and corrected by me on this 11th day of December,2013
I AGREE(MEMBER) I AGREE(MEMBER) PRESIDENT
