BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
VAZHUTHACAUD : THIRUVANANTHAPURAM
PRESENT:
SHRI. G. SIVAPRASAD : PRESIDENT
SMT. BEENA KUMARI .A : MEMBER
SMT. S.K. SREELA : MEMBER
C.C.No. 428/2005 Filed on 19/12/2005
Dated: 16..02..2011
Complainant:
Kamalamma, Russalpuram, Balaramapuram, Thiruvananthapuram.
(By Adv. K. Venugopalan Nair)
Opposite party:
The Manager, The New India Assurance Company Ltd., Divisional Office – 2, II-Floor, K.N. Mathew Building, Gandhari Amman Kovil Road, Thiruvananthapuram – 695 001.
(By Adv. M. Nizamudeen)
This O.P having been heard on 15..01..2011, the Forum on 16..02..2011 delivered the following:
ORDER
SHRI.G. SIVAPRASAD, PRESIDENT:
The facts leading to the filing of the complaint are that, Sri. P. Stephan had taken a Janatha Personal Accident Insurance Claim Policy vide policy No. 431, issued on 5/08/2002 for a sum of Rs. 50,000/-, that the policy was valid from 5/08/2002 to 5/08/2007, that during the validity of the said policy the insured died on 18/6/2004 due to snake bite, that after the snake bite the insured was immediately rushed to a nearby private Vaidyasala namely Bharghavi Vilasom Sidha Medicine and he was treated there but his life could not be saved, that the complainant is the nominee of the said P. Stephan, that she moved death claim to the opposite party, but the opposite party repudiated the claim on the ground that complainant did not produce the Post-mortem certificate. Hence this complaint to direct opposite party to pay the assured amount of Rs.50,000/- with interest along with compensation and cost.
2. Opposite party filed objection contending inter alia that the policy issued by opposite party to the life assured covered accidental death, that as per the terms and conditions of the policy the opposite party is liable to indemnify the insured and pay the insured amount to the nominee only on production of Postmortem Certificate, that inspite of repeated demands complainant did not produce Postmortem Certificate, and thereby opposite party could not honour the claim submitted by the complainant. P. Stephan died due to snake bite is false and baseless, since Postmortem certificate showing the cause of death is not produced by the complainant, that complainant is not entitled to get the assured sum with interest along with compensation and cost, that complainant has no cause of action to file the complaint. Hence opposite party prayed for dismissal of the complaint.
3. The points that arise for consideration are:
Whether the complainant is entitled to get claim amount as per policy?
Whether there is deficiency in service on the part of opposite party?
Whether the complainant is entitled to compensation and cost?
In support of the complaint, complainant has filed proof affidavit as PW1 and has marked Exts. P1 to P9. Two witnesses from the side of the complainant have been examined as PW2 & PW3. In rebuttal, opposite party has filed affidavit and has marked Ext. D1.
4. Points (i) to (iii): Admittedly, Sri. P. Stephen had taken a Janata Personal Accident Insurance Policy No. 431 on 5/8/2002 in the sum of Rs. 50,000/-, that the policy was valid from 5/8/2002 to 5/8/2007, that during the validity of the said policy, the insured died on 18/6/2004. Complainant is the nominee of late Sri. P. Stephen. She moved death claim to opposite party. Opposite party repudiated the claim on the ground that complainant did not produce post mortem certificate. It has been the case of the complainant that the insured Sri. P. Stephen died on 18/6/2004 due to snake bite and opposite party repudiated the claim on flimsy reasons. Evidence of the complainant would consist of oral testimony of PW1 to PW3 and Exts. P1 to P9. Complainant has filed proof affidavit and has been cross examined by the opposite party. Apart from complainant's (PW1) deposition, two witnesses have also been examined as PW2 & PW3. PW2 has deposed that Sri. P. Stephen was bitten by a snake on 18/6/2004 evening at Mudukkonam and he was rushed to Bhargavi Vilasom Vaidyasala at Payarumoodu where his death was declared. In his cross examination, PW2 has deposed that he has been residing near the complainant's residence, that he knows Mr. Stephen from his young age, that on hearing the news that Mr. Stephen was bitten by a snake, he along with other residents assembled there brought him to a Vaidyasala where Mr. Stephen was declared dead. PW2 denied the suggestion put forth by the opposite party that Mr. Stephen's death was not due to snake bite but a natural death. Sri. Viswambharan has been examined as PW3, who has furnished certificate (marked as Ext. P9) issued by Kerala Ayurveda Parampariya Vaidya Federation in which it is seen stated that 'Sri. B. Viswanathan Vaidyan, Bhargavi Vilasom Vaidyasala, Payarummoodu, Mulloor – P.O is the member of this Federation'. In his examination in chief, PW3 has deposed that complainant's husband Mr. Stephen, bitten by a snake was brought to his Vaidyasala on 18/6/2004 at about 4 PM, that he was treated therein and he died after 15 minutes. Though PW3 has been cross examined by the opposite party, nothing was elicited from him to disbelieve his deposition in regard to Stephen's death by snake bite. It is to be noted that in remote villages, it remains the practice that when snake bites a person who may be normally brought by the nearby residents or others assembled therein to the nearest known Vaidyasala for his immediate treatment. In the case in hand also, the same thing happened, the local residents including PW2 brought Mr. Stephen to PW3's Vaidyasala, who attended him and administered him with traditional medicines. The death of the insured due to snake bite was affirmed / supported by Ext. P5 certificate dated 10/7/2004 issued by PW3 and Ext. P8 newspaper (Desabhimani Daily) dated 20/6/2004. Ext. P1 is the Identity card issued by Kerala Panchayat Gramavikasana Society, Muttaikkadu and the New India Assurance Company Ltd. As per Ext. P1 insured's membership No.is 431, policy period is 5/8/2002 to 5/8/2007 and premium amount is Rs. 120/- and complainant is the nominee. A perusal of Ext. P1 reveals that the policy benefit will not be available in case of insured's natural death and suicide. Ext. P2 is the copy of the pamphlet. Ext.P2 deals with the Janatha Personal Accident Insurance Policy. As per Ext. P2 in case of death / disability of the insured, the Insurance Company would give Rs. 50,000/-, that under the said scheme the insured need not pay monthly / yearly amount to opposite party, what needs to be done is that at the time of registration, the insured / member has to pay Rs. 120/- to Insurance Office and Rs. 40/- towards Society's service charges. Ext. P3 is the membership form issued by the Kerala Panchayat Grama Vikasana Society. As per Ext. P3, member's name is P. Stephen and the name of the person who is legally entitled to the insurance amount is Kamalamma (complainant). Ext. P4 is the original death certificate. As per Ext. P4, Mr. Stephen died on 18/6/2004 and place of death Bhargavi Vilasom Vaidyasala, Vizhinjam. Ext. P5 is the document evidencing Stephen's death declared by Viswambharan Vaidyan. Ext. P6 is the letter issued by the opposite party to the complainant directing her to furnish post mortem report to consider the claim. Ext. P7 is the Janata Personal Accident Insurance Claim Form issued to policy No. 431. Ext. P8 is the Desabhimani Daily. Ext. P9 is the certificate issued by Kerala Ayurveda Parampariya Vaidya Federation in the name of Sri. B. Viswambharan Vaidyan. Opposite party's evidence consist of oral testimony of the opposite party and Ext. D1 series. Ext. D1 is the Group Janatha P A Policy. Insured's name is Kerala Panchayat Grama Vikasana Society policy No. 761400/47/02/61/00000172 Deptt: Rural Insurance – Miscellaneous, Policy period: 5/8/2002 to 4/8/2007. Ext. D1(a) is the conditions of Janata Personal Accident Insurance Policy. There is no point in dispute that policy was issued by opposite party to Sri. P. Stephen. The stand of the opposite party is that opposite party is liable to indemnify the insured and pay the assured amount only on production of post mortem certificate, that inspite of repeated demands the complainant did not produce post mortem certificate and hence opposite party was constrained to repudiate the claim for non-production of post mortem certificate. Evidently by Exts. P5 and P9 and by deposition of PW1 to PW3 it would appear that the deceased / insured died due to snake bite. At this juncture, it should mention that since family of the deceased being under shock, deceased not got subjected to post mortem, while the deceased died due to snake bite proved by Exts. P5 & P9. Opposite party did not produce any evidence to prove otherwise. In view of the foregoing discussion and evidence available on record, we are of the considered opinion that claim cannot be rejected on the ground of non-production of post mortem report. Deficiency in service proved. Since deceased died due to snake bite proved by Exts. P5 & P9, complainant is entitled to get insurance claim and insurer opposite party is liable to make payment as per policy.
In the result, complaint is allowed. Opposite party shall pay the complainant the assured sum of Rs. 50,000/- with interest at the rate of 9% thereon from the date of the complaint (that is from 19/12/2005) till realisation. Opposite party shall also pay Rs. 2,000/- as cost. Opposite party shall pay the said amount within one month from the date of receipt of this order.
A copy of this order as per the statutory requirements be forwarded to the parties free of charge and thereafter the file be consigned to the record room.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum, this the 16th day of February, 2011.
Sd/-
G. SIVAPRASAD,
PRESIDENT.
Sd/-
BEENA KUMARI .A,
MEMBER.
Sd/-
S.K. SREELA,
MEMBER .
ad.
C.C.No. 428/2005
APPENDIX
I. Complainant's witness:
PW1 : Kamalamma
PW2 : Viswambharan
PW3 : Murali
II. Complainant's documents:
P1 : The Identity card issued by Kerala Panchayat Gramavikasana Society Muttaikkadu.
P2 : Copy of the pamphlet issued by the opposite party and Kerala Panchayat Grama Vikasana Society
P3 : The membership form issued by the Kerala Panchayath Gramavikasana Society
P4 : Original Death Certificate dated 07/07/2004
P5 : The document evidencing Stephen's death declared by Viswambharan Vaidhayan
P6 : The letter issued by the opposite party to the complainant dated 22/9/2004
P7 : The Janata Personal Accident Insurance Claim Form issued to Policy No. 431.
P8 : The Desabhimani Daily
P9 : Copy of the certificate issued by Kerala Ayurveda Parampariya Vaidya Federation in the name of Sri. B. Viswambharan Vaidyan.
III. Opposite party's witness:
DW1 : J.P. Prakash
IV. Opposite party's documents:
D1 : The Group Janata PA Insured's name is Kerala Panchayat Grama Vikasana Society No. 761400/47/02/61/00000172 Dept: Rural Insurance – Miscellaneous, policy period - 5/8/2002 to 4/8/2007
D1(a) : The conditions of Janatha Personal Accident Insurance policy
Sd/- PRESIDENT.
