Smt.K.Seetha Ravamma W/o late K.V.Subbareddy, aged 50 years, Occ: House hold, R/o Bhulaxmi Camp of Bodhan Mandal, District Nizamabad.



Complainant

AND

1) The Executive Officer, Road Safety Club Pvt., Ltd., 2A, Prakasam Raod, T.Nagar, Chennai – 600 077.

2) The Divisional Manager, National Insurance Co. Ltd., Chennai – 600 040.

3) The Br. Manager, Shri Ram Chits Pvt., Ltd., Bodhan, District Nizamabad.



Opposite Parties

:: O R D E R ::

3. The complainant a housewife and a resident of Nizamabad district is the wife of deceased K.V.Subba Reddy. The deceased is the member of Opposite Party No.1 which has tie up with National Insurance Co. Ltd., i.e. Opposite Party No.2 under Group Personal Accident Master policy No.500500/42/03/8200124. The period of insurance is from 23-06-2004 to 22-06-2005.

The husband of the complainant died on 28-06-2004 due to snake bite on the way to Government hospital, and the same was informed to the Opposite Party along with all required papers also lodged complaint before SHO., Yedpally. The police filed their final report with a finding “Accidental Death” due to snake bite.

Inspite of several representations as there was no response from Opposite Party, approached Insurance Ombudsman at Hyderabad who dismissed the claim vide order dated 16-07-2006 which is negligence and deficiency on the part of Opposite Parties to the complainant therefore approached Forum with a prayer to direct the Opposite Parties 1 to 3 jointly and severally to pay Rs.4,00,000/- towards two policies with interest @ 18% per annum, compensation of Rs.25,000/- and also costs of proceedings.

4. The Opposite Party No.1 filed counter admitting that the husband of the complainant during his life time became member of their club and was covered under group insurance vide master policy No.500500/42/03/8200124 and denying all other allegations of the complainant contending that Opposite Party No.2 issued insurance cover to the deceased and hence if the complainant has any claim or grievance it can be claimed against Opposite Party No.2 company only. However as a responsible company honoring the request of the complainant, when it enquired with Opposite Party No.2 regarding the claim of the complainant, the Opposite Party No.2 through their letter dated 12-01-2006 informed that the claim of the complainant was repudiated due to existing illness and not accident.

Finally contended as per the terms and conditions of the membership certificate the member specifically acknowledged that Road Safety Club Pvt. Ltd, will not be liable in any manner what so ever by virtue of any insurance cover provided and that insurance company will be solely liable in case of any claim.

As there is no deficiency and negligence on their part to the complainant prayed to dismiss the complaint against them.

Opposite Party No.2 filed counter denying all the facts of the complaint subject to the proof of the same materially contending that the thumb impression of the deceased found on the membership forms and the thumb impression of deceased on ROR pass book and Revenue records which are believed to be admitted signatures of the deceased are different from each other and hence subject to the proof of the same.

Though the deceased died on 28-06-2004. The FIR was issued on 15-07-2004. The Opposite Party in their counter raised doubts about the cause of death of the deceased and also genuinous of the Doctor’s certificate as post mortem was not done to know exact cause of death. There was delay in filing FIR and also delay in intimation to them against the terms and conditions of the insurance policy.


Further contended that as per conditions of the membership the insurance cover will be arranged three week from the date enrollment of membership or from the date of existing insurance whichever is later. The deceased enrolled as a member of Opposite Party No.1 on 23-06-2004 and as per conditions, on the date of death i.e. on 28-06-2004 no insurance is covered but as the policy shows the date of commencement of policy is from 23-06-2004 i.e. the date of enrollment of membership only is against policy conditions, the policy was suspected to be fraudulently obtained for monitory benefits.

In view of the above fore mentioned violation of the terms and policy conditions of the policy conditions and after due enquiry the insurance company as well as insurance ombudsmen rightly repudiated the claim of the complainant. Finally prayed to dismiss the complaint against them with exemplary cost as there is no deficiency in service on their part to the complainant.

Opposite Party No.3 filed counter totally denying all the allegations against them subject to the proof of the same.

Opposite Party No.3 contended that the complainant never approached them and made any claim against the Opposite Party with the insurance ombudsmen. The insurance policy was issued by Opposite Party No.2 and hence only insurance company is liable for the payment. Therefore prayed to dismiss the complaint against them with exemplary costs in the ends of justice and equity.


5. During the enquiry in lieu of evidence complainant and Opposite Parties 1 to 3 filed their respective chief affidavits as evidence Ex.A1 to Ex.A9 are marked on behalf of complainant and Ex.B1 to Ex.B9 marked on behalf of Opposite Parties.

During the course of complaint, the Opposite Party No.3 filed a petition to send signatures of the deceased found on original loan disbursement voucher and promissory note issued by the Secretary, PACCS, Pentakalan, to the expert for comparison and opinion and the same is dismissed as per orders in I.A.No.176/08 dated 30-12-2008 as the documents produced by the PACCS do not disclose that they belong to late V.Subba Reddy. As part of Opposite Party evidence affidavit of RW2 filed and was cross examined by the complainant counsel.


6. Heard arguments of both side Advocates.


7. The points for consideration are :


1) Whether there is deficiency in service on the part of Opposite Parties to the complainant ? Whether the repudiation of the claim of the complainant by Opposite Parties is justified ?

2) Whether the complainant is entitled for any reliefs prayed for ? To What relief’ ?

8. POINT No.1 :- The admitted and proven facts are that the complainant husband during his life time became member of the Opposite Party No.1 (Ex.B2, B4) and was insured with Opposite Party No.2 (Ex.B3, B1)under group personal accident policy No.500500/42/03/8200124 period from 23-06-2004 to 22-06-2005 as a part of tie up between Opposite Party No.1 & 3 for four lakhs under two certificate No.SC3/HB000003048, SC3/HB00003047.



The disputed facts are the complainant alleged deficiency and negligence on the part of Opposite Parties 1 to 3 for repudiating the claim inspite of proving that the death was due to snake bite which is accidental and in evidence produced Ex.A1 to Ex.A9 documents.

The counsel for Opposite Party No.1 & 3 contended that they are in way concerned with insurance claim. As the insurance policy was issued by Opposite Party No.2 the grievance has to be settled with the insurance company only. As per terms and conditions on the membership certificate (Ex.B4, B2) the member specifically acknowledges that issue Road Safety Club Pvt. Ltd., will not liable in any manner what so ever by virtue of any insurance cover provided and that insurance company will be solely liable in case of any claim in respect of any deficiency or defect in insurance cover, recovery or payment of compensation processing are settlement of claims or other wise however and all such matters shall be addressed to and sorted out directly with the insurance company as per Ex.B2, Ex.B4 and therefore there are liable.

Further contended however as a responsible company honoring the request of the complainant, enquired with Opposite Party No.2 regarding the claim of the complainant and Opposite Party No.2 through their letter dated 12-01-2006 (Ex.B5) informed them that the claim of the complainant was repudiated due to existing illness and not accident and the same was informed to the complainant there is no deficiency and negligence on their side to the complainant prayed to dismiss the complaint against them.

In view of the mentioned reasons we are of the opinion that there is no deficiency in service on the part of Opposite Party No.1 and 3 to the complainant.

The counsel for the Opposite Party No.2 vehemently argued that there is suspicion regarding death of the complainant husband, because the death of deceased was not informed to them immediately as per terms and conditions of the policy and FIR was also filed with a delay of 17 days moreover before police the complainant raised doubt about the death of her husband. Only basing on the Doctor’s certificate (Ex.A1) the final report was issued by police stating that the deceased died due to snake bite (Ex.A9) and post mortem was done and hence they rightly repudiated the claim of the complainant stating that the deceased died due to present illness as the complainant failed to prove her case. More over the insurance ombudsman after due enquiry has rightly dismissed the claim of the complainant (Ex.A8)

In view of fore mentioned reasons contended they rightly repudiated the claim of the complainant and there is no deficiency in their service to the complainant prayed to dismiss the complaint against them.

The counsel for Opposite Party No.2 mainly stressed that only basing on Doctor’s certificate the final report is issued by police stating that deceased died due to snake bite and no post mortem was done to know the exact cause of death and hence cannot be relied upon.

The National Commission in their judgement in case of Dharmisetty Srinivas Rao V/s New India Assurance Co., Ltd., reported in (2006) CPJ II (NC) held that 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.

In view of the aforementioned judgement we are of the considered opinion that the complainant had proved her case that her husband died due to snake bite and therefore insurance company had wrongly repudiated the claim of the complainant.

Accordingly this point goes in favour of the complainant and against the Opposite Party No.2 only.

9. POINT No.2 :- In view of our findings on the foregoing point No.1 and the reasons mentioned there in we are of the considered opinion that the complainant is entitled for following reliefs.

The Opposite Party No.2 is directed to pay the insurance amount totaling to four lakhs under certificate No.SC3/HB000003047 and certificate No.SC3/HB000003048 to the complainant together with interest @ 9% per annum from the date of filing of the complaint and also Rs.2,000/- as cost of the complaint.

10. IN THE RESULT, the complaint is allowed partly directing:

a) The Opposite Party No.2 to pay Rs.4,00,000/- (Rupees four lakhs only) the insurance amount under certificate numbers SC3/HB000003047 and SC3/HB000003048 to the complainant together with interest @ 9% per annum from 13-09-2007 the date of filing of the complaint till the payment.

b) The Opposite Party No.2 is also directed to pay a sum of Rs.2,000/- towards costs of the complaint.