BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.

F.A.No. 363 OF 2006 AGAINST C.D.No.17 OF 2004
DISTRICT FORUM, NALGONDA.

Between:

Smt Alwala Kanakamma
W/o late Nageshwar Rao
Aged about 30 years, Occ: Cooli
R/o Laxmipuram Village,
H/o Kodad Town and Mandal
Nalgonda District Appellant/complainant

A N D

1. M/s Vijayalaxmi Auto Finance
H.No.1-4, Main Road, Kodad Town
and Mandal, Nalgonda District
( Not pressed)

2. The Divisional Manager,
Oriental Insurance Co. Ltd.
Dharani Complex, II Floor,
Plot No.1-4-249/39, Bypass Road
New Bus Stand, Suryapet Town
Nalgonda Dist. 508 213 Respondents/opposite parties

Counsel for the Appellant: Sri V.Gourisankara Rao

Counsel for the Respondent No.1 Not pressed
Counsel for the Respondent No.2 Sri M.Venkateswarlu



QUORUM: THE HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT
&

SRI R.LAXMINARASIMHA RAO, MEMBER



MONDAY THE TWENTY THIRD DAY OF MARCH

TWO THOUSAND NINE



Oral Order ( As per Sri R.Laxminarsimha Rao, Member)
***

This appeal is filed by the complainant aggrieved by the order of the District Forum Nalgonda in C.D.No.17 of 2004.

The facts giving rise to filing of this appeal are that the husband of the appellant was a Toddy Tapper and during his life time he had joined as a member of the respondent no.1 auto finance. The respondent no.1 had obtained group insurance policy for its members for a sum of Rs.one lakh and the appellant’s husband name was at serial number 1905 in the list. The insurance coverage was for the period from 25.1.2003 to 24.1.2004. On 8.3.2003 the husband of the complainant had gone to answer calls of nature, while so a snake had bitten him. On being informed of the incident by the persons who witnessed the incident the appellant shifted her husband for treatment to a hospital at Kodad where while undergoing treatment, he died. On 9.3.2003 the appellant lodged a complaint before the P.S. Kodad. Her husband’s dead body was subjected to Postmortem examination and the PME report was issued showing the cause of death as due to snake bite. The appellant lodged a claim along with required documents before the respondent No.1 and the respondent no.1 repudiated her claim on 23.5.2003 on the ground that the claim should be lodged with them within 7 days from the date of death of the insured. The respondent no.2 refused to consider the explanation that the appellant offered and they informed her that repudiation of her claim was intimated to respondent no.1. The repudiation of her claim was without any reason and against the principles of justice. Hence, requested the District Forum to allow her complaint.

The appellant has not pressed her claim against the respondent no.1 in the appeal.

The respondent no.2 has filed its written version before the District Forum stating that the husband of the appellant had not died due to snake bite. There was no specific reason mentioned in the PME report as to the cause of death of the appellant’s husband. The Medical Officer who conducted PM examination had not preserved the viscera to send the same to RFSL for chemical analysis. As per the Medical Officer’s report there was no external injuries on the body of the deceased and blood stains were found coming out from the mouth of the deceased. In case of snake bite there should be fang marks visible on the body of the deceased and foam should come out of his mouth. In the absence of any explanation by the doctor who conducted the PM examination as to the absence of injuries on the body of the deceased, it cannot be held that the husband of the complainant died due to snake bite as the PM report itself is ambiguous. The Janata Personal Accident Insurance Policy does not cover the risk on the life of the insured in case of snake bite and the risk only covers with regard to the death of the insured caused due to motor vehicle accident. As per the contents of panchanama the deceased died due to snake bite and the inference so drawn was only on the bases of hearsay evidence. Hence, the respondent no.2 sought to support the repudiation of claim.

Basing on the evidence adduced before it and also on the pleadings of the parties, the District Forum dismissed the complaint.

The point for consideration is

1) Whether there is any deficiency in service on the part of the opposite part of respondent no.2?

2) To what relief?



Point No.1: The facts not in dispute are that the husband of the appellant was a toddy tapper and member of the respondent no.1. It is also not in dispute that the respondent no.1 obtained Janata Personal Accident Insurance Policy covering the risk on the lives of its members including the husband of the complainant for the period from 25.1.2003 to 24.1.2004. The claim of the appellant was repudiated by the respondent no.2 on the ground that the death intimation was not given within 7 days from the date of death of the deceased. The appellant had stated that she had informed the respondent no.1 immediately after the death of her husband. Unfortunately the respondent no.1 remained exparte before the District Forum. Respondent no.2 had not come forward with specific date on which they have received intimation of the respondent no.1 and in case of any default on the part of the respondent no.1, the appellant cannot be found fault with as her statement with regard to the passing immediate intimation of her husband death to the respondent no.1 was not confronted by the respondent no.1. Even otherwise there is no condition in the insurance company requiring the legal heirs or the nominee of the insured to intimate the death intimation within seven days from the date of death of the insured. The fact remains that the appellant immediately after her husband died, gave the death intimation to the respondent no.1 who obtained the insurance policy from the respondent no.2. Hence it cannot be said that the there was any delay in intimating about the death of appellant’s husband to the respondent no.2.

The respondent no.2 had through letter (Ex.A1) reassured the appellant to submit documents, PME report, Death Certificate etc. It appears that the appellant has submitted those documents as there has been no denial in this regard by the respondent no.2 before the District Forum. Though the respondent no.2 has not repudiated the claim of the appellant, a defence was sought before the District Forum that the deceased had not died due to snake bite. The FIR (Ex.A3) was lodged by the appellant that she was informed that her husband died due to snake bite and the cause of death of the deceased has been further supported by inquest report (Ex.A4) and report of PME (Ex.A5). The doctor who conducted PME and the panch witnesses who attended the inquest had clearly stated that the appellant’s husband died due to snake bite. In fact no repudiation of the claim of the appellant has been made by the respondent no.2.

In the absence of any evidence supporting the contention of the respondent no.2 that the death of the deceased was other than due to snake bite, it cannot be held that the appellant’s husband died not due to snake bite. The respondent no.2 had kept the claim of the complainant pending and compelled her to approach District Forum. All the documentary evidence placed on record before the District Forum clearly establish that the husband of the appellant died due to snake bite. In the circumstances we hold that the order of the District Forum is not sustainable. Hence the order of the District Forum is set aside and the appeal is allowed. Respondent no.2 is liable to pay Rs.one lakh towards sum assured under the insurance policy with interest @ 9% per annum from 9.8.2003 i.e., three months after the submission of the claim by the appellant to the respondent no.2 till the date of payment together with costs of Rs.2,000/-.

In the result this appeal is allowed by setting aside the order of the District Forum and consequently the complaint is allowed directing the insurance company/respondent no.2 to pay Rs.one lakh towards sum assured with interest @ 9% per annum from 9.8.2003 till payment together with costs of Rs.2,000/-. Time for compliance four weeks.





PRESIDENT MALE MEMBER

23.03.2009