State Consumer Disputes Redressal Commission
Branch Manager, The Oriental Insurance ... vs Babita on 16 October, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARAKHAND
DEHRADUN
FIRST APPEAL NO. 27 / 2012
Branch Manager, The Oriental Insurance Company Limited
Branch Office - II, Opposite Prabhat Cinema
Bhagat Singh Marg, Saharanpur through
Senior Divisional Manager, The Oriental Insurance Company Limited
Rajpur Road, Dehradun
......Appellant / Opposite Party No. 2
Versus
Smt. Babita W/o late Sh. Vipin Kumar
R/o Village Mandawali, P.O. Gurukul Narsan
District Haridwar
......Respondent / Complainant
Sh. M.N. Mishra, Learned Counsel for the Appellant
Sh. Gopal Narsan, Learned Counsel for Respondent
Coram: Hon'ble Mr. Justice B.C. Kandpal, President
Mr. C.C. Pant, Member
Mrs. Kusum Lata Sharma, Member
Dated: 16/10/2012
ORDER
(Per: Justice B.C. Kandpal, President):
This is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 23.02.2011 passed by the District Forum, Haridwar in consumer complaint No. 160 of 2010. By the order impugned, the District Forum has allowed the consumer complaint against the appellant - insurance company and directed the appellant to pay the insured amount to the respondent - complainant together with compensation of Rs. 2,000/-.
2. Briefly stated, the facts of the case as mentioned in the consumer complaint, are that late Sh. Vipin Kumar, the husband of the complainant - Smt. Babita, was the Member of opposite party No. 1 -
2Iqbalpur Sahkari Ganna Vikas Samiti Limited, Roorkee and was insured with the opposite party No. 2 - The Oriental Insurance Company Limited, Branch Office, Saharanpur (appellant before this Commission) under Janta Personal Accident Insurance Policy. On 13.10.2009, the life assured died on account of snake bite. The complainant lodged the claim with the insurance company and submitted all the required documents. The insurance company, however, closed the claim file of the complainant vide letter dated 28.01.2010 on the ground that no postmortem report and Panchnama of the deceased - life assured was submitted by the complainant. The complainant sent a notice to the opposite parties through her counsel and thereafter alleging deficiency in service on their part, filed the consumer complaint before the District Forum, Haridwar.
3. The appellant filed written statement before the District Forum and pleaded that as per the terms and conditions of the policy, the postmortem of the life assured was necessary and in the absence of the postmortem report, the claim is not payable. It was also pleaded that the death of the life assured due to snake bite has not been established.
4. The District Forum, on an appreciation of the material on record, allowed the consumer complaint vide impugned order dated 23.02.2011 in the above terms. Aggrieved by the said order, the insurance company has filed this appeal.
5. We have heard the learned counsel for the parties and perused the record.
6. From the perusal of the claim form (Paper No. 39), it is evident that the life assured was taken to Community Health Centre, Gurukul Narsan, Haridwar and in the claim form, the nature of injury has been 3 mentioned as suspected snake bite injury and the disease has also been diagnosed as suspected snake bite case. The complainant has also filed the affidavit of Sh. Pradeep Kumar and Sh. Sanjay Kumar before the District Forum in support of her case, who have averred that on 13.10.2009, while the life assured along with the said persons was working in the field, he came shouting at 4:30 p.m. that a snake had bitten him and thereafter the life assured was taken to Community Health Centre, Gurukul Narsan, Haridwar. No evidence to the contrary was filed by the insurance company to show that the deceased's was not a case of snake biting. The claim form has also been countersigned by Pradhan of the village. Merely because the deceased was not subjected to postmortem, it can not be said that he did not die on account of snake bite. The Hon'ble National Commission in the case of Dharmisetty Srinivas Rao Vs. New India Assurance Co. Ltd.; I (2006) CPJ 11 (NC), has held that usually in snake bite cases, the postmortem is not conducted. In the reported case, the death due to snake bite was proved by doctor's certificate and certificate issued by Village Administrative Officer and the insurance company was held liable to pay policy amount with interest. In the instant case, as stated above, the complainant has filed sufficient evidence to prove that the deceased died on account of snake bite and the insurance company has failed to produce any evidence in rebuttal of the same.
7. The insurance company has also taken a stand that on the date of his death, the life assured was 73 years of age and, as such, the complainant is not entitled to get any amount from the insurance company. We do not find any force in this contention for the reason that in the copy of the mark-sheet of the deceased - life assured of Class - X (Paper No. 42), his date of birth has been mentioned as "22.01.68". In the copy of the family register too (Paper No. 44), the 4 year of birth of the deceased has been mentioned as "1968". This apart, the above two persons, who have filed their affidavits before the District Forum, have also stated that on the date of his death, the life assured was between 40-41 years of age. The insurance company has also failed to prove the said contention by adducing any cogent evidence with regard thereto.
8. Learned counsel for the appellant - insurance company cited a decision of the Hon'ble Apex Court in the case of United India Insurance Co. Ltd. Vs. Harchand Rai Chandan Lal; IV (2004) CPJ 15 (SC), in which it has been held that the policy is a contract between the parties and both the parties are bound by the terms of the contract. Learned counsel also cited a decision of the Hon'ble National Commission in the matter of Smt. Dewanti Devi Vs. National Insurance Co. Ltd. and others; 2011 (4) CPR 198 (NC), wherein the same view has been laid down. It is true that the parties are bound by the terms and conditions of the policy of insurance, but we also have to take into account the facts and circumstances of the case. None of the reported decisions pertain to the case of snake bite. In the instant case, the death of the life assured on account of snake bite is duly proved by the evidence available on record. This apart, as is stated above, the Hon'ble National Commission in the case of Dharmisetty Srinivas Rao (supra), has held that usually in snake bite cases, the postmortem is not conducted and the same can not be a ground for repudiation of the claim if the death of the life assured on account of snake bite in duly proved. Therefore, the cited decisions do not provide any help to the insurance company and do not apply to the facts and circumstances of the present case.
9. The District Forum has considered all the aspects of the matter and has passed a reasoned order, which does not call for any 5 interference. The appeal being devoid of merit, is liable to be dismissed.
10. Appeal is dismissed. No order as to costs.
(SMT. KUSUM LATA SHARMA) (C.C. PANT) (JUSTICE B.C. KANDPAL) K