State Consumer Disputes Redressal Commission
Yasa Padma Nalgonda vs The Branch Manager, Lic Of India And ... on 3 April, 2009
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: ADDL.BENCH AT HYDERABAD. F.A.No. 310 OF 2006 AGAINST C.D.NO.71 OF 2004 DISTRICT FORUM, NALGONDA. Between: Yasa Padma W/o late Yasa Malla Reddy Aged 25 years, Occ: Nil, R/o Nomula Village Nakrekal Mandal, Nalgonda Dist. Appellants/complainant A N D 1. The Branch Manager, LIC of India B.O. No.II, D.No.5-2-2, Sri Laxmi Complex R.P.Road, Nalgonda Town (AP) 2. The Divisional Manager, LIC of India Divl.Off: D.No.1-8-170, Lakpathi Bldg., S.D.Road, Secundeabad (AP) 3. The Zonal Manager, LIC of India South Central Zonal Office, Jeevan Baghya, Saifabad Hyderabad Respondents/opposite parties Counsel for the Appellant: Sri M.Ramgopal Reddy Counsel for the Respondents: Sri M.Seshagiri QUORUM: SRI SYED ABDULLAH, PRESIDING MEMBER
& SRI R.LAXMINARSIMHA RAO, MEMBER FRIDAY THE THIRD DAY OF APRIL TWO THOUSAND NINE Oral Order ( As per Sri R.Laxminarsimha Rao, Member) *** This appeal is filed against the order of District Forum Nalgonda in C.D.No.71 of 2004.
The factual matrix that led to filing of this appeal is that the husband of the appellant during his life time obtained insurance policy on 28.2.2000 from the respondent no.1 for a sum assured Rs.25,000/- with accident benefit and the policy was issued for the period from 28.2.2000 to 28.2.2019. The husband of the appellant died on 16.2.2001 and she requested the respondents to pay the amount with benefits under the insurance policy. When the respondents failed to pay the said amount, the appellant had approached the District forum by filing C.D.No.65 of 2002 claiming the benefits conferred by the insurance policy. The District Forum dismissed the complaint giving opportunity to the appellant to lodge claim with the respondents. The appellant had lodged her claim along with the documents; death certificate, policy bond and claim form A, C. The respondents paid the basic sum assured along with bonus and the accident benefits was not paid as the appellant had not submitted copy of FIR, Inquest Report and Report of Postmortem Examination. The appellant had approached the District Forum claiming accident benefit under the insurance policy stating that her husband died due to snake bite and the snake bite being an accident she was entitled to the accident benefit of Rs.25,000/- under the insurance policy.
The respondent no.2 filed counter and the same was adopted by the respondents no.1 and 3. It is stated that the intimation of death of the husband of the appellant was received by them on 12.1.2004 and they settled the claim of the appellant for the basic sum together with bonus on 28.3.2004 and the appellant got issued legal notice claiming accident benefit. She had submitted only death certificate policy bond and claim forms A and C. whenever the life assured was not treated in any hospital during his last illness, an affidavit in lieu of claim form B B should be filed. A reply was given on 4.5.2004 to the notice of the complainant requesting her to submit any cogent evidence for considering her accident benefit claim. As per the terms and conditions of the insurance policy payment of additional benefit equal to sum assured will be made only if the life assured is involved in any accident and the same is proved to the satisfaction of the life insurance corporation and in case of any unnatural death the matter should be reported to the police. FIR, Inquest and Postmortem Report and such documentary evidence should be produced evidencing the circumstances and cause of death. The appellant had not produced any documentary evidence. The deceased was neither given treatment in any hospital nor his death was reported to the police. The accident benefit was not paid to the appellant as she failed to produce any evidence.
Basing on the evidence adduced Exs.A1 to A21, B1 and B2, the District forum dismissed the complaint.
Aggrieved by the order of dismissal of her complaint, the appellant has filed the present appeal on ground that the District Forum failed to consider the document issued by the Mandal Revenue Officer declaring that her husband died due to snake bite.
The point for consideration is whether the appellant is entitled to the accident benefit under the insurance policy.
There is no dispute of the facts that the husband of the appellant had obtained insurance policy for a basic sum of Rs.25,000/-, bonus and additional sum of Rs.25,000/- termed as accident benefit and he died during currency of the insurance policy. It is also not in dispute that the appellant without lodging any claim with the respondent filed C.D.No.65 of 2002 before the District Forum and the District forum directed her to approach the respondents by lodging claim along with relevant documents. Ex.A5, letter addressed by the respondent no.1 to the appellant shows that documents, death certificate original policy bond and FIR, inquest and Postmortem Reports were to be enclosed to the claim by the appellant and under Ex.A6 the appellant through her advocate gave reply that she had sent the claim enclosed thereto the death certificate, original policy bond, claim form A and C and copy of order passed in O.P.No.65 of 2002 on the file of District Forum Nalgonda. The appellant had got issued another letter through her advocate to the respondent no.1 stating therein that affidavit in lieu of claim form B attested by a judicial officer was being submitted as required by the respondents.
The appellant had submitted her affidavit which was attested by Judicial Magistrate of First Class (Prohibition & Excise Offences) Nalgonda stating that her husband died on 16.2.2001 at Nomula and the cause of death of his death was snake bite and further it was stated that medical attendance certificate in claim form B could not be submitted because she was present at the spot at the time of death of her husband and he husband was not taken to hospital for treatment since he died due to snake bite. The respondent no.1 addressed a letter Ex.A10 to the appellant requesting her to produce copy of FIR, Inquest report and Report of Postmortem Examination and an affidavit of a person not being a relative of the appellant and who was present at the spot acquainted with the cause of death of the deceased. In reply to Ex.A10 the appellant through her advocate had sent Ex.A11 stating that she was sending affidavit of Cappidi Chandra Sekhar Reddy in lieu of claim form B attested by JMFC Nalgonda and further it was stated that the death of the deceased was not reported to the police and as such she was not in a position to produce FIR, Inquest and report of Postmortem examination.
Chappidi Chandra Sekhar Reddy, in his affidavit dated 3.2.2004 has stated hat the husband of the appellant died on the way leading from Nomula to Nakerakal on 16.2.2001 and he being acquainted with the deceased, completed the claim form C that the cause of death of the deceased was snake bite. An amount of Rs.26,625/- towards the sum assured including bonus was paid as evidenced by Ex.A13. The appellant got issued Ex.A14 demanding payment of accident death benefit along with interest to which the respondent no.1 gave reply under Ex.A19 informing the appellant that since FIR, inquest report and postmortem examination report were not submitted the accident benefit under the policy was not paid to the appellant. Another notice Ex.A17 was got issued by the appellant demanding for payment of accident benefit with interest and to this notice ex.A19 was issued stating that the policy conditions provide for payment of additional benefit equal to sum assured if the life assured is involved in an accident and the same is proved to the satisfaction of the corporation. In case of any unnatural death, the matter should be reported to the police and FIR, Inquest Report and Postmortem Report and sometimes the chemical report gives the documentary evidence about the circumstances and cause of death. In the present case, the cause of death since reported as accident, the above reports are to be submitted to prove the cause of death. Therefore, there has been correspondence between the appellant and the respondent no.1, the appellant stating that there was no FIR, Inquest Report and PM Exmainaiton report and the respondent no.1 repeatedly asking for the said documents. The District forum dismissed the complaint holding that Ex.A2 death report and Ex.A1 death certificate do not show the cause of death of the deceased and the appellant failed to show any authority that MRO is competent to certify the cause of death and by relying on the third party affidavit, it cannot be held that the deceased died due to snake bite.
A perusal of Ex.A21, register containing the death reports show that Yasa Malla Reddy was reported to have been died on 16.2.2001 and the informant was K.Anasurya and the place of death is Nomula in Nalgonda District. This report was issued by the Mandal Revenue Officer, Nakrekal. In Ex.A1 there are several other death reports and all of the persons whose death was reported, they were reported to have died at Nomula in Nalgonda District and among those persons who are reported to have died, the name of the husband of the appellant was mentioned at Sl.No.7 and informant in all the cases is K.Anasurya. It appears that K.Anasurya is an employee in the Revenue Department and on information given by her the death reports were registered.
Admittedly, the husband of the appellant was not admitted in any hospital for treatment nor was there any report to the police due to which no FIR could be issued. It is the consistent version of the appellant that her husband died due to snake bite and to the effect she filed her affidavit and also the affidavit of Chappidi Chandra Sekhar Reddy. The respondents except insisting on the appellant to produce documents in support of her contention that her husband died due to snake bite, they had not appointed any investigator and in fact there is no denial on their part disputing the contention of the appellant that the snake bite was the cause of the death of her husband. The affidavits of the appellant and Chappidi Chandrasekhar Reddy amply establish that the husband of the appellant died due to snake bite and this fact is further established by the absence of any denial by the respondents. Therefore in the circumstances, we are of the considered opinion that the appellant husband died due to snake bite and our opinion is fortified by the decision of this Commission, in the case of LIC of India Secunderabad vs. Banavath Kamlee 2000 ALD (Cons.) 96 wherein it was held that the widow of the insured is entitled to the accident benefit in view of her deposition and the deposition of her brother-in-law and also of the entry made in death register.
The facts in both the cases being similar, there is no other view to deviate from the conclusion that the appellants husband died due to snake bite. The latches on the side of the appellant and her negligence also should be considered. However, keeping in view of peculiar circumstances of case we hold that appellant is entitled to only the amount of Rs.25,000/- conferred on her as accident benefit by the insurance policy.
In the result this appeal is allowed.
Consequently the complaint is allowed directing the respondents no.1 to 3 to pay an amount of Rs.25,000/- towards accident benefit and Rs.2000/- towards costs to the appellant. Time for compliance four weeks.
PRESIDING MEMBER MEMBER 03.04.2009