UNITED INDIA INSURANCE COMPANY LTD Vs. THUGUNTA NAGA CHANDRIKA

JUDGEMENT

(1.) Being aggrieved by the order passed in C. C. 273/2007 by the District Forum, Prakasam District at Ongole directing the opposite party to pay a sum of Rs.3 lakhs with interest at 9% p.a. from the date of repudiation letter dated 16.05.2007 till the date of realization and directing to reimburse the hostel fee and tuition fee for the period of study subsequent to the death of the deceased in terms and conditions of the policy and with a further direction to pay additional compensation of Rs.1000/- and costs of Rs.1000/-. The impugned order is assailed as erroneous and contrary to the facts and evidence under law.

(2.) The facts of the case disclose that the complainant had taken a policy under Tailor made PA Scheme for Engineering Student Policy bearing No. 052000/42/000733 dated 25.10.2004. Subsequent to the issuance of the policy, the complainants father died due to snake bite on 08.01.2006. He was taken to RNR Hospital, Santhanuthalapadu for treatment where he was admitted for treatment. But on the advice of the doctor, he was shifted to Government hospital, Ongole but on the way he succumbed to it and thereby he was taken back to his house and cremated. Due to sudden death of the complainants father, the entire family was suffering and hence no post mortem and panchanama was done on the dead body. The Village Secretary gave certificate stating that the death of the deceased Srimannarayana was due to snake bite. The complainant got issued a legal notice claiming insurance amount but the opposite party rejected the same which is attributed as deficiency in service.

(3.) The opposite party in its version has taken the stand that upon happening of any event giving raise to claim under the policy, a written notice with full particulars must be given to the company immediately and in case of death, written notice also of the death must be given before internment cremation and in any case within one calendar month after the death as per the policy condition but the intimation was received by the insurance company after six months of the death as there is a violation of policy condition. In fact on 09.08.2006, the opposite party requested the complainant to submit claim papers along with FIR, PM Report, Panchanama etc. but the same were not furnished except addressing a letter dated 15.11.2006 by the mother of the complainant stating that her husband died due to snake bite and she came to know about the existence of the policy only in the month of September, 2006 which is a clear contradiction to the claim intimation letter dated 22.07.2006 submitted by the complainant which was received by the opposite party on 09.08.2006. The companys investigator submitted his report which reveals that the deceased was suffering from diabetes for the last five years and there are no physical injuries over the body of the deceased and that the deceased felt un-easiness on 08.01.2006 at about 7.00 PM and contacted Medical Officer at Santhanuthalapadu who referred him to go to Ongole and on the way the deceased breathed his last. Death took place naturally but not by snake bite. Condition no. 2 of the policy requires proof for making a claim, as such, cause of death is not established properly. So the Insurance company is justified in repudiating the claim.