YASA PADMA Vs. LIC OF INDIA

JUDGEMENT

(1.) THIS appeal is filed against the order of District Forum Nalgonda in C.D. No. 71 of 2004.

(2.) 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 forms -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 Post -mortem 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.

(3.) THE respondent No. 2 filed counter and the same was adopted by the respondent Nos. 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' 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 Post -mortem 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.