NEW INDIA ASSURANCE CO LTD Vs. B SHIVAPPA

JUDGEMENT

(1.) THE revision under consideration is against order of reversal of the finding of the District Forum. The factual backgrounds are that deceased B. Chinna Swamy, the brother of respondent, who obtained Janata Personal Accident Insurance Policy from respondent for Rs.10,00,000 on 31.12.1998 for a period of three years, died during currency of policy on 14.7.2000 pursuant to fall from stair case, sustaining head injury in his house. Allegedly, he was taken to Dr. S. Chandra Sekhar Goud, Civil Surgeon, Head Quarters Hospital Mahabubnagar, where insured died of incident. A certificate came to be issued by Dr. S. Chandra Sekhar Goud on 15.9.2000 stating therein that the insured died on 14.7.2000 due to cardiac respiratory failure caused by head injury. The village Sarpanch too give a certificate on 18.12.2000 holding that that the insured died on 11.7.2000 due to head injury on fail from stair case. The villagers too tiled affidavits on 4.12.2000 as to the cause of death. Panchanama was conducted by village Administrative Officer on 15.7.2000, attested by Additional Revenue Inspector and eventually elaini was submitted to the Insurance Company on 21.12.2000. The claim was, however, repudiated by petitioner holding belated submission of claim to them, respondent not taking recourse to the police lodging FIR pursuant to death of the insured, no autopsy having been carried out over the dead body of the insured and above all death being due to cardiac failure, which was not an accidental death.

(2.) DISSATISFIED with repudiation of claim, petitioner took recourse to consumer grievance redressal agency filing a complaint with District Forum, which was resisted by petitioner Insurance Company reiterating the grounds of repudiation made by them. The District Forum, however, having overruled contentions raised on behalf of respondent herein dismissed complaint. In appeal that was preferred by respondent, order, as has been noticed was reversed putting reliance; on finding of doctor, panchanama and also belated filing of claini by respondent, those being no valid grounds for rejection of the claini by Insurance Company. Now aggrieved Insurance Company is in revision before us. Certain redeeming features however need to be noticed. Though insured on 14.7.2000 itself was shown to have been taken to Dr. S. Chandra Sekhar Goud Civil Surgeon, Head Quarters Hospital Mahabubnagar, shortly, after the incident where he died within one hour, it was not before 15.9.2000 that certificate is shown to have been issued by aforesaid doctor and that too being not supported by treatment papers. If there be treatment provided to the insured not only medical certificate, but other documents too belatedly put on record by respondent in quick succession are affidavits filed of villagers after five months of incident as to cause of death of the insured. Though panchanama was shown to have been conducted by Village Administrative Officer on 15.7.20PO, which was also attested by Additional Revenue Inspector, it is suggested that said panchanama was conducted after the dead body was buried. As we have noticed even claim was lodged to petitioner Insurance Company not before lapse of five months. Even though treating doctor was a Civil Surgeon of the Hospital, the insured was not treated in the Hospital, but at his clinic, which was not followed by postmortem of the dead body. Respondent also failed to take recourse to public authorities. We do not mean to say that merely belated filing of claim by respondent with Insurance Company would get defeated if there be legitimate claim, but what we mean to say that such belated filing of claim did not facilitate the Insurance Company to hold proper Investigation of the claim. Had this been a solitary issue about belated filing of claim, no fingers could have been raised, but as noticed, claimant had not pursued the matter with promptitude at the earliest. Even there being belated issuance of medical certificate that was not supported by affidavit of treating doctor. Finding of doctor does not even speak about presence of any external injury or internal haemorrhage on body of the deceased and above all no finding was recorded by doctor that cardiac respiratory failure was followed by head injury. These unusual features, which have surfaced in case of respondent, do not sound well about genuineness of the claim and in our view the repudiation of claim in these circunv stances by Insurance Company, which was upheld by District Forum cannot be said to be erroneous. The order of the State commission, which is not sustainable, is accordingly set aside and the revision petition succeeds with no order as to costs.