P PRABHAVATHI Vs. NATIONAL INSURANCE CO LTD

JUDGEMENT

(1.) The case of the complainant, who is the wife of late Kamalakar, a practising Advocate of Narsipatnam Bar, aged about 43 years took out a 'janatha Personal Accident Insurance' from the opposite party for Rs.10,00,000/- commencing from 5.12.1997 lasting for a period of 12 years. While so he accidentally slipped and fell down from the staircase of their house while he was getting down from the upstairs of his house, as a result of which he sustained chest injury and died. When the complainant made a claim for the insurance amount, the opposite party repudiated the said claim on the ground that condition Nos.2 and 4 of the policy exclude the peril. Hence this complaint claiming a sum of Rs.10,00,000/- with interest @ 18 per cent per annum from 15.8.2000, the date of death of the insured together with compensation of Rs.50,000/- and costs of Rs.10,000/- was filed.

(2.) We have gone through the complaint and perused the material papers carefully. Condition No.2 of the policy is extracted below for ready reference : "proof satisfactory to the Company shall be furnished of all matters upon which a claim is based. Any medical or other Agent of the Company shall be allowed to examine the person of the Insured on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the Company and in the event of death to make a post-mortem examination of the body of the Insured and such evidence as the Company may from time-to-time require (including a post-mortem examination if necessary) shall be furnished within the space of fourteen days after demand in writing and in the event of a claim in respect of loss of sight the Insured shall undergo at the Company's expense such operation or treatment as the Company may reasonably deem desirable. Provided that in the case of a valid claim arising under Sub-clauses (a), (b) or (d) all sums payable hereunder shall be payable only on the delivery of this Policy cancelled and discharged. "

(3.) A reading of this condition leaves no doubt that- (i) Proof to the satisfaction of the company shall be furnished on all matters upon which claim is based; (ii) Any medical or other agent of the company shall be allowed to examine the insured/injured/dead; (iii) In the event of death post-mortem examination of the body of the insured shall be done/furnished, the information shall be furnished within a period of 14 days after demand in writing etc.