POGU NARAYANA Vs. ORIENTAL INSURANCE COMPANY LTD

JUDGEMENT

(1.) Aggrieved by the order in C. D. No.285/2002 on the file of District Forum, Nizamabad, the complainants preferred this appeal.

(2.) The brief facts as set out in the complaint are that the complainant Nos.1 and 2 are the sons of late Pogu Hanumanthu, who was a member of the opposite party No.2 society, was insured under Group Personal Accident Policy of the opposite party No.1 and died on 14.11.1999 due to drowning in a canal by accidental fall. The police registered the case and held inquest and post-mortem was also conducted and Dr. K. Venkatarao, Civil Asst. Surgeon, who conducted autopsy opined that the cause of death is due to drowning. Thereafter the complainants made a claim for Rs.1,00,000 submitting all the necessary documents and on 27.4.2001, opposite party No.1 informed opposite party No.2 that the complainants are not entitled to the insurance amount as the deceased was insane and fell down into the canal due to insanity and died due to asphyxia which is not an accidental death. The complainants submit that the deceased was not an insane person and the police filed a final report stating that the deceased fell down accidentally and died while bathing after washing his clothes. Hence the complaint seeking a direction to opposite party No.1 to pay the insurance amount of Rs.1,00,000 with interest at 24% p. a. and compensation of Rs.25,000 and other reliefs.

(3.) Opposite Party No.1 filed counter admitting the issuance of Group Personal Accident Policy to opposite party No.2 for its members through opposite party No.3 and contends that the information of death of late P. Hanumanthu was given after 30 days which is a contravention of condition No.1 of the policy. They further contended that the claim attracts exception Clause 5 (d) of the policy which states that the opposite party is not liable to pay compensation in respect of death if it falls directly or indirectly by veneral diseases or insanity and the life assured died due to insanity. They further submitted that the complaint is not filed within 12 calendar months from the date of repudiation by them and hence the claim is deemed to have been abandoned by the claimant. They admit that they sent letter dated 27.4.2001 to opposite party No.2 repudiating the claim and stated that the complainants are not entitled for the insurance amount as the life assured died due to insanity. They contend that the claim is not genuine and submitted that soon after the receipt of the documents, they appointed G. Venkata Prasad Reddy to assess the truth of the claim and after thorough inquiries he submitted his report stating that the deceased died due to insanity and the final report submitted by the Police is also to the same effect and, therefore, there is no deficiency of service on their behalf.