PRAMJIT KAUR & 2 ORS. Vs ORIENTAL INSURANCE COMPANY LTD. & 2 ORS

Late Shri Jagmohan Singh, husband of the complainant No.1 and father of the complainants Nos.2 & 3 obtained two insurance policies from the opposite party-Oriental Insurance Co. Ltd.. Under the aforesaid policy the insurance company was to pay the insured amount to the nominees of the insured, in case he was to die in an accident. Late Shri Jagmohan Singh died on 13-08-2010. Alleging that he had died due to snake bite in the fields, a claim was submitted to the insurance company. The claim, however, came to be repudiated by the insurance company on the ground that (i) the intimation of the death was not given to them immediately and (ii) post mortem was not conducted on the dead body of the deceased. Being aggrieved from the rejection of the claim the complainants approached the concerned District Forum by way of a complaint seeking payment of the insured amount along with interest.

The complaint was resisted by the insurance company on the same ground on which the claim had been repudiated.

Vide its order dated 13-06-2013 the concerned District Forum directed the insurance company to pay a sum of Rs.5,50,000/- to the complainant along with interest on that amount at the rate of 9% per annum, Rs.25,000/- as compensation and Rs.10,000/- as cost of litigation.

Being aggrieved from the order passed by the District Forum the insurance company approached the concerned State Commission by way of an appeal. Vide impugned order dated 13-11-2014 the State Commission allowed the appeal and dismissed the complaint. Being aggrieved the complainants are before us by way of this revision petition.

It is not in dispute that intimation of the death of the deceased was given to the insurance company after seven days of his death. Under the terms of the policy, the intimation of the death ought to have been given to the insurance company immediately after the death had occurred. The purpose behind insisting upon immediate reporting of the death to the insurance company is to enable the said company to investigate the cause of the death. This is more so, in a case where the claim is payable only in a case of accidental death. If a prompt intimation of the death is not given to the insurance company, it may not be possible for the investigator appointed by the insurance company to ascertain the correct cause of the death of the insured, since valuable evidence in this regard may be lost with the passage of time. The insurance company was entitled to repudiate the claim on this ground alone.

It is also an admitted position that the insurance policy taken by the deceased was not a regular life insurance policy but it only carried an accidental benefit in case he was to die in an accident. The case of the complainants being that the deceased had died on account of snake bite when he went to his fields the onus was on them to prove the cause of his death. The complainant did file a certificate purporting to be issued by Dr. Kalra, but neither filed his evidence by way of affidavit nor did they examine him as a witness before the District Forum. Consequently, the certificate purporting to have been issued by him did not stand duly proved. In the absence of either the affidavit or verbal deposition of Dr. Kalra, the District Forum could not have accepted the certificate purporting to have been issued by him as regards the cause of death of Late Shri Jagmohan Singh. Had the complainants filed his evidence by way of affidavit or produced him as a witness, the insurance company would have got an opportunity to cross-examine Dr. Kalra as regards the cause of the death of the deceased. That having not been done there is no escape from the conclusion that the complainants failed to establish that the deceased had died on account of an accident.

The learned counsel for the petitioner has drawn our attention to a report dated 10-08-2011 purporting to be issued by Dr. Vipin Gupta, Medical Investigator appointed by the insurance company. The aforesaid report, to the extent it is relevant reads as under: "Underwriters : OIC DO-14, Patparganj Indl. Area

Insured''s name : Mr. Jagmohan Singh

Policy Details : 271700/48/2011/1095 & 1096 SI 5.0 lakh

Claim No. : 2011/275 & 276

Medical report - Insured Mr. Jagmohan Singh 42 year''s old male was bitten by a snake while working in his rice fields on 12/8/2010 night. He came back to his home and died while in sleep. A local doctor-Dr. H. S. Kalra was called and as per his certificate he saw 2 marks of snake bite on insured''s left leg. No post mortem was done.

Opinion - As per my opinion the present claim is not within the purview of PA/NSP policy as the cause of death is not certified by post mortem report. Hence the present claim is not admissible as per NSP/PA policy terms and conditions."

The contention of the learned counsel for the petitioner is that in the above report Dr. Vipin Gupta himself certified that late Shri Jagmohan Singh has died due to snake bite while working in the rice fields. We, however, are unable to accept the contention. The facts noted against the heading ''medical report'' are in fact the information provided by the complainants to the insurance company whereas the view of Dr. Vipin Gupta finds mention under the heading ''opinion''. Admittedly, Dr. Vipin Gupta did not examine the dead body of the deceased, since the intimation to the insurance company itself was given after one week of his death. Therefore, Dr. Vipin Gupta could not have certified the cause of the death of the deceased. In our view, it would not be correct to say that the facts given against the heading ''medical report'' in the aforesaid documents are the opinion of Dr. Vipin Gupta as regards the cause of the death of late Shri Jagmohan Singh. Therefore, reliance upon the aforesaid documents by the petitioners is wholly misplaced.

For the reasons stated hereinabove, we find no ground to interfere with the order passed by the State Commission. The revision petition is accordingly dismissed. No order as to costs.