A. Venkatarami Reddy, President - The complaint CD 279/91 was filed by one P. Trinada Rao the elder brother of the assured P. Surya Parmeshwara Rao against the New India Assurance Company Head office, Divisional Manager and Branch Manager claiming a sum of Rs. 1,57,500/- with interest at 24% p.a. from the date of death of policy holder i.e. 20-4-1994 till the date of payment and other reliefs.

2. It is alleged in the complaint that P. Surya Parameshwara Rao took 'Hospitalization and Domiciliary 'Hospitalization Benefit Policy' from the opposite parties on 21-6- 1988 covering a period of 12 months from 3-6-1988 to 26-1989 and after the lapse of the above said policy the assured took another Hospitalisation and Domiciliary 'Hospitalisation Benefit policy' for the period from 30-6-1989 to 29-6-1990. The assured died on 20-4-1990 due to snake bite while attending the calls of nature. The family doctor was immediately called but the assured just died by the time the Doctor came and the Doctor after observing the symptoms opined that the death was due to snake bite. The death of the assured was recorded in Gram Panchayat as due to snake bite by the Executive Officer. The Sarpanch also confirmed that the death of the assured was due to snake bite. On the next day the opposite parties were informed about the death of the assured and the complainant made a representation on 23-4-1990 to the third opposite party intimating the death of the assured and asked to guide him with regard to the claim. After some correspondence between the parties, wherein the opposite party Insurance company asked for some particulars with regard to the death of the assured it ultimately repudiated its liability by letter dt. 17-1-1991 stating that the matter was investigated by the officials of the opposite party Insurance company as well as the private investigators and that there was no substantial evidence to show that the assured died due to snake bite i.e. by accident. Thereupon a legal notice was issued on 26-3-1991 to the opposite party insurance company claiming the policy amount and also 5% compensation of the claim with interest at 24% p.a.

3. In the counter affidavit filed by the Deputy Manager of opposite party Insurance company, it was stated that the complainant failed to produce the material evidence that the assured died due to snake bite, that the death certificate issued by a private Nursing Home or by the Registrar of Births and deaths cannot be taken into consideration as the complainant has not proved beyond reasonable doubt that the assured died due to snake bite. No post-mortem was conducted to show that the assured died due to snake bite. It was also stated that there is no necessity for the assured to go to outside the house to answer calls of nature when septic laboratory is provided in his house. Hence it is doubtful whether the assured died due to snake bite. They admitted the receipt of the telegram intimating the death and also letters from the complainant. It was also stated that a reply was sent on 19-7-1991 through their counsel. Md. Jawahar Ali in reply to the notice dt. 23-6-1991 issued on behalf of the complainant. Since the opposite party suspected foul play, they rightly repudiated their liability to pay any amount under the policy.

4. It was further stated that the very name of the policy suggests that any expenses incurred by the insured for hospitalisation due to any injury suffered will be compensated and as the assured in this case was not hospitalized, the question of payment of any amount under the policy does not arise and that the complainant is put to strict proof that he is the legal heir of the deceased. Hence it is prayed for dismissal of the complaint.

5. A reply was filed by the complainant re-iterating the allegations made in the complaint and asserting that there is no condition under the policy that in case of every death postmortem certificate must be produced to prove the cause of death. The su