IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Thursday the 31st day of March, 2016
Filed on 19.02.2014
Present
- Smt. Elizabeth George (President)
- Sri. Antony Xavier (Member)
- Smt.Jasmine.D. (Member)
in
C.C.No.46/2014
between
Complainant:- Opposite Parties:-
Smt. Reshmi Sebastian 1. The General Manager
W/o late Sebastian Reliance General Insurance
Palliparambil House
Vadakkal P.O. 2. The Manager, Reliance General
Thiruvampady General Insurance, First Floor
Alappuzha Vishnu Building, K.P. Vallom
(By Adv. Mathew James) Road, Kavanthara, Kochi
(By Adv. C. Muraleedharan –
opposite parties 1 and 2)
3. The Manager, Kerala State
Co-operative Federation for
Fisheries Division Ltd.
Matsya Fed, Kamaleswaram
Thiruvananthapuram
(By Adv. Kalavoor Vijayakumar)
O R D E R
SMT. ELIZABETH GEORGE (PRESIDENT)
The case of the complainant is as follows:-
The complainant is a widow and mother of two children. Complainant’s husband late Sebastian was a fisherman and died in an accident on 3.7.2011 between 9 p.m. and 6 a.m. on 4.7.2011 while crossing the unnamed railway gate at Vadakkal. Complainant’s house is situated east of the railway track and his family house is situated at the west of the track. Complainant’s husband after seeing his mother coming to his house, only then he was hit by the train. Complainant’s husband was a fisherman and through third opposite party, complainant used to regularly remit the insurance premium against the accident. The policy No. was 2213312914000002. Though there was valid insurance for an amount of Rs.3 lakhs opposite parties repudiated the claim of the complainant stating that the death of the complainant’s husband is not an accident and it is suicide. Complainant’s husband had valid insurance and his death was absolutely an accident. Therefore complainant is entitled for the insurance amount of Rs.3 lakhs. Non-payment of the claim amount from the part of the opposite party is the clear deficiency in service. Hence the complaint is filed to direct the opposite parties to pay a sum of Rs.3 lakhs with interest along with compensation and costs.
2. The version of the opposite parties 1 and 2 is as follows:-
There is no deficiency in service on the part of the opposite parties. The complaint is barred by limitation. The complainant was insured for personal accident claim through Matsya Fed. The police records and investigation report disclosed that the incident was in night while crossing the Railway line which is a suicidal attempt. Hence the company is not liable to pay any amount as per the policy. The policy provides death or bodily injury solely and directly caused by accidental, violent, external and visible means resulting in death or permanent total disablement of the insured. Since in the present case no such accidental injury or death by violent, external and visible means but due to a suicidal attempt. Hence the company is not liable to pay any amount.
3. The version of the third opposite party is as follows:-
The object of the third opposite party is to ensure economic and social development of fishermen community by implementing various development and welfare schemes. As per the Fishermen Group Personal Accident Insurance Scheme for the year 2011-12 the deceased Sebastian Palliparambil had remitted the premium amount before the Vadackal – Kanjiramchira Fishermen Development Welfare Co-operative Society F(A) 11 on 26.3.2011 as per receipt No.1845. The policy holder Sebastian died on between 9 p.m. on 3.7.2011 and 6 a.m. on 4.7.2011 by hitting a train while crossing the unnamed railway gate at Vadakkal. The house of the deceased is situated at the east of the railway track and his family house is situated at the west of the track. While he was coming after seeing his aged mother to his house he was hit by the train. Though there was a valid policy for an amount of Rs.3 lakhs the first and second opposite parties repudiated the claim of the wife of the deceased, the complainant stating that her husband’s death was not occurred due to an accident but it was a suicide. Absolutely there was no suicidal tendency on the part of the complainant’s husband and he was leading a very happy family life. In order to escape from the liability to pay the insurance claim of Rs.3 lakhs, the first and second opposite parties are raising this unsustainable contentions. Since the death is due to an accident the first and second opposite parties are liable to pay the compensation as per the contract of insurance.
4. The complainant was examined as PW1. The documents produced were marked as Exts.A1 to A8. The witnesses were examined as PW2 and PW3. The investigation officer was examined as PW4. The document produced through him was marked as Ext.A9. The opposite parties have no oral evidence. The documents produced from the part of the opposite parties were marked as Exts.B1 to B4. The third opposite party produced two documents which were marked as Exts.B5 and B6.
5. The points came up for considerations are:-
- Whether the complaint is barred by limitation?
- Whether there is any deficiency in service on the part of the opposite parties?
- Whether the complainant is entitled to get relief and cost?
6. Point No.1:- According to the opposite parties, the complaint is barred by limitation. The letter of repudiation was sent on 2.4.2012 and petition is filed on 17.5.2014 after a period of 2 years, hence the complaint not maintainable. On perusing the document, we came to see that Ext.A2 letter dated 3.4.2012 was sent to the Manager, Kerala State Co-operative Federation for Fisheries Development Ltd. by the Reliance General Insurance Company informing that since the cause of death is not due to any accidental injury, the claim is not admissible as per the terms and conditions of the policy. Ext.A3 is the letter dated 8.10.2012 sent by the third opposite party to the complainant informing that the claim was repudiated by the insurance company stating that her husband’s death was not occurred due to an accident, but it was a suicide. Complainant came to know that her claim was repudiated by the letter dated 8.10.2012 and the claim was filed before this Forum on 19.2.2014, that is within the period of 2 years and hence the complaint is maintainable.
7. Points 2 and 3:- It is an admitted fact that as per the Fishermen Group Personal Accident Insurance Scheme for the year 2011-12 the deceased Sebastian Palliparambil, the husband of the complainant had remitted premium amount before the Vadakkal Kanjiramchiramchira Fishermen Development Welfare Society A-11 on 26.3.2011 as per receipt No.1845. According to the opposite parties 1 and 2 the police records and investigation report disclosed that the incident was at night while crossing the railway line which is a suicide attempt. As per the policy issued by the opposite parties 1 and 2 company shall be liable for the death, bodily injury solely and directly caused by accidental violation external visible means resulting in death or permanent total disablement of the insured. Since no such injuries, death was due to suicidal attempt, company is not liable to pay any amount. According to the complainant, her husband’s death was absolutely an accident while crossing the railway gate at Vadacanal. In order to prove her claim, she produced Ext.A4 FIR, Ext.A5 Postmortem report, Ext.A7 Inquest report, Ext.A8 Final report, Ext.A9 the FIS etc. On perusing the Final report we came to see that under the title brief facts of the case, it is stated that, “ ”. In this case neither the first information report nor the final report submitted by the police do not contain even an observation that it was a case of suicide. Admittedly no evidence has been adduced by the opposite parties 1 and 2 to prove that the deceased had committed suicide so as to bring the claim under the suicide exclusion clause mentioned in the policy terms and conditions. A mere assertion that the insured had committed suicide is not sufficient to repudiate the claim preferred by the complainant. More over third opposite party stated in the version that there was no suicidal tendency on the part of the complainant’s husband and he was leading a very happy family life. The third opposite party also stated that while the complainant’s husband was coming after seeing his aged mother to his house he was hit by the train. Since the opposite parties 1 and 2 failed to prove with independent material evidence that the insured had committed suicide, we are of opinion that the repudiation of the claim of the complainant by the opposite parties amounts to defect and deficiency in service.
In the result, complaint is allowed. The opposite parties 1 and 2 are directed to pay an amount of Rs.3 lakhs (Rupees three lakhs only) with 9% interest per annum from the date of complaint till realization to the complainant. Since the primary relief is granted no further relief as to compensation and cost. The order shall be complied within one month from the date of receipt of this order.
Dictated to the Confidential Assistant transcribed by her corrected by me and
pronounced in open Forum on this the 31st day of March, 2016.
Sd/- Smt. Elizabeth George (President) :
Sd/- Sri. Antony Xavier (Member) :
Sd/- Smt.Jasmine.D. (Member) :
Appendix:-
Evidence of the complainant:-
PW1 - Reshmi.M. (Witness)
PW2 - Augustine (Witness)
PW3 - James (Witness)
PW4 - H. Abubakker (Witness)
Ext.A1 - Accident Insurance Premium Receipt (Photo copy)
Ext.A2 - Registered letter dated 3.4.2012 (Photo copy)
Ext.A3 - Letter dated 8.10.2012 (Photo copy)
Ext.A4 - First Information Report (Photo copy)
Ext.A5 - Post Mortem Certificate dated 4.7.2011
Ext.A6 - Paper news (Photo copy)
Ext.A7 - Inquest Report (Photo copy)
Ext.A8 - Final Report (Photo copy)
ExtA9 - Scene mahazor and depositions
Evidence of the opposite parties:- Nil
Ext.B1 - Reliance Personal Accident Insurance Policy (Group) – terms
Conditions (Photocopy)
Ext.B2 - Accident Insurance Claim Form (Photocopy)
Ext.B3 - FIR (Photo copy)
Ext.B4 - Registered letter dated 3.8.2012 (Photocopy)
Ext.B5 - Agreement executed on 1.3.2011 (Photocopy)
Ext.B6 - Group Personal Accident Insurance Policy Schedule (Photocopy)
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite parties/S.F.
Typed by:- pr/-
Compared by:-
