SMT. RAVI SUSHA : PRESIDENT
Complainant filed this complaint under sec.35 of the Consumer Protection Act 2019 seeking to get an order directing opposite parties to pay Rs.15,00,000/- to the complainants along with interest and also cost of the proceedings of this case.
The case of the complainant as stated in the complaint, in brief , is that the complainants are wife and son of deceased Raneeshan, the RC owner of Autorikshaw KL 13-Z-5594, died in a motor vehicle accident dtd.26/2/2020 The 1st OP is the insurer of the autorikshaw. On 26/2/20 at about 11.55p.m, Mr.Raneeshan was going to Aster MIMs hospital by driving his autorikshaw along with 1st complainant for consulting doctor. Unexpectedly the autorikzhaw toppled into the down side of the road and the Raneesan was seriously injured. On 17/3/2020 at 8.00 a.m the husband of the 1st complainant died. The deceased Raneeshan was the driver and RC owner of the Auto taxi and the same is validly insured with the OP including his personal accident coverage. It is submitted that the 1st complainant submitted claim application before the OP claiming compensation amount, but the OP repudiate her claim. So the OP is liable to pay the compensation for the death of the Raneeshan in the accident. Hence the complaint.
After receiving notice, 1st OP Insurance company, entered appearance and filed its version, stand taken by the insurance company is that the cause of death of the insured was not due to any of the minor injuries caused in the accident, whereas the death of the insured was heart failure and cardiac arrest.1st OP states that as per the final report, the police has observed that on 26/2/20 at about 23.55 hours, Mr.Raneeshan.P.K(deceased insured) was going to Aster MIMs hospital due to chest pain by driving the auto taxi to consult a doctor, but when he reached the bypass road, his chest pain increased and thereby he lost control over the vehicle and the auto rickshaw fell into a ditch on the road side, he passed away on 17/3/2020 while under the treatment due to cardiac arrest at First Neuro hospital ,Mangalore and hence further action dropped u/s 174 Cr.P.C by them. Moreover the death summary issued from the First Neuro hospital Mangalore shows that the death of the insured was due to cardiac arrest. The fact that no postmortem conducted on the deceased will prove that the death was not due to the injuries sustained in the accident as alleged in the complaint. Therefore the complainants are not entitled for compensation under the personal accident insurance policy. The complainants have no cause of action against the 1st OP, since the complainant has not intimated the incident or report the claim and file claim form and submit all documents pertaining to the claim and the vehicular documents and the driving license of the deceased immediately after the accident or within a reasonable time. The OP was not afforded an earliest opportunity to process the claim. There is no deficiency in service or unfair trade practice on the part of 1st OP. Hence prayed for the dismissal of the complaint.
On the basis of the contention of 1st OP. Complainant has taken steps to implead 2nd OP and as per IA No.23/22 dtd 9/3/2022, 2nd OP has been impleaded. OP.No.2 , on being served, entered appearance and filed version. The contentions of 2nd OP are that this OP is no way related to this case and not at al liable to pay any compensation to complainant as it is a separate legal entity doing the business of loan on security of vehicles and the claim is evident from the very relief sought in the complaint and the complainants are not specified the ground whom they seek the relief. Nowhere in the complaint is whispered what is role of the this OP in the above and how it related to the cause of the case or how is it liable to the complainants. Hence prayed for the dismissal of the complaint.
At the evidence stage 1st complainant has filed her chief affidavit and documents examined as PW1, and the documents got marked as Exts.A1 to A7. PW1 was cross examined by 1st OP, insurance company. OPs neither submitted documents nor adduced oral evidence. After closing the evidence the learned counsel of complainant and 2nd OP filed argument notes.
The question to be considered as to whether the complainants are entitled to get the insurance claim amount?
There is no dispute that the husband of 1st complainant, deceased Raneeshan was an RC owner of KL-13-Z-5594 autorikshaw and the said autorikshaw was insured with 1st OP having policy No.10003/31/20/454030 with a period from 29/1/2020 to 28/1/2021.
Complainant’s case is that the insured succumbed due to the seriousness of injury happened to him from the accident of his autorikshaw. It is stated that the deceased was in unconscious till his death due to the grievous head injury occurred to him. Since he has, motor commercial vehicle package policy with 1st OP, and the policy was in active on the accidental date, the insured is entitled to get the death benefit from the insurance company(1st OP).
The OP’s contention is that the cause of death of the insured was not due to any of the minor injuries sustained to him in the accident. Whereas the death of the insured was following a heart failure and cardiac arrest. Hence 1st OP is not liable to pay the death benefit to the insured. 1st OP submitted that as per the final report, the police has observed that on 26/2/20 at about 23.55 hours, Mr.Raneeshan.P.K(deceased insured) was going to Aster MIMs hospital due to chest pain by driving the auto taxi to consult a doctor, but when he reached the bypass road, his chest pain increased and thereby he lost control over the vehicle and the auto rickshaw fell into a ditch on the road side, he passed away on 17/3/2020 while under the treatment due to cardiac arrest at First Neuro hospital ,Mangalore and hence further action dropped u/s 174 Cr.P.C by them.
Here complainants submitted Exts.A1 to A7 for proving their claim. Ext.A1 is First information report of Edakkad police station. In FIR, the section by the police is under 279, 304 A IPC. Exts.A2&A3 are wound certificates. It is seen that history and alleged case of injury as Alhlo RT A1 car toppled. In Ext.A7 post mortem certificate also states “partially healed abraded contusion ,7x3cm, associated with diffuse swelling involving right external ear, partially healed abrasion 2x2cm, over back of left ear, contusion, 17x13cm, over back of right scapular region, no evidence of intracranial hemorrhages.”
Hence from the available evidence, there was like Exts.A1,A2 and A7 the injury happened due to road traffic accident and in Ext.A7 death was caused due to the injury sustained. With regard to 2nd OP, as the complainant did not seek any relief, 2nd OP is exonerated.
For the reasons stated above, we are of the opinion that, the complainants are eligible to get the policy benefit of the deceased insured as per the policy ie, the sum assured with cost.
In the result, complaint is allowed in part. 1st opposite party is directed to pay Rs.15,00,000/- to the complainants 1 &2 equally within 45 days from the date of receipt of the certified copy of this order with Rs.10,000/- towards cost of the proceedings of this case. Failing which Rs.15,00,000/- will carry interest @4% per annum from the date of order till realization. Complainants can execute the order as per provisions in Consumer Protection Act.
Exts:
A1- Copy of FIR
A2- Wound certificate from MIMs Hospital
A3- Wound certificate from First Neuro Hospital
A4- Discharge summary from MIMs hospital
A5- Death certificate
A6-Family membership certificate
A7- Post mortem certificate
PW1-Rejina.P.K - 1st complainant
Sd/ Sd/ Sd/
PRESIDENT MEMBER MEMBER
Ravi Susha Molykutty Mathew Sajeesh K.P
eva
/Forwarded by Order/
ASSISTANT REGISTRAR
