DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  6^th day of March, 2023

Present      :   Sri. Vinay Menon V.,  President

                  :  Smt. Vidya A., Member                        

                  :  Sri. Krishnankutty N.K., Member                                Date of Filing: 26/08/2020   

                         CC/96/2020

1. Sumi,

W/o.Late Venkiteswaran K.C.,

House No.51, Vidyagiri, Rail Nagar,

Olavakkode, Palakkad – 678 002

2. Nanditha,

D/o.Late Venkiteswaran K.C.,

House No.51, Vidyagiri, Rail Nagar,

Olavakkode, Palakkad – 678 002

3. Nithish,

S/o.Late Venkiteswaran K.C.,

House No.51, Vidyagiri, Rail Nagar,

Olavakkode, Palakkad – 678 002                                     -                       Complainant

       (Ops 2 &3 represented by OP1, Mother & Legal Guardian)

       By Adv.K.Dhananjayan)

                                                                                    Vs

1. United India Insurance Co. Ltd.,

Head Office at 24, Whites Road,

Chennai – 600 014

2. The Manager / Authorised representative,

 United India Insurance Co. Ltd.,

Head Office at 24, Whites Road,

Chennai – 600 014

3. United India Insurance Co. Ltd.,

Mission School Junction, PLI Branch Office,

Palakkad – 678 014                                                          -           Opposite parties

       (OP  by Adv.M.Krishnadas)

O R D E R

By  Sri. Vinay Menon V., President

1. Pruned to essentials, pleadings are that the first complainant and her two children, OPs 2 & 3, are the successors in interest of one deceased Venkiteswaran.K.C., who died pursuant to grievous  injury sustained in a road traffic accident. At the time of accident the vehicle was insured with the opposite party. The insurance carried Rs.15 lakhs, to which the complainants are legally entitled. Yet a claim raised  by the complainants were repudiated by the opposite party company. Aggrieved thereby, this complaint is filed.
2. The opposite parties admitted the accident on 5/3/2019 and the existence of a valid personal accidental coverage policy. But the opposite party contented that the injuries suffered by the insured were not serious and there were only abrasions pursuant to the accident. The medical records showed that the injured was taken to Kovai Medical Centre and Hospital Ltd. on 5/3/2019 itself and was discharged of 3/4/2019. There was no history of head ache, convulsion or ENT bleeding. Past history was noted as nil and not relevant. He was admitted again on 30/4/2019 in connection with history of head ache since 12/4/2019. His admission was only for medical management and his condition was vital and stable on 16/7/2019.  The deceased died a natural death on 7/8/2019, i.e. after 5 months from the date of accident and it was only a natural death due to brain abscess i.e. not attributable to any accident as reported in the Medical Certificate of Cause of Death issued from Kovai Medical Centre. It was under these circumstances that the claim was rejected.  The complainants had already claimed compensation by filing a claim default MACT, Palakkad
3.  The following issues arise for consideration:

1. Whether the death of deceased was consequent upon the accident dated 5/3/19 ?
2. Whether there is deficiency in service/unfair trade practice on the part of the opposite party?

3.   Whether the complainant is entitled to any of the reliefs sought for?

4.   Reliefs, if any?

4.         (i)         Complainant filed proof affidavit and marked Exts. A1 to A8.  

(ii)        Opposite party filed proof affidavit and marked Exts. B1 & B2.  

Issue No.1                                                                                                                                                                                                                                               

5.         Per complaint pleadings, the deceased met with an accident on 5/3/2019 and the death was consequent upon this accident.  The opposite party staunchly opposed this pleading contenting that the accident on 5/3/2019 was a minor accident and death had occurred on 7/8/2019. Ie. after 5 months.

6.         In order to ascertain the factual matrix in the correct perspective we have to ascertain what is insured.  Ext.B2 is the policy schedule cum insurance certificate. Page 1 of the schedule at its bottom part states the limit of liability. The relevant portion is the first item which is “Under section II – I(1) Death or bodily injury in respect of anyone accident…….”

7.         In page 4 of terms and conditions, under the head “Personal Accident Cover For Owner – Driver” the following condition is relevant to note;

            “Subject otherwise to the terms, exceptions, conditions and limitations of this Policy, the Company undertakes to pay compensation as per the following scale for bodily injury, death sustained by the owner-driver of the vehicle in direct connection with the vehicle insured or whilst mounting into / dismounting from or travelling in the insured vehicle as a co-driver, caused  by violent, accidental and visible means which independently or any other clause shall within 6 calendar months of such injury result in:”

8.         In order to ascertain whether the cause of death fell into any of the categories stated supra the only document that we can rely upon is Ext.A8, which is the Medical Certificate of Cause of Death issued by Kovai Medical Centre and Hospital. Ext.A8 shows the date of death as 7/8/2019. Cause of death is shown as brain abscess and manner of death, natural.

9.         In view of the certificate marked as Ext.A8, we are of the opinion that the death of the deceased will not fall into categories covered under Ext.B2 insurance coverage.

            Issue Nos.2 to 4

10.       Consequent on the findings in Issue 1, we hold that there is no deficiency in service on the part of the opposite party. The complainant is not entitled to any of the reliefs sought for. Resultantly, the complaint is dismissed.

11.       In the facts and circumstances of the case, the parties are directed to suffer their respective costs.

                  Pronounced in open court on this the 6^th  day of March   , 2023.           

                                                                                           Sd/-

                                                                                              Vinay Menon V

                                                      President

                                                              Sd/-

   Vidya.A

                       Member        

         Sd/-                                                       Krishnankutty N.K.

                                                                                                      Member

APPENDIX

Exhibits marked on the side of the complainant :  

Ext.A1 – Copy of relevant pages of ration card bearing No.1946020586

Ext.A2 – Copy of RC book for vehicle bearing No.KL09Q5802

Ext.A3 –  Copy of FIR bearing No.0070 dated 8/3/2019

Ext.A4 – Copy of driving license bearing NO.9/3522/1994  

Ext.A5  – Copy of certificate of insurance  bearing policy No.1012013118P114770358

Ext.A6 –  Copy of letter dated nil issued by complainant

Ext.A7 –   Copy of communication dated 7/5/2020 

Ext.A8 –   Copy of medical certificate of cause of death

Exhibits marked on the side of the opposite party:

Ext. B1:  Certified copy of  claim in OP(MV) No.1296 /2019 on the file of MACT Palakkad.

Ext. B2:   Copy of Policy certificate and schedule.

Court Exhibit:  Nil

Third party documents:  Nil

Witness examined on the side of the complainant: Nil

Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.