SRI.K. VIJAYAKUMARAN, PRESIDENT. Complaint for realization of Insurance amount other charges, compensation etc. The averments in the complaint can be briefly summarized as follows: The first complainant is the father, 2nd complainant is the mother, 3rd, 4th and 6th complainants are the sisters and 5th complainant and the 3rd opp.party are the brothers of the deceased Muhammed Kunju Sajeev. The deceased was working and residing at Dhamam, Kingdom of Saudi Arabia He has insured himself with the 1st opp.party under Pravasi Bharathiya Bima Yojana 2003 and the company issued policy No.4041/4056000126/00/000 valid from 10.1.2005 to 9.1.2007. The 2nd complainant was the nominee. The said policy covered the benefits such as death, permanent total disability, family hospitalization, medical [Hospitalization] expenses, Repatriation Expenses, Air fare for attendant, Employment contingency etc.. While so he died on 19.3.2006 in Saudi Arabia. At the time of death he was aged 26 years He was having no illness. His dead body was brought to his house and his brother who was working in Saudi Arabia accompanied the dead body. The 2nd complainant preferred a claim before the first opp.party, but the claim was repudiated. The repudiation was without any bonafide and reasonable grounds. Hence the complaint. The opp.party filed a joint version contending interalia, that the complaint is not maintainable either in law or on facts. The complainants have approached this Forum with unclean hands by suppressing the material facts regarding the case. It is admitted that this opp.party had issued a Pravasy Bharathiya Bima Yogana, 2003 policy to Mr. Muhammed Kunju Sajeev for a period commencing from 10.1.2005 to 9.1.2007. The insurance coverage given was subject to terms and conditions stipulation and exclusions contained in the policy schedule. The personal Accident risk to a sum of Rs.2,00,000/- is covered under the policy for the death or permanent total disability due to the sole and direct cause of an accident. If the insured dies on account of an accident the legal heirs are entitled to get a sum of Rs.2,00,000/- apart from the compensation of Rs. 30,000/- towards repatriation expenses and one economy class return air fare for attendant who is accompanying the dead body. The above benefits under the policy are available only if death or bodily injuries is resulted due to the proximate cause of an accident alone. The 2nd complainant has submitted a claim form before this opp.party on 3.4.08for getting personal accident benefit under the policy. The complainant has produced a medical report and death certificate of the deceased. The opp.party while scrutinizing the medical report of the deceased it was found that the deceased was died due to complete arrest of heart and respiration. It is also noticed in the medical certificate that there was no external injury or cuts or violent sign no bleeding from the orifices of the body. The cause of death is not due to an accident but it is only a natural death . The complainant did not produce the police report, Postmortem report of the deceased etc. before the opp.party which are essential documents to enable this opp.party to determine the eligibility of the claimant under the personal accident cover of the policy.. Since the cause of death was not due to an accident and the complainants fail to produced the above documents along with the claim form, the claim submitted by the 2nd complain ant was repudiated on 10.4.2006 itself and the repudiation was proper and for valid reasons in accordance with the terms and conditions of the policy. Therefore the complainants have no cause of action against the opp.party. It is also to be noted that no where in the complaint it is stated that the deceased died due to an accident. The complainants have filed a vexatious claim and therefore the same is liable to be dismissed in limine with compensatory costs to the opp.party. Points that would arise for consideration are: 1. Whether the complainants are entitled to get the amount as per the policy. 2. Whether there is deficiency in service on the part of the opp.party 3. Reliefs and costs. For the complainant PW.1 is examined. Ext.P1 to P8 are marked. For the opp.party DW.1 is examined. Ext. D1 to D4 are marked. POINTS: The policy is admitted. There is also no dispute that the insured died while working abroad. The contention of the opp.party is that the coverage as per Ext. D1 policy is available only if death of insured is occurred due to an accident and no coverage is available in the case of a natural death. It is the case of the opp.party that the records produced by the complainants would clearly show that the death of insured was on account of heart disease. The learned counsel for the opp.party would argue that the complainant has not produced the death certificate issued by the hospital where the insured was treated last nor they produce any postmortem report or other document to establish that the insured died on account of any accident and therefore under the exclusion clause in the policy condition no coverage is available. As a matter of fact the complainant did not produce the death certificate issued from the hospital where the insured was treated last and no explanation in this regard is forthcoming. The learned counsel for the complainant would argue that the policy conditions were not furnished to the insured which is obvious from the non production of any acknowledgement of receipt of policy condition by the insured. The case of the opp.party is that the condition is an integral part of the policy and so no separate acknowledgement of policy condition is necessary. Even assuring that the policy condition was not given to the insured it is of no significance as in the policy itself the benefits of the policy are stated. When the policy itself shows that the same covers personal accident [covers death and permanent total disability] the burden is on the complainant to establish that the death of the insured was due to accident, which in our view the complainants failed to discharge. In these circumstances it cannot be said that the repudiation is not proper. We find no reason to interfere with the repudiation. There is no deficiency in service also. Point found accordingly. In the result the complaint fails and the same is hereby dismissed. No costs. Dated this the day of April, 2010. . I N D E X List of witnesses for the complainant PW.1. – Mohammed Kunju List of documents for the complainant P1. – Disability certificate [2 Nos.] P2. – Policy certificate P3. – Death Certificate P4. – Airway bill P5. – Letter from Central Hospital, Damam P6. – Signature clearance certificate P7. – Certificate issued by Commissioner of Customs P8. – Repudiation letter List of witnesses for the opp.parties DW.1.- Jayachandran R List of documents for the opp.parties D1. – Policy and conditions D2. – Medical report of deceased D3. – Certificate issued by Saudi Arabia D4. – Repudiation letter | 
