SRI.K. VIJAYAKUMARAN, PRESIDENT.

            Complaint for realization of insurance claim, compensation, costs etc.

The averments in the complaint can be briefly summarized as follows:

The first complainant is the widow and the 2^nd and 3^rd complainants are the daughters and 4^th complainant is the son of deceased Joseph Poulin, who was an employee of Central Excise and Customs, Kollam.  On 16.4.2006 at about 10.15 p.m.  the said  Joseph Poulin  while tieing a net over the well situated in the residential compound fell into the well and died.   The body was taken out  by the  Fire force personal and the Kilikollor Police has registered Crime No.192/06 for unnatural death.   The police has filed a  final report to the RDO, Kollam stating that the death was due to an accident.   At the time of death the insurer was an employee of Central Excise and Customs, Kollam and  member of the Central Excise Employees Co-Operative Credit Society Ltd,   Ernakulam.  The first opp.party through the 2^nd opp.party has insured the life of the deceased under a Group Insurance claim and sum assured is Rs.5,00,000/-  As per the policy condition  in case the insured dies in an accident their legal heirs are entitled to get  sum assured Rs.5,00,000/-.  The premium was remitted  regularly through the 2^nd opp.party and the policy was valid at the time of accident.   Immediately after the accident the complainants preferred a claim before the first opp.party but the claim was repudiated.  Hence the complaint.

          The first opp.party filed a version contending, interalia, that the complaint is not maintainable either in law or on facts.   The definition complaint, complainant, consumer dispute service as defined in Section 2[1] of the Consumer Protection Act do not cover the claim made out in the complaint.  It is admitted that this opp.party has issued a Group Personal Accident Policy infavour of the Central Excise Employees Co-Operative Credit Society  covering the risk of the list of members attached with the policy.   As per the above policy a sum  insured of Rs.5,00,000/ is covered for the death of the insured person due to accident only.  In this case a claim was reported by the 2^nd opp.party  in respect of the death of  one Joseph Pauline occurred on 16.4.2006 who was a member covered under the Group Personal Accident  Policy issued by this opp.party.  This opp.party thereafter requested the 2^nd opp.party to produce the necessary documents such as criminal case records postmortem certificate and the other relevant documents in support of the claim which was furnished by the 2^nd opp.party.     On scrutinizing the records it was noticed that  the death of Joseph Pouline was  occurred due  to suicide who had jumped in to the well  after consuming alcohol.    The FI statement to that effect  was given  by none other than the   nephew of the  deceased.  But the investigating agency later  on come to a finding that the death was not due to suicide but due to an accidental fall of the deceased in to the well.    The investigating agency suppressed the actual cause of death in the final report submitted by him after realizing the fact that the deceased was having an insurance coverage  if the death is occurred due to an accident alone.  The opp.party therafter deputed one investigator Mr. Sasidharan for finding out the real cause of death of  Joseph Pauline and  after detailed investigation found that the deceased was a habitual drunkard who was very much worried about his adverse financial constraints he is facing in connection with the marriage of his daughter.   It is also revealed in his investigation that the deceased used to threaten in public that he would commit suicide inorder to facilitate his son to get an employment on compassionate ground. The investigator further reported that the death of Jose Pouline  was a suicide due to intentional drowning and not due to an accident.  Hence the claim was repudiated.   There is no deficiency in service on the part of the opp.party.  Hence the opp.party prays to dismiss the complaint.

Points that would arise for consideration are:

1.     Whether there is deficiency in service on the part of the opp.parties?

2.     Reliefs and costs.

For the complainant PW.1 is examined.   Ext. P1 to P6 are marked.

For the opp.parties D1  is marked.

Point:

As a matter of fact the policy in this case is admitted.  There is also no dispute that the insured Josph Pauline who was employed in the Central Excise and Customs, Kollam  died on 16.4.2006 at about 10.15 p.m.  by falling into the well of his house.  The contention of the opp.parties is that the said josph Pauline after consuming alchohol   jumped into the well and committed suicide whereas the definite case of the complainant is that he accidentally fell into the well while attempting to tie a net over the well.   The opp.parties are relying on Ext.D1 the FI Statement given by one Binoy who is a close relative of the deceased in which he has stated to the police that the deceased committed suicide by jumping into the well.   The opp.parties have repudiated the claim as the insurance coverage as per the terms of the policy is available only in case of accidental death and the death of the insured herein was suicide.

          PW.1 to 3 were examined on the side of the complainants PW.1 is the son in law of the deceased.  He has stated that the death of insured was due an accident and not suicide and the FI statement in this case was given by a person who was not actually present there.  PW.3 is the person who is alleged to have given the FI statement in this case.  He has denied having given any statement to the police regarding the death of the deceased.

          The case of the opp.party  as pointed out earlier is that the deceased after consuming alcohol committed suicide by jumping  into the well.  Ext.P4 is the postmortem certificate in respect of the deceased which does not show  the presence of alcohol in the body of the deceased which negatives the story of the 1^st opp.party.   Ext.P3  is the refer report filed by the police before the concerned Magistrate which shows that the death of the deceased was an accidental one.   Though the opp.parties would contend that the insured committed suicide absolutely no evidence was adduced to establish that contention.  The case of opp.party that the deceased consumed alcohol at the time of his death is also stands disproved by Ext.P4 postmortem certificate and Ext.P3 refer report.   From the materials now before us we hold that the death of the insured was due to an accident and as such the complainants are entitled to get the insurance amount as per Ext.P5 policy and the repudiation of the claim amounts to deficiency in service on the side of the opp.parties.  Point found accordingly.

          In the result the complaint is allowed directing the opp.parties to give the insurance amount of Rs. 5,00,000/-  as per Ext.P5 to the complainants with interest @ 9% per annum from the date of complaint till payment.   The opp.parties are also directed to pay the complainants a sum of Rs.5,000/- as compensation and Rs.1500/- towards costs.

The order is to be complied with within one month from the date of this order.

Dated this the   27^TH    day of November, 2010.

                                                                       I N D E X

List of witnesses for the complainant:

PW.1. – Leons

PW.2. – Symon

PW.3. – Binoy

List of documents for the complainant

P1. – Power of Attorney

P2. – Copy of FIR

P3. – Photocopy of Final Report

P4. – Post mortem report

P5. -  Certificate issued from United India Insurance

P6. – Intimation Letter

List of witnesses for the opp.party : NIL

List of documents for the opp.party:

D1 – First Information