DOF. 11 / 1 /05

                                                     DOO.1/7/10

IN THE CONSUMER DISPUTES REDRESSAL FORUM, KANNUR

Present: Sri.K.Gopalan:  President

Smt.K.P.Preethakumari:  Member

Smt.M.D.Jessy:               Member

Dated this, the 1^st  day of July 2010

C.C.No.13/2005

1. P.K.Praseetha,

   W/o.Late C.P.Dileepkumar,

   Deepam, P.O.Chala

2. C.P.Dipin

3. C.P.Dilna (minor)

   (Rep. by mother P.K.Praseetha)

4. C.P.Deepna (minor)

   (Rep. by mother P.K.Praseetha)

   (All are residing Deepam, P.O.Chala)                                    Complainants

5. Malathi.C.P.,

  ‘Malathi Nivas’,

   P.O.Chala.

   (Rep. by Adv.O.G.Premarajan)

Divisional Manager,

New India Assurance Co.Ltd.

Divisional Office,

Century Plaza, Thavakkara,                                                      Opposite party

Kannur.

(Rep. by Adv.V.K.Rajeev)

O R D E R

Sri.K.Gopalan, President

            This is a complaint filed under section 12 of consumer protection act for an order directing the opposite party to pay an amount of Rs.8, 00,000/- towards the benefits envisaged by the Pravasi Suraksha- Kudumba  Arogya Scheme and to pay Rs/.1.,00,000/- as compensation together with the cost of this proceedings.

            The case of the complainants in brief is as follows: The complainants are wife, children and mother of the deceased C.P.Dileep Kumar, who was working in Sultanate of Oman for more than 21 years. Mr.Dileepkuamr and his family members insured with the opposite party dt.12.4.01 under Kudumba Arogya Scheme (KAS) and Pravasi Suraksha (PSI) for Rs.8, 00,000/-. The same was valid up to 11.4.06. As per the Pravasi Scheme, the complainants are entitled to get Rs.5, 00,000/- in case of death of the insured. Apart from that two children of the deceased are entitled to get Rs.50, 000/- each as educational grant and 3^rd and 4^th complainants, as unmarried daughters of the insured are entitled to get Rs.50, 000/- each as marriage grant incase of death of the insured. As per the Kudumba Arogya scheme complainants are entitled to get Rs.1, 00,000/- as premium and service tax was paid and oppose party issued the certificate of Insurance. On5.2.03 while the insured was taking boiled water on a lighted kerosene stove his apparels got ignified and as a result of which he sustained serious burn injuries. He was taken to Dhanalakshmi Hospital, Kannur and there from to Omega Hospital Mangalore and then shifted to Burns Unit of University Medical Centre, Mangalore but succumbed to the injuries on14.2.03.The complainants thereafter submitted claim before the opposite party. The opposite party repudiated the claim by raising some untenable and false contentions under the exclusion clause No.5 of the Pravasi Suraksha certificate. Lawyer notice was sent. Opposite party sent reply stating that opposite party conducted an investigation and that Dr.Rahul R Menon of Omega Hospital, Mangalore has stated at that time in his reference letter to the opposite party that the injury was self inflicted. It is further stated that Dr.U.Anandakini of University Medical centre, Mangalore also opined that the injuries were self inflicted. The doctors never talked to the injured or to the bystanders. It was impossible to arrive at such a conclusion. It is further averred that Dileepkumar had locked himself in the kitchen and pored kerosene over his head and get himself on fire. All those allegations are untrue and incorrect. Dileepkumar sustained burn injuries on accidental burn. It was neither self inflicted nor suicidal. N o enquiry is made neither in the locality nor in the family. The police registered a crime as 56/03 of Edakkad Police station and final report submitted before the sub Divisional Magistrate, Tellicherry by the S.I of police stating clearly that the death of Dileepkumar is an accidental one. The contra averments by the opposite party are only to run away from liability. The denial of claims without any reasonable cause amounts to deficiency of service on the part of opposite party. Hence this complaint.

            In pursuance of notice opposite party entered appearance and filed version denying the main allegations of the complainant. The contentions in brief raised in the version are as follows: Opposite party issued the policy as mentioned in the complaint. As per the investigation conducted by the opposite party they could understand that the diseased Dlileepkumar was working in Gulf for some year and had returned loosing the job and he was also mentally disturbed and depressed due to his heat ailments following a bypass operation on 8.9.02 and also duet to financial crisis as a result of the loss of his job. On 5.2.03 at 3.30 a.m he entered into the kitchen of his house with the intention of committing suicide, locked himself inside and poured fuel over his head and set himself on fire. The first and second complainant who witnessed the scene opened the window and tendered water using hose through the window and neighbours and people who gathered there broke opened the door and extinguished the first. The injured was taken to Dhanalakshmi Hospital, Kannur and there from removed to Omega Hospital, Mangalore and then referred to University Medical centre where he was admitted on 6.2.03, but he succumbed to the injuries in the Hospital on 14.2.03. Post mortem was done at Dist. Hospital Mangalore. The medical case summary issued by Dr.Rahul R Menon, M.D9Hospital Administrator) of Omega Hospital reveals that the burn injury on the deceased was self inflicted. The case summary records also show that the operation was conducted on the deceased earlier from the hospital for coronary artillery Bypass grafting on 8.9.02 which is 6 months before his suicide. Dr. U.Anand Kini of University Medical Centre, who had treated the patient, is of opinion that these injuries could only be self inflicted. The statement collected from M.V.Saseendran, Milma Agent, and Chala who is a close friend of the deceased will show that Dilipkmumar had committed suicide. The driver of the taxi car kL.13F.3627 who took the deceased to the hospital also stated that deceased had committed suicide. Mr.P.Sajeevan, Postman also opined that the deceased has committed suicide. Death was not an accidental one but suicide. As per clause 5 insurers is not liable in the case of suicide. The versions of police are intentional and deliberate lies with the ulterior motives to support the complainants. The claim repudiated on the basis of the finding that death was due to self inflicted injuries with calculating intention of committing suicide. Hence there is no deficiency in service. Hence to dismiss the complaint.

            On the above pleadings the following issues have been taken for consideration.

1. Whether there is any deficiency in service on the part of opposite party?

2. Whether the complaint is entitled for compensation as prayed in the complaint?

3. Relief and cost

            The evidence consist of the oral evidence  adduced by PW1,PW2, DWs1  to 4, Exts.A1 to A14, B1 to B 5 and Ext.X1.

Issues 1 to 3

            Admittedly the deceased Mr.Dileepkumar and his family members insured with the opposite party dt.12.4.01 under Kundumba Arogya Scheme (KAS) and Pravasi Suraksha (PSI) for Rs.8, 00,000/- which was valid up to 11.4.2006. As a result of serious burn injuries Mr.Dileepkuamr was taken to hospital and finally succumbed to the injuries. Claim submitted but repudiated on the ground that death was due to self inflicted injuries with calculating intention of committing suicide.

            The case of the complainants is that while the insured was taking boiled water on a lighted kerosene stove his apparels got ignified and sustained serious burns injuries immediately he was taken to  Dhanalakshmi Hospital, Kannur and there from to Omega Hospitals, Mangalore, where from he was shifted to Burns Unit of University Medical centre, Mangalore. O n 14.2.03 he succumbed to the injuries. Police registered a crime as 56/2003 of Edakkad police station and enquired about the death of Dileep Kumar. Police submitted the final report before the sub Divisional Magistrate, Tellicherry stating clearly that the death of Dileepkuamr is an accidental one.

            Ext.A1 is the copy of certificate of insurance. Ext.A2 is the post mortem report, which described wounds position thus: “Burn injuries present over the face, chest, abdomen, and both upper limbs and partially over the left thigh. Total body surface brunt is 55% and of 11 degree in nature. The burnt areas are ulcerated with slough-formation and foul smelling discharge present over the burnt areas”. Ext.A3 is the FIR, the content of which is as follows: 5.2.2003 XobXn kqamÀ 9.30 aWn-¡z-b-em-f-¸n  e£-a-W³ aI³ Zneo]v F¶-bmÄ Sobmsâ ho«n sh¨v as®® Ìu X«n-a-dnªv s]mÅ-teäv aT-K-em-]p-cT  UMC  Bip-]-{Xn-bn NnInÂk-bn-en-cns¡ 14.2.03 \p cm{Xn 21.00 aWn-tbmsS ac-W-s¸-«p-sh-¶pT aäpT Mr. Karunakaran, S/o.Krishnan in his FI  statement stated that:

ac-W-s¸« Znen]v `mc-y-bpT 3 a¡-fp-sam-¶n¨v taÂ]-dª Øe¯v Xma-k-am-Wv. Zneo]v akv¡-änÂtPm-en-sN-bvXp-h-cn-I-bm-bn-cp-¶p. \m«n h¶n-«vkq-amÀ 6am-k-t¯m-f-am-bn. 2 amkT ap³]v bp.-F-T.-kn-bn sh¨v lmÀ«v kT-_-Ô-amb Hm¸-td-j³ sN-bvXn-cp-¶p. Hm¸-td-j\p tijT i_vZT hf-sc Ipd-bp-I-bpT \S-¡m-\pT  aäpT hnj-aap­mbn-cp-¶p. 5.2.03mT XobXn Ime-¯v kp-amÀ 9 1/2 aWn ka-b¯v ho«nse  ASp-¡f apdn-bnÂsh¨v I¯n-sIm-­n-cn-¡p¶ as®® käu-hn \n¶p-T- Xn-f-¨p- sIm-­n-cn¡p¶ shÅT FSp-¡p-T-t]mÄ A_-²-¯n Ìu tZl¯v andª v [cn¨ncp¶ hkv{X-¯n Xo]n-Sn¨v  s]mf-f-teäp. `mc-y-bp-tS-bpT a¡-fp-tS-bpT \ne-hn-fn-tI«v  Rm\pT {]Xo-]-\pT aäpT tNÀ¶v HmSn-s¨¶p Zneo-]n\ NnIn-Õ-¡mbn  I®qÀ [\-e-£an  Bip-]-{Xn-bn-epT  XpSÀ¶v aT-K-em-]p-cT  bp.-F-T.kn Bip-]-{Xn-bn F¯n¨v NnInÂkn¨p hcth 14.2.03 XobXn cm{Xn 9 aWn-tbmsS ac-W-s¸-«p.  Ext.A4 is the final report in crime No.56/03 of Edakkad Polcie station. The report consist of the statement that “aT-K-em-]p-c-T-bq-Wn-th-gvknän saUn-¡Â skâÀ Bip-]-{Xn-bn NnInÂk-bn Ign-bth Kpcp-X-c-amb s]mf-f-te-ä-Xns\ XpSÀ¶v NnInÂk ^en-¡msX Zneo]v IpamÀ  14.2-.2003þmT XobXn cm{Xn 10 aWn¡v ac-W-s¸-«-Xm-sW-¶pT ac-W-Im-c-y-¯n aäp bmtXmcp kT-i-b-hp-an-söp hy-à-am-bpT sXfn-bp-¶p-­v. IqSmsX  Zneo]v Ipam-dn-sâ -ar-Xp-tZ-lT Iodn ]cn-tim-[\ \S-¯nb UMC Opinion as to cause of death. ‘ Death was caused due to septicemia as the result of burn injuries  F¶¶p hy-à-ambn tcJ-s¸-Sp-¯n-bn-«p-f-f-Xn-\m-epT Cu  tIÊn-sâ-A-t\-z-j-WT CtXm-Sp-IqSn ]qÀ¯n-bm¡n Cu tIÊv  Death was caused due to Septicemia as a result of burn injuries Bbn IW-¡m¡n FAD Bbn ]cn-K-Wn¨v  _lp-am-\-s¸« tImS-Xn-bpsS A\vvthjW ^b-en \n¶p-T-Ip-dhp sNbvXp-D-¯-c-hp-­m-hp-¶-Xn-evt¡mbn    Cu A´n-a-Xo-cp-am-\-dn-t¸mÀ«v kaÀ¸n¨p sImf-fp¶p.

            Ext.A3 FIR and A4 final report of the police to sub Divisional Magistrate reveals that there is no doubt in the investigation of police with respect to the death of the Dileep kumar.. Both Fir and final report makes clear that the death of Dilpeepkmar is out of accidental burn injuries. Ext.A4 categorically stated hat there is no other doubts with respect to the cause of death.  The very sentence written is thus “A_-²-¯n käu andªv hoWv Xo B-fn-¡¯n [cn-¨n-cp¶ hkv{X-¯n\p Xo]n-Sn¨v apJ-¯pT  s\©-¯pT  Ac-¡v ap-I-fn-ep-T -Kp-cp-X-c-ambn s]mf-f-teäv aT-K-em-]p-cT bqWn-th-gvknän saUn-¡Â skâÀ Bip-]-{Xn-bn NnIn-Õ-bn Ign-hsh Kpcp-X-c-am-b-s]m-f-f-te-ä-Xns\ XpSÀ¶v Nn-InÕ ^en-¡m-sX-Zn-eo]v IpamÀ 14.2.03 Xo-bXn cm{Xn 10-þ11 aWn¡v ac-W-s¸-«-Xm-sW-¶pT hy-à-am-bpT sXfn-bp-¶p-­v. It makes clear that police is very much sure that it is proved to be free from suspicion and the death is nothing other than that of accidental fire.

            PW1 wife of the deceased filed chief affidavit in tune with the pleadings. She has stated the contention of the opposite party that Dileep Kumar entered into the kitchen of his house with the intention of committing suicide, locked him from within and poured fuel over his head and set himself on fire is absolutely false. She has also adduced evidence by way of affidavit in lieu of chief examination that the alleged kitchen does not have doors. She has stated thus:kT-`-hT \S¶ Asp-¡-f¡v hmXn-en-Ã. taÂ]-dª FÃm-B-tcm-]-W-§-fpT  Ak-X-y-hpT sXäm-b-Xp-am-Ip-¶p. BI-kvan-I-am-bp-­mb A]-I-S-s¯-Xp-SÀ¶m-WvZn-eo]v Ipam-dn\p  burn injury D­m-b-Xv. Ah kz-bT tF¸n¨tXm Bß-l-X-ym-]-c-tam-A-Ã. Zneo-]vIp-am-dn\p taÂ]-d-ª-X-c-¯n-ep-ff A]-I-ST  D­m-t¡-­-Xmb bmsXm-cp-Im-c-W-hp-an-Ã. PW1 was cross examined for opposite party elaborately. In her cross examination she has deposed that the deceased husband had been serviced in gulf for 21 years. Bypass operation was done 5 months before the death. He did not loose the job in gulf. The incident took place at about 9.30 P.M. She was there in the courtyard of the house. She saw the incident when she came to kitchen hearing the sound. She poured water by using hose . She further deposed that she saw her husband preventing the fire. She deposed thus:`À¯m-hp- ssI-sIm­v Xo X«p-¶-XmWv Rm³ I­-Xp. PW2 is the retired police S.I who submitted Ext.A4 final report before the Sub Divisional Magistrate. In his chief examination he has adduced evidence that “5.2.03 \p Rm³-F-S-¡mSv tÌj-\nse F.-F-kv-ssF Bbn-cp-¶p.  AtX tÌj-\nse  Cr.56/2003 Bb Hcp ss{IT dPn-ÌÀ sNbvXp. 5.2.03 XobXn  Ime¯v 9 1 / 2 aWn-¡v Zneo]v IpamÀ F¶-bmÄ  Sobmsâ ho«n sh¨v  as®® käu X«n-a-dn¨v s]mf-f-teäp NnInÂk-bn-em-bn-cpt¡ 14.2.20-03\p  cm{Xn-a-c-W-s¸-«p F¶m-Wv]-cmXn. Rm\mWv At\-z-j-W-T- \-S-¯n-b-Xp.  At\-z-j-W-¯n   A_-²-¯n as®-®-X-«n-a-dnªv  s]mf-f-te-äp -F-¶p-a-\-Ên-em-bn. AXn-sâ -A-Sn-Øm-\-¯n  ss^\ dn-t¸mÀ«v tImS-Xn¡v  kaÀ¸n-¨p. dnt¸mÀ«n Fgp-Xn-b-t¸mÄ  Kymkv käu F¶v-F-gp-Xn-bXp sXän-t¸m-bXmWv. s]mf-f-te-äXp  as®-®- k-äu-hn \n¶p Xo]n-Sn-¨m-Wv.  AXp-{]-Im-c-T -sIm-Sp¯ dnt¸mÀ«mWv  Ext.A4.aXn-bmb At\zjW-T-\-S-¯n-bm-Wv dn-t¸mÀ«vsIm-Sp-¯Xp.  In the cross examination PW2 has also deposed Fhat he was the person who registered the FIR. Nothing could be brought out in the cross examination against what is stated in the chief examination. The evidence of PW2 proves the contents of FIR and Ext.A4 final report.

            DW1 is the investigator of New India Insurance who conducted investigation in accordance with the direction of the Insurance Company. Ext.B1 is the investigation report submitted by DW1. He has given evidence that “ Hospital  

 \n¶p collect  sNbvX  evidence sâbpT   local knsâ ssIbnÂ\n¶p  collect  sNbvX-Xn-sâ-bpT ASn-Øm-\-¯n-em-Wv. R§-fpsS A`n-{]m-b-¯n Zneo]v IqamÀ a-cn-¡m-\n-S-bmb  kml-N-c-yT kmT-]-¯n-I-_p²nap-«m-Wv.  tUmIvS-dnsâ dnt¸mÀ«n self inflicted injury F¶m-WvI-­Xp . University Medical Centre \n¶p  In«nb  medical report  BWv. AXp-{]-Im-cT   item No.3   self burns F¶m-WvI-­-Xp. CsX-ÃmT {]Im-cT Hcp  unnatural death Bbn-«mWv R§Äa-\-Ên-em-¡n-bn-«p-f-f-Xp.

            DW1gives evidence that he is the investigator of New India Assurance Co.  And he conducted the investigation. He has taken statement from one Mr.Sashi who is a Milma agent, Mr.C.Babu and another Sajeevan Chala. It is on those statements and the report of doctors that he came in to conclusion that the death was unnatural.

            In the cross examination he has deposed that no document produced before the Forum to show that he has been serving as the investigator of New India Insurance company. He has also deposed that there is appointment letter authorizing him to conduct investigating in respect of the death of Mr.Dileep Kumar. He has further deposed in cross examination that “ Rm³-C-Xp-ambn _Ô-s¸« medical reportsH¶pT ]cn-tim-[n-¨n-«n-Ã. Rm³   investigationsâ `mK-ambn Bip-]-{Xn-bnse     case sheet   H¶pT ]cn-tim-[n-¨n-«n-Ã. kT-`-h-hp-ambn _Ô-s¸«v t]meokv register sNbvX FIR s\]än Rm³ a\-Ên-em-¡n-bn-«n-Ã. Zneo-]vIp-am-dnsâ  _m¦v tcJ-IÄ H¶p-T -Rm³]-cn-tim-[n-¨n-«n-Ã. Kerosene  X«n andª  A_²¯n  ]cn-¡v]än  ancn-¨-Xm-sW¶p  t]meokv dnt¸mÀ«v sImSp¯ Imc-yT Rm³ a\-Ên-em-¡n-bn-«n-Ãv.

            Neither the document to show that DW1 was the investigator of New India Assurance co. nor the letter of authorization entrusting him to conduct the investigation regarding the death of Dileep Kumar has been produced before the Forum. DW1 in his chief examination adduced evidence that he derived at conclusion that the death was suicide by the statements of certain persons and the reports of the doctors. What he has deposed in cross examination is hat he did not examine any of the medical report in connection with the incident. Case sheet also had not been examined. The statement that he has derived on the conclusion that the death was suicide on the basis of statement given by those persons cannot be believed. More over DW1 also deposed in cross examination that he did not know anything about the FIR registered by the concerned police. He has also having no information about Ext.A4 final report. DW1 has given evidence in chief that the reason for suicide which he understood was financial difficulties but in cross examination deposed that he has not attempted to verify the bank account of the diseased Dlieep Kumar. Without verifying the existing financial position how can it be conclude that there is financial difficulties for the deceased. The evidence of DW1 is so weak, good for nothing to depend which seems to be totally unreliable. This is a case wherein the burden fully lies upon opposite party to prove that the deceased was committed suicide. Hence any person conducing investigation can only be derived at a proper conclusion based on facts relevant which is sufficient enough to be free from doubt. It is difficult to understand how does the investigator derive at a conclusion without examining the case sheet, without knowing the details of FIR, without understanding and analyzing the final report Ext.A4 submitted by the police, that the deceased has committed suicide. How can it be believed that deceased has committed suicide because of the reason of financial difficulties without verifying the bank balance of the deceased? An investigation which had not been taken into consideration the above pointed out aspects can only be considered as quite mechanical or something done for only name sake without application of mind.

            It is quite wonderful to se that an investigator derived in conclusion that the deceased in the above matter, who had been allegedly served as a salesman in a Supermarket in Sultanate of Oman and was working under Khamis Mohammed Saidal Farsi, P.BN.No.435, SUR.411, Sultanate of Oman for the last 21 years, was in financial difficulties without verifying his bank balance.DW2 in his cross examination deposed that Zneo-]n-\p-B-ß-l-Xy sNt¿­ kmT-]-¯nI kml-N-c-y-§Ä CsÃ-¶m-WvRm³  a\-Ên-em-¡n-b-Xp.       

What more is necessary to say that the investigation was not proper and dependable? Though DW2 is a witness turned hostile he has deposed in his cross examination that he was aware of the fact that the death was occurred due to accident.

            DW3 deposed in his chief examination that the deceased attempted suicide. But the doctor did not explain the cause of death.  In the cross examination answer to a question whether this type of injury can be caused form a fall of kerosene from upper part?  The doctor answered ‘accidentally it can be caused. On going through the evidence it can be seen that doctor has opined three possibilities namely

(1)   either he has done himself; or

(2)   some other person has done; or

(3)   By an accident.

In the light of the evidence of DW3 doctor it cannot be jumped into

Conclusion that the death was as a result of suicide. Doctor has not exposed such a definite opinion in their evidence.

During the cross examination DW4 was asked the specific question what all the documents upon which you have concluded the death as suicide? The answer is investigation report, medical report; claim form etc. and also added it is based on the investigation report submitted Biju Nobert, the agency authorized by the Insurance Company. DW4 also deposed that “Investigation report ]cn-k-c-hm-kn-I-tf-bpT  tcmKnsb tlmkv]n-ä-en sIm­p- t]mb Btfm-SpT At\-z-jn-¨mWv  dnt¸mÀ«vX-¿m-dm-¡n-b-Xp. Iio-{µ³ ,_m-_p,- k-Po-h³ F¶n-h-cpsS  tÌäp-saânsâ ASn-Øm-\-¯n-em-Wvdn-t¸mÀ«vsN-bvX-Xp. The statement of the above said three persons are the basis of the report submitted by the investigator appointed by insurance company. Mr.Sajevan was adduced evidence before the Forum as DW2. DW4 also deposed that he was not aware whether any one of those persons wee examined. DW4 also deposed that “claim repudiate sN¿p-¶-Xn\p ap³]v police report  sImSp¯ Imc-yT And-bn-Ã. t]mÌvtamÀ«T dnt¸mÀ«n accidental burn injury F¶mWv ]d-ªn-«p-f-fXp. It is clear that these aspects haven’t been considered while repudiating the claim. The evidence of DW4 makes clear that the postmortem report mentioned that it was accidental burn injury due to kerosene oil stove blast. Ex.B1 also pointed out this fact.

            Ext.B1 report on investigation under the sub heading Postmortem report has stated that “In the postmortem report it is mentioned that it was accidental burn injury due to kerosene oil stove blast”. The report says that they interviewed Mr. M.C. Saseendran, Milma Agent Chala and he opined that Mr.Dileepkumar committed suicide. It is also stated that they have obtained statements from M.C.Babu, the taxi driver, M.P.Sajeevan the neighbour of the deceased and the postman of that area.  Report continues to say that he met Mrs.PV.Shyamala, Panchayath member of Chala Panchayath. But the report did not contain statement of any one of these persons. The above said postman Mr.Sajeevan adduced evidence as PW2. He is the only person examined before the Forum. Others did not give evidence nor does the report contain their statement as part of it. But DW1 deposed that “Document No. IV Â Ext.11F¶p Fgp-Xn-b-Xp- Rm-\m-Wv. iin F¶ anÂa tFPânsâ    statement B Ext. II. Ext. III F¶v Fgp-Xnb tcJ-bpT  investigation   sâ `mKam-Wv. kPo-h³ Nme-bpsS      statement BWv“. Mr. Sajeevan DW2, the postman denied the alleged statement given by him in his cross examination. None of the statements added as annexure of Ext.B1 report. Certain letters written in some white papers are seen produced. It is contended that those letters are written by Saseendran, Babu and Sajeevan. But it is not marked and proved through witnesses.

            DW2 has specifically deposed in his chief examination that “Dileep Kumar acn-¨Xp  A]-I-S- a-c-W-sa-¶mWv Rm³ a\-Ên-em-¡p-¶Xp “. No other person mentioned whose statements alleged to be gathered has not been examined to prove what they said with respect to the incident.

            The close examination of the entire evidence goes to show that the opposite party failed to discharge onus of proof to establish a justifiable ground to repudiate the claim. Opposite party could not prove that the death of the insured was due to self inflicted injury with the intention to commit suicide. It has also been taken into account that the Life Insurance Corporation of India entertained the claim before them and disbursed the entire claim amount without any objection. Any how, on consideration of the available evidence before us we are of opinion that the repudiation claims is a deficiency in service on the part of opposite party. The complainants are entitled for the insurance amount.  Opposite party is liable to pay the sum insured. It is pleaded that as per the Pravasi Scheme complainants are entitled to get Rs.5, 00,000/- in case of the death of the insured. More over two children are entitled to get Rs.50, 000/- each as educational grant. 3^rd and 4^th complainants are entitled for Rs.50, 000/- each as marriage grant. Complainants are also entitled to get Rs.1, 00,000/- as per Kudumba Arogya Scheme. There is no dispute raised by opposite party in respect of the amount except upon the cause of death. Opposite party’s case is that complainants are not entitled for the amount since insured committed suicide.

            DW4 is the Asst. Manager of New India Assurance Company Ltd. He has deposed in his cross examination that if the death is due to accident the relative are entitled for Rs.5 lakh in such policies as taken by deceased Dileepkumar. He deposed that “Dileepkumar  FSp¯ t]mfn-kn-bm-sW-¦n  A]-I-S-a-c-W-T-k-T-`-hn-¨m 5 e£T cq]- A-t±-l-¯n-sâ- _-Ôp-¡Ä¡v In«pT. Ip«n-IÄ¡v A³]-Xn-\m-bn-cT cq]- sh-¨-In-«p-T.               . The contention of opposite party is that complainants are not entitled for claim and not that policy amount is different. Dispute is with respect to claim only. Hence complainant are entitled for Rs.5,00,000/- as per Pravasi Scheme and two children of the deceased are entitle for Rs.50,000/- each as educational grant and  so also 3^rd and 4^th  complainants are entitled for Rs.50,000/- each as marriage grant. Complainants are also entitled for Rs.1, 00,000/- as per Kudumba Arogya Scheme. Altogether complainants are entitled for Rs.8, 00,000/- as insured amount together with Rs.1000/- as cost of these proceedings. The issue Nos. 1 to 3 is found in favour of complainants.

            In the result, the complaint is allowed directing the opposite party to pay

Rs.8, 00,000/-(Rupees Eight lakh) as policy amount together with Rs.1000/-(Rupees One Thousand only) as cost of this proceedings to the complainants within one month from the date of receipt of this order failing which the complainants are at liberty to execute the order as per the provisions of consumer protection act.

                                    Sd/-                          Sd/-                             Sd/-

President                      Member                       Member

APPENDIX

Exhibits for the complainants

A1.Copy of the insurance certificate issued by OP to deceased  Dileepkumar

A2. Copy of the postmortem report

A3. Copy of FIR

A4.copy of final report submitted by the SI of police before Sub.Dvl.Magi.Tly.

A5.Copy of the claim form submitted by the complainants

A6.copyof the reply sent by OP

A7.Copy of lawyer notice sent to OP

A8.Reply

A9. to A11.Certificate of birth in respect of complainants 2 to 4.

A12. Copy of the postmortem report

A13.copy of final report submitted by the SI of police before Sub. Dvl.Magi.Tly

A14. Copy of FIR

Exhibits for the opposite party

B1.Coipy of investigation report

B2.copy of hospital details of late Dileepkuamr issued by UMC, Mangalore

B3.Statement submitted by P.Sajeevan (DW2)

B4.Insurnace policy with conditions.

B5.Claim form dt.11.7.03

Witness examined for the complainant

PW1.P.K.Praseetha

PW2.T.Suresh

Witness examined for the opposite party

DW1.Biju Norbert

DW2.P.Sajeevan

DW3.Dr.U.Anand

DW4.R.Suresh Babu

                                                            /forwarded by order/

Senior Superintendent

Consumer Disputes Redressal Froum, Kannur