By Smt. C.S. Sulekha Beevi, President,<br /> <br /> 1. Complainant is the mother of deceased/insured Ayyappan who had availed a 'Jeevan Pariraksha Insurance' policy with opposite party. Ayyappan died on 04-4-05 after fall from coconut tree which happened due to the cardiac arrest sustained by him while climbing the tree. Though complainant who is the nominee under the policy preferred a claim before opposite party, it was repudiated on unsustainable grounds. Complainant alleges deficiency in service and prays for payment of Rs.50,000/- as benefits under the policy along with interest and cost.<br /> <br /> 2. Opposite party filed version admitting the issuance of policy. It is submitted that the insurance coverage under the policy is only for death arising solely and directly from accident caused by external, violent and visible means. It is contended that in the claim form, the details of accident is stated as “death by accident falling from coconut tree” where as the medical report showed “fatal head injury cardiac arrest” as well. That the medical certificate issued from the hospital where the insured was admitted stated that “died on 04-4-05 due to internal injuries and cardiac arrest. A fall from coconut tree caused for the injuries on the same day.” The claim was repudiated because complainant did not produce records to show the nature and extent of injuries sustained. There was no First Information Report, Accident cum wound Certificate or Post Morteum report. The records submitted did not clinchingly or conclusively establish that death was due to injuries caused in the accident as alleged by complainant. The claim was found to be inadmissible since cause of death was not substantiated and hence repudiated. There is no deficiency in service and complaint is liable to be dismissed.<br /> <br /> 3. Evidence consists of affidavit filed by complainant and Exts.A1 to A6 marked on her behalf. Counter affidavit filed by opposite party and Exts.B1 to B4 marked on the side of opposite party. Either side has not adduced any oral evidence.<br /> <br /> 4. Points for consideration:-<br /> (i) Whether opposite party is deficient in service?<br /> (ii) If so, reliefs and costs.<br /> <br /> 5. Point (i):-<br /> It is the say of complainant that her son who is the insured herein, suffered cardiac arrest while climbing a coconut tree on 04-4-05 and fell down from the tree. He was taken to P.G.Medical Trust Hospital, Nilambur but died on the same day. Opposite party resists the claim contending that complainant has not substantiated with reliable documents that death was accidental which comes within the cover of the policy. Much thrust was laid by opposite party that though complainant contends the death was caused by accident, neither First Information Report was registered nor was an autopsy conducted. It was submitted on behalf of opposite party in the absence of these documents the cause of death cannot be established to be arising out of accident. Admittedly First Information Report has not been registered nor postmortem conducted. Complainant relied upon Ext.A4 and A5 documents. Ext.A4 is the certificate issued by doctor at P.G.Medical Hospital on the same day of accident. In Ext.A4 the cause of death is stated as under:<br /> “........................has died on 04-4-05 due to internal injuries and cardiac arrest. A fall from coconut tree caused for the injuries on the same day.” <br /> <br /> Ext.A5 is the certificate issued by Village Officer in which it is certified that the insured who was a coconut climbing labourer, fell down while climbing coconut tree and died on 04-4-05. It is evident from these documents that there was no cause for suspicion or doubt in respect of the cause of death. Sec.174 of Criminal Procedure Code provides for inquiry by Police on receiving information regarding accident. This section provides for investigation by police in cases of unnatural or suspicious death. The scope of sec.174 is very limited, the object being merely to ascertain whether a person has died under suspicious circumstances or unnatural death and if so what is the apparent cause of death. Sec 174(3) provides the instances where police has to forward the body for post mortem. Thus there is a discretion given to the police even on receiving information regarding an accident whether or not to send the body for post mortem. It is crystal clear that if there is no doubt as to the cause of death it is not incumbent to conduct an autopsy. The intention of conducting an inquiry after registering an First Information Report and also conducting post mortem is only to clear any suspicion regarding the cause of death. When complainant or any one else had no suspicion regarding the cause of death it is not mandatory to set the law into movement by registering an First Information Report. The materials placed by complainant sufficiently prove the consistent case put forward by her that death resulted due to fall from coconut tree due to cardiac arrest suffered by the deceased while climbing the coconut tree. Opposite party though denies the death to be accident has not adduced any cogent evidence to controvert the case put forward by complainant. The attempt of opposite party is only to pick holes in the evidence tendered by complainant and this attempt has failed miserably. We conclude that insured died as a result of the accident fall from coconut tree which happened due to cardiac arrest while climbing the tree.<br /> <br /> 6. It is the further contention of opposite party that the death though may be accident is not accidental death which is covered by Ext.A1 policy. It is submitted that only death arising solely and directly from accident caused by external, violent and visible means is covered by the policy. This position has been settled by Hon'ble National Commission which has taken the view in, Mrs. Padma Ramachandran Vs. National Insurance Co. 2008 CTJ 832 (CP) NCDRC decided on 29-4-2008 that “violent means includes any external, impersonal cause, such as drowning or inhalation of gas or even undue exertion on the part of the assured. In such cases, the death is not due to internal cause and that any cause, which is not internal must be external. But this does not mean that the injury must be external”. In the instant case, the assured suffered cardiac arrest due to the undue exertion while climbing the tree. He fell down from the tree and died. The principles laid in the above stated decision are squarely applicable to this case and we have no doubt to hold that the death of assured herein, is covered by Ext.A1 policy. Complainant is therefore entitled to the benefits under the policy. When the cause of death is sufficiently established by records and when there is no grounds to suspect the genuineness of a claim opposite party ought not to have repudiated the claim on flimsy and unsustainable grounds. We find opposite party deficient in service.<br /> <br /> 7. Point (ii):-<br /> In the light of discussions made above, the claim for Rs.50,000/- as benefits under the policy is only to be allowed. Opposite party is liable to compensate for the deficiency. Ordinarily Insurance Companies have to settle a claim within three months of receiving the claim. In this case claim was submitted on 04-7-05. Opposite party ought to have settled the claim on or before 04-10-05. Complainant is an illiterate lady aged above 65 years. She has stated that the assured son was a coconut climbing labourer and was her only source of income. Opposite party ought to have redressed the grievance at the earliest. We therefore consider that complainant is entitled to interest @ 12% per annum from 04-10-05 which would be sufficient compensation to the complainant.<br /> <br /> 8. In the result, we allow the complaint and order opposite party to pay Rs.50,000/- (Rupees fifty thousand only) to the complainant along with interest @ 12% from 04-10-05 till payment together with cost of Rs.1,000/- (Rupees one thousand only) within one month from the date of receipt of copy of this order.<br /> <br /> Dated this 22nd day of August, 2008.<br /> 1. Sd/-<br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> Sd/-<br /> E. AYISHAKUTTY, MEMBER<br /> <br /> <br /> <br /> <br /> <br /> APPENDIX<br /> <br /> <br /> Witness examined on the side of the complainant : Nil <br /> Documents marked on the side of the complainant : Ext.A1 to A6<br /> Ext.A1 : Photo copy of the Jeevan Pariraksha Insurance Certificate<br /> dated, 31-3-2003 issued by opposite party in the name of deceased Ayyappan<br /> Ext.A2 : Photo copy of the Death Certificate dated, 08-4-05 issued by <br /> Sub Registrar, Births and Deaths, Nilambur Grama Panchayat<br /> in the name of Ayyappan.<br /> Ext.A3 : Photo copy of the Jeevan Pariraksha Accident Insurance Claim Form<br /> dated, 04-7-05.<br /> Ext.A4 : Photo copy of the Medical Certificate dated, 04-4-05 given by Dr.I.R.Raveendhranath, P.G.Medical Trust Hospital, Nilambur <br /> in the name of deceased Ayyappan.<br /> Ext.A5 : Photo copy of the Certificate dated, 22-4-05 given by Village Officer, Amarambalam in the name of deceased Ayyappan. <br /> Ext.A6 : Repudiation letter dated, 08-12-205 by opposite party to complainant.<br /> <br /> Witness examined on the side of the opposite parties : Nil<br /> Documents marked on the side of the opposite parties : Ext.B1 to B4<br /> <br /> Ext.B1 : Jeevan Pariraksha Insurance Certificate dated, 31-3-2003 issued by <br /> opposite party in the name of deceased Ayyappan<br /> Ext.B2 : Medical Certificate dated, 04-4-05 given by Dr.I.R.Raveendhranath, <br /> P.G.Medical Trust Hospital, Nilambur in the name of deceased Ayyappan.<br /> Ext.B3 : Medical Report issued by P.G.Medical Trust Hospital, Nilambur.<br /> Ext.B4 : Claim Intimation Form dated, 04-7-05 submitted by complainant<br /> to opposite party.<br /> <br /> 1. Sd/-<br /> C.S. SULEKHA BEEVI, PRESIDENT<br /> <br /> <br /> Sd/-<br /> E. AYISHAKUTTY, MEMBER