By Smt.Padmini Sudheesh, President The case of complainant is that the complainant is the widow of insured Varghese who was a policy holder of respondent vide policy No.774088607. The policy is valid from 28/5/02 and the instalment premium was paid regularly. The insured Varghese Madakkappilly was murdered on 9/6/05 at 9.25 at Thanikkudam. As per the policy the complainant is entitled to a sum assured of Rs.2,00,000/- plus an additional sum equal to sum assured in case of death. So the total sum assured for the death of an insured person will became 4,00,000/- with bonus. The complainant submitted all valid necessary documents and original insurance policy to the company. But the company reduced the claim and allowed to the complainant only Rs.2,23,672/- only. As per the terms of the policy clause 10(b) the insured person was entitled to an additional sum equal to sum assured. But the respondent repudiated the claim and allowed only Rs.2,23,672/-. The complainant had filed an application before the respondent company for getting full claim as assured by the policy. But the respondent rejected the application on 15/3/07 without any reason. As per the policy complainant is the nominee and so she is entitled to file this application. The act of the respondent is deficiency in service. Hence the complaint. 2.The counter of respondent is that it is admitted that the respondent issued a policy bearing No. 774088607 with conditions and privileges shown overleaf to the life assured Varghese Madakkappilly for a basic sum assured of Rs.2,00,000/- with accident benefit and the nominee under the policy is Smt.Mary the complainant. The date of commencement of policy was on 28/5/02. It is true that the life assured was murdered on 9/6/05. On receipt of death intimation the respondent requested the complainant to submit necessary forms for considering the claim. The respondent was provided with police records and reports in Crime No.303/2005 of Viyyur Police Station. From the police reports it was abundantly revealed that the life assured was murdered in relation to the murder of another person named Reji which occurred one month prior to his murder. As death claim, the complainant was eligible only to get sum assured and bonus after deductions as per rules and conditions under the policy.Thus the respondent settled the claim of complainant for Rs.2,23,672/- on 28/7/05 on execution of discharge given by the complainant in full and final satisfaction of all her claims under the policy. The averment that the complainant is entitled to get a total sum of Rs.4,00,000/- with bonus is not sustainable. After executing the discharge of all her claims under the policy in full and final satisfaction and after receipt of the amount the complainant is estopped from claiming any benefit under the policy. So the complainant has no bonafides to file this complaint. Regarding the claim for double accident benefit it is revealed from the investigation that the life assured was murdered in relation of the murder of another person named Reji one month prior to his murder. More over the life assured was the President of Congress(I) Madakkathara Ward Committee and the above said murdered Reji was CITU worker and both were rivals and belonged to rival political parties. From the police records it can be seen that the dominant intention was to kill the life assured. Such killing is a premeditated murder and not an accidental murder but is a murder simplicitor. Since the police reports and nature of killing by stopping a vehicle, dragging out the victim by a number of persons indicate nothing but a murder by plan and design and does not come under the ambit of accident under Clause 10(b) of the policy conditions. Besides Clause 10 stipulates that the accidental death is to be proved to the satisfaction of the Corporation. The records reveal that it is a premeditated, planned and designed murder. That is why the respondent rejected the claim of double accident claim of the complainant. The averment that the complainant is entitled to get an additional sum equal to sum assured as per the terms of the policy Clause 10(b) is not correct. As per Clause 10(b) of the conditions and privileges of the policy it can be seen that accident benefit is payable only “if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward violent and visible means and such injury shall within 120days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. The records like police reports, Post Mortem Certificate, Inquest report etc. confirm that the murder of the life assured was not an accidental one where as it was a designed, planned murder. This is confirmed by records which show that the life assured was murdered in relation to the murder of another person. It can be seen that the nature of planning of attack by obstruction of the vehicle in which the life assured was travelling by a group of people and forcibly bringing him out, the overt acts, injuries etc. resulting in his death show that it is a designed, planned murder. From these, the perpetrators have a motive against the victim to kill him and the motive and intention are clearly brought out in the policy reports. The dominant intention of their premeditated act was to kill the life assured as per plan and design. Such killing is not an accident murder. The planned or designed murder will not come through the ambit of death by accident. So the respondent rightly rejected the claim of double accident benefit. There is no cause of action against the respondent and there was no deficiency in service from this respondent. Hence dismiss. 3. The points for consideration are : 1) Is there any deficiency in service from the respondent? 2) If so reliefs and costs ? 4. The evidence adduced consists of Exhibits P1 to P5, the oral testimony of PW1 and Exhibits R1 to R7. 5. Points: The complainant’s husband Varghese Madakkappilly had taken a policy bearing No. 774088607 from the respondent for a sum assured of Rs.2,00,000/- with accident benefit. The complainant is the nominee under the policy. The life assured Varghese was murdered on 9/6/05 and after the murder the complainant had been applied to get the policy benefit. It was refused by the respondent and has settled the claim for Rs.2,23,672/- and this amount paid to the complainant. But the complainant seeks double benefit of the policy i.e. accident benefit in addition to the amount she already received. This claim of complainant is disallowed by the respondent. 6. The respondent states that the complainant is eligible to get only death benefit worth Rs.2,23,672/- and not entitled to get accident benefit as per conditions No.10(b) of the policy. According to the respondent the accident benefit was disallowed on the ground that premeditated planned and designed murder will not come under the purview of accidental benefit preferred under conditions No.10(b) of the policy. The death benefit worth Rs.2,23,672/- was disbursed to the complainant after due execution of undertaking and consent to this effect by the complainant herself. They further stated that the complainant executed the same and accepted the amount as full and final satisfaction. So according to the respondent the complainant is not entitled to get any more benefit. 7. The respondent stated that since the murder was premeditated planned and designed it will not come under the purview of accidental death provided under conditions No.10(b) of the policy. Exhibit R1 is the original policy document and Clause 10(b) states that to pay an additional sum equal to the sum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward violent and visible means and such injury shall within 180 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. By relying this clause the respondent stated that the Corporation is not liable to pay accident benefit and the death of the life assured is not an accidental death. According to the respondent the murder was a designed premeditated and planned one and so they are not liable to pay accident benefit to the complainant. It is their contention that the accident was not an accident directly occurred and so a planned accident. The thing stated is that he was murdered in relation to the murder of one Reji nearly one month back who belonged to rival political party and a CITU worker. According to the Corporation the deceased was the then President of Congress (I) of Madakkathara Panchayat and the reason behind the murder of complainant’s husband was that he helped and given protection to the accused persons of the deceased Reji CITU worker. It is also stated that after the murder of Reji CITU workers were inimical with the life assured and the CITU workers threatened him many times that he will be murdered soon. The counsel for respondent filed a detailed argument note and in which these things are also stated. But there is no records before us to show the alleged enmity existing between CITU and Congress workers at Madakkathara Panchayat. The true copy of Expres report (FIR) in crime No.303/05 of Viyyur police is produced and marked as Exhibit R4 and contained argument put forward by the respondent. It is stated that there was enemity in connection with the murder of CITU worker Reji and the insured was murdered intentionally with this enemity. The copy of charge sheet would also contain the same enmity. These are the records available to the respondent to come to such a conclusion. The complainant who is examined as PW1 deposed that ………………… (in Malayalam words) …………………………………………………………. She again deposed that the…………(In Malayalam words)…………………. So it is her case that he was not murdered with plan and design. It was only because of misunderstanding. The records relied by the Corporation are only the police records and those are documents which need corroborating. The police officials are not examined before the Forum and the documents issued by them can not be believed without corroboration. The respondent did not adduce any oral evidence to ensure that there was planned and designed murder. It is admitted that the death was due to murder and the complainant is entitled for death claim and the respondent had already settled the claim. The only dispute is with regard to the accident benefit. By relying the police records the respondent disallowed the claim of complainant. But the complainant stated that the murder was only on a misunderstanding and it was not a planned designed murder. We have no option but to believe the words of PW1 since the police records are remain uncorroborated and are cannot be reliable. So the complainant is entitled for the accident benefit. 8. The respondent further stated that the complainant accepted death benefit amount worth Rs.2,23,672/- as full and final satisfaction. The respondent produced the discharge form signed by complainant and marked as Exhibit R3. It is a printed form signed by the complainant on 28th July 2005 after one month of the death of her husband. So the contention of respondent that she had accepted the amount as full and final satisfaction cannot be believed. It is a printed form and the complainant may be put signature without going through the details. She deposed during cross examination that it is incorrect to say that she is not entitled for further amount. Exhibit R3 is dated 28/7/05 the discharge form executed by PW1 in which it is also stated that full and final settlement of the claim. But Exhibit P5 dated 28/7/05 is a letter from respondent contains an endorsement that “accident benefit will be considered by Divisional office, Ernakulam”. It is sufficient to realize that Exhibit R3 is not the final and full settlement of the claim. Exhibit P3 the letter from Corporation says that the double accident benefit claim is rejected by the competent authority. So the contention of respondent “full and final settlement” is also failed. From the above discussion it is clear that the complainant is eligible to get the double accident benefit also. 9. In the result the complaint is allowed and the respondent is directed to pay the double accident benefit with interest at the rate of 12% per annum from the date of complaint till realization with cost Rs.750/- (Rupees Seven hundred and fifty only) within two months from the date of receipt of copy of this order. Dictated to the Confdl. Asst., transcribed by her, corrected by me and pronounced in the open Forum this the 27th day of September 2010.
| | [HONORABLE Rajani P.S.] Member[HONORABLE Padmini Sudheesh] PRESIDENT[HONORABLE Sasidharan M.S] Member | | 
