O R D E R
By Smt.Padmini Sudheesh, President
The case of complainants is that their son Suresh was a member of Great India Service Club which is a voluntary service organization. He insured with the respondent for a sum of Rs.1,00,000/- under Jeevan Reksha Insurance Policy. While the policy was in force the son Suresh met with an accidental death by drowning in a well situated in complainants residential house on 10/12/2000. The complainants being the nominees submitted their claim to the company with relevant documents. But the respondent rejected the claim by stating that late Suresh was of unsound mind, his mental condition had deteriorated two days prior to his death, he had turned violent and uncontrollable and that his mental condition had contributed his death. These allegations are incorrect and Suresh was of sound mind and healthy body. The rejection of claim is a deficiency in service. Hence the complaint.
2. The counter averments are that this respondent admits that this respondent has issued a Tailor made Insurance policy covering the person stated in the policy. The policy do not cover any accident due to intentional self injury, suicide, caused directly or indirectly by insanity or mental problems. The claim of complainant do not come under the purview of the policy. Cheruthuruthy police has registered a crime regarding the death of Suresh as natural death. First information report is given by the close relative, the uncle of the deceased Suresh namely Kumaran. FIR states that the deceased committed suicide by jumping into the well. First informant also stated to the police that the deceased was having symptoms of insanity before two or three days of the incident and was under treatment and was very violent and ran into the well and jumped into the well. This respondent conducted investigation and the investigation report shows that deceased Suresh was a mental patient and unsound mind and was very violent and committed suicide by jumping into the well. So this respondent is not liable to pay any compensation. This respondent denies that the death was accidental. The deceased committed suicide and the mental illness contributed to the incident. There is no deficiency in service by this respondent. Hence dismiss.
3. Points for consideration are that :
1) Is there any deficiency in service from respondent ?
2) If so reliefs and costs ?
4. Evidence adduced consists of oral testimonies of PW1,PW2, Exhibits P1 to P12 and Exhibits R1 to R6.
5. The complaint is filed to get the policy amount from the respondent on account of death caused to the son of complainants. Complainants are the father and mother of insured Suresh who was met with an accidental death by drowning into a well on 10/2/2000. It is the case that after the death the complainants applied to the respondent company to get death claim amount but it has been refused by the company by stating unsoundness of mind etc. to late Suresh.
6. In the counter the respondent company admitted the policy and stated that since the deceased was a mental patient and unsound mind and was very violent and committed suicide by jumping into the well they are not liable to pay any compensation to complainants. It is stated that the policy do not cover any accident due to intentional self injury, suicide caused directly or indirectly by insanity or mental problems.
7.The mother of deceased is examined as PW2 and Exhibits P1 to P12 and Exhibits R1 to R3 are marked through her. She deposed that the deceased son had the disease of Epilepsy and Dr.Varghese Paul had been treated him. She also stated that no other doctors have treated the son against the Epilepsy. Suggestive question asked during cross examination with regard to treatment against mental disease. But she categorically denied the same.
8. Dr.Varghese Paul is examined as PW1 who has 48 years of experience at the time of examination before the Forum. He deposed that on 9/12/2000 he has examined late Suresh and issued Exhibit P1 certificate. According to PW1 he had treated late Suresh for Epilepsy and none other disease. As per Exhibit P1 till 14/9/1993 the late Suresh had treatment for Epilepsy. It is stated in Exhibit P1 that when the doctor saw him on 19/12/2000 he understand that late Suresh stopped all medicines. The date mentioned in Exhibit P1 as 19/12/2000 is clarified by doctor in the box by stating it was a mistake and the actual date was 9/12/2000. So as per Exhibit P1 late Suresh had treatment for Epilepsy.
9. It is the contention of respondent in their counter that they have conducted an investigation and the investigation report shows that deceased Suresh was a mental patient and unsound mind and was very violent and committed suicide by jumping into the well. But this contention of respondent is totally incorrect. Exhibit R3 is the report of insurance investigator and in which it is reported that late Suresh was an old Epilepsy patient and there was no fits for the last four to five years and suddenly on 9/12/00 the symptoms of old illness was appeared and was taken to Jubilee Mission Hospital. In Exhibit R3 there is no mentioning about unsoundness of mind or insanity to late Suresh. The insurance investigator given a detailed report in which it has repeatedly stated that the deceased was an Epileptic patient.
10. One of the contentions of respondent is that the FIR states that the deceased committed suicide by jumping into the well. Exhibit R4 is the copy of FIR in which it is stated that the deceased due to mental disease jumped into the well and committed suicide. In the F1 statement also it is stated so. The marking of Exhibit R4, the copy of FIR seriously opposed by complainant by stating without examining the SI of police it can not be marked. This is a case of 2002 and steps against SI have been taken several times but he did not turn up. It can be very well seen from the proceedings. Even if it is sated by the police, from the evidence of PW1 doctor and from Exhibit R3 it is very well clear that the deceased was not a person of unsound mind. In Exhibit R3 the investigator reported that he visited Cheruthuruthy police station and confirmed that Suresh’s death was due to drowning by falling into the well followed by Epilepsy. The insurance investigator had done a very good job by enquiring the matter with local people, the Cheruthuruthy police, Jubilee Mission Hospital etc. The investigation report is produced from the part of company itself and if any difference with regard to the investigator’s report the company can very well examine the investigator before the Forum. There is no such attempt made by company. This document is marked through PW2 the mother of late Suresh.
11. The complainant also produced document to show the mental condition of deceased which was fit at the time of incident. Exhibit P2 is an interview card from Polytechnic, Kottayam dated 23/11/00 in which the date of interview stated is 5/12/00. Exhibit P2, P11, P9 and P10 would show the sound mind of the deceased Suresh. There was not at all any evidence to show that the deceased was a mental patient or an insane person. Epilepsy is not a mental disease. PW1 doctor also deposed epilepsy is different from mental disease unsoundness of mind and lunacy. According to him epilepsy patient can lead normal life and having normal mental condition. So the rejection of claim by Exhibit P3 is a serious deficiency in service and the complainants are entitled to get the claim with interest.
12. In the result the complaint is allowed and the respondent is directed to pay the death claim of Rs.1,00,000/- with interest at the rate of 12% per annum from the date of complaint i.e. on 31/10/2002 till realization with costs Rs.700/- within a month 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 11th day of November 2011.
Sd/- Padmini Sudheesh, President
Sd/-
Rajani.P.S., Member
Sd/- M.S.Sasidharan, Member
Appendix
Complainant’s Exhibit
Ext. P1 Certificate of doctor dt. 11/4/02
Ext. P2 Identity card
Ext. P3 Repudiation letter
Ext. P3(a) Postal cover
Ext. P4 Copy of Post Mortem certificate
Ext. P5 Copy of lawyer notice
Ext. P6 Postal receipt
Ext. P7 Postal acknowledgement
Ext. P8 Relation certificate
Ext. P9 Employment exchange card
Ext. P10 Calicut university hall ticket
Ext. P11 B Sc mark list
Ext. P12 Interview card from Kottayam polytechnic
Complainants witness
PW1 – Dr.Varghese Paul
PW2 - Santhakumari
Respondents Exhibits
Ext. R1 Copy of Tailor made group personal accident policy
Ext. R2 Accident claim form
Ext. R3 Investigation report
Ext. R4 Copy of FIR
Ext. R5 Lr. dtd. 6/3/02
Ext. R6 Jeevan Raksha Insurance Policy Certificate
Id/-
President
