Since the complainants and the subject matter are same, these two complaints are taken together for disposal.

                       

            In O.P.753/02 the case of the complainants is as follows: First complainant is the wife of Late Raveendranathan and 2^nd and 3^rd complainants are the children of first complainant and the said Late Raveendranathan. On 14.12.01 Raveendranathan died due to an accidental fall from the terrace of his residential house. The accident occurred due to slip of feet at about 6.30 P.M. when he was checking the water level in the tank on the roof of the house. Immediately he was taken to nearby M/s.Maria Thressia Hospital at Kuzhikkattussery by family members and neighbours and at 8.10 p.m. he was died. Death certificate was issued from the hospital stating the cause of death as “Cardio Respiratory Arrest Secondary to Head Injury”. The deceased Raveendranathan was maintaining a premium saving bank account as A/c.No.825 with 2^nd respondent. As per the terms of the said account, the said Raveendranathan is entitled for Personal Accident Insurance cover under first respondent’s Group Accident Insurance Policy for a sum of Rs.3,00,000/- for a period of 3 years from 5.2.99 to 15.2.02. After the death of said Raveendranathan 3^rd complainant as the nominee of the bank account and the insurance policy intimated the death to the Ist and 2^nd respondents. Ist respondent issued a claim form to 3^rd complainant on 12.3.02 and she submitted the same on 23.3.02. But the first respondent refused to accept the same stating that the form is not accompanied by the police report and post mortem report. Since 3^rd complainant was employed at Doha, she was unable to pursue the matter thereafter for some time. Hence later again vide lawyer notice dated 25.5.02 duly filled up claim form along with all available documents were submitted. Then the first respondent issued a reply stating that without postmortem report and FIR they are unable to honour the claim and repudiated the claim under the policy. The 2^nd respondent is made as a proper and necessary party and no relief is sought against the 2^nd respondent. Hence the complaint.

 

            2. In O.P.512/03 the case of complainants is that the deceased Raveendranathan was the holder of Janatha Personal Accident Policy No.100104/47/97/E-47/13354 for a period of 10 years from 30.1.1998 to 29.1.2008 for an amount of Rs.1,00,000/- and the policy covers accidental death also. First complainant is the wife of Late Raveendranathan and 2^nd and 3^rd complainants are the children of first complainant and the said Late Raveendranathan. On 14.12.01 Raveendranathan died due to an accidental fall from the terrace of his house situated at Ashtamichira Desom Vadakkumbhagam Village. The accident occurred due to a slip of feet at about 6.30 p.m. when he was checking the water level in the tank on the roof of the residential house. Family members and neighbours immediately took him to nearby M/s. Maria Thressia Hospital at Kuzhikkattussery and at 8.10 P.M. he died due to injury sustained. Death certificate was issued from the hospital stating the cause of death as “Cardio Respiratory Arrest Secondary to Head Injury”.   Since the death was due to an accidental fall, no postmortem was conducted. The doctors at hospital also suggested that postmortem is not necessary in such cases. It is also told that postmortem is required only in cases of death of suspicious circumstances or in case of suicide. Hence later funeral was conducted observing religious obsequious. After the death of said Raveendranathan 3^rd complainant as the nominee under the bank account and the insurance policy intimated the death to the Ist respondent and submitted the claim form. Thereafter the correspondence to get the claim form processed was not fruitful. Hence at last on 27.5.02 vide lawyer notice, 3^rd complainant demanded the settlement of the claim for which respondent issued a reply dated 13.6.02 stating that the claim is under investigation and they will proceed. As no action is forthcoming, a further reminder dated 30.4.03 was issued. They sent a letter dated 9.5.03, and intimated that they are repudiating the claim for want of production of post mortem certificate and police report. The denial of claim under the policy constitutes deficiency in service on the part of respondent.

 

            3. The version filed by respondents-1 and 3 in O.P.753/02 and the respondent in O.P.512/03 are as follows: It is not evident that the accident occurred due to a slip of feet, when the deceased was checking the water level in the tank on the roof of the residential house. The insurance cover provided by the company is subject to the terms and conditions of insurance policy. The documents to be produced in case of accidental death are death certificate, post mortem report, FIR, name of the nominee, banker’s certificate and other relevant documents. In the absence of the said documents the company is not in a position to process the claim. The repudiation of the claim was with valid and proper reasons and in accordance with the terms and conditions of the policy. Here no post mortem was conducted and no crime has been registered in connection with these cases. Hence there is no deficiency in service on the part of these respondents. The complaints are not maintainable due to lack of territorial jurisdiction. The complainants may be directed to produce the documents as requested earlier and to comply the terms and conditions of the policy. Without which the reliefs sought in the complaints are not allowable. The reliefs and compensation claimed is without any basis and hence denied. The 3^rd respondent in O.P.753/02 is not in any way connected with the said policy. Therefore the 3^rd respondent is an unnecessary party. Hence dismiss.

 

            4. The counter of 2^nd respondent in O.P.753/02 is as follows: The averments in paragraph 1 and 2 of the complaint are to be proved by the complainants. The decision in respect of the settlement of claims rests solely with the insurance company, which is the first respondent. In view of the above, this respondent has no role to play in the settlement of claims. Further it is clear from the complaint that there is no claim made by the complainant against this respondent. Hence dismiss the complaint as against the second respondent.

 

            5. The points for consideration in both cases are:

 

(1)   Is there any deficiency in service?

(2)   If so, reliefs and costs. 

 

            6. The evidence consists of Exts. P1 to P22, Ext. X-1, and Exts. R1 and R2.

 

            7. Points: The case of complainant in both cases in brief narrates here: Complainants are wife and children of deceased Raveendranathan. Sri. Raveendranathan died due to an accidental fall from the terrace of his residential house on 14.12.2001. The accident occurred due to a slip of feet at about 6.30 p.m. when he was checking the water level in the tank on the roof of the house. Immediately he was taken to M/s. Maria Theresa Hospital at Kuzhikkattussery and at 8.10 P.M. he died due to the injury sustained. The deceased was the holder of Janata Personal Accident Policy No. 100104/47/97/E-47/13354 for a period of 10 years from 30.1.1998 to 29.1.2008 for an amount of Rs.1,00,000/- and the policy covers accidental death also. After the death the complainants applied for the accidental benefit but was not granted. So O.P.512/03 is filed to get the policy benefit.

 

            8. In the counter company stated that the accident was not due to a slip of feet from the roof of the residential house. It is true that the deceased was the holder of Janata Personal Accident Policy. But the documents demanded by the Company were not produced. The documents like FIR, Post mortem certificate etc. are to be produced to process the claim. They also stated that no post mortem was conducted and no crime has been registered in connection with the alleged accidental death. So they repudiated the claim.

 

            9. O.P.753/02 was filed to get policy benefit from the Ist and 3^rd respondent Company as per the Personal Accident Insurance cover under first respondent’s group accident insurance policy for a sum of Rs.3,00,000/-. According to the complainants the deceased was maintaining a premium savings bank account as account No.825 with 2^nd respondent. After the death the complainants approached the first respondent for the benefits of the policy. But the claim was dishonoured stating that without post mortem report and FIR they are unable to grant the claim. So O.P.753/02 is filed.

 

            10. The averments in the counter of Ist and 3^rd respondents are the same in O.P.512/03. So not repeating again. The 2^nd respondent filed counter stating that the decision in respect of the settlement of the claim rests solely with the Insurance Company.

 

            11. O.P.512/03 filed to get the benefit under the Janata Personal Accident Policy for an amount of Rs.1,00,000/-. O.P.753/02 filed to get the benefit under group accident insurance for an amount of Rs.3,00,000/-. In both the cases claim was denied due to lack of post mortem certificate and FIR. The definite case of the complainants is that the deceased was died due to fall from terrace. Ext. P4 is the copy of death certificate issued from Maria Theresa Hospital Kuzhikkattussery shows that the cause of death as cardio respiratory arrest secondary to head injury. It is also stated in the certificate that the patient came H/O fall from Terrace at about 6.30 p.m. with gasping and also stated that the patient was declared dead at 8.10 p.m. on 14.12.2001 itself. So as per the medical report the death was due to fall from terrace and died on the same day itself within two hours of the incident. Ext. X-1 case sheet explains the condition of the deceased at that time.

 

            12. Both the claims were dishonoured due to lack of postmortem report and FIR. According to the insurance company both these documents are very essential for honouring the claim. But those documents were not produced before the company since no post mortem was conducted and no case was registered by the police. The complainants state that since the death was due to an accidental fall no post mortem was conducted. They also stated that the Doctors at the hospital also suggested that post mortem is not necessary in such cases. It is also stated that post mortem is required only in cases of death of suspicious circumstances or in a case of suicide. Regarding this aspect Ext. P20 and Ext. P21 were produced by the complainants. Ext. P21 is the copy of the debate done in Kerala Legislative Assembly. It contains the question regarding the conducting of post mortem in some circumstances. The Chief Minister replied that it is not necessary in undoubtful circumstances. 

 

            13. The more important thing noted is the medical records. There is nothing stated by the doctors about the need of postmortem. If the complainants disagreed to conduct post mortem it will definitely become a part of hospital records. There is no mention about it. The need of post mortem or the demand for post mortem from the hospital authorities is not stated in hospital records. So definitely there is no scope for any suspicion regarding the death. The company did not try to clear off their doubts by appointing their own investigators. They simply denied the claims for non-production of FIR and post mortem certificate. The need of those was not looked into. After accepting the premium the Insurance Company are taking every possible methods to dishonour claims. This is very bad practice and to be discouraged. 

 

            14. The wife of deceased was examined in O.P.735/02 as PW1 and that deposition is taken to this file and marked as Ext. P22. Joint trial was allowed with all these three cases and O.P.735/02 was settled by the respondent after due payment. She has established her own case during examination and nothing brought against. The Insurance Company cross-examined about the non-production of FIR and post mortem certificate. They not even put a case that they are suspicious about the death. If any suspicion they had to aver it in their counter. They had no such case. They demanded those certificates because it is their procedure to be followed in death cases. Here there is no need of post mortem certificate and the reasons already discussed above. The repudiation of both claims shows deficiency in service on the part of Insurance Company and the company is liable to pay compensation also.

 

            15. In the result, both the complaints are allowed and the first and third respondents in O.P.753/02 are directed to pay a sum of Rs.3,00,000/- (Rupees three lakhs only) to the complainants and Rs.5000/- (Rupees five thousand only) as compensation and costs Rs.1000/- (Rupees one thousand only). The respondent in O.P.512/03 is directed to pay Rs.1,00,000/- (Rupees one lakh only) the sum assured with Rs.5000/- (Rupees five thousand only) as compensation and costs Rs.1000/- (Rupees one thousand only) to the complainants. Comply the order within two months.