By Sri. K. Gheevarghese, President:

The complaint filed under section 12 of the Consumer Protection Act 1986.

The complaint in brief is as follows:- The Complainant's wife was a member in the 2^nd Opposite Party's bank with member No.1836. The 1^st Opposite Party was the insurer of the members of the 2^nd Opposite Party Bank under the scheme of Kissan Credit Card for the Personal Accident Insurance. The terms of policy was such that if any member met with an accident to death, the insurer was liable to give the policy holder sum of Rs. 1,00,000/-. The Complainant's wife died due to falling of tree on head and had undergone treatment. The death was on 28.12.2007 from Medical College Hospital Calicut. The claim of the Complainant for compensation for the policy holder was not considered by the insurer. The claim was repudiated on the ground that the deceased was not undergone postmortem and no crime was registered and the FIR was not sent along with the claim form for processing of the claim. The repudiation of the claim of the Complainant is a deficiency in service. There may be an order directing the Opposite Party to give Rs.1,00,000/- the sum assured along with interest at the rate of 16%. The Complainant is also to be compensated with Rs.5,000/- towards the cost along with compensation.

2. The Opposite Party filed version in brief it is as follows:- The wife of the Complainant was an insured member in Janatha personal Accident Policy to the members of Kissan Credit Card holder of the Meenangady Service Co-operative Bank as admitted by the Opposite Party. On processing the claim it was seen that the request of the Complainant for the sum assured was not accompanied with FIR and Postmortem report. The repudiation of the claim on 10.06.2009 was for the reason of non production of the required and relevant documents. If the death of Complainant's wife was due to accident on fall of tree it would have been supported by the documents required to be given as per the terms of policy. The Complainant failed to produce those documents of postmortem report, FIR and the claim was repudiated on finding that the terms of policy was not complied by the Complainant. There is no deficiency in service on the part of the Opposite Party. The complaint is to be dismissed with cost.

3. The points in consideration are:-

1. Whether any deficiency in service on the part of the Opposite Parties?

2. Relief and cost.

4. Points No.1 and 2:- The evidence in this case consists of proof affidavit of Complainant and Opposite Parties. Exts.A1 to A11 and Ext.B1 are the documents produced in support of the contentions. The Complainant contented that the death of the insured was due to fall of tree on head and the insured had undergone treatment in Medical College Hospital. The treatments continued from 11.12.2007 to 28.12.2007, the date of death. The death certificate issued from Meenangady Panchayat and other documents such as the letter from the member of Legislative Assembly witness that the death was due to accident in tree fall and those were forwarded to the Opposite Party. The C.T report of the Medical College, Hospital also confirms that the cause of death was due to fall of tree. The Opposite Party has no case that the Complainant's wife is not a policy holder. The repudiation of the claim was only on the non production of FIR and postmortem certificate. Apart from These two documents the certificate of the Village Officer in the respective Village was also forwarded to the Opposite Party for the consideration of the same. The member No.1836 Vasanthakumari, wife of Complainant's death was absolutely due to tree fall on her head from the face of the records produced. The production of the postmortem certificate and FIR are the documents which are necessary in support of establishing the accident. The other documents produced by the Complainant also substantially confirm the purpose that the death of the Complainant's wife was due to accident. The claim amount of Rs.1,00,000/- is desirably to be given to the Complainant since the Complainant had entitled for the claim.

In the result, the complaint is partly allowed. The 1^st Opposite Party is directed to give Rs.1,00,000/- (Rupees One Lakh only) to the Complainant, the husband of the policy holder along with cost of Rs. 2,000/- (Rupees Two thousand only ) within one month from the date of receiving this order.

Pronounced in open Forum on this the day of 28^th June 2010.

PRESIDENT: Sd/-

MEMBER : Sd/-

MEMBER : Sd/-

A P P E N D I X

Witness for the Complainant:

PW1. Ramachandran. Complainant.

Witness for the Opposite Parties:

OPW1. Hamza Office Asst. United India Insurance Co. Ltd., Kalpetta.

Exhibits for the Complainant:

A1. Copy of Personal Accident Insurance – Claimants Statement.

A2. Copy of Death Certificate. dt:01.01.2008.

A3. Copy of Letter. dt:07.01.2008.

A4. Copy of Certificate. dt:18.08.2009.

A5. Copy of Janata Personal Accident Claim Form. dt:14.01.2008.

A6. Copy of C.T. Scan Report. dt:11.12.2007.

A7. Copy of C.T. Report. dt:11.12.2007.

A8. Copy of C.T. Report. dt:11.12.2007.

A9. Copy of Group Janatha Personal Accident Policy.

A10. Copy of Kissan Credit Card Linked Personal

Accident Insurance Scheme. dt:31.03.2006.

A11. Copy of Identity Card. dt:13.1.1999.

Exhibits for the Opposite Parties:

B1. Claim File.