By. Sri. K. Gheevarghese, President:-
The complaint filed against the opposite parties for the accident benefit of the insured.
2. The complaint in brief is as follows:- The complainant is the nominee of an accident benefit policy of Rs.1,00,000/- numbered 792964014. The policy conditions asserts that if the insured died in accident the nominee of the insured would be given additional amount equal to policy amount along with the policy sum and the bonus. The insured the brother of the complainant fell down in the bath room of the insured's friends house. The insured was taken to Pariyaram Medical College immediately and in course of treatment the insured died on 04.04.2010. The death of the insured has reported to Payyanur police station and FIR 283/10 was registered which was followed by postmortem. The death of the insured and finding in postmortem was that the insured died due to accident. When fell down a the head hit on the ground and injury resulted lead to the death of the insured.
3. The complainant was given the bonus and sum of the policy when applied by the opposite party. The accident benefit of the scheme is rejected on the ground that the death of the insured is not due to accident. The documents produced by the complainant to the opposite party that the death of the insured is due to accident but the request was rejected which resulted this complaint. There may be an Order directing the opposite party to give the complainant the accident benefit of Rs.1,00,000/- with interest at the rate of 12% along with cost and compensation of Rs.10,000/-.
4. The opposite party filed version in short it is as follows:- The policy No.792964014 is issued under Plan No.14(endowment) for 15 years. The commencement of the plan started from the 25.04.2004 under premium payable under salary savings scheme was Rs.611/- on monthly basis. The policy holder put the complainant as the nominee. The death of the insured was on 04.04.2010 and Rs.1,17,801/- was given to the nominee as insured sum plus bonus. The FIR details the death of the insured at the residence of his friend at Vellor, Kandoth. The Insured fell down due to giddiness on his way to bath room for vomiting on 04.04.2011. The giddiness caused falling that lead to injury to the assured but the death of the assured is not an accident. Additional amount equal to sum of the assured amount is payable to assured only if the death is due to accident. The fall which caused death of the assured is not an accident. The nominee was given sum assured plus bonus. The additional amount equal to the sum assured in case of death due to accident is not payable in this case. Hence the claim was not considered. The complaint is to be dismissed with cost.
5. The points that are to be decided:-
1. Is there any deficiency in service on the part of opposite parties?
2. Relief and cost.
6. Points No.1 and 2 :- The evidence in this case consist of the proof affidavit of the complainant and opposite party. Ext.A1 to A7 and the Ext.B1 are the documents produced. The oral testimony of the complainant, opposite party and the Doctor who conducted the postmortem in Pariyaram Medical College is also considered.
7. The complainant's case is that the life assured met with an accident and died. The records which are necessary to consider the claim of the complainant providing equal sum of the policy amount in addition to other benefits are not considered. According to the opposite party the death of the life assured is not consequent to an accident. The repudiation of the extra amount for accidental death was only for reason that the death of the life assured was not accident. The complainant was sent a cheque of Rs.1,17,801/- on 25.10.2010. Ext.A2 is the FIR No.283 of Payannur Police. The brief of the FIR is that the life assured fell down on the way to bath room in the house of one Aravindakshan which was at Kandoth. The giddiness caused the diseased to fell down and he was taken to Pariyaram Medical College. Death of the life assured was on 04.04.2010 and postmortem was conducted from there. The Postmortem Certificate is Ext.A3 and the report of the injury of contusion 7X6 on the back of the neck, on the right side. There was a fissured fracture in the occipital bone, extending to the foramen magnum. The case of death in the postmortem report is head injury.
8. The opposite party is examined as OPW1. On examination it is admitted that no other documents contrary to accident is produced by them. The cause of death is the only reason according to opposite party for the rejection of the additional benefit. The Doctor who conducted postmortem in Payannur Medical College is examined as PW3. The body of the life assured was identified and issued the Postmortem Certificate. The death of the life assured is due to the injuries in head. PW3 disagrees that the vomiting was not the reason to became unconscious though injuries were not visible accidentally. The death of the life assured was due to injury on head. The policy conditions interpret accident which consists of outward violent and visible means according to the opposite party. But the head injury due to fall is the reason for the death of the life assured and which is an accident. The complainant is the nominee admitted by the opposite party who is entitled to get equal amount of the policy sum in addition to the earlier benefit received from the opposite party along with cost.
In the result complaint is partly allowed. The opposite party is directed to give Rs.1,00,000/- ( Rupees One Lakh Only) to the complainant with an interest at the rate of 12% from the date of claim to the complainant. The complainant is also entitled to get Rs.1,000/- (Rupees One Thousand Only) towards cost and compensation. This is to be complied by the opposite party within one month from the date of receipt of this Order.
Pronounced in Open Forum on this the day of 17th March 2012.
Date of Filing:27.10.2011.
