By. Sri. K. Gheevarghese, President:-
The complaint filed against the opposite party for the additional benefit of the policy for the accidental death of the insured.
2. The complaint in brief is as follows:- The complainant is the nominee put by his brother who had undertaken an accident benefit policy while in government service. The Policy number of the diseased is 791925535. The scheme envisages that the insured if died in accident the nominee would be getting an additional amount equal to the sum assured along with bonus. The insured was a regular payee of the policy installments. The insured Sudhir fell down in the house of his friend Aravindashan and he was treated in Pariyaram Medical College and on 04.04.2010 the brother of this complaint died. Payyannur police registered FIR and postmortem was done. The reason for the death of the insured was injury on head due to fall.
3. The complainant moved a claim before the opposite party to get the benefit as envisaged in the policy. But the opposite party issued the complainant only sum assured with bonus. The additional benefit of accidental death was not given to this complainant. There by caused a loss of Rs.1,50,000/-. The request of the complainant for the additional benefit of the accidental death which is equal to the sum assured but the opposite party rejected the claim on the ground that the death of Sudhir is not resulted by an accident. The postmortem report and FIR elucidated the death of the insured is due to injury consequent to the fall. There may be an order directing the opposite party to issue the complainant an additional amount of Rs.1,50,000/- in addition to cost Rs.3,000/- and compensation of Rs.10,000/-. The complainant is also entitled to get interest at the rate of 10% from the opposite party.
4. The opposite party filed version in short it is as follows:- The policy holder Sudhir. C.R was admitted in the policy bearing number 791925535 it was for a period of 15 years under a plan Jeevan Surabhi. The assured sum was Rs.1,00,000/- and the premium payable was under salary scheme of Rs.956/-. On death intimation and production of death certificate Rs.1,74,520/- was paid to the nominee. The FIR details the death of the insured which was at the residence of his friend Aravindashan at Vellore, Kandoth and it was due to giddiness on his way to bath room. The assured had undergone treatment in Payannur Medical College and died on 04.04.2010. The FIR details that the assured had unconsciousness at the time of vomiting that had caused him to fell down. The death of the assured is not an accident. The double accident benefit equal to the basic sum assured is payable if the assured die due to accident which caused outward violent and visible means. The policy condition 10-2 details accident benefit. The benefit of additional sum equal to the sum assured is payable if the death of the assured was absolutely due to an accident.
5. In this case the assured fell down on the way to bathroom due to giddiness and the additional benefit of the assured sum was rejected on the ground that the death of the assured was not due to accident. The policy of the assured was for an amount of Rs.1,00,000/-. The claim of the complainant of Rs.1,50,000/- is double accident benefit of the policy conditions. The complaint is not maintainable and it is to be dismissed with cost to the opposite party.
6. The points in considerations are:-
1. Is there any deficiency in service on the part of the opposite party?
2. Relief and Cost.
7. Points No.1 and 2 :- The evidence in this case consist of the proof affidavit of complainant and opposite party. Exts.A1 to A4 and Ext.B1 are the documents produced. The oral testimony of the complainant and opposite party and Doctor who did the postmortem is also considered.
8. The case of the complainant is that the diseased, brother of the complainant was a policy holder in the salary savings scheme. The claim of the complainant for additional benefit of the scheme for the accident death of the assured is not sanctioned by the opposite party instead Rs.1,74,520/- that includes the basic amount with bonus is only given. The opposite party contended that the death of the assured Sudhir is not an accident. The additional benefit equal to sum assured in case of accidental death is not paid to the nominee on the ground that the death of the assured was due to giddiness on the way to bathroom for vomiting for that the death of the assured cannot be counted as an accident. Ext.A2 is the FIR accordingly the death of the insured was due to fall on his way to bathroom for vomiting. The contention of the opposite party is that the death of the insured was not due to accident and the double benefit sanctionable in the case of the accidental death cannot be considered in the case of this insured.
9. The Doctor who conducted postmortem is examined as PW2, the body of the insured was identified. On examination he deposed that the cause of death of the individual was due to head injury which was resulted by a fall. The force of fall and nature of injury lead to the death of the insured who was an health man. In the observation of this witness the brain showed bleeding and it was due to fall. The opposite party is examined as OPW1. The dispute of the opposite party is that the injury if internal it cannot be considered as accident. The sum assured is Rs.1,00,000/-. As per the policy conditions the nominee of the insured is entitled for the benefit one and half times the sum assured along with other benefits. From the evidence of the complainant and witness, the death of the injured is due to fall and injury.
In the result the complaint is partly allowed. The opposite party is directed to give the complainant the nominee of the insured Rs.1,50,000/- ( Rupees One Lakh and Fifty Thousand Only) with an interest at the rate of 12% from the date of claim to the complainant till the date of realization of the amount. The complainant is also entitled to get Rs.1,000/- ( Rupees One Thousand Only) towards cost. This Order is to be complied within one month from the date of receipt of this.
Pronounced in Open Forum on this the day of 17th March 2012.
Date of Filing:27.10.2011.
