BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM,

ERNAKULAM.

Date of filing : 12/10/2009

Date of Order : 27/07/2011

Present :-

Shri. A. Rajesh, President.

Shri. Paul Gomez, Member.

Smt. C.K. Lekhamma, Member.

C.C. No. 543/2009

Between

 

And

O R D E R

A. Rajesh, President.

1. The case of the complainant is as follows :

The husband of the 1^st complainant and the father of the other complainants Mr. P.J. Punnan had availed a loan from the Ernakulam District Co-operative Bank Ltd., Pampakuda Branch. The bank had obtained the master policy No. 101300/46/05/99/00001110 of the opposite party for its beneficiaries. Accordingly, Mr. P.J. Punnan was given a personal accident coverage of Rs. 3,60,000/- for the period from 08-03-2006 to 07-03-2021. While so on 03-06-2009, the said Punnan died in a rail accident. He was hit down by a train, while he was waking through the railway track near Velloor. The deceased was a real estate broker by profession and he used to travel to various places in connection with his job. On that day, he had gone to Velloor in connection with a property deal. After his death, a claim was lodged before the opposite party. But it was repudiated by them by their letter dated 10-09-2009 stating that the death reported as suicide by run over. The allegation of suicide is absolutely false. The deceased Punnan had no family problems, health problems or financial problems that would have compelled him to commit suicide. The younger son of the deceased is working abroad and earning sufficient income so as to looking after the family. The complainants are entitled for the claim amount of Rs. 3,60,000/- along with interest at the rate of 12% p.a. from the date of claim till realisation. Hence this complaint.

2. Defense of the opposite party :

The opposite party admits the issuance of the policy. A claim was lodged before the opposite party in connection with the death of Ponnan, who had been covered under the above policy. The coverage was granted for personal accident. After receiving the claim intimation, the opposite party had requested for relevant documents including the police reports. The opposite party had obtained a certified copy of the final report, which was filed before the Hon'ble Sub-Divisional Magistrate Court, Pala. In the final report, the conclusion of the police was that the death was due to suicide. The opposite party repudiated the claim, since the claim clearly falls within the Exclusion Clause of the policy. The complainants are not entitled for any reliefs as claimed in the complaint. There is no deficiency in service on the part of the opposite party. The opposite party is not liable to pay any amount to the complainants.

3. The 1^st complainant was examined as PW1. The witness for the complainants was examined as PW2. Exts. A1 to A4 and X1 were marked on the side of the complainants. No oral evidence was adduced by the opposite party. Exts. B1 and B2 were marked on their side. Heard the counsel for the parties.

4. The only point that emanated for consideration is whether the complainants are entitled to get insurance claim from the opposite party to the tune of Rs. 3,60,000/-?

5. The parties are in consensus on the following issues :

1. The deceased was a beneficiary of Ext. B2 policy.

2. Ext. B2 policy is valid from 08-03-2006 to 07-03-2021.

3. During the currency of the policy, the deceased breathed him last on 03-06-2009.

4. The police submitted Ext. B1 final report before the Sub-Divisional Magistrate Court, Pala stating that the deceased had committed suicide.

6. According to the complainants, the death of the deceased was due to a train accident, and therefore, the complainants are entitled to get insurance claim as per Ext. B2 policy. The opposite party contended that the deceased committed suicide and so they are not liable to pay any amount to the complainants as per Exclusion Clause No.1. Exclusion Clause No.1 in Ext. B2 reads as under :

“The company shall not be liable under this policy for payment of compensation in respect of death, injury or disablement of the insured.

(a) from intentional self injury, suicide or attempted suicide”.

7. The 1^st complainant was examined as PW1, she deposed in tune with the averments in the complaint. PW2 is the Investigating Officer in Crime No. 149/2009 of Velloor Police Station which has been registered after the death of the deceased. PW2 deposed that there was no eye witness for the death of Punnan and he has not received any suicide note from the scene of occurrence. He further stated that he has interrogated the relatives and neighbours of the deceased and came to the conclusion that the said Punnan committed suicide. Ext. A4, the housing loan account statement of the deceased goes to show that he had been promptly remitting the instalments in the loan account and there had been no dues which goes against the contentions of the opposite party whatever. In fact, no conclusive proof is on record to come to a conclusion that the deceased had committed suicide. The Hon'ble Rajasthan State Consumer Disputes Redressal Commission in State Insurance and GPF DEPTT & Ors. Vs. Ladkanwarsutania (III (2005) CPJ 493), held in para 7 as follows :

“On taking a prima facie view of the injuries found on the person of the deceased insured we had felt inclined to agree with Mr. Vyas that the deceased insured might have died a suicidal death but on a closer study of the documents referred to above we are not inclined to interfere with the impugned order on the basis of the assumed probability. We find no iota of evidence on record to suggest that the deceased insured was having or could have, reasons to commit suicide. He was a Government servant aged 54 years, gainfully employed as an Inspector in the Co-operative Deptt. of the State Government. There is no suggestion to the effect that the deceased was having any problem with his service colleagues, juniors or superior officers or facing any charges or disciplinary actions. There was also no history of any sort of depression on his part caused by any social or family discord or problem. Instead, there was positive evidence in the statements of the Panches to the Punchnama, police officials in the site map and seizure and other memos, gagmen on duty and deceased's own wife that he had died of injuries caused accidentally to him by a moving train. The railway track and the poles whereat the unfortunate incident had taken place were also not too far away from the inhabitant area of the city of Kota. The Insurance Ombudsman had also negatived suicide as cause of the death of the deceased. Taking into account all the facts and circumstances of this case, including those pointed out above, and keeping in mind the aims and object of the Act, we are not inclined to disturb the impugned order which legitimately and justly represents a realistic approach to the provisions of a beneficial legislation.”

8. Being guided by a superior authority of better maturity and knowledge we have no hesitation to hold that the opposite party is liable to pay the insurance claim of Rs. 3,60,000/- to the legal heirs of deceased Punnan.

9. Accordingly, we allow the complaint and direct that, the opposite party shall pay the insurance claim of Rs. 3,60,000/- (Rupees Three lakhs and sixty thousand only) to the complainants being the legal heirs of deceased Punnan.

The order shall be complied with, within a period of one month from the date of receipt of a copy of this order, failing which the above amount shall carry interest @ 12% p.a. till payment.

Pronounced in open Forum on this the 27^th day of July 2011.