<br /> <br /> By SRI.K. VIJAYAKUMARAN, PRESIDENT.<br /> <br /> This is a complaint filed by the complainant for realization of Insurance amount of Rs.1 lakh and other reliefs.<br /> <br /> The averments in the complaint can be briefly summarized as follows:<br /> <br /> The complainant is the mother of late S. Sofya, who had met with a Road Traffic Accident on 13.12.2004 and had succumbed to the injuries at the Government Hospital, Ernakulam. The diseased was a Manorama discount Card Holder, a scheme adopted and launched by the 3rd opp.party and she was the beneficiary under the scheme. The scheme was introduced by the 1st and 2nd opp.parties with the connivance of the 3rd opp.party. The complainant’s daughter has taken the policy number 4005/0001749 with certificate No. As 592277-KLMPH 17/ 568083. The policy had validity from 4.8.2004 to 3.8.2005. The complainant is the nominee under the policy and the capital sum insured was Rs. 1,00,000/- . The policy has got a coverage in respect of the accidental death of the person insured. The opp.party 1 and 2 have received consideration from the 3rd opp.party and from the diseased Sofya . The diseased was a bonafide subscriber of the media Malayala Manorama Daily printed, published and circulated under the supervision of the third opp.party. The complainant had duly submitted the claim form along with the relevant documents for getting the Insurance claim in respect of the accidental death of the beneficiary her claim was repudiated. Hence the complaint.<br /> <br /> Opp.party 1 and 2 filed a joint version contending, interalia, that <br /> the complaint is not maintainable either in law or on facts. The opp.party admits the issuance of a Personal Accident Policy covering the deceased Sophia who was a Manorma Discount Card Holder The said policy was a Group Personal Accident Policy which was valid for a period of one year from 4.8.2004 to 3.8.2005. The averments made in paras 4 to 5 are to be proved by the complainant. The complainant has to prove that she is the sole legal heir of the deceased. The averments in para 13 and 14 are false and hence denied. The wordings in the policy conditions clearly state that the claims arising while doing an illegal act is not payable. From the available records, it is clear that the deceased was traveling on the motorcycle with two other persons. Seating capacity of a motorcycle is 1+1 and as per the provisions of law also it is an offence to ride a motorcycle with two pillion riders. Knowing all these the deceased has traveled on the bike with two others and the purpose of the journey was also not good. So the complainant is not entitled to get any compensation from the opp.party. Hence the opp.party 1 and two prays to dismissal of the complaint.<br /> <br /> The 3rd opp.party filed a separate version contending as follows: The complaint is illegal, irregular and improper as far as the 3rd opp.party is concerned. The complaint is opposed to law facts and circumstances of the case as far as the 3rd opp.party is concerned . The complaint is liable to be dismissed . The 1st and 2nd opp.parties entered into a Memorandum of understanding with the 3rd opp.party whereby a Personal Accident Insurance Scheme was formulated for the subscribers of Malayala Manorama Daily represented through Malayala Manorama Discount Cardholders and their family and family duly authorized by the representatives of Malayala Manorama. The policy insurance and all the commitments there under including the claims servicing shall be the responsibility of the 1st and 2nd opp.parties and in case of any disputes arising out of dishonour of the claim. It is the responsibility of the 1st and 2nd opp.parties to defend such disputes and the 3rd opp.party shall stand indemnified of all such claims as per the terms and conditions in the Memorandum of understanding. In the light of the said memorandum of understanding the 3rd opp.party is legally liable to be indemnified by the 1st and 2nd opp.parties. The 3rd opp.party is not in any way liable to pay any amount to the complainant . Hence 3rd opp.party prays to dismiss the complaint.<br /> <br /> Points that would arise for consideration are:<br /> <br /> 1. Whether the complainant is entitled to get compensation.<br /> 2. Whether there is deficiency in service on the part of the opp.parties<br /> 3. Reliefs and costs.<br /> <br /> <br /> <br /> For the complainant PW.1 is examined. Ext.P1 to P9 are marked.<br /> <br /> No oral or documentary evidence is adduced by the opp.parties<br /> <br /> <br /> Points 1 to 3<br /> <br /> As a matter of fact the issuance of Personal Accident Insurance Policy covering the diseased Sofia and the subsistance of the policy at the time of the diseased are admitted it is also an admitted fact that the diseased was a Malayala Manorama Discount Card holder and the policy was a Group Personal Accidental Policy. The grievance of the complaint is that inspite of the above facts the opp.party refused to entertain her claim for the insurance amount due to her as the nominee of her diseased daughter without any valid reason. The fact that the insured died in a road Traffic Accident is also not disputed. However, the contention of the opp.party is that the insured was riding in a motor cycle violating traffic rules at the time of accident. According to the opp.parties since the death occurred while proceeding towards engaging in an unlawful act, the insured is not entitled to get the amount as per the policy. It is the further case of the opp.party that the motor cycle involved in the accident was a stolen vehicle which also would show that the diseased was engaged an unlawful act.<br /> <br /> Though a contention that the insured died while doing an unlawful act is raised no material, worth believable was produced to establish those contentions. The opp.parties did not adduce any evidence either oral or documentary to establish their case. The complainant has produced Ext,P8 final report filed by the police in respect of the accident. In the charge the prosecution has stated that the motor cycle traveled by the deceased was being driven along the road in a lawful manner. To use the words in the charge, from which it is obvious that the motor cycle was being ridden as per low. Had there been any unlawful usage of the motor cycle there would have been a charge against the ride of the motor cycle and mention regarding that aspect also would have been there in Ext.P8. Other than raising the allegation that there were 2 pillion riders in addition to the rider of the motor cycle, as pointed out earlier no material was produced to establish that contention. It is true that PW.1 the mother of the diseased has stated that she heard that other than the rider there were 2 pillion riders in the motor cycle at the time of the accident. But that evidence need not been given much importance as PW.1 is not a eye witness to the incident or was no where near the place of occurrence. In our view the prosecution version in Ext. P8 charge is more believable than the hearsay evidence of PW.1<br /> <br /> The learned counsel for the complainant argued that the opp.parties not only rejected the legitimate claim of the complainant but also made defamatory allegations against the diseased. There is force in that contention. The opp.parties had averred in their version as well as in the argument note that the motor cycle ridden by the diseased at the time of incident was a stolen one. It appears that they have jumped to such a conclusion merely because nobody turned up to get the vehicle released from police. Such a conclusion is unfair and as argued by the counsel for the complainant it is made with a view to evade from their liability.<br /> <br /> The contention of the opp.party is that the other regal representatives of the diseased were not produced by the complainant and so she cannot be given the insurance amount. Ext.P2 policy shows that the complainant is the nominee of the diseased and it is well settled that the nominee can receive the insurance amount even without the junction of the other legal representatives . On a careful consideration of the entire evidence now before us, we are of the view that there is deficiency in service on the part of the opp.party in refusing the lawful claim of the complainant. We hold that the complainant is entitled to receive the amount as per the Ext.P2 Insurance Policy. Points found accordingly.<br /> <br /> <br /> In the result the complainant is allowed, directing the opp.parties 1 and 2 to pay the complainant Rs.1,00,000/- [Rupees One Lakh] with interest at the rate of 9% per annum from 15..3..2005 till payments and Rs.15,000/- towards compensation and cost. The order is to be complied with within one month from the date of this order.<br /> <br /> <br /> <br /> Dated this the 21st day of June, 2008.<br /> <br /> <br /> <br /> I N D E X<br /> <br /> <br /> List of witnesses for the complainant<br /> PW.1. – Abida Beevi<br /> <br /> <br /> List of documents for the complainant<br /> P1. – ICICI Insurance Premium receipt<br /> P2. – ICICI Insurance policy<br /> P3. – Complainant’s Hushand’s Manorama Discount card.<br /> P4. – True copy of the Advocate’s notice to the parties<br /> P5. – Postal receipt<br /> P6. – Acknowledgement card<br /> P7. – True copy of the FIR in Crime No.4074/04<br /> P8. – True copy of the charge sheet in FIR<br /> P9. – True copy of the Post mortem certificate of Sofya issued from Govt. Hospital, Ernakulam<br /> <br />