By Smt. Padmini Sudheesh, President<br /> <br /> Petitoners’s case in brief is as follows:<br /> <br /> Petitioner is the mother of deceased Tony. The late Tony was a subscriber of medi-claim policy and he had remitted the premium amount for one year. He had joined in the policy on 22/9/00. The policy amount assured was Rs.1,00,000/- and the insurance coverage was 6/10/00 to 5/10/07. The complainant is the nominee of the policy. On 22/5/01 at 12.10 AM while he was engaged in his work he was murdered by a group of people. On 1/4/02 the nominee applied for the insurance amount with sufficient documents. But the Company refused to settle the claim. The Divisional Manager wanted to submit the final investigation report from Police authorities to settle the claim. She also submitted that document, but not settled. Later Lawyer notice sent, a reply has sent stating untenable matters. But the claim not settled. Hence this complaint.<br /> <br /> The Counter of the Company is as follows:<br /> <br /> 2. This respondent denies the allegation in the petition that this respondent has asked the petitioner to produce the Final Report in the Crime No.115/2001 for settling the claim. What this respondent has asked in their letter dated 1/4/2002 is that the petitioner must produce the Final Report to enable the Company to proceed further in the matter. There was no assurance whatsoever from the company that claim will be settled and payment made on furnishing this document. The deceased Tony has inflicted cut injuries on the body of first accused in the Crime No.115/2001 namely Ramadas @ Dasan @ Kuttikadiyan about three months prior to this incident and in retaliation to this criminal act the accused in crime No.115/2001 of Mannuthy Policy Station has attacked the son of the petitioner on 27/3/03 and he died of the injuries sustained. As per exception clause (5) of the policy issued to Tony it is clearly incorporated “The Company shall not be liable under this policy for payment of compensation in respect of death of the insured arising or resulting from the insured committing any breach of law with criminal intent”. The allegation in the petition that this respondent is evading payment under one pretext or other is not correct. Petitioner is not entitled for any amount against this claim. Hence dismiss.<br /> <br /> 3. The points for consideration are:<br /> 1) Whether the petitioner is entitled for the insurance benefits ?<br /> 2) Is there any deficiency of service ?<br /> 3) Reliefs and costs ?<br /> <br /> 4. The evidence consists of Exhibits P1 to P8 and R1 to R11.<br /> <br /> 5. Point No.1 The mother of the deceased Tony is the complainant herein. She is sought for the insurance benefits on the death of her son. The company had rejected her claim stating the policy exception clause (5). The exception states that the company shall not be liable under this policy for payment of compensation in respect of death of the insured arising or resulting from the insured committing any breach of law with criminal intent. The case of the company is that late Tony had attacked Dasan on an earlier occasion and on retaliation the said Dasan and some others murdered Tony. The act of Tony was a breach of law with criminal intent. The records of crime No.115/01 shows that late Tony had attacked Dasan prior three months. Whether that attack was with criminal intent or not is not explained any where. Whether late Tony had done it in pursuance of self defence or not is not known. No records are before us. Only on this point the claim was rejected. There is also no records to establish that he was a criminal and involved in so many criminal activities. No piece of paper is produced to establish that point. The company investigator who has visited the petitioner’s house had stated that late Tony was the only earning member of the family and his younger sister is not married and parents are physically weak for any job. By the death of Tony their only means of livelihood has lost. The only ground for non-settling the claim has not proved. So the petitioner is entitled for the insurance benefit. As per the cover of policy the petitioner is entitled for Rs.1,00,000/-. So she is entitled for that sum.<br /> <br /> 6. Point No.2 The company can very well settle the claim much earlier. They repudiated the claim without genuine ground. The only allegation is an attack to one Dasan. If Tony was a known criminal the company can straight away reject his application even before joining the policy. They did not do it. The company is also responsible for deficiency in service.<br /> <br /> 7. In the result this complaint is allowed and the respondent company is directed to provide to the petitioner Rs.1,00,000/- (Rupees One lakh only) with 12% interest per annum from 22/5/01 and 6% interest from today till realization. The company is further directed to pay Rs.2,000/- (Rupees Two thousand only) towards costs of this complaint. Comply the order within two months.<br /> <br /> Dictated to the Confdl. Asst., transcriber by her, corrected by me and pronounced in the open forum this the 28th day of July 2008.<br />