By Jayasree Kallat, Member:<br /> Complainant is a widow of Sreedharan, a Tailor by profession, who had joined as a member in the Children’s birth day fund and Educational Project. A scheme introduced by second opposite party. Membership No.. is 45754. Sreedharan paid Rs.500/- for the membership on 14-2-03. The date of maturity according to the policy certificate was on 14-2-2018. Second opposite party had assured that each and every member of this project is covered by insurance benefits under the National Insurance Company Ltd. In the projects membership certificate the personal accident Master’s policy Number of Sreedharan is 571000/42018110422. It was clearly and specifically stated that every person who takes membership in the second opposite party under the project will be insured with National Insurance Company Ltd. for accident death insurance benefit after 30 days from the date of admission. Sreedharan had taken a membership and his wife was appointed as the nominee. Unfortunately on 15-7-04 between 7.30 P.M. and 9.30P.M. husband of the complainant fell down from C.H. Fly over in Calicut city. He was taken to Calicut General Hospital and from there to Calicut Medical College. There were fatal injuries and eventually he succumbed to death. This incident was an accident. The complainant as the nominee of the deceased Sreedharan approached the first opposite party and claimed benefits under the project for which she is entitled to get from the first opposite party. The first opposite party rejected the claim stating that “the insured was under the influence of ‘Alchahole’ at the time of accident which is against under the policy conditions.” The complainant assumed that first opposite party meant the word Alcohol. Complainant alleges that reason for rejection of the claim is false, fictitious. Sreedharan did not have the habit of consumption of Alcohol. There is no evidence to show that on the fatal accident date 15-7-04 Sreedharabn was under the influence of Alcohol, The deceased body was taken to Forensic department in Medical College Hospital, postmortem was conducted by well experienced Doctor of forensic department. In the postmortem report nothing is stated to say that the deceased had consumed Alcohol prior to the accident. According to the complainant there is no reason for repudiating the claim. She is entitled to claim the entire benefits of the membership policy as she is the lawful nominee of the membership holder of Mr. Sreedharan. Complainant alleges unfair trade practice and deficiency of service on the part of opposite party.<br /> <br /> Opposite party-1 has filed a version denying all the allegations and averments contained in the complaint. Opposite party admits that complainant’s husband has been insured with first opposite party with policy No.571000/42018110422 ( N.F.45654) and the period of insurance is from 4/3/03-04 to 2/4/04-05 for an amount of Rs.50000/-. The first opposite party contents that the statement of the complainant that the incident was an accident is not correct. As per the F.I.R. statement it is clear that the deceased was under the influence of Alcohol at the time of accident. On 19-11-04 first opposite party sent a letter stating their inability to settle the claim since the insured was under the influence of Alcohol. The first opposite party admits that a typing mistake occurred in that letter. The word Alcohol was typed as Alchohole. It was an oversight. The first opposite party also contents that they are not liable to pay any amount if there is any violation of policy condition. It is stated in the exception clause No.3.2.7 (b) of Master Policy agreement. According to first opposite party the sum insured in the name of deceased is only Rs.50000/- and the nominee cannot claim an amount higher than that. The first opposite party is not liable to pay any other amount claimed in the petition. The first opposite party submits that for the reason mentioned above the complaint is to be dismissed with costs and damages to the opposite party.<br /> <br /> The second opposite party also had filed version contending that the petition is not maintainable. The second opposite party admits that the complainant is the nominee of the membership holder who had a membership under the scheme offered by the second opposite party on 14-2-03. If the contributor does not make any default in their contribution, they are eligible for personal accident benefits for a selected period. As the half yearly contribution of this membership holder is only Rs.500/- he was insured for Rs.50000/-. Second opposite party has a privity of contract with the National Insurance Company Ltd. (First opposite party). As the second opposite party has not undertaken to indemnify the membership holder and there is no agreement between second opposite party and the membership holder, Second opposite party is not liable and responsible to compensate the membership holder. The second opposite party had insured the membership holder with the company as per the terms and conditions stipulated in the application form as well as in the membership certificate. If at all it is found that the complainant is entitled for any amount that may be ordered to be recovered, it is from the first opposite party. Hence petition against second opposite party may be dismissed.<br /> <br /> The point for consideration is whether the complainant is entitled to get any relief?<br /> <br /> PW1 and 2 were examined on complainant’s side and Exts.A1 to A10 were marked. No oral evidence for opposite party-1 and 2 and Exts.B1 and B2 were marked on O.P’s side.<br /> <br /> The complainant’s case is that her deceased husband Sreedharan had taken membership in the scheme introduced by opposite party. Membership number is 45754. Opposite party had issued policy certificate in the name of Sreedharan which is marked as Ext.A1. The terms and conditions of the project are described on the overleaf of the certificate. In Clause-2 under the title of the insurance coverage it is stated that every person who takes membership in the second opposite party under the project will be insured with National Insurance Company Ltd., for accident death insurance benefit after 30 days from the date of admission. The husband of the complainant was regularly paying the instalments as his contribution to the project. Unfortunately on 15-7-04 between 7.30 P.A. and 9.30 P.M. he happened to fall down from C.H. Fly over in Calicut City. He was taken to Calicut General Hospital and from there to Calicut Medical College. Injuries were fatal and eventually he succumbed to death. The complainant being the lawful nominee of the deceased Sreedharan approached the first opposite party and claimed benefits under the project which she is entitled to get. But the opposite party rejected the claim benefit. The reason stated for rejection of the claim was that “the insured was under the influence of Alcohol.” The complainant states that this reason for rejection of the claim is absolutely false, fictitious and without any bonafides. Mr. Sreedharan was never in the habit of consumption of Alcohol. At this instance the opposite party-1 has produced the First Information Report from the Town Police Station which is marked as Ext.B2. The reason for the opposite party to reject the claim is that Johny.A. had stated in the F.I.R. that Sreedharan had attended the funeral ceremony of Johny’s Father-in-law and later on both Johny and Sreedharan had taken Alcohol. The same Johny was examined as PW2 on complainant’s side. In the deposition of PW2 Johny Page-3 he had denied the statement given in the F.I.R. that both he and Sreedharan had taken Alcohol. As the same person has given two different versions in the F.I.R. and deposition given before the Court under oath, the Forum is not accepting both versions. Then the only proof before the Forum to examine whether the deceased Sreedharan was under the influence of Alcohol on the day of his death is the postmortem report which is marked as Ext.A5. There is no mention about the deceased being under the influence of Alcohol in the postmortem report. The post mortem report can be considered as a realiable document. As the post mortem report does not mention about any Alcohol influence in the body of the deceased the Forum has come to the conclusion that the deceased Sreedharan was not under the influence of Alcohol at the time of death. Now the question to be considered is whether the complainant is entitled for the accident claim benefit from opposite parties? As the complainant is the nominee of the deceased and complainant’s husband had died due to an accident the opposite parties are liable to indemnify the claim of the complainant. As per clause-2 in Ext.A1 it is stated that every person who takes membership in the second opposite party under the project will be insured with National Insurance Company Ltd. For accident death insurance benefit after 30 days from the date of admission. The deceased Sreedharan became a member in the opposite parties’ project by paying Rs.500/- as membership amount and Rs.7/- as bank charges on 14-2-03. Sreedharan died on 15-7-04. Hence we are of the opinion that the complainant being the lawful nominee of the deceased Sreedharan is entitled for the claim benefits under the project of the opposite parties. The opposite parties have no right to reject the claim filed by the complainant. As to the amount claimed by the complainant we are of the opinion that it is an exorbitant one. The sum assured for accident insurance in the name of deceased Sreedharan is Rs.50000/-. Hence we are of the opinion that the complainant is entitled to get Rs.50000/- from the opposite parties.<br /> <br /> In the result the petition is allowed and the opposite parties are severally and jointly liable to pay Rs.50000/- to the complainant and a cost of Rs.1000/-.<br /> <br /> Pronounced in the open court this the 20th day of October 2008.<br /> <br /> Sd/- Sd/- Sd/-<br /> PRESIDENT MEMBER MEMBER<br /> <br /> APPENDIX<br /> <br /> Documents exhibited for the complainant.<br /> A1. Membership certificate issued by 2nd O.P. to the complainant dt. 14-2-03.<br /> A2. Receipt dt. 14-2-03 issued by the agent of the second opposite party. <br /> A3 series ( 2 in Nos.) Renewal subscription receipts issued by 2nd O.P. dt. 14-2-03and<br /> 14-2-04. <br /> A4. Certificate issued from the Department of Forensic Medicine,<br /> M.C.H. Calicut dt. 21-8-04.<br /> A5. Photocopy of postortem report dt. 16-7-04.<br /> A6. Photocopy of Janata Personal Accident Insurance Policy claim form.<br /> A7. Letter dt. 19-11-2004.<br /> A8. Photocopy of Regd. Lawyer notice dt. 2-12-04.<br /> A9 series . Postal receipt and acknowledgement.<br /> A10. Reply notice dt. 15-1-05.<br /> <br /> Documents exhibited for the opposite party.<br /> B1. Photocopy of Master Policy agreement.<br /> B2. Photocopy of Postmortem report.<br /> <br /> Witness examined for the complainant:<br /> PW1. Thankamani. C. (Complainant)<br /> PW2. Johny.A., Kandamkulam Paramba, Cherootty Road, Calicut-32.<br /> Witness examined for the opposite party.<br /> None.<br /> Sd/- President<br /> // True copy //<br /> (Forwarded/By order)<br /> SENIOR SUPERINTENDENT.<br /> <br />