SRI. JIMMY KORAH (PRESIDENT)<br /> Complainants filed the complaint alleging the deficiency of service against the opposite party. Complainants are the legal heirs of deceased C.A.M. Shajahan who was the holder of a Pravasi Suraksha-Kudumba Arogya Policy of New India Assurance Company. The period of policy was from 22-08-2000 to 21-08-2005. The coverage under the policy is of Rs. 10,00,000/- for accidental death and Rs. 50,000/- for educational benefits. In addition to this persons listed in the schedule are entitled to get medi-claim up to Rs. 1,00,000/- under Kudumba Arogya Scheme. Petition suffered some sickness at Saudi Arabia and he returned to Kerala for further treatment. While on his treatment the said Shajahan died on 02-11-2004. He was died due to eythema-multiforme, cirrhosis of lever and specticemia. This was caused due to an allergy of medicine. Hence this is an accidental death. The complainant preferred claim application before the opposite party but the opposite party has granted benefit of medi-claim under Kudumba Arogya Scheme and the benefit under Pravasi Suraksha was not granted. Against this the complainants preferred this petition.<br /> 2. Opposite party filed version stating that the opposite party has given Rs. 7,174/- in response to the claim preferred by the complainant as medi-claim under Kudumba Arogya Scheme. This amount was received a full and final settlement. The claim under Pravasi Suraksha can be given only on accidental death. The said Shajahan died not due to any accidental death hence the repudiation of the claim under Pravasi Suraksha is legal and valid. Hence there is no deficiency of service on the part of the opposite party.<br /> 3. Petitioner filed proof affidavit and cross examined. Petition examined Dr. C.A. Abdul Khader, Asst. Professor, Medical College Hospital, Alappuzha, and produced four documents. The documents are marked as Exts. A1 to A4. On the side of the opposite party they produced proof affidavit of the Branch Manager and five documents. The documents are marked as Exts. B1 to B5. <br /> 4. Considering the rival contentions of both parties this Forum framed the following issue:-<br /> “Whether there is any deficiency of service on the part of the opposite party by repudiating the claim under Pravasi Suraksha Scheme?”<br /> 5. Regarding the contention of full and final settlement as raised by the opposite party they relied Ext. B3 voucher. This voucher shows that the complainant put her signature in blue ink and the writings including the amount written in another ink (black colour) of another person’s handwriting. Apart from that this is a printed format. The wordings in Ext. B3 shows that they agreed to accept in full satisfaction and discharge of their claim upon the Company under policy No. 47/05/80510 in respect of K.A.Claim. KA.Claim means Kudumba Arogya. This shows that they were given full satisfaction in respect of Kudumba Arogya Scheme only. Further it is to be noted that immediately after the receipt of repudiation letter complainants filed present petition. This petition can treated as their objection and non satisfaction of the processing of the claim. Hence the contention regarding full satisfaction is not sustainable<br /> 6. The main dispute is whether the cause of the death of the deceased C.M.A. Shajahan was due to accidental death. Here it is pertinent note that the evidence of the expert Dr. C.A. Abdul Khader. He stated that the disease which leads to the cause of death is due to severe drugs reaction. The said doctor deposed that “In severe drugs reaction characterized by multiple erthy matter and bullons skin lesion along involvement of mucosal surface including eye, oral cavity and other internal organs. (Q) Erythema multiforme F tcmKs¯ XpSÀp-Å-Xsà aäv tcmK-§Ä? (A) AsX. Sceptiscemia A§-s\-bpÅ AWp-_m[ sIm­p-­m-Ip--Xm-Wv. AWp-_m[ ico-c-¯n _m[n¨p Ign-ªm B´-cnI Ah-b-h-§Ä¡v XI-cmdv kw`-hn-¡pw. (Q) Cu tcmKw aqÀ¨n-¨-Xp-sIm­v 02-þ11-þ2004  tcmKn ac-W-s¸«p? (A) AsX. (Q) Cu acWw Hcp kzm`m-hnI acWw BtWm? (A) AÃ. Drug reaction BWv. (Q) A§-bpsS \nco-£-W-¯n Cu tcmKn-bpsS ac-W-¯nsâ aqe-Im-cWw severe drug sâ reaction sIm­sÃ? (A) XoÀ¨-bm-bpw. (Q) tcmK-_m-[n-X-\mbn Xs-bmWv can-¨-bmÄ A§-bpsS ap¼n F¯p-Xv? (A) AsX”. This indicates that due to the drug reaction injury was caused to his body and resulted into infection of his internal organs. This bodily injury and the infection of his internal organs resulted into death. According to the complainants, the injury caused to the deceased due to accidental and the same can be considered as an accidental death. On the other hand the opposite party contended that it can be considered only as a natural death and not due to any accident. It is also to be noted that in the version of the opposite party they have stated in paragraph 6 of the version “the policy covers only accidental death and permanent disablement due to accident”. They have no case that the injury should have been resulted from any bodily injury which is in type of any road accidents, or any other fall or accidental murder or any other injury which might have been seen in visible nature. Here it is to be meticulously analyzed the terminology accidental death. In the judicial dictionary written by K.J. Aiyar (13th edition). The word accidental is defined in page 12 & 13 as follows”-<br /> “Accident means that which happens without being expected, something unforeseen and unexpected and casual (Fenton Vs. Thorley – 1903 A.C. 443; Starr Vs. General Accident Assurance 1905 1 KB 3871)<br /> An effect is accidental when the Act by which it is caused is not done with the intention of causing it and when its occurrence has a consequence of such act as is not so probable that a person of ordinary prudence ought, under the circumstances in which it is done, to take reasonable precautions against it.”<br /> 7. The meaning given to the word ‘accident’ in Chamber’s 21st Century dictionary has been stated as: “An unexpected event which causes damage or harm; something which happens without planning or intention; chance managed it by accident.”<br /> 8. The Honourable High Court of Kerala in the case of Devshi Bhanji Khona Vs. Mary Burno and another, 1985 ACJ 299 considered the fact that whether the death of a workman due to heart failure while carrying load can be considered as an injury suffered on account of accident. The Honourable High Court held that the said death is an unexpected way and that could certainly be considered to be accident. In the said decision honourable High Court relied the dictionary meaning of Chamber’s dictionary.<br /> 9. In the present case the disease which caused the death of Shajahan was caused due to the allergic effect of the medicines. This is an undisputed fact. At the time of the death deceased Shajahan is at the age of 39. The opposite party has no case that the diseases caused to the allergic effect are a pre existing disease. Hence the cause of death is an unexpected event which caused the bodily injury through allergic reactions which resulted the infection of the internal organs of the deceased Shajahan. From the above discussions it can be concluded that the death of Shajahan is an accidental death.<br /> 10. The relief claimed by the petitioner is for Rs. 10.5 lakhs. It is admitted that the legal heirs are entitled to get for the death of insured person for an amount of Rs. 10,00,000/-. Since the death of Shajahan is an accidental death and the nominee is entitled to get Rs. 10,00,000/- (Rupees Ten Lakh only). Further Rs. 50,000/- is entitled to get for 2 dependent children as educational grant. Here the deceased has only 1 child. Hence they are entitled to get Rs. 25,000/- (Rupees Twenty Five Thousand) only.<br /> 11. From the above discussions and findings it can be seen that the repudiation of Pravasi Suraksha Insurance Scheme of the deceased is not correct. Hence the repudiation of the claim dated 21-06-2005 is not correct and valid in law. Hence this complaint is allowed. Complainants are entitled to get Rs. 10,25,000/- (Rupess Ten Lakh and Twenty Five Thousand only) from the opposite party.<br /> 12. In the result, petition allowed and opposite party is directed to pay Rs. 10,25,000/- (Rupees Ten Lakh and Twenty Five Thousand only) to the complainant within 45 days from the date of receipt of this order. Considering the nature of disputes in this case there is no order of compensation. Parties shall bear their costs. If the opposite party failed to pay compensation within 45 days and in such a circumstances the complainants are entitled to get interest for the award amount @ 9% per annum from the date of order.<br /> Complaint allowed.<br /> Pronounced in Open Forum on this the 29th day of May, 2008.<br /> Sd/- Sri. Jimmy Korah<br /> Sd/- Sri. K.Anirudhan<br /> <br /> Sd/- Smt. N.Shajitha Beevi<br /> <br /> APPENDIX<br /> <br /> Evidence of the complainants:<br /> <br /> PW1 - Rehumath.M<br /> PW2 - Dr. C.A. Abdul Khader<br /> Ext. A1 - Photocopy of Certificate of Insurance<br /> Ext. A2 - Treatment Certificate dated, 26-02-2005<br /> Ext. A3 - Photocopy of Medical Certificate<br /> Ext. A4 - Letter dated 21-06-2005 from The New India Assurance Company Ltd. to Mrs. Rehumath.M<br /> <br /> Evidence of the Opposite party:<br /> <br /> Ext. B1 - Policy copy with condition<br /> Ext. B2 - Claim form and the statement submitted by the complainant<br /> Ext. B3 - Medical Certificate<br /> Ext. B4 - Signed discharge voucher<br /> Ext. B5 - Letter of repudiation<br /> <br /> <br /> // True Copy //<br /> <br /> By Order<br /> <br /> <br /> <br /> <br /> Senior Superintendent<br /> To<br /> Complainants/Opposite party/SF<br /> <br /> Typed by: Sh/-<br /> Compd by:<br />