D.o.F:26/2/08<br /> D.o.O:22/8/08<br /> IN THE CONSUMER DISPUTES REDRESSAL FORUM KASARAGOD <br /> CC.NO.10/08 <br /> Dated this, the 22nd day of August 2008 <br /> <br /> PRESENT:<br /> SRI.K.T.SIDHIQ : PRESIDENT<br /> SMT.P.RAMADEVI : MEMBER<br /> SMT.P.P.SHYMALADEVI : MEMBER<br /> <br /> Mrs. Nafeesa<br /> W/o Mhamood(late)<br /> Arthipalla House, : Complainant<br /> Perdala Po, Nekraje ,<br /> Kasaragod.<br /> <br /> The New India Assurance Co. Ltd,<br /> Divisional Office, Kottarathil Buildings, : Opposite party<br /> Palayam, Thiruvananthapuram.<br /> <br /> ORDER<br /> SRI.K.T.SIDHIQ: PRESIDENT:<br /> <br /> The issue to be settled in this complaint is whether the death of the complainant’s husband Mohammed Mohamood was an accidental death caused by violent, outward and visible means so as to make her eligible for the insurance benefits covered under the insurance policy obtained by her husband under the Pravasi Suraksha Policy.<br /> Nafeesa, the wife of deceased Mohammed Mohamood filed this complaint claiming insurance benefits covered under the Pravasi Suraksha Policy. According to Nafeesa her husband late Mohmood was working abroad and he had obtained a Pravasi suraksha policy No.760500/06/012/00000369 when he was on leave. Thereafter, he went to Saudi Arabia and on 15/8/2007 while he was crossing the road one dashing vehicle tried to hit him. He ran away and when reached his room died due to the shock. This fact was reported by a person accompanying him at the time of death. The body of Mohamood, the deceased husband of Nafeesa was cremated in Saudi Arabia itself as instructed by her. Thereafter Nafeesa submitted her claim for insurance benefits before the New India Assurance Co. Ltd but the insurer was declined to grant compensation as per policy on the ground that the policy is only applicable if death occurred due to motor accident/traffic accident. According to Nafeesa in Pravasi Suraksha Policy any kind of death will come within the purview of the policy. Hence the complaint alleging deficiency in service on the part of New India Assurance Co. Ltd against the denial of insurance benefits.<br /> 2. The New India Assurance Co.Ltd entered appearance and filed their version. According to them, the death of Mohammed Mohmood was not a death coming within the purview of the policy conditions and the policy issued covers, if the insured person sustain any bodily injury resulting solely and directly from accident caused by violent, outward visible means and if such injury shall be the sole and direct cause of the death of the insured person. The cause of death of the insured person herein was not due to any accident and no bodily injury was sustained to him and it was a natural death. Hence the complainant is not entitled to claim the policy amount. As per condition No.8©(l) of the policy Nafeesa is bound to produce records from police as evidence of accidental death and postmortem certificate etc to the insurer to prove the death was due to accident. Nafeesa failed to produce them. The documents produced by Smt.Nafeesa shows that the death was not due to an accident but was a natural death. Hence the complainant is not entitled to any benefit under the policy and the complaint requires a dismissal.<br /> 3. Complainant, Smt.Nafeesa has produced Exts.A1 to A5 in support of her case. The New India Assurance Co.Ltd produced Exts.B1 & B2. Counsels of both sides heard and the documents perused.<br /> 4. The only point to be settled in this case is whether the death of Sri.Mohammed Mohamood, the husband of Smt.Nafeesa was a death resulting solely and directly from accident caused by violent outward and visible means. Ext.A4 is a true translation of the medical report prepared by one Dr.Mohamed Anees ul Rahman issued by the Superintendent of Medical Center under the Ministry of Health General Directorate of health affairs Riyadh, Saudi Arabia. In Ext.A4, the doctor certified that the possible reason for death was the hidden reason for the halt of breathing and heart due to severe injuries from traffic accident. The medical report also states that according to police report the circumstances of the death is natural death. As far as the death is concerned the opinion of the medical men are more relevant than the report of the police. In Ext.A4 the possible reason of death is noted as Hidden reason for the halt of breathing and heart due to severe injuries from traffic accident. <br /> 5. Whether this death can be considered as the death caused from accident caused by violent, outward and visible means for the purpose of insurance cover?<br /> 6. In our view in this case the death caused to the insured is an accidental death as it was not natural and that the insured did not intend to die due to halting of breath and heart due to the severe injuries from traffic accident. Violent means includes any external impersonal cause, and even undue exertions on the part of the assured. In such a cases the death is not due to internal cause and that any cause which is not internal must be external. But this does not means that the injury must be external. This is the law settled in England for the identical terms of insurance policy and most of the insurance companies have borrowed their forms of the policy from their counter parts in England and the law settled on the subject by the English courts can be the basis for deciding matter. In this matter the specific case of Smt.Nafeesa is that the death of her husband occurred while her husband was crossing the road, one dashing vehicle tried to hit her husband and he ran away and when reached his room die due to the shock. If that be so, it may be due to the undue exertion of the assured, the shock might have caused.<br /> 7. The Hon’ble National Consumer Disputes Redressal Commission had occasions to consider the meaning and definition of the words accident, violent External and visible means, violent means very elaborately in a number of decisions. In one of the decision reported in IV( 2007) CPJ 355(NC) in the case of Rita Devi @Rita Gupta vs. National Insurance Co.Ltd, few illustrations of accidental deaths are given in the said decision which entitles the claimants for compensation. The paragraph 49 of the said order is reproduced below;<br /> From the aforesaid law developed in other countries and in this country, it is clear that the injury or death caused by lightening, sun-stroke or earthquake has been held to be accidental. Further, where a man in the course of his work is exposed to excessive heat coming from a boiler and becomes exhausted and the death occurs, it would be an accidental death. Similarly, a person working in a icy cold water and thereafter, sustains pneumonia which causes his death, such death is also considered to be an accidental death. Similarly, if the assured is seized by a fit and drowns or falls in front of a train and killed, death is due to external cause and is an accidental death. Death resulting from the threats by miscreants is also considered to be an accidental caused by external violence and visible means. In substance, death which does not occur in the usual course or natural course of events or events/ causes which could not be reasonably anticipated is considered to be accidental one. Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect and it is by natural external violent force. Further, ‘cold wave’ is an untoward event which is not expected or designed, and an ordinary man could not expect the occurrence. <br /> In the above , it is stated that death which does not occur in the usual course or natural course of events or events/causes which could not be reasonably anticipated is considered to be an accidental one. If that be so, we hold that the death of Mohammed Mohamood the husband of Nafeesa who died due to the shock caused to him when a dashing vehicle tried to hit him, came within the purview of this illustration and hence the insurer is liable to compensate the claimant and the non settlement of claim amounts to deficiency in service.<br /> 8. Reliefs& Costs:<br /> As per the Pravasi Suraksha policy issued to the assured, the sum insured which would be payable in the case of death of the policy holder is Rs.5,00,000/-(Rupees five lakhs only). The complainant Smt. Nafeesa is the nominee of the assured as per the policy. The documents produced before us is sufficient enough to establish that the death of the assured Mohammed Mohamood was an accidental death and no further documents are necessary for the settlement of claim. Hence she is eligible to get the said amount of Rs.5,00,000/-.<br /> Therefore, we allow the complaint and the New India Assurance Co. is directed to pay Rs.5,00,000/- ( Rupees five lakhs only) with interest @ 9% per annum from the date of complaint along with a cost of Rs.2000/- to Smt. Nafeesa. Time for compliance of this order is 30 days from the date of receipt of copy of order.<br /> <br /> MEMBER MEMBER PRESIDENT<br /> Exts;<br /> A1- Policy schedule<br /> A2-20/9/07-letter issued by OP to complainant<br /> A3- Death Certificate<br /> A4-Certified Translation of Medical Report<br /> A5-Lawyer notice<br /> B1-10/9/07-letter issued by complainant to OP<br /> B2- office copy of Ext.A1<br /> <br /> MEMBER MEMBER PRESIDENT<br /> eva/ <br /> <br />