Tamil Nadu

North Chennai

CC/114/2018

Dr.Sudhahari - Complainant(s)

Versus

Royal Sundaram Alliance Insurance - Opp.Party(s)

Vijayaraghavalu

18 Jun 2019

ORDER

 

                                                            Complaint presented on:  12.11.2018

                                                               Order pronounced on:  18.06.2019

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHENNAI (NORTH)

2^nd Floor, Frazer Bridge Road, V.O.C.Nagar, Park Town, Chennai-3

 

PRESENT:  TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL -  PRESIDENT

 

TMT.P.V.JEYANTHI B.A., MEMBER - I

 

TUESDAY  THE 18^th   DAY OF JUNE 2019

 

C.C.NO.114/2018

 

Dr.Sudhahari,

W/o. Dr.Aravinth,

Ganesh Nursing Home,

No.21, Arcot Road,

Rangapuram, Vellore Town,

Vellore Taluk, Vellore District.

                                                                                        …..Complainant

 ..Vs..

1. Royal Sundaram alliance,

Insurance Company Ltd.,

By its Manager,

Chennai – 600 014.

 

2.The Branch Manager,

Royal Sundram Alliance

Insurance Company Ltd.,

Vellore - 6.

.....Opposite Parties

Date of complaint                                 : 28.11.2018

Counsel for Complainant                      : M/s.Shah & Shah

 

Counsel for    opposite parties                  : M.B.Gopalan Associates,

                                                                    N.Vijayaraghavan, M.B.Raghavan

 

 

O R D E R

 

BY PRESIDENT TMT.K.LAKSHMIKANTHAM, B.Sc., B.L., DTL.,DCL, DL & AL

          This complaint is filed by the complainant to direct the opposite parties to pay a sum of Rs.20,00,000/- under Insurance Policy and other accrued benefits  u/s 12 of the Consumer Protection Act.1986.

1.THE COMPLAINT IN BRIEF:

          The  husband of the complainant  Dr.V.Aravinth, on payment of the required premium amount at Vellore has taken an Insurance Policy No.PASBIG 0010/Certificate No.PS 00052659000106 covering the period from 02.08.2012 to 01.08.2013 for  a sum of Rs.20,00,000/- from the opposite parties for any unnatural and unforeseen death occurred to him. The complainant is the nominee under the insurance policy. The complainant’s  husband Dr.Aravinth was killed  by some unknown persons at 7.15 p.m on 23.10.2012 at L.P.M. Street, kosapet, Vellore and a case has been registered in Cr.No.653 of 2012  in the South Police Station, Vellore for the incident. The complainant obtained a claim form from the opposite parties and filled the same with all the required information by the opposite parties  which includes the copy/certificate of the policy, copy of the FIR, the death certificate and other  details and sent it to 1^st opposite party. The 1^st opposite party sent a reply stating that the policy covers only accidental death and not other death like murder.  The complainant,  through her advocate, sent a notice dated 22.02.2013 apprising the 1^st opposite party that policy covers an unnatural death by not only in an accident but due to unforeseen causes like murder as in the case. The 1^st opposite party received the notice on 26.02.2013 but neither complied with the demand nor sent any reply. It is nothing but deficient of service and unlawful and unfair business trade practice.  Hence the complaint.

2. WRITTEN VERSION OF THE   OPPOSITE PARTIES IN BRIEF:

          The husband of the complainant Mr.Aravinth had taken a Personal accident policy No.PS0005259000106 valid from 02.08.2012 to 01.08.2013, and the said personal accident policy was issued subject to terms and conditions and covered only accidental death caused due to external, violent and visible means but not otherwise. The complainant made a claim on 07.12.2012 under the personal accident policy stating that her husband Mr.Aravinth Reddy was  intentionally murdered on 23.10.2012 as motorcycle-borne three members gang stabbed him with a knife at the back of his neck and Mr.Aravinth succumbed to injuries on the spot itself.  The complainant’s husband was intentionally murdered due  to previous animosity, as the deceased Aravinth Reddy was intentionally murdered as per the plan that was hatched by the gang. The insurance is not covered under the personal accident policy issued to deceased Aravinth Reddy. The motorcycle born culprits targeted Mr.Aravinth Reddy who was coming out of clinic and hacked him to death at the spot and fled, which only shows that the intention of the gang was to kill Mr.Aravinth due to previous enmity. The Claim of the Complainant was repudiated as the same was not admissible under the policy conditions as the policy issued to the deceased covered only any death by accident which occurred due to external violent and visible means and not intentional and pre-planned intentional murder. The claim of the insured was not payable as per the terms and conditions of the policy. Hence complaint is to be dismissed with costs.

                  

3. The complainant and the  opposite parties  had come forward with their respective proof affidavit and documents. Ex.A1 to Ex.A9 were marked on the side of the complainant and the opposite parties filed  proof affidavit and documents Ex.B1 to Ex.B5  were marked.  

          4. The written arguments of the complainant and the  opposite parties  were filed and the oral arguments of the both were heard.

5. POINTS FOR CONSIDERATION:

          1. Whether there is deficiency in service on the part of the opposite parties?

          2. Whether the complainant is entitled to any relief? If so to what extent?

6. POINT NO :1 

 The complainant is a doctor by profession and her husband who was also a doctor had taken out  personal accident policy from the respondent for a sum of Rs.20,00,000/- and the said policy was in force for  the period from 02.08.2012 to 01.08.2013. The complainant’s husband Dr.Aravinth was murdered by some unknown persons on 23.10.2012 at about 7.15 p.m. at Vellore and the case has been registered in Crime No.653/12 at South Police Station Vellore.  The copy of the Insurance Policy is Ex.A1. FIR copy and death report are in Ex.A8 and Ex.A9. Death certificate given by Vellore Municipality is Ex.A2. Subsequent to the death of the complainant’s husband, the complainant claimed seeking payment of claim for death of her husband due to murder.

 7. The copy of the claim is Ex.A3. The claim was repudiated by  the opposite parties on the ground that the death was not due  to accident but due to pre-planned murder and such planned murder cannot be considered as accident and the policy covers only accidental death due to accident. The intimation was given by the opposite parties vide their letter dated 11.01.2013 in Ex.A4. Thereafter the complainant issued notice dated 22.02.2013 through her counsel to the opposite parties and its acknowledgement is in Ex.A6. There is no reply given by the opposite parties.

8. The complainant would  contend that the insured Dr.Aravinth was a doctor by profession which is a  noble profession rendering valuable service to the society. He had no enmity with anybody and no criminal, civil case against him, though he had been murdered by a gang, it is only an accident and also due to mistaken identity and there was also no motive in the minds of the accused. The complainant relied upon the following decisions:

1.  

VS

LIFE INSURANCE CORPORATION OF INDIA.

(NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION (F.B.)

CITATION : 2008 LAW SUIT (C0) 1056

 

2. ROYALSUNDARAM ALLIANCEINSURANCE CO LTD

                                                                  VS

PAWAN BALRAM MULCHANDANI.

(NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION (D.B.)

CITATION : 2018 LAW SUIT (CO) 1305

Relying upon  Halsbury’s Laws of England , it is held that Murder is an accident so far as the Insured is concerned. It is also  discussed that the insured is not party  to the Murder and he did not give any provocation and the event is an unlooked for mishap or an untoward event which was not expected and designed  by the insured and nor the insured had expected the occurrence, hence it was concluded as accidental.

9. The opposite parties  submitted personal accident policy as Ex.B1, the claim form and FIR are Ex.B2 and Ex.B3, Post Mortem  and claim repudiation letter are Ex.B4 and Ex.B5 and opposite parties would contend that personal accident policy obtained by the husband of the complainant  covers only accidental death due to external, visible, violent means but not otherwise and facts of the case reveals  the  death of  the complainant’s happened due to planned intentional murder.  Hence opposite parties had rightly repudiated the claim and there is no deficiency in service on the part of the opposite parties and submitted the following submissions by producing citations:

1.  LIC OF INDIA & ANR.

Vs

CHINTHAREDDY VIJAYAMMA

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI

( 2016 SCC ONLINE NCDRC 734)

 

2.  DHEERAJKUMAR AND ANOTHER

VS

BAJAJ ALLIANZ  GENERAL INSURANCE CO.LTD.,

IN THE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION

(2018 SCC ONLINE NCDRC 605)

 

 

 

3. SMT. MAMTA THAKUR

VS

UNITED INDIA INSURANCE COMPANY LIMITED & ANR.

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI

(2016 SCC ONLINE NCDRC 1607

Wherein the difference between murder  which is not an accident and murder which is an accident is distinguished as it depends on the proximity of the  cause of such murder .If the dominant intention of the felony  is to kill any particular person then such killing is not  an accidental murder but is a murder Simplicitor, while if the cause of the murder or act of the murder  was originally not intended and the same was caused in furtherance of  any other felonies act then such murder is an accidental murder.  

              10. Here in the present case, the circumstances and the incident vary from the cited cases by the complainant. Here the incident is stated  in fair as, ‘ahnuh Vnjh fhuz¤Â‰fhf v‹ kfid bfhiy brŒJ cŸsh®fŸ. ÏJ r«kªjkhf jh§fŸ érhç¤J elto¡if vL¡FkhW nf£L¡bfhŸ»nw‹.’  It means that there is some reason behind the incident.i.e. murder. The complainant has stated in the claim form in the column, in Nature and cause of incident, it is stated as “Planned Murder” thereby it was within the knowledge of the complainant as so, who is also a doctor by profession. As explained by the Apex Court in the cited cases, if there  would have been a plan  to commit murder, it is not called as an accident, if the murder was planned  then the whole incident cannot be considered as an accident, but one which is intended. There is no proof filed by the complainant and nowhere in the records it is stated that there is a mistaken identity by the gang so as to come to the conclusion that no motive in the minds of the accused as alleged by the complainant.

          The Coverage class of the policy reads as follows:-

“If at any time during the currency of the Certificate, the Insured Person shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means, anywhere in the world, then the company shall pay to the Insured Person or nominee(s)/Legal heir(s) of the Insured Person as the case may be.”

Hence as argued on  the side of opposite parties,  the question for examination arose for the claim on the point of  death  whether the murder was  due to accident or not and test should also be whether the incident was an accident  since the policy covers the incident and resultant death. If the incident is not accidental, the resultant death will not be covered. In simple words one can say that whether the murder was planned or happened by chance. In the present case the complainant being a doctor by profession herself  admitted and filled up  the claim Forum and indicated in the respective coloumn as planned murder, and in FIR  it is narrated as for some reason he was killed thereby prima facie proved that there was a plan to commit murder by the felony and the dominant intention of the act of felony was to kill the deceased insured, which only shows that it is a clear case of Murder Simpliciter as per explanation by Hon’ble Supreme Court in the cited cases by the opposite parties. Since the present case falls under the category of Murder Simpliciter,  the opposite parties  are right in repudiating the claim preferred by the complainant.   Therefore this Forum is of the view that the claim has been repudiated by opposite parties  for valid reason such as the same is not covered under the policy issued and there is no deficiency in service on the part of opposite parties. 

11. POINT NO:2

 Since it is concluded in point No.1 as there is no deficiency on the part of opposite parties, the complainant  is not entitled to any relief and the complaint fails and deserves to be dismissed, accordingly the complaint is dismissed. No costs.

In the result, this complaint is dismissed. No costs.

          Dictated to the Steno-Typist transcribed and typed by her corrected and pronounced by us on this 18^th  day of June 2019.

MEMBER – I                                                                PRESIDENT           

         

LIST OF DOCUMENTS FILED BY THE COMPLAINANT:

Ex.A1  Xerox copy of Insurance Policy

Ex.A2  dated 29.10.2012 Xerox copy of Death Certificate issued by Vellore Municipal Corporation

Ex.A3 Xerox copy of the claim form sent by the complainant

Ex.A4  Letter dated 11.01.2013 by opposite party to complainant

Ex.A5 Copy of the Notice dated 22.02.2013 sent by the counsel of the complainant to the opposite party

Ex.A6 Postal receipt dated 23.02.2013

Ex.A7  Postal Service copy of the notice on 26.02.2013.

Ex.A8 Copy of the First Information Report (FIR) in Crime No. 653 of 2012  Registered in Vellore South Police Station

Ex.A9 Death report given by Inspector of Police, Vellore South Police Station

 

LIST OF DOCUMENTS FILED BY THE   OPPOSITE PARTIES:

 

Ex.B1 Copy of policy with terms and conditions

 

Ex.B2 Claim Form

 

Ex.B3  Copy of FIR

 

Ex.B4 Post Mortem Report

 

Ex.B5  Claim Repudiation Letter

 

 

 

MEMBER – I                                                               PRESIDENT