O R D E R
By Sri.C.T.Sabu, President
The case of the complainant is as follows: The complainant was legally wedded wife of Madhu E, holder of personal accident policy (Policy No.137300-0000-00) Insured for an amount of Rs.4,00,000/- by the 1st opposite party and the 2nd opposite party is the intermediary in the matter of issuance of said personal accident policy. The said policy was issued for a period of one year from 29/10/2012. Complainant’s husband was a political leader of Indian National Congress brutally murdered by a group of people on 16/2013 at about 9.35am. As per the terms and conditions of the policy complainant being the nominee under the policy entitled to get the insured sum of Rs.400,000/- from the opposite parties. After his death, complainant has submitted the claim form duly attested by Deputy Manager, State Bank of India, P.B. Division, Thrissur. Complainant has sent to opposite party’s Kochi office the original certificate of insurance on 10/9/2013 by way of Registered Post as demanded by the opposite parties. Opposite parties have issued communications to complainant regarding registering of claim and demanding documents. Complainant has given all the documents demanded by 1st opposite party including copy of FIR, Postmortem certificate, copy of Ration Card, Death Certificate, Death Summary issued by West Fort Hospital, Thrissur, Identity cards of complainant and deceased Madhu E. Complainant has also submitted copy of driving license of Madhu E., Marriage Certificate etc. to the opposite party. But opposite parties have without properly considering the claim form and documents submitted by the complainant, rejected the claim as per letter dated 14/5/2015 alleging that complainant has not produced the required documents. Hence this complaint filed. The complainant claimed Rs.4,00,000/- with interest at the rate of 12% for the policy amount and for a compensation of Rs.1,00,000/- with cost of Rs.30,000/-.
2. The complaint was admitted and issued notice to the opposite parties. 1st opposite party appeared through their counsel and filed detailed version by admitting the policy and denied all other contentions raised by the complainant. The main contention raised by the opposite party is that in spite of repeated reminders the complainant did not submit the required documents. Hence they would content that after lapse of 365 days the claim has been closed. Also continued that there is consumer relationship between the parties and there is no deficiency in service on their part. According to them they are ready to pay the amount but the complainant does not produce the required documents. Hence they seek dismissal of the complaint. 2nd opposite party contended that they are only an intermediary and there is no privity of contract between the complainant and the 2nd opposite party. The complainant or her late husband is only a customer of the 1st opposite party. The complaint is not maintainable and there is no cause of action against the 2nd opposite party. Hence this complaint has to be dismissed.
3. Then the case was posted for evidence and the points for consideration are that
1)Whether there is any deficiency in service or unfair trade practice happened from the side of opposite parties?
2) If so, reliefs and costs
4. The complainant filed detailed proof affidavit in which she has affirmed and explained all the averments stated in the complaint in detail. To prove the case of the complainant 15 documents were produced and marked as Exts.P1 to P15. From the side of opposite parties also filed proof affidavits, in which they have affirmed and explained all the contentions raised in tune with the versions filed by them. The documents produced by the 1st opposite party are marked as Exts.R1 and R2.
5. The following facts admitted in evidence and are proved beyond reasonable doubts and they are 1. Complainant is a legally wedded wife of decease Madhu E. 2. Madhu E is a holder of personal accident policy 3.Death of Madhu occurred during the validity period of policy and 4.Madhu E was murdered by a group of people and persons responsible for his murder was convicted and sentenced to undergo imprisonment for life in SC 185/2014 of Sessions Court, Thrissur. Under such circumstances whether there is any justification for the opposite parties for denying the policy amount to the complainant who is the nominee cum wife the deceased.
6. The only contention raised by the 1st opposite party is that the complainant failed to submit the required documents to the opposite parties in spite of repeated reminders.
7. The accident in terms of the policy generally meant sudden unforeseen and unexpected physical event caused by external and violent
visible means. As held in the cases of Nisbet Vs.Rayne & Burn (1910)(2) Kings Bench 689, Board of Management of Trim Joint Dist. School Vs.Kelly (1914) Appeal cases 667, Rita Devi & Ors. Vs. New India Assurance Co. Ltd. 2000 (5) SCC 113, the personal accident insurance policies are gaining popularity with every passing days as per the cover if during occurrence of the insurance policy, the insured person shall sustained any bodily injury then the insurer is liable to pay the insured or the legal heirs (as the case may be). As unintended and unforeseen injuries occurrence, something that does not acquire in the shorten course of events or that could not be reasonably anticipated. An accident is attributed towards sudden or unforeseen and unexpected event in their words it is an event which does not acquire in the usual case or that could not be reasonably anticipated. Therefore it has to be said that on the facts and circumstances of this case the death of the deceased was caused accidently and the complainant succeeded to prove the case. The opposite parties have not adduced any contra evidence to prove otherwise their contention regarding about the lack of submission of necessary documents.
8.In such circumstance we are in the opinion that there is any justification for the opposite party denying the policy amount to the complainant and the complainant is entitled to get the insured amount. As there is no privity of contract between the complainant and 2nd opposite party the 1st opposite party alone is liable to pay the amount as per the insurance policy.
9.In the result we hereby direct the 1st opposite party to pay the amount of Rs.4,00,000/- (Rupees Four lakh only) covered by the insurance policy along with interest of 12% from the date of submission of the claim (10/9/2013) till the date of payment. 1st opposite party is also directed to pay Rs.10,000/- (Rupees Ten thousand only) as cost of this complaint. Comply this order within 30 days from the date of receipt of copy of this order. 2nd opposite party is exonerated from paying any amount.
Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Commission this the 17th day of April 2021.
Sd/- Sd/- Sd/-
Sreeja.S Dr.K.Radhakrishnan Nair C.T.Sabu
Member Member President
Appendix
Complainant’s Exhibits
Ext.P1 Copy of policy dtd. 29/10/12, Ext.P2 Postal receipt, Ext.P3 Copy of claim form, Ext.P4 repudiation letter dt. 14/5/15, Ext.P5 Copy of lawyer notice dtd. 9/5/16, Ext.P6 Postal receipt, Ext.P7 Reply notice dtd.3/6/16, Ext.P8 copy of final report in Crime 771/2013, Ext.P9 Copy of death certificate dtd. 15/6/16 of Madhu Eacharath,, Ext.P10 Copy of Postmortem certificate dtd. 12/6/13, Ext.P11 copy of inquest report, Ext.P12 copy of final report, Ext.P13 copy of postmortem certificate, Ext.P14 copy of final Information report, Ext.P15 copy of Judgement dt. 8/5/15
Opposite Parties Exhibits
Ext.R1 Policy with terms and conditions
Ext.R2 series letters sent by OP to complainant
Id/-
President
