Date of filing : 03-08-2011
Date of order : 31-12-2011
IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD
CC. 193/2011
Dated this, the 31st day of December 2011
PRESENT
SRI.K.T.SIDHIQ : PRESIDENT
SMT.P.RAMADEVI : MEMBER
SMT.K.G.BEENA : MEMBER
1. Prema, D/o.Ambady, } Complainant
2. Prajina, W/o. Praveen Kumar,
3. Prajisha
(Nos 1 to 3 are R/at Fishermen colony,
Adkathbail beach, Po.Kasaragod. 671121.
(Adv.U.S.Balan, Kasaragod)
The Branch Manager, L.I.C of India, } Opposite party
Jeevan Jyothi, M.G.Road,
Po.Kasaragod. 671121.
(Adv.P.V.Jayarajan, Kasaragod)
O R D E R
SMT.K.G.BEENA, MEMBER
The gist of the complaint is that Sri.Upendran the husband of the complainant No.1 and father of the complainant’s Nos. 2 and 3 died accidentally on 18-12-2010 at high seas, while engaged in hectic fishing. Sri. Upendran during his life time has taken a life insurance policy from opposite party for an amount of `10,000/-. On his death as per the conditions of policy double accident benefit will accrue. Complainant No.2 applied for double accident benefit, but opposite party has paid only `10,000/- plus bonus repudiating the claim of the complainant No.2. There is no material support the repudiation. Hence the complaint.
2. According to opposite party, policy is admitted. But double accident benefit is payable for basic sum assured only bonus is not eligible for double accident benefit. According to opposite party on perusal of the documents submitted by the complainants, the death of the assured was not due to the accident. Hence double accident benefit was rejected and the same has been communicated to the 2nd complainant (nominee) under the policy vide letter dated 15-03-2011. As there is no scope for oral evidence. Exts A1 to A4 marked on the side of complainant and Ext.B1 marked on the side of opposite party. Both sides heard and documents perused.
3. The questions raised for consideration are:-
1. Whether the death is caused due to accident?
2. If so what is the relief?
4. Issue No.1.
Here the deceased is fisherman who usually engaged in hectic fishing at high seas who might have developed a skill to escape from water in ordinary case. But due to the unexpected Cardiac arrest Upendran could not escape.
5. Here Sri. Upndran, the husband of the complainant No.1 died accidently on 18-12-2010 at high seas, while doing fishing at high seas close to Kasaba beach on 18-12-2010 at 6.30 A.M. The assured fainted and fell into the sea and was immediately taken out and was rushed to the hospital. As per postmortem certificate stomach contained few ml. of digested food-no fluid; which indicates that the falling in to the water had nothing to do with the death of the assured. The opinion as to the cause of death is recorded as “Due to CAD, myocardial infraction with cardiac arrest” in postmortem report.
6. In Deepak Jaiswal V Oriental Insurance Company I (2006) CPJ 29 (NC) National CDRC observed as follows: Death caused by ‘cold wave’ is considered to be an accidental death’ for the purpose of insurance cover. For the purpose of Insurance cover death caused by cold wave is accidental death. It is also clear that the injury or death caused by lightening, sun stroke or earth-quake 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 becames exhausted and death occurs, it would be an accidental death. Death due to cold wave is not natural and it would be accidental because all the persons may get the same effect and it is by natural external violence force. Further ‘cold wave’ is an untoward event which is not expected or designed, ordinary man could not expect the occurance”. Moreover, Rita Devi @ Rita Gupta V National Insurance company the Hon’ble National Commission has explained what is Accident in the following words “Halbury’s Laws of England, the meaning of the word ‘accident’’ is given and also “accidental death” in case of exposure to natural elements as stated to be accidental death. The word accident or its adjective “accidental” is no doubt used with the intention of excluding the operation of natural causes such as ‘old age, congenital or insidious disease or the natural progression of some constitutional physical or mental defect. But the ambit of what is included by the word is not entirely clear. It has been said that what is postulated is the intervention of some cause which is brought into operation by chance so as to be fairly describable as fortuitous. The idea of something haphazard is not necessarily inherent in the word. It covers any unlooked for mishap or untoward event which is not expected or designed, of any unexpected personal injury resulting from any unlooked for mishap or occurance. The test of what is unexpected is whether the ordinary reasonable man would not have expected the occurance it being irrelevant that a person with expert knowledge forge of medicine, would have regarded it as inevitable. The stand point is that of the victim, so that even willful murder may be accidental as far as the victim is concerned Back’s Law Dictionary, seventh edition defines ‘accident’ as follows:
Accident: An unintended and unforeseen injurious occurance, something that does not occur in the usual course of events or that could not be reasonably anticipated.
7. The accident policies means an event which takes place without one’s foresight of expectation.
8. It is settled law that when two reasonable interpretations of the terms of the policy are possible, the interpretation which favour the insured is to be accepted and not the interpretation which favours the insurer. The terms of the insurance policy are drafted one sided by the insurance company. The Patna High Court in Kamalavati Devi V. State of Bihar and Ors 2002(3) BLJ 26 held that the death of the insured was caused due to heart failure caused as a result of threatening by the armed miscreants was plainly covered by the expression ‘external violent and any other visible means”.
10. It is apparent that the death of the husband of the complainant is covered under the life insurance policy. On his death as per the conditions of policy double accident benefit will accrue. Accordingly the opposite party is liable to pay the double accident benefit under the policy. Accidently falling into the sea was sole cause of death of Upendran. The death occurred due to accident arising out of external violence and visible means which is not expected or designed, ordinary man could not expect the occurance.
In the result, complaint is allowed and opposite party is directed to pay `10,000/- with interest at the rate of 12% from 15-03-2011 (date of repudiation) till payment with a cost of `3000/- which shall be paid within 30 days from the date of receipt of this order.
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Exts.
A1. Photocopy of FIR.
A2. Photocopy of Post-Mortem Certificate.
A3. 15-03-2011 letter sent by LIC
A4. 25-02-2011 Repudiation letter
B1. Photocopy of Post-Mortem Certificate
Sd/- Sd/- Sd/-
MEMBER MEMBER PRESIDENT
Pj/ Forwarded by Order
SENIOR SUPERINTENDENT
