IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Monday the 31st day of August, 2015
Filed on 01.04.2015
Present
1. Smt. Elizabeth George (President)
2. Sri. Antony Xavier (Member)
3. Smt. Jasmine D (Member)
in
CC/No.108/2015
Between
Complainant:- Opposite parties:-
Smt. Salomi Mathew 1. The Commissioner, Kerala
W/o Late K.C. Mathew Fishermen’s Welfare Fund Board
Kallupathra House Poonkunnam, Thrissur – 680 002
Kainakari Grama Panchayath
Kainakary East P.O., Kuttanadu Taluk 2. Fisheries Officer/Regional Alappuzha District Executive, Kerala Fishermen’s
(By Adv. M.G. Reshu) Welfare Fund Board
Ambalappuzha, Alappuzha Dt.
3. The Manager, United India
Insurance Co. Ltd., Regd. And
Head Office – 24, Whites Road
Madras – 600 141
O R D E R
SMT. JASMINE D. (MEMBER)
The facts of the complaint in short are as follows:-
The complainant is the wife of deceased Sri. K.C.Mathew, who availed an insurance policy with the third opposite party under the Group Insurance Scheme. The said policy was provided by the first and second opposite parties which was implemented through Kerala State Insurance Department. As per the terms and conditions of the said policy, the dependant of the deceased is entitled for compensation on the death of the insured. Thus, the complainant, being the dependant of late Sri. K.C.Mathew, is eligible to get compensation from the third opposite party to the tune of Rs.2 lakhs. Accordingly the complainant submitted relevant records as directed by the opposite parties. The second opposite party even conducted an enquiry regarding the cause of death of Sri.K.C.Mathew and submitted an enquiry report before the first opposite party. The complainant submitted applications as demanded by the opposite parties with relevant documents. Also, the complainant filled up the claim form of the third opposite party and submitted the same with the death certificate from the hospital. Thereafter, many times the complainant contacted the opposite parties for the settlement of the claim. The complainant further alleged that she has produced all the documents demanded by the opposite parties, but they rejected the claim and hence filed this complaint alleging deficiency in service on the part of the opposite parties.
2. Notices were issued to the opposite parties. Opposite parties 1 and 2 appeared before the Forum and filed their versions. Third opposite party did not appear before the Forum and hence set exparte.
3. The version of the first opposite party in short is as follows:-
The husband of the complainant was a member of Fishermen’s Welfare Association holding the membership No.3872. The members of the Fishermen’s Welfare Association was insured with the third opposite party under the Group Insurance Scheme and the sum assured is Rs.2,12,000/- in case of accidental death. The premium is paid by the Kerala Government. As per the agreement with the third opposite party in case of a death of any member, the applicant must submit the documents to prove the cause of death and a recommendation letter from Fisheries Department along with Postmortem report, FIR and death certificate. But the complainant has not produced the aforesaid documents along the claim form. Third opposite party has informed the first opposite party that the complainant has not produced the required documents demanded by the third opposite party and hence the claim was rejected and the same was intimated to the complainant also.
4. The version of the second opposite party is as follows:-
The complainant is the wife of deceased Sri. K.C.Mathew, a member of Kerala Fishermen’s Welfare Fund Board submitted the claim form on 18.11.2011 before the second opposite party. The said application and the enquiry report of Fisheries Officer, Ambalappzuha has sent to the regional office on enquiry, we came to know that the husband of the complainant was died due to snake bite while doing fishing work and also entitled for the benefit as per the Group Insurance Scheme. But the complainant has not produced FIR and Postmortem report. Later, we came to know that the postmortem has not been done and the same was not intimated to the police station also. But the third opposite party is at liberty to consider the claim based on records furnished by the complainant and there is no deficiency in service on the part of the second opposite party.
5. The complainant filed proof affidavit and documents produced were marked as Exts.A1 to A9. Opposite parties produced 5 documents which were marked as Exts.B1 to B5.
6. Considering the allegations of the complainant and contentions of the opposite party, the Forum has raised the following issues:-
1) Whether there is any deficiency in service on the part of the opposite party?
2) Whether the complainant is entitled to get any reliefs?
7. The case of the complainant is that the complainant’s husband late Sri. K.C. Mathew who is a member of Kerala Fishermen’s Welfare Fund Board has availed an insurance policy with the third opposite party under Group Insurance Scheme. The said policy was provided by opposite parties 1 and 2. The complainant’s husband Sri. K.C. Mathew died on 20.9.2011 due to snake bite while doing fishing work. The complainant submitted claim for getting the benefits covered under the Group Insurance Policy along with documents. But the third opposite party rejected the claim stating that she has not produced FIR and Postmortem report. Hence the complainant is before us seeking a direction against the opposite parties to settle the insurance claim along with compensation. The complainant filed proof affidavit and documents Exts.A1 to A9 were marked. Ext.A1 is the copy of personal accident insurance claimant’s statement, Ext.A2 is the copy of relationship certificate, Ext.A3 is the copy of claim form, Ext.A4 is the copy of checklist, Ext.A5 is the copy of enquiry report of the Fisheries Officer, Ext.A6 is the copy of application, Ext.A7 is the copy of death certificate from the T.D. Medical College Hospital, Ext.A8 is the copy of Death certificate and Ext.A9 is the copy of letter dated 19.9.2013. According to the opposite parties 1 and 2, the husband of the complainant the deceased K.C. Mathew was insured under the Group Insurance Scheme and therefore she is entitled to get the benefit under the policy. The opposite parties filed 5 documents which were marked as Exts.B1 to B5. Ext.B1 is the conditions of policy, Ext.B2 is the letter dated 12.11.2012 issued to the complainant, Ext.B3 is the letter dated 1.1.2013 issued by the first opposite party to the third opposite party, Ext.B4 is the letter dated 3.7.2012 written by the third opposite party to the first opposite party and Ext.B5 is the letter dated 12.12.2012 written by the complainant. As per Ext.B1 it can be seen that the sum assured in case of accidental death of the insured is Rs.2 lakhs and the documents need to be produced are the original death certificate, copy of FIR and Postmortem report. The complainant has filed all the documents except Postmortem report and FIR. In the instant case, postmortem was not done due to unawareness of the complainant and her relatives. So there is no postmortem report. The death was also not intimated to the nearby Police Station and hence no FIR was lodged. So the complainant was not in a position to produce the Postmortem report and FIR as demanded by the third opposite party. In Ext.A4 enquiry report of the Fisheries Officer, it was clearly stated that the death was due to snake bite, while the deceased Mathew engaged in fishing work. From Ext.A7 death certificate issued from the T.D.M.C.H. Vandanam, the doctor clearly stated that “Mr.K.C. Mathew was died on 20.9.011 due to snake bite while doing work.” The third opposite party rejected the claim only on the basis that the complainant has not produced Postmortem report and FIR. The purpose of the said insurance is to provide assistance to the family in case of mis-happening of a member. Here the deceased K.C. Mathew was the only bread winner of the family who left behind wife and 2 minor children. So they are fully entitled to get the insurance benefits. From Ext.A4 and A7, we can undoubtedly say that the death was due to snake bite. So it definitely comes under accidental death. If the cause of death is proved beyond doubt, we are of the opinion that the documents sought for by the third opposite party ie. Postmortem report and FIR were not relevant in this case. The rejection of the claim by third opposite party stating that the complainant has not produced FIR and Postmortem report is not sustainable. The complainant is entitled to get the claim under the said policy from the third opposite party. On a perusal of the written statement filed by the opposite party 1 and 2 and also from the documents produced by the first opposite party, we can’t find any deficiency in service on the part of the first and second opposite parties. We can’t held opposite parties 1 and 2 liable for any deficiency in service. For the reasons stated above third opposite party liable to pay insured amount of Rs.2 lakhs, but they are not liable to pay compensation for mental agony and hardship.
In the result, the complaint is allowed. The third opposite party is directed to the pay the insured amount of Rs.2,00,000/- (Rupees two lakhs only) to the complainant. There is no order as to compensation or costs to the complainant. The order shall be complied within one month from the date of receipt of this order.
Dictated to the Confidential Assistant, transcribed by her corrected by me and pronounced in open Forum on this the 31st day of August, 2015.
Sd/- Smt. Jasmine.D. (Member) : .
Sd/- Smt. Elizabeth George (President):
Sd/- Sri. Antony Xavier (Member) :
Appendix:-
Evidence of the complainant:-
Ext.A1 - Copy of personal accident insurance claimant’s statement
Ext.A2 - Copy of relationship certificate
Ext.A3 - Copy of claim form
Ext.A4 - Copy of checklist
Ext.A5 - Copy of enquiry report of the Fisheries Officer
Ext.A6 - Copy of application
Ext.A7 - Copy of death certificate from the T.D. Medical College Hospital
Ext.A8 - Copy of Death certificate
Ext.A9 - Copy of letter dated 19.9.2013
Evidence of the opposite parties:-
Ext.B1 - Conditions of policy
Ext.B2 - Letter dated 12.11.2012 issued to the complainant
Ext.B3 - Letter dated 1.1.2013 issued by the first opposite party to the third opposite
party
Ext.B4 - Letter dated 3.7.2012 written by the third opposite party to the first opposite
party
Ext.B5 - Letter dated 12.12.2012 written by the complainant
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:- pr/-
Compared by:-
