IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Thursday the 31st day of December, 2015
Filed on 29.01.2015
Present
1. Smt. Elizabeth George (President)
2. Sri. Antony Xavier (Member)
3. Smt. Jasmine D (Member)
in
CC/No.30/2015
Between
Complainants:- Opposite parties:-
- Smt. Mercy @Laly 1. The District Manager (Matsyafed)
W/o Arulappan Kerala State Co-operative
Aresseril, Vadackal P.O. Federation for fisheries
Alappuzha Development Ltd., Alappuzha
(By Adv. Kalavoor Vijayakumar)
2. Robert, S/o Arulappan 2. The Divisional Manager, New India
-do- -do- Assurance Company Ltd., Trivandrum
Divisional Office, IInd Floor
- Binu, (Minor), S/o Arulappan Rema Plaza, S.S. Coil Road
Represented by Mother Mercy Thampanoor, Trivandrum – 695 001
-do- -do-
- Meritta (Minor)
D/o Arulappan
Represented by Mother Mercy
-do- -do-
(By Adv. Azeem Muhammed)
O R D E R
SMT. JASMINE D. (MEMBER)
The brief facts of the case in short are as follows:-
The complainants are the legal heirs of the deceased Sri. Arualppan, who died during fishing on 7.9.2013. Late Arulappan was a member of the first opposite party. The first opposite party insured its members under a Group Insurance Scheme with the second opposite party. On 7.9.2013 morning at about 9.30 while the deceased Sri. Arulappan tried to pull out the rope to pull the boat to seashore a huge wave hit him and thrown to sea. He was immediately taken to hospital but died due to drowning. Subsequently the opposite parties repudiated the claim of vide letter dated 25.11.2013 and 2.12.2012. The reason for repudiation is that as per FIR and newspaper Late Arulappan fainted and fell on the boat which resulted in death. The complainants were solely depended on the income from Late Arulappan. Now they are struggling to meet both end of life. The first complainant is a patient and other complainants educating children. After the death of Late Arulappan Government declared a scheme to the fishermen who dies in accident during fishing. First opposite party has to distribute that relief. The complainants are abstained from getting that relief also. The acts of the opposite parties caused much mental agony and pain to the complainants for which they are entitled for general as well as special damages. The complainant sustained much mental agony and hence filed this complaint.
2. Notice was served to the opposite parties. Both parties appeared before the Forum and filed their version.
3. Version of the first opposite party is as follows:-
Complaint itself is not maintainable either in law or on facts against the first opposite party. As per the Fishermen Group Personal Accident Insurance Scheme for the year 2013-14 the deceased Arulappan who was a member in the first opposite party had remitted the last premium amount on 16.3.2013 through the Vadackal-Kanjiramchira fishermen Welfare Co-operative Society No. F(A)11 vide receipt No.743 for the year 2013-14. The policy holder Arulappan died on 7.9.2013 due to drowning during the course of his fishing at Arabian Sea by a huge wave. While he was engaging the fishing on a fishing boat on 7.9.2013 he fell down from the boat to the sea due to the hit of heavy wave and he died due to drowning. His death was accidental as per the post mortem report. Despite there is a valid policy for an amount of Rs.5,00,000/- the second opposite party repudiated the claim raised by the complainant. The first opposite party furnished full details about the accident to the second opposite party without any delay. The first opposite party is not liable and there is no deficiency of service also on the part of the first party Matsyafed. The first opposite party had taken all necessary steps for getting the claim amount to the complainants and Forum may pleased to exonerate the first opposite party.
3. The version of the second opposite party is as follows:-
The complaint is not maintainable. There is no deficiency in service as alleged by the complainant. The alleged death of Sri. Arulappan is not during the time of fishing. It is submitted as per FIR, the insured person Arulappan fainted and fell on his back while taking rope from the boat and died on the way to hospital. The news paper report also confirms this incident. Hence the company has no liability under the policy which covers only death due to accident. Hence the complainants are not entitled for any benefit under the policy. The repudiation of the claim is on the basis of policy conditions. Late Arulappan fainted and fell down on the boat and this is the reason for the death. The contra allegations are not correct. This opposite party admits the validity of fisherman group insurance policy covering the date of death on 7.9.2013 of Arulappan. The benefit under the policy is Rs.5,00,000/- for accident death and Rs.2500/- for funeral expenses and admissible medical expenses up to Rs.1,00,000/- and for education expense of one child Rs.5,000/- and maximum Rs.10,000/-, if more than one dependent child. So, total benefit payable for a genuine and admissible claim is Rs.6,12,500/-. In the present case, company received a request from the District Manager Matsyafed claiming the benefit, but since as per the policy condition natural death not covered. As per FIR, FIS and the newspaper cutting death was not due to any accident. Hence the company has no liability. Hence the company repudiated the claim on that ground and it was intimated to the claimants. Hence in any event there is absolutely no deficiency of service on the part of company and the company has no liability to compensate the complainants herein. Hence the complaint may be dismissed.
4. Complainant was examined as PW1. The documents marked as Exts.A1 to A5. The second opposite party produced documents which were marked as Exts.B1 to B3. Ext.B4 marked subject to objection.
4. Considering the allegations of the complainant and the opposite parties, the Forum has raised the following issues for consideration:-
1) Whether there is any deficiency in service on the part of the opposite parties?
2) Whether the complainant is entitled to get any reliefs?
5. Point Nos.1 and 2:- The case of the complainants is that the complainants who are the legal heirs of late Sri. Arulappan who is a member of the first opposite party availed an insurance policy with the second opposite party under Group Insurance Scheme. Sri. Arulappan died on 7.9.2013, while doing fishing. The complainant submitted a claim before the second opposite party for getting the benefits covered under the Group Insurance Policy. But the second opposite party rejected the claim. Hence filed this complaint, seeking a direction against the opposite parties to settle claim along with compensation and costs. The complainant filed proof affidavit and documents Ext.A1 to A5 were marked. Ext.A1 is the pass book issued by the Kerala Fishermen Welfare Fund Board, Thrissur, Ext.A2 is the copy of FIR, Ext.A3 is the copy of FIS, Ext.A4 is the copy of inquest report and Ext.A5 is the copy of postmortem report. The second opposite party produced 4 documents which were marked as Exts.B1 to B4. Ext.B1 is the policy document, Ext.B2 is the copy of FIS and FIR, Ext.B3 is the rejection letter and Ext.B4 is the copy of newspaper cutting marked subject to objection. The insurance claim of the complaints have been rejected by the second opposite party by Ext.B3 letter dated 25.11.2013. The reason for rejection of the claim as per the letter reads as follows:-
“ As per FIR, the insured person Mr.Arulappan fainted and fell on his back while taking rope from the Boat and died on the way to Hospital. The Newspaper report also confirms this incident. Hence we express our inability to consider the claim under the policy which covers only death due to accident.”
From the documents Exts.A2 and A3 it was clearly stated that late Sri. Arulappan fell backwards when the powerful waves hit him while engaging in fishing work. Further on Ext.A5 it was stated that the cause of death is due to drowning. From these documents, we can undoubtedly say that the death of Arulappan was as accidental death. Admittedly late Sri. Arulappan has a valid insurance at the time of death. The purpose of the said insurance is to provide assistance to the family in case of mishappening of a member of the first opposite party. Here the deceased Sri. Arulappan was the only bread winner of the family who left behind wife and 3 children. They are fully entitled to get the insurance benefits. The complainants are entitled to get the claim under the said policy from the second opposite party. On a perusal of the written statement filed by first opposite party and also the evidence on record, we can’t find any deficiency in service on the part of the first opposite party. So we can’t held first opposite party is liable for any deficiency in service. Therefore the second opposite party is liable to pay the insurance claim on the basis of the policy document. The complainants are entitled to get the benefit under the policy Rs.5 lakhs for accidental death and Rs.2,500/- for funeral expenses. Since the complainants also produced the school certificates, they are also entitled to get Rs.10,000/- for education expense. From the evidence on record, it is clear that Sri. Arulappan died on the way to hospital, hence not entitled for any amount under the head medical expenses and the claim is calculated as Rs.5,12,500/-. Since the second opposite party has not given the insurance amount to the complainants they have committed deficiency in service. The second opposite party is liable to pay the insurance claim along with compensation and costs. So the complaint is to be allowed.
In the result, the complaint is allowed. The second opposite party is directed to pay the insurance claim of Rs.5,12,500/- (Rupees five lakhs twelve thousand and five hundred only) to the complainants. The second opposite party is further directed to pay an amount of Rs.3000/- (Rupees three thousnd only) towards compensation to the complainant and Rs.2000/- (Rupees two thousand only) towards costs of this proceedings. The order shall be complied within one month from the date of receipt of this order. Failing which amount 5,12,500/- shall carry interest @ 9% per annum from the date of complaint till realization.
Pronounced in open Forum on this the 31st day of December, 2015.
Sd/- Smt. Jasmine.D. (Member) :
Sd/- Smt. Elizabeth George (President):
Sd/- Sri. Antony Xavier (Member) :
Appendix:-
Evidence of the complainant:-
PW1 - Mercy @ Laly (Witness)
Ext.A1 - Pass book issued by the Kerala Fishermen Welfare Fund Board
Ext.A2 - Copy of FIR
Ext.A3 - Copy of FIS
Ext.A4 - Copy of inquest report
Ext.A5 - Copy of postmortem report
Evidence of the opposite parties:-
Ext.B1 - Policy document
Ext.B2 - Copy of FIS and FIR
Ext.B3 - Rejection letter
Ext.B4 - Copy of newspaper cutting (Subject to objection)
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite parties/S.F.
Typed by:- pr/-
Compared by:-
