Adv.Ravi Susha, Member

          This complaint is filed by the complainants against the repudiation of insurance claim under the group personal accident insurance scheme made by the opposite parties. The case of the complainant is brief as follows.

          Complainants are the legal heirs of late Subramanian, who was a fisherman and member of the Vallanathuruth - Pandarathuruth  Fishermen Development Welfare Co-Operative Society Ltd. No.FA (Q) 13 and was insured under Group Personal Accident Insurance Scheme 2002-03. Matsyafed had implemented Group Personal Accident Insurance Scheme for the year 2002-03 with the 1^st opposite party. As per the terms of the scheme the members of the Primary Fishermen Development Welfare Co-operative Societies affiliated to Matsyafed. Who paid premium before 31^st march 2002 was eligible for insurance compensation for death or disablement under the scheme. Deceased Subramanian paid, through the society, Rs.35/- towards annual premium for the year 2002-2003 vide receipt No.6774 dtd : 10.03.2002.

          While the policy was in force the insured Subramanian died on 02.01.2003 in a road accident.

          The death of Mr. Subramanian was intimated to the opposite parties in time and submitted application by the 1^st complainant for getting the death benefit. The complainants are entitled to get compensation from the 1^st opposite party as contemplated by the insurance policy. But the 1^st opposite party repudiated the claim of the complainants. Hence this complaint.

(3)

The deceased Subramanian was having no insurance coverage with the 1^st opposite party under the Group Personal Accident Insurance Policy issued in favour of the 2^nd opposite party in this case. It is submitted that the deceased was totally a stranger to this opposite party against whom no insurance coverage was granted by this opposite party as on the alleged date of accident. In the absence of a privity of contract in between the opposite parties 1 and 2 to 4 covering the risk of the deceased Subramanian, this opposite party has no contractual obligation to pay compensation to the legal heir of the deceased. It is therefore submitted that the 1^st opposite party has been impleaded in to this complaint without making any proper enquiry about the exact particulars of an insurance coverage of the deceased with the 1^st opposite party in this case.

          It is submitted that the 1^st opposite party entered into the contract of insurance with the 2^nd opposite party’s office at Trivandrum, granting Group Personal Accident Insurance Coverage for the Fishermen those who have enrolled into the scheme after remitting the premium amount as per the procedure framed under the master policy agreement. It is submitted that the 1^st opposite party cover the risk of the fishermen under the Personal Accident Insurance Scheme, whose premium amount has been paid by the 3^rd opposite party as per the list submitted by them seeking insurance coverage for the fishermen those who enrolled into the scheme. The risk of the fishermen enrolled into the scheme of insurance will commence only from receipt of the premium amount by the 1^st opposite party as envisaged under the provisions of 64-VB of the Insurance Act. No risk will be assumed by the insurance company unless and until the premium amount for the risk insured for a particular individual has been received by the insurance company.

          It is a duty of the 3^rd opposite party to submit a list of fishermen against whom insurance coverage is seeking by them under the Group Personal

(4)

Accident Insurance Coverage along with remittance of premium for such risk. The risk of the fishermen under the above scheme will commence only after receiving the premium amount from the 3^rd opposite party, specifying the list of persons / fishermen against whom the premium is paid by them. In the instant case no premium has been paid by the 3^rd opposite party covering the risk of the deceased Subramanian and as per the list submitted by the 3^rd opposite party, the name of the deceased Subramanian is not included in the said list. It is therefore submitted that no policy was issued by this opposite party in the name of the deceased Subramanian as per the list of persons insured under the above scheme on the basis of the list submitted by the 3^rd opposite party.

          This opposite party has no contractual liability to indemnify the 2^nd, 3^rd and 4^th opposite parties or to compensate the applicant in this case in the absence of a concluded contract covering the risk of the deceased in this case.

Points :-

          1.   Whether the deceased Subramanian was having insurance coverage

               with the 1^st opposite party under the Group Personal Accident

               Insurance Policy?

         2.  Whether there is any deficiency in service on the part of the opposite

     party 1 to 4

3.        Relief and cost

Points 1 to 3

          First complainant was examined as PW1, and Exts.P1 to P5 were marked. From the side of opposite parties 2 to 4, DW1 was examined and marked Exts.D1 to D6. From the side of additional opposite parties DW2 was examined and marked Exts.D7 to D9.

(5)

From the evidence of PW1 and DW1 and from Ext.D2, it is clear that the deceased Subramanian was a member of the Vellanathuruth – Pandarathuruth Fishermen Development Welfare Co-operative Society affiliated to Matsyafed and was insured under the Group Personal Accident Insurance Scheme 2002-2003. Ext.D4 shows that the deceased Subramanian had remitted premium of Rs.35 vide receipt No.6774 with Membership No.174 dtd: 10/03/02. The Learned Counsel for the 1^st opposite party argued that on verification of CD submitted by the 2^nd opposite party it is found that Subramanian (the deceased husband of the complainant) had remitted the premium. But there was some decrepancy about the details of the Subramanian shown in the list and due to the above reason the 1^st opposite party was not in a position to arrive a conclusion that the claim preferred by the complainant is with that of the Subramanian named in the list submitted by the 2^nd opposite party and hence repudiated the claim of the complainant.

          Opposite parties 2 to 4 contended that the 1^st opposite party without perusing relevant records on 17/06/2003 had reported that claim had been considered as closed due to the reason that the deceased was not enrolled under the Group Personal Accident Insurance Scheme 2002-2003. Opposite parties 2 to 4 found that the deceased Subramanian’s Society Membership in the claim application due to error was typed as 169 instead of 174 in the enrolment list. Opposite parties 2 to 4 duly informed about the mistake of enrolment number to the opposite parties on 21.06.04 but the 1^st opposite party had not settled the claims.

          On considering entire evidence oral and documentary we are of the view that the denial of claim of the complainant with respect to the deceased Subramanian by the 1^st opposite party is unfair. There is unfair trade practice on the part of the 1^st opposite party.

(6)

          In the result the complaint is allowed. The 1^st opposite party is directed to pay Rs.1, 50,000/- with 9 % interest from the date of complaint (Group Personal Accident Policy) to the complainants and additional opposite parties 5 to 7 equally. The 1^st opposite party is also directed to pay Rs.5000/- as cost to the proceedings. The order is to be complied with within one month from the date of receipt of the complaint failing which the complainant will be entitled for interest at 12% from the date of this order.

                                Dated this the 15^th day of May 2012.