KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.
APPEAL No. 774/2004
ORDER DATED: 31-03-2011
PRESENT:
SHRI. M.V. VISWANATHAN : JUDICIAL MEMBER
SHRI. M.K. ABDULLA SONA : MEMBER
Mrs. V.F.Rema,
W/o Prabhakaran, : APPELLANT
Chandroth Baby Villa,
East Palloor, Mahe.
Vs.
The Divisional Manager,
The New India Assurance Company Ltd.,
Tarapore Tower, II Floor, : RESPON DENT
826 Anna Salai, Chennai-2.
JUDGMENT
SHRI.M.V. VISWANATHAN : JUDICIAL MEMBER
Appellant is the complainant and respondent is the opposite party in OP.62/01 on the file of CDRF, Kannur. The complaint therein was filed alleging deficiency of service on the part of the opposite party in repudiating the insurance claim preferred by the complainant in her capacity as nominee of the life assured, P.P.Pramod with respect to the Janatha Personal Accident Policy issued in the name of the life assured. The opposite party entered appearance and filed written version denying the alleged deficiency of service. The opposite party, Divisional Manager, New India Assurance Company Limited justified the action of the Insurance Company in repudiating the insurance claim. It was contended that the death of the life assured was suicidal death, which is not covered by the insurance policy. Thus, the opposite party prayed for dismissal of the complaint.
2. Before the Forum below, a witness was examined on the side of the complainant as PW1. Exts.A1 to A7 documents were also marked. No oral evidence was adduced by the opposite party. Exts.B1 to B3 documents were marked on the side of the opposite party. On an appreciation of the evidence on record, the Forum below negatived the case of the complainant regarding deficiency of service. It was held that the life assured had a suicidal death which is excluded by the life policy. Hence by the impugned order dated:9th January 2004, the complaint was dismissed without cost. Hence the present appeal.
3. When this appeal was taken up for final hearing, there was no representation for the respondent/opposite party. We heard the learned counsel for the appellant/complainant. He submitted his arguments based on the grounds urged in the Memorandum of the present appeal. He vehemently argued for the position that the burden was upon the opposite party/insurance company to establish their contention that the claim preferred by the complainant is excluded by the exclusion clause in the insurance policy. But the Forum below by relying on the exclusion clause simply dismissed the complaint in OP.62/01. It is submitted that the final report filed by the investigating officer and the investigation report filed by the insurance investigator were not proved. But the Forum below placed reliance on those documents. Thus, the appellant/complainant prayed for setting aside the impugned order passed by the Forum below and to allow the complaint in OP.62/01.
4. The points that arise for consideration are:-
1. Whether the respondent/opposite party, New India Assurance Company Limited can be justified in repudiating the insurance claim preferred by the appellant/complainant?
2. Is there any reliable material available on record to accept the case of the respondent/opposite party that the life assured P.P.Pramod had a suicidal death?
3. Whether the claim preferred by the appellant/complainant being the nominee of the life assured, P.P.Pramod is legally sustainable?
4. Is there any sustainable ground to interfere with the impugned order dated:9th January 2004 passed by the CDRF, Kannur in OP.62/01?
5. Points 1 to 4:-
There is no dispute that the appellant/complainant is the mother and nominee of the life assured, P.P.Pramod. The life assured, P.P.Pramod was having Janatha Personal Accident Policy coverage for a sum of Rs.2.lakhs and the said policy was valid and effective on 1/4/1999, the date on which the life assured was found dead on the railway track between Thalassery and Mahe. The said policy was effective for the period from 18/12/1998 to 17/12/2000. It is also an admitted fact that the life assured P.P.Pramod died and his body was found dead on the railway track on 1/4/1999. Ext.A2 FIR lodged by Kannur Police Station would show that the said death was an unnatural death. Ext.A3 postmortem certificate issued by the doctor attached to General Hospital, Thalassery would show that the life assured P.P.Pramod was run over by a train and he died due to hemorrhage and shock due to injury to vital organs. Ext.A3 postmortem certificate issued by the Civil Surgeon attached to General Hospital, Thalasasery has categorically certified that the life assured P.P.Pramod sustained serious injuries to his vital organs and that it was stated that the life assured P.P.Pramod was run over by train. Ext.A2, FIR was lodged based on the information given by the duty station master, Thalassery Railway station. It is to be noted that injury caused to a person by running over of a train and the consequent death of that person can be treated as an accidental death. So, the claim preferred by the appellant/complainant being the nominee of the life assured to get the benefit under A1 Janatha Personal Accident Policy certificate is to be allowed.
6. The respondent/opposite party, New India Assurance Company Limited repudiated the insurance claim preferred by the appellant/complainant on the ground that the life assured, P.P.Pramod committed suicide. It is true that suicidal death of the life assured is excluded by A1 Janatha Personal Accident Policy. A1 Janatha Personal Accident Policy certificate would make it clear that death due to accident only is covered by the said policy. The available materials on record would give an indication that the life assured had an accidental death. Then, it is for the respondent/opposite party/insurance company to establish that the life assured had a suicidal death.
7. The respondent/opposite party relied on B1 final report filed by the Station House Officer, Thalassery. It was filed before the SDM Court Thalassery. The insurance company has also relied on B2 investigation report filed by K.V.Kunjiraman Nair. B1 final report filed by the SHO, Thalassery Police station would give an indication that the life assured P.P.Pramod committed suicide. But the SHO, Thalassery who filed B1 final Report has not been examined in this case. There is no case for the respondent/opposite party/insurance company or the investigating officer who submitted Ext.B1 final report that anybody has witnessed the alleged incident of committing suicide by the life assured P.P.Pramod. It is further to be noted that nobody has seen the life assured, Pramod committing suicide by jumping or walking in front of a moving train. It is pertinent to note at this juncture, that B1 final report has not been proved by examining the investigating officer who prepared the final report. No witness to B1 final report has been examined before the Forum below. In effect, B1 final report is the creation of the investigating officer based on some surmises and conjectures. Even that final report has not been proved by examining the investigating officer. The Forum below cannot be justified in simply relying on B1 final report without any supporting material. The mere fact that in B1 final report it is stated that the deceased P.P.Pramod committed suicide cannot be taken as a ground to come to a definite conclusion that in fact the deceased Pramod committed suicide. B1 final report cannot be relied on for arriving at a finding that the life assured, P.P.Pramod had suicidal death.
8. B2 is the investigation report filed by the insurance investigator, K.V.Kunjiraman Nair. Respondent/opposite party, insurance company has not examined the aforesaid insurance investigator to prove Ext.B2 report. No witness referred to in B2 report has been examined before the Forum below. In fact Ext.B2 investigation report has not been proved by examining the investigator or any witness to the said report. This State Commission have no hesitation to hold that the Forum below has gone wrong in relying on Ext.B2 investigation report without any supporting evidence.
9. The respondent/opposite party failed to prove Ext.B1 and B2 reports. The Forum below cannot be justified in relying on B1 and B2 report for arriving at a conclusion that the life assured P.P.Pramod committed suicide. On the other hand, the facts, circumstances and the available evidence would only show that the life assured P.P.Pramod had an accidental death the hitting of a moving train and that as a result of the injury sustained in the said accident, the life assured, P.P.Pramod died on 1/4/1999. If that be so, the appellant/complainant being the mother and nominee of the life assured, P.P.Pramod is entitled to get the benefits under A1 personal accident policy certificate.
10. Admittedly, the sum insured as per A1 Janatha Personal Accident Insurance Policy certificate is Rs.2.lakhs. The appellant/complainant is shown as the nominee of the life assured. Her name is shown as nominee in A1 insurance policy certificate issued by the opposite party/New India Assurance Company Ltd. So, the appellant/complainant is entitled to get the insured sum of Rs.2,lakhs with all other benefits due under A1 Janatha Personal Accident Insurance Policy. The respondent/opposite party, New India Assurance Company Ltd was deficient in rendering service to the appellant/complainant being the nominee of the life assured. So, the respondent/opposite party, New India Assurance Company Ltd is to be made liable to pay the insured sum of Rs.2.lakhs with all the benefits under the A1 insurance policy to the appellant/complainant with interest at the rate of 9% per annum from the date of the complaint in OP.62/01. The appellant/complainant is also entitled to the cost of the proceedings and the same is fixed at Rs.2000/-. These points are answered accordingly.
In the result, the appeal is allowed. The impugned order dated:9th January 2004 passed by CDRF, Kannur in OP.62/01 is set aside. The complaint in OP.62/01 is allowed and thereby the respondent/opposite party, New India Assurance Company Ltd is directed to pay the appellant/complainant the insured sum of Rs.2.lakhs with all other benefits due under A1 Janatha Personal Accident Insurance Policy with interest at the rate of 9% per annum from the date of complaint in OP.62/01 till the date of realization. The appellant/complainant is also entitled to get cost of Rs.2000/- from the respondent/opposite party.
M.V. VISWANATHAN : JUDICIAL MEMBER
M.K. ABDULLA SONA : MEMBER
VL.
