CONSUMER DISPUTES REDRESSAL FORUM, KOTTAYAM.
Present
Sri. Santhosh Kesavanath P. President
Smt. Bindhu M.Thomas, Member
Sri. K.N. Radhakrishnan, Member
CC No 226/11
Saturday the 23rd day of June, 2012
Petitioner : Rosamma Joseph,
Thuruthel House,
Muttuchira PO, Kottayam.
2) Paul P.Joseph,
do-do-do
3) Mathew Joseph
do-do-do
4) Rosmy Joseph,
do-do-do
5) Smitha Rani Joseph
do-do-do
(Adv.Jose Joseph.K)
Vs.
Opposite party : 1) Malayala Manoramma,
Rep.by its Managing Director,
Kottayam.
(Adv.P.C.Abraham)
2) The Oriental Insurance Co,.Ltd.,
Rep.by its Divisional Manager,
Divisional Office, Kottayam.
(Adv.Sajan.A.Varghese)
ORDER
Smt. Bindhu M.Thomas, Member
The crux complainant’s case is as follows:
The first opposite party is company having its head office at Kottayam and branches at different parts of the world. The Malayala Manorama launched an insurance scheme in association with the 2nd opposite party for the subscribers of Malayala Manorama. Complainants are the legal heirs of Sri. Joseph Pailo who died in an accident on 11-09-10. The first complainant is his wife and complainants 2 to5 are his children. The complainants and Sri. Joseph Pailo were subscribers of Malayala Manorama. They have insured themselves with the opposite party under the Manorama Life Guard Scheme. The second opposite party also issued certificate No.164337 dated 22-3-10. Sri. Joseph Pailo had a valid manorama discount card also. The husband of the first complainant and father of complainants 2 to 5 fell in a stream at Kurissumood near Muttuchira on 11-09-10. Pursuant to it he was taken to the Holy Ghost Mission Hospital Muttuchira and on the way he died. The matter was informed to the Kaduthuruthy Police and police registered crime no. 653/10 for unnatural death. On 12-09-10, post mortem was done by police surgeon and found the death was due to drowning. The claim of the complainants was rejected by letter dated 27-01-11 stating the deceased was under the influence of alcohol at the time of accident. The allegation that Sri. Joseph Pailo was under the influence of alcohol at the time of the accident is utter falsehood. The second opposite party is liable to pay the amount to the complainants. There is deficiency of service and unlawful trade practice on the part of the second opposite party in rejecting the claim.
The first opposite party entered appearance but failed to file version and was set expartee. The second opposite party entered appearance and filed version with the following main contentions.
i) As per the various statements available with the police report it has been mentioned by almost all persons who were questioned by the police in connection with the case, that deceased was a habitual drunkard. On the date of death he had consumed alcohol sitting on a culvert and has accidentally slipped and fell in to the canal and drowned. The final report of the police in connection with the case of death of Joseph Pailo clearly states that the deceased had consumed alcohol just before the accident and has fallen in to the canal while he was intoxicated
ii) As per exclusion cause 5(b) of GPA Policy, the second opposite party is not liable in respect of the death/injury of the insured person whilst under the influence of the intoxicating liquor.
iii) The complainants are not entitled for the amounts claimed as compensation. The amount of compensation covered by the said policy is Rs.1,00,000/- in case of accidental death of the insured person. Additional benefit of Rs.,15,000/- will be available only if they hold a valid Manoramma Discount Card. All other benefits like Mangalya nidhi etc are available only on payment of additional premium for the same. In this case no additional premium for any further benefits other than the minimum available under the policy is paid.
The opposite party contented that there is no deficiency in service on their part and prayed to dismiss the complaint with costs to them.
Points for consideration are:
i) Whether there is any deficiency in service or unfair trade practice on the part of opposite parties?
ii) Reliefs and costs?
Evidence consists of affidavits filed by both parties and Exts.A1 to A5 and B1 to B3
Point no.1
Heard both sides and perused the documents. It is not in dispute that the father of the complainants has insured himself and his family members with the opposite party under the Manoramma Life Guard Police Scheme. It is also not in dispute that the claim occurred during the subsistence of the policy. The counsel for the complainant submitted that the claim was rejected stating that the deceased was under the influence of alcohol at the time of the accident. The said repudiation is produced and marked as Ext.A5. The counsel for the first opposite party submitted that final report of the police in connection with the case of death of Joseph Pailo clearly states that the deceased had consumed alcohol just before the accident and has fallen in to the canal while he was intoxicated. Evidencing the said submission the copy of final report is produced and marked as Ext.B3 The complainant produced the post mortem report and it is marked as Ext.A4. Nothing is mentioned in Ext.A4 postmortem report about the alcohol consumption of Joseph Pailo. Moreover it is stated in Ext.A4, that stomach contained 150ml of watery fluid mixed with mucosa flakes having no unusual smell. In our view post mortem report is a more reliable document compared to final report. As there is no mention of alcohol consumption in Ext.A4, we disregard the aforesaid contention of opposite party.
The second opposite party averred that the amount of compensation covered by the said policy is Rs.1,00,000/- in case of accidental death of the insured person. The second opposite party further averred that additional benefit of Rs.15,000/- will be available to the complainants only if they hold a valid Manorama discount card. The complainants have produced the original discount card and it is marked as Ext.A2. As Mr. Joseph had a valid discount card, we find that the complainants are eligible for the aforementioned Rs.15,000/-.
The complainants further submitted that they are entitled for the Mangalya nidhi. Where as the second opposite party averred that for all other benefits like Mangalaya nidhi etc, an additional premium amount was to be paid and no such payment was made by Mr. Joseph. The complainants produced original personal accident certificate cum receipt issued by the opposite parties and it is marked as Ext.A1. From Ext.A1, it is understood that Mr.Joseph Pailo had paid premium of Rs.90/- as accident death cover for 6 persons and additional premium of Rs.60/-as disability cover for 6 persons. No other additional premium is seen paid for mangalayanidhi or vidya nidhi. After scanning the entire evidence placed on record, we feel that the complainants are entitled for claim amount of Rs.1,00,000/- for the accidental death cover and Rs.15,000/- for holding manorama discount card. In our opinion, the act of second opposite party in repudiating the claim on flimsy reasons is a clear case of deficiency in service. Point no.1 is found accordingly.
Point no.2
In view of the findings in point no.1 the complaint is ordered as follows
The second opposite party will pay Rs.1,15,000/- with interest @ 9% per annum from the date of repudiation till payment to the complainants along with a compensation of Rs.3000/- and litigation cost of Rs.1000/-. Each complainant will get one fifth of the total awarded amount including compensation and cost.
This order will be complied with within one month of receipt of the copy of the order.
Smt. Bindhu M.Thomas, Member Sd/-
Sri. Santhosh Kesavanath P. President Sd/-
Sri. K.N. Radhakrishnan, Member Sd/-
Appendix
Documents of complainants
Ext.A1-Original premium receipt
Ext.A2-Original discount card
Ext.A3-Copy of FIR
Ext.A4-Copy of postmortem report
Ext.A5-Original repudiation letter
Documents of 2nd opposite party
Ext.B1-Copy of personal Accident Certificate
Ext.B2-The Group Personal accident policy
Ext.B3-Photocopy of final report.
By Order,
Senior Superintendent.
