<br /> <br /> By SRI.K. VIJAYAKUMARAN, PRESIDENT.<br /> <br /> <br /> Complainant filed this complaint claiming insurance amount.<br /> <br /> The averments in the complaint can be briefly summarized as follows:<br /> <br /> <br /> The Husband of the complainant was a finsherman who died on 5.4.2004. While engaged in fishing he fell down inside the boat and sustained injuries and finally succumbed to the injuries. The deceased was a member of Koivila Inland FDWCS and a member of Group Scheme implemented by the Matsiya Fed along with United India Insurance Company. He was regularly remitting the necessary premium which was being collected by Kollam District Matsiya Fed Officer. As a legal representatives of the diseased the complainant is entitled to get the insurance amount due to the diseased, for which she has submitted an application which was not considered by the opp.party 3. On enquiry it was revealed that the Chavara Police registered Crime No.133/2004 in connection with the incident in which an inquest report was prepared without properly conducting the investigation and inaction of the opp.party 3 is because of the above request report. The Insurance company is evading payment of Insurance amount on the ground that the complainant’s husband died due to a heart attach. Since the complainant’s husband died due to the injuries sustained in the accident she is entitled to get the insurance amount due to her husband and hence the complaint.<br /> Opp.party 1 and 3 filed a joint version. It is admitted that the diseased was a fisherman and a member of Koivila Inland Fishermen Development Welfare Co-operative Society Ltd. Kollam with membership No.PMS/603/97 and he had remitted the insurance premium for the year 2004-05 implemented by the United India Insurance Co. Ltdd. As per receipt No.6555 dated 31.3.2004. The Group Personal Accident Insurance Scheme was implemented as an Insurance Scheme through United India Insurance Company Ltd for Fishermen who are the members of FDWCS affiliated to Matsyafed, who is acting only as a facilitator to furnish the required details to the Insurance Company. As per this scheme a member fisherman has to remit Rs.50/- per year as premium and the dependent of the diseased will get 1.5 lakh as compensation for the death of the insured person in any accident. It is reported that diseased while engaged in fishing activity at the Arabian Sea on 5.4.2004 suddenly slipped and fell on the deck of fishing boat “Kitchu”. He was taken to the Shankers Hospital, Kollam and given necessary treatment.At 11.20 am that day he died.The wife of the deceased has applied for Insurance claim. The claim was forwarded by the District Manager, Matsyafed, Kollam to Matsyafed Head Office, Thiruvananthapuram and the same had been sent to the Insurance Company for settlement. The Senior Branch Manager, United India Insurance Co.Ltd. repudiated the claim as per the letter No.100403/GEN/81:2005,due to the reason that the deceased had died due to heart failure.. The Matsyfed has already informed the complainant the refusal of the claim. The Matsyafed is acting only as a facilitator to furnish the required details to the Insurance Co. for settlement and it is the sole discretion of the Insurance Co. regarding settlement of the claim.; Matsyafed has no liability what so ever in the settlement of the claim.<br /> <br /> The 2nd opp.party filed version contending interalia, that the complaint is not maintainable either in law on or facts. This consumer case requires voluminous evidence and the same can be tried only before a Civil Court. This Forum lacks jurisdiction to try this proceedings. The deceased person Antony John had a Malsyafed Fisherman Accident Insurance Scheme at the time of death. The insured was standing on the side of the boat and he suddenly fell down on weakness and then fainted. Immediately he was taken to Sankers Hospital, Kollam and the Doctor there declared him dead. The postmortem was conducted in District Hospital, Kollam. The claim was repudiated since the policy recitals in this aspect is crystal clear and going by the terms and conditions of the policy the 2nd opp.party has no other go than to repudiate the claim. The claim is not sustainable since the deceased had died due to heart attack. Indemnification by this 2nd opp.party can be done only when the death is occurring out of an accident. This 2nd opp.party cannot pay compensation on the following grounds. The proximate cause of death is Heat Attack and not accident. Death due to heart attach is confirmed by 1. Sri. Pramod, 2. Sri. Lawrence, 3. Sri. Lazer, 4. Sri. Varghese and 5. Sri. Xavier. The statements of the above persons is recorded in the inquest report in Crime No.133/2004 of Chavara Police Station where all of them also confirmed that the deceased had the prior history of heart attack. Declaration from Smt. Susi Antony, W/o. deceased confirming the death of her husband due to heart attack.. The inquest report was silent about any external swelling or abrasion. The report from Dr. K. Sarath Chandra Bose, Sankers Hospital confirming death due to heart attach. It is also confirmed by Dr. V. Prathapan, District Hospital, Kollam. The independent investigation was also done by the 2nd opp.party to check the veracity of the claim and the investigation report is also that the deceased had a history of Cardiac Arrest and the same does not fall within the ambit of the policy. Considering all these aspects the 2nd opp.party came to the conclusion that the complainant’s claim does not fall within the ambit of the policy . Hence the 2nd opp.party prays to dismiss the complaint<br /> <br /> <br /> Points that would arise for consideration are:<br /> <br /> <br /> 1. Whether the complainant is entitled to get the Insurance claim?<br /> 2. Whether there is deficiency in service on the part of the opp.parties?<br /> 3. Reliefs and costs.<br /> <br /> <br /> For the complainant PW.1 is examined. Ext. P1 is marked.<br /> <br /> For the opp.party DW.1 is examined. No Exts. Marked<br /> <br /> Points 1 to 3<br /> <br /> It is an admitted fact that the complainants husband deceased Antony John was a member of Matsyafed Fisherman Accident Insurance Scheme and that he died while engaged in fishing in open sea. The dispute between the parties is with regard to the cause of death. Second opp.party repudiated the claim of insurance amount made by the complainant on the ground that the deceased died due to heart attack whereas the contention of the complainant is that the deceased died due to a fall inside the boat on his chest and consequential injuries sustained by him. Dw.1 is the Asst. Divisional Manager of Opp.party 2. Though she would state that the deceased died due to heart attack in cross examination she has admitted that no documents were produced to establish that aspect. In the version opp.party 2 has stated the names of five persons to prove that the deceased died due to heart attack. But none of them was examined to prove that contention. In the version they have further stated that there is a report from one Dr. Sarath Candra Bose of Sankers Hospital, Kollam confirming the version that the death of the deceased is due to heart attack. Neither that report was produced nor that doctor was examined for reasons best known to them.. The opp.parties other than raising certain contention no attempt was made to establish that the deceased died due to heart attack and not due to an accident.<br /> <br /> Ext.P1 is the postmortem certificate in respect of the deceased prepared by Dr. V. Prathapan of District Hospital, Kollam. In Ext.P1 the opinion as to the cause of death is stated as “Death was due to the injuries sustained to the chest. The veracity of Ext.P1 is not at all challenged. The fact that the deceased fell down inside the boat on his chest when the boat swayed is not disputed. It is well settled that the proper document as to the cause of death is the postmortem certificate and when the postmortem certificate confirms that the death of deceased is due to an accident the opp.parties are not justified in repudiating the claim which amounts to deficiency in service on the part of opp.party2. From the evidence now before us we hold that the death of the deceased is due to an accident and that the complainant is entitled to get the insurance amount as per Ext. D1. Point found accordingly.<br /> `In the result the complaint is allowed, and opp.party 2 is directed to pay the complainant the insurance amount as per Ext. D1 with interest at the rate of 9% per annum from the date of repudiation till payment. The opp.party 2 is also directed to pay Rs. 2500/- towards compensation and costs to the complainant.. The order is to be complied with within one month from the date of this order.<br /> <br /> <br /> Dated this the 30th day of August, 2008.<br /> <br /> I N D E X<br /> <br /> List of witnesses for the complainant<br /> PW.1. Susi Antony<br /> <br /> List of documents for the complainant<br /> P1. – Postmortem<br /> <br /> List of witnesses for the opp.parties<br /> DW.1. - G. Leela<br /> <br /> List of documents for the opp.parties : NIL<br /> <br />