The averments in the complaint are as follows. The complainants are the legal heirs of deceased Narayanan who was an insurance policyholder of respondent company by claim No.710600/47/02/00024, Dollars save card No.l91212, the policy covered during the period from 10.5.1999 to 9.5.2009. The policy covers the accidental death for Rs.5,00,000/- and while taking the policy Narayanan put the first complainant as his nominee for the assured amount. On 7.1.02 at about 12.00 noon while Narayanan was engaged in the business of making crackers under the employment of one Varghese, S/o. Pyloth, Konkoth House, Parampaya Desom the crackers exploded and got fire by which Narayanan and one child were injured and due to the burn injuries on 12.1.2002 Narayanan expired. The respondent Company has duty to release the policy amount to the nominee by the death of policyholder. The complainants approached several time to the second respondent personally to avail the insurance benefits but repudiated the claim. Hence this complaint. The complaint is amended as per direction in I.A.360/07.

 

            2. The averments in the counter are as follows: The respondents admit that the first respondent has issued a Janatha Personal Accident Policy in the name of one P.K. Narayanan, Pulikkal House, Amamkuzhy Road, Mulamkunnathukavu, Thrissur at the instance of M/s. Dollars India Card Ltd. vide Dollars Save Card No.191212 for the period from 10.5.99 to 9.5.09 as per the terms and conditions of the Master Policy Agreement No.4771060000846 and the sum assured of the policy per subscribers per annum is Rs.5,00,000/- and the risk covered is only for the accidental death and the injuries mentioned in the policy. The condition No.1 of the policy says that ‘upon the happening of any event which may give rise to a claim under this policy the insured shall forthwith give notice thereof to the company. Unless reasonable cause is shown. The insured should with in one calendar month after the event, which may give rise to a claim under the policy, give written notice to the company with full particulars of the claim’, it further says that ‘it also further expressly agreed and declared that if the company shall disclaim liability to the insured for any claim hereunder and such claim shall not within 12 calender months from the date of such disclaimed have been made the subject of a suit in a court of law, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverably hereunder. As per the provisions in the policy the Company shall not be liable under this policy for payment of compensation in respect of death injury disablement of the insured from arising or resulting from the insured committing any breach of the law with criminal intent. The first respondent received all the documents in connection with the settlement of claim only on 10.9.04. On perusal of the documents the respondents noted that the deceased was engaged in the manufacture of crackers without statutory licence along with one Varghese and both have been implicated as accused in the case, which is registered under IPC Section 286, 304(A) and also under Sec. 4 of Explosive Substances Act R/W 5 and R/W Section 9(B) 11. And also the fact is further endorsed by the statement given by the nominee in the inquest report. As per the group JPA policy, liability for injury arising or resulting from the insured committing any breach of law with criminal intent is excluded from the scope of policy. In the above case since there is a breach of law and illegal use of explosives, the respondents were unable to entertain the claim preferred by the complainant and repudiated it vide letter dated 4.10.04. There is no deficiency in service on the part of these respondents. Hence dismiss.

 

            3. The points for consideration are:

(1)    Is there any deficiency in service on the part of respondents?

(2)    If so, reliefs and costs.

            4. The evidence consists of Exts. P1 to P17 and Ext. R1 to R9.

 

            5. Point No.1: The complaint is filed to get insurance policy benefits from the Company. The case of complainant is that the deceased Narayanan who was the father of first and third complainants and husband of second petitioner was an insurance policyholder of the respondent company as per policy No.710600/47/02/00024 and the policy has coverage during the period from 10.5.99 to 9.5.2009. The policy covers the accidental death for Rupees five lakhs.According to the complainants on 7.1.02 at about 12.00 while the deceased Narayanan was engaged in the business of making crackers under the employment of one Varghese, S/o. Pyloth, Konkoth House the crackers exploded and got fire by which Narayanan and one child were injured and on 12.1.02 the Narayanan expired. As per the policy the complainants are entitled for Rupees five lakhs as the insurance coverage. So the complainant approached several times to respondents but the benefits did not provide by the Company and they repudiated the claim. The complainants have produced seven documents and marked as Exts. P1 to P7. The important defence put forward by the Company in repudiating the claim and also to contend the case is that the Company shall not be liable under this policy for payment of compensation in respect of death injury disablement of the insured from, arising or resulting from the insured committing any breach of law with criminal intent. The respondents have produced nine documents and marked as Ext. R1 to R9. Ext. R1 is the copy of policy with conditions in which the fourth proviso states that the Company shall not be liable under this policy for payment of compensation in respect of death injury or disablement of the insured from arising or resulting from the insured committing any breach of the law with criminal intent. According to the respondent Company the deceased Narayanan was engaged in the manufacture of crackers without statutory licence along with one Varghese and both have been implicated as accused in the case and which is registered under IPC Section 286, 304(A) and also under Section 4 of Explosive Substances Act R/W 5 and R/W Section 9(B) 11. According to the company liability for injury arising or resulting from the insured committing any breach of law with criminal intent is excluded from the scope of policy. Since there is a breach of law and policy condition in the illegal use of explosives the respondents were unable to entertain the claim preferred by the complainants.   So it is clear that the repudiation of the claim is only on the reason that the deceased had done the work of crackers without licence is a breach of law. It is true that it is a breach of law since lack of licence. The police has registered crime under IPC Section 286, 304(A) and also under Section 4 of Explosive Substances Act R/W 5 and R/W Section 9(B) 11. Ext. R3 is the copy of F.I.R. with F.I. statement in which it is stated that the first accused while making crackers and other connected things at his residence with the help of the second accused without having lawful licence in a negligent manner so as, it may cause danger to properties, the 2^nd accused and one Noble got injured and due to fire and the upper portion of the said house got fire and destroyed. The intention of the parties is not stated anywhere in the police records. They were under preparation to commit crime by using the explosives is not stated by the police who had conducted investigation of the crime. The intention is very relevant and no evidence to establish that there was criminal intent. The view of the Company is right if there was criminal intention to commit crimes. They had done the work without due licence is only the thing done by them and this is a breach of law since statutory licence is a must. The time of manufacture is also relevant. The work was at about 12-00 noon and in the veranda of the residential house of Varghese who has already mentioned. If the intention was not genuine there may not be the chance of making in the daytime and also in the residential house veranda. The police never mentioned that the house is non-residential and more over a 12 years old boy was also there and he also got injured and he died because of the explosion. So it is proved that there was no criminal intention in manufacturing the crackers and there is no previous crime alleged against these persons. In the final report which is marked as Ext. P2 the occupation of the person Varghese is shown as crackers manufacturing. From the above discussion it is clear that the repudiation on the ground of “breach of law with criminal intent” is illegal and unfair and shows service deficiency. Even if the Company is taken the contention that there was delay in submitting the documents by the son of deceased Narayanan, the repudiation of the claim was only on the basis of the ground which is already discussed.

 

             6. Point No.2: As per the terms and conditions of the policy if death occurs to a policyholder the nominee is entitled for five lakh rupees. In the present case the first complainant is the nominee stated in Ext. R1 document. But according to law the legal heirs have equal right in the absence of any other document. So all the complainants have equal right over the capital sum assured by the company.

 

            7. In the result, complaint is allowed and the respondents are directed to pay Rs.5,00,000/.- (Rupees five lakhs only) to the complainants as the amount covered by the policy within one month and also Rs.1000/- (Rupees one thousand only) as costs to the litigation.