By Smt.Padmini Sudheesh, President The facts of the case are that the 1st petitioner is the widow of late Anto and 2nd petitioner is the daughter of late Anto and 3rd petitioner is the mother of late Anto. The deceased Anto had taken Pravasi Suraksha Welfare Scheme Policy No.47/49591 for Rs.5,00,000/- from the respondents covering period from 5/1/1998 to 4/1/2003. The said Anto died on 26/11/01 at Kanjany in a sudden unexpected incident. The Anthikkad police registered Crime446/01 under the caption of “Man Missing”. Later the body of Anto was recovered and Post-mortem was done. The petitioners believe that the said Anto was murdered. The death of Anto is under investigation of Crime Branch C.I.D., Thrissur. Now the 1st petitioner filed a writ petition before the Hon’ble High Court of Kerala for CBI enquiry into the death of Anto. The complainants are the legal heirs of Anto. After the death of Anto the 1st petitioner being the nominee under the policy filed application and also produced available documents for getting the amount covered under the scheme to the respondents. Several letters and requests were made to get the amount. But the respondents were reluctant to pay the amount without any tenable reasons. Being aggrieved by that the complainants filed OP.1106/03 before the Consumer Disputes Redressal Forum, Thrissur for directing the respondents to pay Rs.5,00,000/- and the Forum directed the respondents to consider the claim within 2 months of order and in the order it was held that if the respondents repudiate the claim the complainants are at liberty to approach the Consumer Forum again. After the said order the petitioner received registered letter dated 9/6/06 from the respondents by repudiating the claim of complainants. The reasons stated in the letter are without any basis. The respondents were purposefully not paid the amount and troubling the complainants. The said act of respondents caused irreparable loss and mental agony to the complainants. So the respondents are liable to pay compensation also. The deceased Anto not violated any of the conditions of the policy. Hence the complaint. 2. The averments in the counter are that the respondents company had issued a policy under Pravasi Suraksha Social Welfare Scheme to Mr.Anto T Paily as per policy certificate No.761400/47/97/49591 for a period from 5/1/1998 to 4/1/2003 and the sum insured is only for Rs.5,00,000/- subject to the terms and conditions are true. As per condition No.2(b) in case of death due to accident the party should produced records from police as evidence of accidental death and post mortem report etc. for speedy disposal of the claim. The complainants have prove that her husband died due to accident covered under the policy by way of producing valid documents. The allegation that she has produced all the relevant documents enabling the respondents to settle the matter is false and denied. As per the records the insured person died on 26/11/01. The matter informed to this respondents office only on 14/12/01. On 21/1/02 the complainant has submitted the claim form along with attested copy of inquest report, FIR and Post mortem certificate dated 28/11/01. On perusal of post mortem report it is found that blood taken from the body of the insured preserved for detection of alcohol and Bone Marrow preserved for diatom test. The final police report/charge has not produced along with claim form and respondents waited for the results of this report. In the meanwhile the respondents received letters from the complainant calling upon to settle the claim as special case even though they have not submitted the police final investigation report and analytical lab report regarding the content of alcohol in the blood. On 5/11/03 this respondent sent a registered letter to the complainant asking to produce those documents for an early disposal of the claim. The respondents also intimated that unless they received the above documents they will not be in a position to proceed with their claim. However these respondents have not received any reply from the complainant. But the complainant had straight away filed a complaint before this Hon’ble Forum as OP.1106/03 which was dismissed by this Forum with an observation that since there was no repudiation the complaint was not maintainable and directed the company to consider the claim and dispose the matter as early as possible. The final report submitted by the investigating agency before the Court of Chief Judicial Majistrate, Ernakulam in page 11 last para stated that the entire staff of Hill Top bar were examined and they stated that late Anto and Anthony consumed liquor on 26/11/01 during about 8 pm to 9 pm. However the chemical analysis report of the blood sample of deceased Anto reveals total absence of Alcohol. Hence the Government of Kerala is being requested for initiation of regular departmental action against the officials who are responsible for non finding of the alcohol in the sample. The death had occurred in the same night. The consumption of liquor is confirmed in the final report where 6 bills of Hill Top bar were produced. The CBI was convinced that the insured had consumed alcohol but the same has not been reported by the analyzing authority for which action was ordered to be taken. The relevant lab report may be a conspiracy only to take insurance claim. With regard to opinion as to the cause of death Dr.Jayaraman while explaining the impact of injury suffered on the body of deceased remarked that as per his report Sl.No.1,2 and 3 of page No.9 and 10 noted that the injury is sufficient enough to make a man unconscious and also consumption of alcohol will contribute to the unconsciousness and in such a case a man will not be able to come out of water. The CBI has asked the Government of Kerala for departmental action against the officials responsible for non finding of alcohol in the blood sample. While post mortem was conducted the blood was preserved for detection of alcohol and bone marrow preserved for diatom test. It is to be noted that in the diatom test when the insured entered the water he was alive. From these points it is clear that the insured was under the influence of alcohol which is an exclusion under the Pravasi Suraksha policy taken by late Anto. So the death will not come under the policy conditions and the respondents had repudiated the claim and duly intimated the matter to the complainants. The complainants are not entitled to get any amount as compensation. There is no deficiency in service on the part of these respondents and dismiss the complaint. 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 adduced consists of Exhibits P1 to P15 and oral testimony of PW1 on the part of complainants and Exhibits R1 to R17 and oral testimony of RW1 to RW3 on the part of respondents. 5. Points: It is the case of complainants that they are eligible to get Rs.5,00,000/- as the death claim of deceased Anto. The 1st complainant is the wife of late Anto and 2nd complainant is the minor daughter and 3rd complainant is the mother of late Anto. The deceased Anto was a subscriber of Pravasi Suraksha Social Welfare Scheme policy issued by respondents vide No.47/49591. The policy had coverage from 5/1/98 to 4/1/03. Anto died on 26/11/01. According to the complainants he was died in a sudden unexpected incident and the Anthikkad police registered Crime 446/01 for man missing. The complainants believe that the said Anto was murdered . After the death the 1st complainant being the nominee under the scheme filed application with the respondents to get the accident benefit. But the respondents dishonoured her claim and the complainant filed OP.1106/03 before the Forum claiming Rs.5,00,000/- and the Forum directed the respondents to consider the claim of complainant within 2 months of order and also held that if the respondents repudiate the claim of complainant they are at liberty to approach the Forum again. Accordingly they approached the respondents again and they repudiated the claim and this complaint is filed. 6. The respondents in their counter contended that the complainants have to prove that the deceased was died due to an accident covered under the policy by way of producing valid documents. They also contended that the insured was under the influence of alcohol which is an exclusion under the Pravasi Suraksha Policy taken by late Anto. So the respondents stated that the death will not come under the policy and the complainants are not eligible to get any amount. 7. The cause of death is in dispute that if the insured person was under the influence of alcohol at the time of his death, the legal heirs not entitled for the accidental benefit. According to the complainants late Anto was not under the influence of alcohol. The 1st complainant who is examined as PW1 deposed that her husband was not the habit of consuming liquor. During cross examination she deposed she is not aware about the consumption of liquor by her husband with one Anthony in a bar in the eve of his death. She stated as she is not aware and it does not mean that he was a person not consuming liquor. 8. The complainants produced Exhibits P1 to P15 documents to substantiate their case and in which Exhibit P5 is the Post mortem certificate of late Anto. In the certificate it is certified that the cause of death is the combined effects of drowning and head injury. In Exhibit P5 it is also stated that blood preserved for detection of alcohol. Bone marrow preserved for Diatom test. Exhibit P11 the chemical analysis report would show that Ethyle alcohol was not detected in the blood. So as per these documents we can conclude there was no consumption of liquor by the deceased Anto at the time of death. 9. But the 1st complainant who is the wife of late Anto has doubt with regard to the cause of death of her husband and she deposed before the Forum also that she suspects the death of her husband as a murder. She approached the Hon’ble High Court of Kerala to investigate the cause of death of her husband by CBI and CBI investigated the matter and final report submitted before Chief Judicial Magistrate Court, Ernakulam. The complainants produced the certified copy of report of CBI and it is marked as Exhibit P4. The CBI conducted a very detailed investigation and it is revealed from the report submitted by them. In the report they stated that they had verified the allegation, suspicion, presumption made by the complainant by examining a large number of concerned witnesses and were found to be false or not substantiate. They have reported that late Anto consumed six pegs of alcohol and Dr.Jayaraman who conducted Post mortem did not find any unusual smell and during the chemical analysis no Ethyle alcohol was found. It is also reported that Dr.Jayaraman stated that Anto’s body was in early decomposition stage and having unpleasant odour, so even if alcohol was present, the smell could not be appreciated. So he preserved 20ml blood and sent the same to Chemical Examiner for testing the presence of Ethyle alcohol. If there was any liquor the Chemical Examiner should have given report on the sample sent by him. But the Chemical Examiner Laboratary, Ernakulam has given report that presence of ethyl alcohol was not detected. In the Exhibit P4 report the CBI also reported that during their investigation six original bills of “Hill Top” bar dated 26/11/01 bearing Nos.130192, 130199, 71222, 130206, 130205 and 130168 were seized from one Sebastian. The waiter, Hill Top bar Mr.Subash vide these bills served a half bottle of six pegs of Vodca to late Anto and Anthony (RW1) during 7pm to 9pm on 26/11/01. According to CBI their investigation has revealed that both Anto and Anthony consumed six pegs of vodca each. The entire staff of the Hill Top bar was examined by them and stated that Anto and Anthony consumed liquor. But the Chemical analysis report of blood sample of late Anto totally reveals absence of alcohol. According to CBI it is against the real facts and they requested to the Government of Kerala for initiation of departmental action against the officials who are responsible for non finding of the alcohol in the sample. This document is produced by complainants themselves and it goes against the case of complainants. 10.It is the definite case of respondent that in intoxication the deceased Anto fell into the river and death was caused. After the investigation CBI had closed the file and their findings are there in the Exhibit P4 report. There is no further attempt on the part of complainant to reinvestigate the matter and it was asked during cross examination to the 1st complainant and she deposed that she did not remember the pendency of such an application before the Hon’ble High Court. RW1 Anthony deposed that on the way to Kanjani they have entered in Hill Top bar and consumed vodca of six pegs each. During cross examination the counsel for complainants asked to him about the grudge existing between him and the complainants. He deposed there is no grudge and the consumption of liquor is true. 11. RW2 the bar Manager of Hill Top was examined and he deposed that the bill book was taken by CBI for investigation which contents the bills of late Anto. He deposed that Anto used to come to bar. It is true that the visit of bar does not mean the visit must be for consumption of liquor. But during cross examination he stated to whom these bills are issued. The statements of RW2 is vague and nothing is brought to establish about the consumption of liquor by late Anto. 12. RW3 is the witness cited by respondents and turned hostile during examination. He deposed that he has filed a report before the Hon’ble High Court by stating the report of CBI is not correct. But no document is produced by him to show that he has approached the Hon’ble High Court against the report of CBI. He deposed that the investigation conducted by CBI is not correct. But there is no steps taken by them to challenge Exhibit P4 report. The CBI elaborately discussed about the investigation report and there is no other evidence to disregard the report filed by CBI. 13. The respondents repudiated the claim of complainant as per Exclusion clause No.4(b) of the policy. The policy is produced and marked as Exhibit R1. In the present case it is proved that at the time of accident which caused the death of Anto, he was under the influence of alcohol and the repudiation of the claim on the ground of Exclusion clause No.4(b) of the policy is genuine and there is no deficiency in service on the part of respondents. So the complainants are not eligible for the relief sought. 10. In the result, the complaint stands dismissed. Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum this the 12th day of July 2010.
| | [HONORABLE Rajani P.S.] Member[HONORABLE Padmini Sudheesh] PRESIDENT[HONORABLE Sasidharan M.S] Member | | 
