Sri. Jacob Stephen (President):<br /> <br /> The complainants 1 to 4 filed this complaint against the opposite parties for getting a relief from this Forum.<br /> <br /> 2. The brief facts of this complaint is as follows: The first complainant is the wife of late Mr. S. Purushothaman and the additional 2 to 4 were the children of the first complainant. The first complainant’s husband S. Purushothaman had taken an insurance policy for himself from the opposite parties for an amount of Rs. 3 lakhs. A Janata Personal Accident Policy Certificate with serial No. 00042122 was issued to him by the second opposite party. Dollars Save Card No. of the same is 124472. The policy was valid for the period from 29.01.1999 to 28.01.2009. The complainant, who is the wife of the insured, was the nominee in the said policy. The said Purushothaman died in a train accident on 8.11.2001 and the complainant as the nominee is entitled to receive the insurance claim. After the death of the said Purushothaman, the complainant had sent the duly filled Janata Personal Accident Claim Form dated 31.01.2003 to the second opposite party along with all the relevant documents/records necessary for processing the claim. Despite several requests by the complainant, and personally taking up the matter with the second opposite party, the claim amount due under the insurance policy has not been allotted to her. The non-payment of the claim amount is a deficiency of service on the part of the opposite parties. The complainant is entitled to get the claim amount of Rs.3 lakhs with interest and compensation for the mental agony and hardships caused to the complainant. Therefore, the complainants filed this complaint for realising an amount of Rs.3 lakhs being the insurance claim with 12% interest per annum from 31.01.2003 and an amount of Rs.25,000/- as compensation towards mental agony and hardships sustained by them. The complainant’s seeks for the reliefs prayed for in the complaint.<br /> <br /> 3. The third opposite party filed a common version for himself and for and on behalf of opposite parties 1 and 2 with the following contentions: The complaint is not maintainable either in law or on facts. The opposite parties admitted the issuance of the policy to the deceased and its validity and the receipt of the claim form from the first complainant. But the claim form was not duly filled and not accompanied with the requisite documents. So they have sent a letter to the complainant requesting her to return the claim form duly filled up with the requisite documents. They have also requested the complainant to clarify the discrepancies regarding the date of death, age of the deceased noticed by them in the FIR, post-mortem etc. and the reason for the delay in submitting the claim after a long gap of one year. The said clarifications and other relevant documents were not furnished by the complainant in time. Due to the aforesaid reasons, they have not settled the claim. Instead of furnishing the information as demanded by the opposite parties, the complainant had filed this complaint before this Forum. In the circumstances, there is no deficiency in service from the part of the opposite parties and this complaint is liable to be dismissed and the opposite parties canvassed for the dismissal of this complaint with their cost.<br /> <br /> 4.On the above pleadings, the following points were raised for consideration:<br /> <br /> <br /> <br /> (1) Whether the complaint is maintainable before this Forum?<br /> <br /> (2) Whether the complainants are entitled to get a relief as prayed for in the complaint?<br /> (3) Reliefs and Costs.<br /> <br /> 5. The evidence in this case for the complainant consists of the oral evidence of the additional 3rd complainant who has been examined as PW1 and Exts. A1 to A18, which are marked on the basis of the proof affidavit filed by the complainant. The evidence of the opposite parties consists of the oral evidence of the third opposite party who has been examined as DW1 and Exts. B1 to B8, which are marked on the basis of the proof affidavit filed by the third opposite party. After closure of the evidence, both sides heard.<br /> <br /> 6. Point No.1: The complainant is a consumer of the opposite parties. The dispute is with regard to the deficiency of service of the opposite parties. Therefore, this complaint is maintainable before this Forum under the C.P. Act.<br /> <br /> 7. Point Nos. 2 & 3: The complainant’s case is that the first complainant’s husband Sri. S. Purushothaman had taken a Janata Personal Accident Policy for himself from the opposite parties for an amount of Rs.3 lakhs. During the validity of the said policy, the policy-holder died in a train accident on 8.11.2001. The deceased was a business-man and the accident took place in between Ponpadi and Nagiri Railway Stations in the State of Tamil Nadu while he was on a business tour. The first complainant is the nominee in the policy and the other complainants are the children of the deceased and hence they are the legal heirs of the deceased. At the time of the death, the deceased was managing all his affairs by himself. So the complainants are not aware of this insurance policy. Subsequent to the death of the deceased, the additional third complainant took charge of the business of the deceased. Later in November 2003, PW1, the third additional complainant while verifying the accounts, came to know about the insurance policy. Immediately thereafter, the first complainant sent a letter to the second opposite party requesting to issue a claim form for submitting the claim. On getting the claim form, the same was duly filled and forwarded to the second opposite party with all relevant documents required for settling the claim.<br /> <br /> 8. Thereafter also, the complainant sent certain other documents as requested by the opposite parties. The additional third complainant personally met the third opposite party and explained to him the reasons for the delay in advancing the claim and their inability and difficulties for submitting the documents demanded by the opposite parties in time. Apart from the documents submitted by the complainants, the second opposite party demanded and insisted Chemical Analysis Report from the hospital where the post-mortem was done. According to the complainant, the Chemical Analysis Report is not available and is not necessary for the settlement of this claim since the death was caused due to an accident. However, even after receiving all the documents and explanations, the opposite parties faild to settle the claim. In the circumstances, the complainants have filed this complaint before this Forum. But even after filing this complaint and even after forwarding one claim through this Forum vide its order dated 8.8.2006 also, the opposite parties evaded the payment on one pretext or the other. The non-settlement of the complainants’ claim by the opposite parties is a deficiency of service. Therefore, the complainant prays for allowing the reliefs as prayed for in the complaint.<br /> <br /> 9. In order to prove the complainant’s case, PW1 has filed a proof affidavit along with 18 documents, which were marked as Exts.A1 to A18. Ext.A1 is the photocopy of the Janata Personal Accident Policy Certificate in the name of the deceased. Ext.A2 is the photocopy of the FIR in crime No.351/01. Ext.A3 is the photocopy of the Rough Sketch. Ext.A4 is the photocopy of the Inquest Report. Ext.A5 is the photocopy of the Final Report in crime No.351/01 submitted by the Sub Inspector of Police before the Court of Executive Magistrate, Tiruttani. Ext.A6 is the photocopy of the Post-mortem Certificate. Ext.A7 is the Death Report. Ext.A8 is the photocopy of the Journey-cum-reservation ticket. Ext.A8(a) is the photocopy of the excess fare ticket. Ext.A9 is the photocopy of the Identity Card of Rotary Club, Ranni. Ext.A10 is the photocopy of a visiting card in the name Madhu Purushothaman of Matha Silk House, Pazhavangadi P.O., Ranni. Ext.A11 is the Original Death Certificate dated 3.1.2002 issued by the Tahsildar, Taluk Office, Tiruttani. Ext.A12 is the photocopy of the Electoral Identity Card of the deceased S. Purushothaman bearing No.KL/14/111/057548. Ext.A13 is the Original Ration Card (Old) bearing No.41011 of the deceased and his family. Ext.A14 is the photocopy of the letter sent by the complainant to the second opposite party for issuing the claim form. Ext.A15 is the photocopy of the newspaper cutting in Mathrubhoomi daily dated 9.11.2001. Ext.A16 is the photocopy of the claim form. Ext.A17 is the certificate-dated 22.1.2005 issued by the Village Officer, Pazhavangadi. Ext.A18 is the intimation letter issued by Ranni Branch Office of the LIC settling the claim of the first complainant as per policy No.041296187.<br /> <br /> 10. The main contention of the opposite parties is that, the complainant evaded the queries of the opposite parties for clarifying the doubts with regard to the death of the deceased. The opposite parties’ doubts are the following: The date of death is 8.11.2001. But the date of death noted by the first complainant in her application for the issuance of the claim form is 6.11.2001. The difference of age of the deceased mentioned in the FIR is 30 years whereas it was 58 years in the Inquest Report. The name of the deceased was seen as Madhu Purushothaman in certain documents and as S. Purushothaman in certain other documents. The reason for delay in intimating the claim was also not explained and Chemical Analysis Report was also not produced. The above doubts are not clarified by the complainant irrespective of opposite parties reminders and also the complainant has not produced the Chemical Analysis Report. Because of the above said laches of the complainants, the opposite parties are constrained to settle the claim. It is also contended that, in the case of such accidental death, the documents as well as the clarifications mentioned above are highly essential for the settlement of the claim. Since the complainants failed to convince the opposite parties that the death was a clear accidental death to the satisfaction of the opposite parties for the settlement of the claim, they have not allowed the claim. Therefore, they are not responsible for the non-settlement of the claim. They have not committed any deficiency of service in any manner and the opposite parties pray for the dismissal of the complaint.<br /> <br /> 11. In order to prove the contentions of the opposite parties, the third opposite party filed a proof affidavit along with 7 documents, which were marked as Exts.B1 to B7 series. Ext.B1 is the photocopy of the letter-dated 25.11.2002 sent by the second opposite party to the complainant. Ext.B2 is the photocopy of the Janata Personal Accident Insurance Claim Form. Ext.B3 is the photocopy of the letter-dated 6.2.2003 issued by the second opposite party to the complainant. Ext.B4 is the photocopy of the letter-dated 19.6.2003 issued to the complainant by the second opposite party. Ext.B5 is the photocopy of the letter-dated 5.9.2003 issued by the second opposite party to the complainant. Ext.B6 is the photocopy of the registered letter dated 25.3.2004 sent by the second opposite party to the complainant. Ext.B7 is the Janata Personal Accident Insurance Policy issued by the opposite parties to the complainant’s husband. Exts.B7(a) and (b) are the relevant portions of Ext.B7 insurance policy. Ext.B8 is the photocopy of the Surveyor’s Report dated 25.8.2003. <br /> <br /> 12. On a perusal of the materials on records, there is no dispute regarding the death of complainant’s husband S. Purushothaman and the existence of a valid insurance policy at the time of the death. The only question is whether the death was due to an accident or not and whether the complainants are entitled to get the insurance claim and whether the opposite parties’ repudiation alias the delay in settling the claim is justifiable or not. The negative stand taken by the opposite parties are justified by saying that the complainants are not furnished the clarifications demanded by them. The first clarification demanded by the opposite parties is with regard to the difference in the date of death of the deceased seen on various documents. According to the opposite parties, the date of death seen on Ext.A14 is 6.11.2001 whereas the other documents like Inquest Report, Post-mortem etc. is 8.11.2001. With regard to this difference in the date of death, the complainant has stated that it is only a clerical mistake while preparing the Ext.A14 letter. Though the date of death noted in Ext.A14 is 6.11.2001, all other statutory documents shows that the date of death is 8.11.2001. So it is very clear that the date of death of the deceased is 8.11.2001. Moreover, Ext.A14 is only a letter requesting for the issuance of the claim form. That letter and the date noted in it are immaterial for settling the claim and so we are constrained to reject the contentions of the opposite parties in this regard. <br /> <br /> 13. The next clarification demanded by the opposite parties is with regard to the difference in the name and age of the deceased noted in different documents. In the FIR, Inquest Report etc., the name of the deceased is noted as Madhu Purushothaman and his age is noted as 30 years whereas the actual name of the deceased is S. Purushothaman and his age is 58 years as per the original records of the deceased. With regard to this doubts, the complainant has stated that the Inquest Report, FIR etc. were prepared by the police at the spot of the incident on seeing unidentified dead body and on the basis of visiting card, railway reservation ticket and Rotary Club card which were found from the body. The visiting card found from the body was the visiting card of the complainant’s son Madhu Purushothaman. On a perusal of the Inquest Report i.e Ext.A4 it can be seen that the clarifications given by the complainant are genuine and true. So the entries regarding the name and age of the deceased seen on the FIR, Inquest Report etc. have no force as the FIR, Inquest Report etc. are prepared by the police on the basis of the informations gathered from an unidentified dead body. The attestors of the inquest report was also strangers to the deceased. So the demand of clarifications of the doubts about the age and name based on the FIR and Inquest Report of the deceased is baseless.<br /> <br /> 14. The next issue is with regard to the non-production of Chemical Analysis Report of the death of the deceased. But Exts.A2 to A8(a) and Ext.B8 clearly shows that the deceased S. Purushothaman died in an accident by falling down from a running train on 8.11.2001 while he was travelling from Vijayawada to Thiruvananthapuram. Ext.A5 final report prepared by the police officials after the investigation of the case also shows that the death was an accidental death. None of the police records shows any doubts to the cause of the death other than an accidental death. The Chemical Analysis Report is required only when there is a suspicion about the cause of death. In the case of the death of the deceased, the investigation agency and the legal heirs of the deceased have no doubts of the cause of death. The final report in this case filed by the competent authority was also accepted by the concerned Magistrate. In the circumstances, a demand for an unavailable chemical analysis report by the opposite parties is not justifiable and is unwarranted. <br /> <br /> 15. In cross examination DW1 admitted that the death of the deceased was due to an accident on 8.11.2001 and claim form was issued to the complainant fully knowing that the death was caused before one year and the claim will be allowed in belated claim applications, if the claimants shows reasonable grounds for the delay in submitting the claim form which was properly explained in this case. The above admissions by DW1 and Ext.B8 investigation report clearly shows that the claim of the complainant can be allowed. But the opposite parties have denied the claim of the complainant by raising baseless and unreasonable objections. The opposite parties have failed to adduce any evidence for substantiating their contentions. From the deposition of PW1, it is clear that the complainants have made earnest attempts to clarify the doubts of opposite parties. But they have not cared to hear the complainant. <br /> <br /> 16. As per Ext.A1, the policy certificate, the claimant/nominee shall submit the claim form duly completed, death certificate, post-mortem certificate and copy of FIR. In this case, it is proved that all the above documents are submitted before the opposite parties. It is also pertinent to note that the opposite parties have not produced the Master Policy Agreement No.4771060000840 referred in Ext.A1.<br /> <br /> 17. Moreover, the order sheet dated 27.7.2006 and 8.8.2006 of this Forum also shows that this Forum have forwarded the claim form and other documents to second opposite party with the consent of the opposite parties counsel for settlement. Even after this also the opposite parties evaded the payment. <br /> <br /> 18. On the basis of the above discussions and on the basis of the materials on record, we do not find any laches on the part of the complainant in making a valid and a proper claim before the opposite parties and we find that the opposite parties are solely responsible for the non-settlement of the complainant’s claim. So we hold that the opposite parties have committed gross deficiency of service to the complainants by not settling the claim. In the circumstances, the complaint is allowable. Considering the nature of the deficiency of service of the opposite parties, the complainants are entitled to get reasonable compensation, cost and interest. <br /> <br /> <br /> <br /> 19. In the result, the complaint is allowed, thereby the opposite parties are directed to pay an amount of Rs.3 lakhs (Rupees Three lakhs only) to the complainants as the legal heirs of the deceased being the insurance claim amount with interest at the rate of 10% per annum from the date of filing of this complaint with a compensation of Rs.10,000/- and cost of Rs.2,500/- (Rupees Two thousand five hundred only) within one month from the date of receipt of this order, failing which the interest at the rate of 12% per annum will follow till the whole paymount.<br /> <br /> Declared in the Open Forum on this the 31st day of October, 2008.<br /> <br /> (Sd/-)<br /> Jacob Stephen,<br /> (President)<br /> <br /> Smt. C. Lathika Bhai (Member) : (Sd/-)<br /> <br /> Sri. N. Premkumar (Member) : (Sd/-)<br /> <br /> Appendix:<br /> <br /> Witness examined on the side of the complainants:<br /> PW1 : Madhu Purushothaman.<br /> Exhibits marked on the side of the complainants:<br /> A1 : Photocopy of the Janata Personal Accident Policy Certificate. <br /> A2 : Photocopy of the FIR. <br /> A3 : Photocopy of the Rough Sketch. <br /> A4 : Photocopy of the Inquest Report. <br /> A5 : Photocopy of the Final Report submitted by the Sub Inspector of <br /> Police before the Court of Executive Magistrate, Tiruttani. <br /> A6 : Photocopy of the Post-mortem Certificate. <br /> A7 : Death Report. <br /> A8 : Photocopy of the Journey-cum-reservation ticket. <br /> A8(a) : Photocopy of the excess fare ticket. <br /> <br /> A9 : Photocopy of the Identity Card of Rotary Club, Ranni. <br /> A10 : Photocopy of the name slip of Matha Silk House, <br /> Pazhavangadi P.O., Ranni. <br /> A11 : Original Death Certificate dated 3.1.2002 issued by the Tahsildar, <br /> Taluk Office, Tiruttani. <br /> A12 : Photocopy of the Electoral Identity Card of the deceased S. <br /> Purushothaman bearing No.KL/14/111/057548. <br /> A13 : Original Ration Card (Old) bearing No.41011 of the deceased and <br /> his family. <br /> A14 : Photocopy of the letter sent by the complainant to the second <br /> opposite party for sending the claim form. <br /> A15 : Photocopy of the newspaper cutting in Mathrubhoomi daily <br /> dated 9.11.2001. <br /> A16 : Photocopy of the claim form. <br /> A17 : Certificate-dated 22.1.2005 issued by the Village Officer, <br /> Pazhavangadi. <br /> A18 : Letter issued by Ranni Branch Office of the LIC settling the claim <br /> of the first complainant as per policy No.041296187.<br /> Witness examined on the side of the opposite parties:<br /> DW1 : Satheesan.<br /> Exhibits marked on the side of the opposite parties:<br /> B1 : Photocopy of the letter-dated 25.11.2002 sent by the second <br /> opposite party to the complainant. <br /> B2 : Photocopy of the Janata Personal Accident Insurance Claim Form. <br /> B3 : Photocopy of the letter-dated 6.2.2003 issued by the second <br /> opposite party to the complainant. <br /> B4 : Photocopy of the letter-dated 19.6.2003 issued to the complainant <br /> by the second opposite party. <br /> B5 : Photocopy of the letter-dated 5.9.2003 issued by the second <br /> opposite party to the complainant. <br /> B6 : Photocopy of the registered letter dated 25.3.2004 sent by the <br /> second opposite party to the complainant. <br /> B7 : Janata Personal Accident Insurance Policy issued by the opposite <br /> parties to the complainant’s husband. <br /> B7(a) : Relevant portion of Ext.B7 insurance policy. <br /> B8 : Photocopy of the Report on Investigation. <br /> (By Order)<br /> <br /> Senior Superintendent.<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />