Date of filing : 23-10-2009 Date of order : 30-09-2010 IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD C.C. 174/08 Dated this, the 30th day of September 2010 PRESENT SRI.K.T.SIDHIQ : PRESIDENT SMT.P.RAMADEVI : MEMBER Nafeesa, W/o. Late.Mohammed Mahmood, Arthipalla House, Badiaduka, } Complainant Po.Perdala, Kasaragod.Dist. (Adv.C. Ravikumaran Nair, Kasaragod) The New India Assurance Company Ltd, } Opposite party Kottarathil Building, Palayam, Thiruvananthapuram. (Adv.A.C. Ashok kumar, Kasaragod) O R D E R SRI.K.T.SIDHIQ, PRESIDENT In paucis verbis the case of complainant Smt. Nafeesa is as follows:- The complainant’s husband Late Mohammed Mahmood was a pravasi Suraksha policy holder issued by opposite party. The policy number is 7605000/06/12/0000396. When he was abroad, on 15-08-2007 while he was crossing a road, one dashing vehicle tried to hit him. He ran away and when he reached his room died due to the shock. This fact was reported by a person accompanying him at the time of death. The dead body was cremated in Saudi Arabia. As per the terms and conditions of policy unmarried children are entitled for `50,000/- each below the age of 25 years and for education of the children as educational grant. A further sum of `50,000/- each shall be paid as marriage grant to 2 unmarried daughters below the age of 25 years. Thus total amount of `1,00,000/- is pending due from opposite party. The daughter of the complainant is 20 years and entitled to the amount for her marriage and the son is entitled for the educational grant. Though a notice was issued on 25-04-08 the opposite pay did not pay the amount. The elder daughter of the complainant is already married and the son is studying in standard VII. Therefore the complaint praying for an order against opposite party directing them to pay `1,00,000/- as per the policy issued to her husband. 2. The New India Assurance Co.Ltd entered appearance and filed their version. According to them, the death of Mohammed Mohmood was not a death coming within the purview of the policy conditions and the policy issued covers, if the insured person sustain any bodily injury resulting solely and directly from accident caused by violent, outward visible means and if such injury shall be the sole and direct cause of the death of the insured person. The cause of death of the insured person herein was not due to any accident and no bodily injury was sustained to him and it was a natural death. Hence the complainant is not entitled to claim the policy amount. As per condition No.8©(l) of the policy Nafeesa is bound to produce records from police for evidence of accidental death and postmortem certificate etc to prove that the death was due to accident. Nafeesa failed to produce them. The documents produced by Smt.Nafeesa show that the death was not due to an accident but it was a natural death. Hence the complainant is not entitled to any benefit under the policy and the complaint requires a dismissal. 3. The complainant had sent a letter dt.10-09-2007 to the opposite party stating that her husband expired from Riyadh in Saudi Arabia on 15-08-07. But nothing is mentioned about the accident in that letter. If the death was due to an accident it would have been mentioned in that letter. In reply to that letter this opposite party has sent a letter dated 20-09-2007 requesting her to inform about the cause of death and also requesting to send evidence substantiating the cause of death and other relevant documents mentioned in the policy and also informed her the policy is applicable in case of accidental death of the insured person. Along with that letter opposite party enclosed a claim form to be filled duly with supporting documents. But complainant has not returned or complied minimum formalities. The complainant filed CC.10/2008 claiming the amount as per the policy and it is allowed. The complainant ought to have raised all her claims in CC 10./2008 itself. 4. Death of the husband of the complainant was a natural one and complainant has not mentioned the name of the unmarried daughter. In the application form for the policy complainant’s husband mentioned the name of only one daughter. As per the complaint one daughter is already got married. 5. There is no deficiency on the part of opposite parties and hence the complaint is liable to be dismissed. 6. Opposite party filed additional version. In that opposite party contended that the complaint is barred by resjudicata since the matter in issue in this complainant in complaint No CC.10/2008 are same and between the same parties and issues are already decided by the Forum.. 7. Complainant filed proof affidavit and Exts.A1 to A3 marked. Complainant faced cross-examination by the learned counsel for opposite party. On the side of opposite party Exts B1 to B4 marked. Both sides heard. Documents perused. 8. Whether the death of the complainant’s husband was accidental or natural is already decided by the Forum in CC.10/2008 and it is found that death of complainant’s husband is accidental and therefore the opposite parties were directed to pay compensation. But in the complaint CC.10/08 the claim of the complainant was for `5,00,000/- due to them as per clause 1 (1) of the policy that is for the capital sum insured as stated in the policy in case of death of the assured. But in this complaint the claim is under clause 6(a) and 6(b) of the policy. Therefore the contention of the opposite party that the claim of the complaint is barred by resjudicata is not sustainable. 9. Since the main issue is already settled in earlier complaint and the same is confirmed by Hon’ble State Consumer Disputes Redressal Commission in Appeal No.219/2008 as per judgment dated 31-12-2009 further discussions of the said facts and issue is unnecessary in this case. Another contention of opposite party is that in the letter dated 10-09-2007 sent by complainant to opposite party stating that her husband expired at Riyadh in Saudi Arabia on 15-08-07 doesnot contain anything about the accident. According to opposite party had the death been due to any accident then that would have find a place in the said letter. This contention even if accepted doesnot liberate the opposite party from paying compensation since it can be considered only as an omission. The Medical Report of the doctor who examined the dead body of the deceased Mohammad was suggesting that the death is due to halting of breath due to the severe injury sustained in the traffic accident. The said doctor who prepared the medical report may be quite ignorant about the Prvasi Suraksha Policy hold by the deceased and therefore it cannot be hold that doctor prepared a bogus report regarding cause of death of deceased to get benefits to the dependants of the deceased. It is relying on that certificate the earlier complaint was decreed in complainant’s favour. Therefore the omission to note that aspect in the notice would not be fatal to the claim of the complainant. 10. The complainant is claiming `50,000/- under clause 6(a) and `50,000/- under clause 6(b). As per that in case of accidental death of the insured person employed abroad an amount of `50,000/- each shall be paid to 2 dependent children as educational grant if they are unemployed and below the age of 25 and with proof of continuing education for a govt/university recognized course. In the case of a minor, payment will be made to the nominee shown in the enrolment form or guardian with an undertaking that fund will be utilized for the intended purpose. Complainant produced Ext.A2 certificate issued by Head Mistress of G.B.U.P.S Perdala to prove that her minor son Mohammed Haseem .M. is studying in VII standard of the said school. Ext.A2 makes it clear that complainant is entitled for `50,000/- as per clause 6(a) of the policy. 11. Ext.A3 is the photocopy of S.S.L.C of Jameela, the daughter of complainant According to complainant Jameela is unmarried and hence she is entitled for 50,000/- as per clause 6(b) of the policy. 12. The opposite party has not produced any document to rebut the claim of the complainant under clause 6(b). 13. Therefore the complainant is entitled for `1,00,000/- under clause 6(a) 6(b) of the Pravasi Suraksha Policy issued to Mohammed Mahmood. In the result, complaint is allowed and opposite party is directed to pay `1,00,000/- to the complainant. Before disbursement of the amount complainant shall give an undertaking to opposite party that the sum of `50,000/- given as educational loan to her minor son will be utilized for his education purpose only. Time for compliance is 2 months from the date of receipt of copy of the order. Failing which opposite party shall pay interest @ 9% for `1,00,000/- from the date of complaint till payment. Sd/- Sd/- MEMBER PRESIDENT Exts. A1. Photocopy of Pravasi Suraksha Kuduma Arogya Scheme enrolment form.No.4189 of Mohammod Mahmood. A2. SSLC true copy of Jameela.M. A3. 21-10-08 Certificate issued by Headmistress, GBUPS, Perdala. B1. Photocopy of policy. B2. 10-09-07 letter sent by complainant to opposite party. B3. 17-09-07 copy of lawyer notice. B4. 10-09-07 letter issued by OP to complainant. PW1. Nafeesa. Sd/- Sd/- MEMBER PRESIDENT Pj/ Forwarded by Order SENIOR SUPERINTENDENT | 
