P.Q. Barkath Ali, President
This is an appeal filed Under Section 15 of Consumer Protection Act 1986 by the opposite parties, Life Insurance Corporation of India in CC.No.191/2011 on the file of Consumer Disputes Redressal Forum, Wayanad challenging the order of the Forum dated 17/03/2012 by which the Forum directed the appellant to pay to the complainant Rs.1,50,000/- being the accident benefit due under a policy taken by Sudheer, the brother of the complainant who died in an accident.
The case of the respondent / complainant as testified by him as PW1 and as detailed in the complaint before the Forum is brief is this:
PW1, the complainant is the nominee of an accident benefit policy, Ext.B1 dated:25.04.2004 of his brother Sudheer. The sum assured was Rs.1,00,000/- with bonus. The condition of the policy is that if insured dies in an accident, the nominee will be entitled to an additional amount equal to the sum assured plus bonus. Another condition is that if the insured dies 6th to 10th year of policy, the nominee will be entitled to an additional amount equal to half of the sum assured. On 01/04/2010, the insured fell down in the bathroom in the house of his friend PW2 and sustained serious injuries on the head. While undergoing treatment at Pariyaram Medical College he died on 04/04/2010. Payyannur police has registered the case as Crime No.283/2010. The postmortem finding is that insured died as a result of the head injuries sustained in the accident. Rs.1,74,520/- was paid to the complainant being the sum assured plus bonus, but the accident benefit was rejected on the ground that insured died not in an accident.
The first appellant / first opposite party is Wayanad Branch of Life Insurance Corporation of India and the second appellant / second opposite party is its Divisional Manager at Kozhikode. They in their version contended thus:
On the death of the insurer Rs.1,74,520/- was paid to the complainant who is the nominee of the policy being the sum assured and Rs.50,000/- being the special benefit as the person died after 5 years of this policy with bonus. The insured fell down in the bathroom of his friend PW2 due to giddiness and he died while undergoing treatment in the hospital which cannot be treated as an accident. Therefore, the claim for additional sum of Rs.1,00,000/- was denied therefore the complaint may be dismissed.
PWs1 to PW3 were examined, Exts A1 to A7 were marked on the side of the complainant and OPW1 was examined and B1 was marked on the side of opposite parties before the Forum. On an appreciation of evidence the Forum found that insured died in an accident and that therefore the complainant is entitled to an accident benefit under the policy and directed to the appellants to pay Rs.1,50,000/- being the accident benefit with interest and a cost of Rs.1500/-. The opposite parties challenge the said order in this appeal.
Heard the counsels of the both sides.
The following points arise for consideration:
1. Whether the insured died in an accident?
2. Whether the impugned order of the Forum can be sustained?
The main question which arises for consideration is whether the death of the insured is an accidental one or not. The relevant condition in Ext.B1 policy is 10(2) (b) which provides that the accident must have been caused by outward, violent and visible means. Based on the above condition the counsel for appellants submitted that the insured fell down and sustained injuries which cannot be considered as an accident involving outward violent and visible means.
I unable to agree. The evidence of PW1 the complainant, PW2 the friend of deceased in whose house the accident has happened, PW3 the doctor who conducted postmortem shows that the injured fell down in the bathroom and sustained injuries on his dead causing his death. In my view such an accident has to be considered as an accident involving outward, violent and visible means as provided under condition 10(2) (b) of the policy. That being to the complainant is entitled to the accident benefit under the policy Ext.B1. The findings of the Forum on this point is confirmed.
There is another aspect in this matter. The Lower Court has ordered Rs.1,50,000/- treating it as the sum assured. On going through Ext.B1 policy it is that the sum assured in the policy is Rs.1,00,000/- only. Therefore the complainant is entitled only Rs.1,00,000/- as the accident claim benefit being the additional amount equal to sum assured interest and cost as ordered by the Forum Rs.50,000/- being the special benefit due to complainant as insured died after 5 years of the policy has already been paid by the company
In the result, the appeal is allowed in part. The appellant/ opposite party is directed to pay to the complainant Rs.1,00,000/- with interest 10% and cost of Rs.1,000/- as ordered by the Forum. In this appeal the respondent / complainant is entitled to a cost of Rs.3,000/-.