GUWAHATI OMBUDSMAN CENTRE Complaint No. 11-G2-025/13-14 Mrs. Saraswati Dey – Vs – The National Insurance Co. Ltd
Insurance Ombudsman Date of Order : 03.03.2014Complainant: The Complainant stated that her husband Shyamal Dey procured Group Janata Personal Accident Insurance Policy No. 100300/47/01/9600022/03/96/30415 from the National Insurance Co. Ltd. through Golden Multi Services Club of G.T.F.S, Agartala covering the period from 01.03.2004 to 28.02.2019. While the policy was in force, her husband Shyamal Dey was murdered by unknown miscreant on 06.07.2010. Dead body was found next day morning near the house of Anadi Deb at Maharanipur under Teliamura P.S. In this regard Police case was registered against the unknown miscreant vide TLM P.S. case No. 60/10 dated 07.07.2010 under section 302 I.P.C. Post mortem was done on 07.07.2010 at Teliamura Hospital, Teliamura. Thereafter, the Complainant, being the nominee under the policy, lodged a claim before the Insurer along with all supporting documents. But, the Insurer has repudiated the claim on the ground that death of the Insured was not resulted solely and directly from any accident caused by external visible and violent means. Being aggrieved, she has filed this complaint. Insurer : The Insurer has stated in their “Self Contained Note” that they received a claim from the nominee under Policy No. 100300/47/01/9600022/03/96/30415 stating that the insured Shyamal Dey died on 07.07.2010. The said claim was repudiated vide their letter dated 26.07.2012. It is not a case of accident because no FSL report was submitted. The documentary evidences prove that the death of the Insured was not resulted solely and directly from any accident caused by external visible and violent means. Decision : I have carefully gone through the entire documents available on record. The copy of the policy document has been furnished to this Authority which shows that Mr. Shyamal Dey was the insured under the above policy covering the period from 01.03.2004 to 28.02.2019 wherein Mrs. Saraswati Dey was made the nominee. The scope of covered under the policy were – ‘Death, Permanent total disablement, Loss of Limbs, Loss of Eyes of Insured Person resulting solely and directly from accident caused by external visible and violent means, subject to terms, conditions, exclusions of J.P.A. Insurance’. The Complainant has submitted a copy of Death Certificate issued by the Additional District Registrar, Birth & Death, Teliamura R.D. Block which discloses that the Insured Shyamal Dey died on 07.07.2010. The copy of the F.I.R. relating to the Teliamura P.S. case No. 6/10 dated 07.07.2010 shows that dead boy of Shyamal Dey was found on 07.07.2010 at Maharanipur, near the house of Anadi Deb, Teliamura PS. The Complainant has produced the copy of Police Report before this Authority which shows that a dead body of one Syamal Dey was found lying at Maharanipur in a road side ditch near the house of one Anadi Deb. A nylon rope was fastened with the neck of the deceased and it was suspected case of murder. The information was recorded in G.D. Register vide TLM P/S GDE No. 288 of 07.07.2010. It is further stated in the Police Report that in course of investigation, received SFSL Report and Postmortem Report, they opined that the cause of death is strangulation. In this connection, Police arrested three accused persons namely Joydeep Deb, Samir Kanti Deb and Santosh Sarkar. Postmortem examination on the dead body of Shyamal Dey was also done on 07.07.2010 at Morgue, Teliamura Rural Hospital on being referred by Police and the report of the Postmortem examination discloses that the attending Doctor found that the cause of death is Cardio Respiratory Failure following strangulation. It is crystal clear from the above documents that the cause of death of the Insured Shyamal Dey was strangulation. So, it was a pre-plan murder case therefore it cannot be said to be an accident case. In the policy document, murder is not covered. As per terms and conditions of the policy, the Complainant is not entitled to get the claim amount. Considering the entire facts and circumstances, I am of view that the Insurer has rightly repudiated the claim of the Complainant as the death of the Insured was not resulted solely and directly from any accident caused by external visible and violent means. Finding no ground to interfere with the decision of the Complainant, the complaint is treated as dismissed and is treated as closed.