Kerala

Idukki

CC/105/2018

Salini Biju - Complainant(s)

Versus

Branch Manager Life Insurance Co operation of India - Opp.Party(s)

30 Apr 2019

ORDER

DATE OF FILING :02/07/2018

IN THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 30^th day of April 2019

Present :

SRI. S. GOPAKUMAR PRESIDENT

SMT.ASAMOL P. MEMBER

CC NO. 105/2018

Between

Complainant : 1 . Salini, W/o Late Baiju,

Perumanthadathil House, Kalayanthani,

Alakode presently residing at Ezhalloor P.O.,

Kumaramangalam Village, Thodupuzha.

2 . Aleena Mary P.B., D/o Late Baiju,

A minor represented by her mother and next friend,

Salini W/o Late Baiju, Perumanthadathil House,

Ezhalloor P.O., Kumaramangalam Village,

Thodupuzha.

3 . Aqueena Mary P.B., D/o Late Baiju,

A Minor represented by her mother and next friend,

Salini W/o Late Baiju, Perumanthadathil House,

Ezhalloor P.O., Kumaramangalam Village,

Thodupuzha.

(By Adv: T.J.Augustine)

And

Opposite Party : Life Insurance Corporation of India,

Thodupuzha Branch, Pulimoottil Plaza, Pala Road,

Thodupuzha represented by its Branch Manager,

Thodupuzha.

(By Adv: M.V.Francis)

 

O R D E R

SRI. S. GOPAKUMAR (PRESIDENT)

 

The case of the complainant is that,

 

First complainant is the wife of deceased Baiju Isaac and second and third complainants are their children. The deceased Baiju Isaac was a holder of LIC policy bearing No.393274926 issued by the opposite party. As per the terms of their policy the insurance coverage will be the double amount of the

 

(Cont....2)

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sum assured in cases of accidental death. The sum assured of this policy is Two Lakhs Rupees. While so, the said Baiju Isaac met with an accident on 15/09/16 sustaining electric shock and died. The first complainant claimed the policy benefit. But the opposite party paid only sum assured and denied to pay the accidental benefit on the reason that, the Baiju Isaac died while fishing using electricity, is a breach of law.

 

Complainant further averred that denying the full benefit under the policy amounts to gross deficiency in service. The opposite party sent reply to the legal notice to the complainant stating the above reason at the same time, opposite party has not specified what law is broken by the deceased Baiju Issac. Complainant further stated that, every accident is caused by some sort of negligence by some persons. The opposite party has assured additional benefit in the events of accidental death. The deceased Baiju Isaac has taken the insurance policy with the bonafide belief that the opposite party will act according to their assurance regarding additional benefit is the event of accidental death. The denied of accidental death benefits to the complainants in the violation of the policy condition. Against this the complainants filed this petition seeking relief such as to direct the opposite party to pay the accidental death benefit as per the nature of the policy along with interest, compensation and cost.

 

Upon notice opposite party entered appearance and filed detailed reply version admitting the issuance of the above said policy. In their version opposite party further contented that the life assured had also opted, a rider for accidental benefit, which assures double the sum assured on the happening of death due to accident. Death of the policy holder, Baiju Isaac is occurred due to electric shock while he and his friends were fishing by using electricity from the inverter, in a stream. Here the death of the policy holder was occurred while he was fishing by using electricity, in public water, which he is not authorised to do according to law. As per the policy terms and condition 10 (b) (iv) LIC will not be liable to pay double accident benefit to the life assured, if the death of the life assured shall result from, the life assured committing any breach of law, it is very clear from FIR, FIS, inquest report and post mortem certificate in Crime No.1510/2016. Opposite party further contented that, the act of fishing using electricity from a water body is clearly prohibited by law, because it will cause harm to the user himself and other

(Cont....3)

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people using the public water such as river, stream, pond etc. The policy condition 10 (b) (iv) says that, “the corporation will not be liable to pay the additional sum referred in policy condition 10 (a) or (b) above, if the disability or the death of the life assured shall result from the life assured committing breach of law”. The opposite party is denied the accidental benefit because the life assured had violated the policy condition and terms. Hence there is no deficiency in service from the part of the opposite party is rendering service to the complainants according to terms and conditions upon which the said policy is issued to the life assured.

 

Evidence adduced by the complainants by way of proof affidavit and documents. The first complainant was examined as PW1 and Ext.P1 to Ext.P8 were marked. Ext.P1 is the Renewal Premium receipt, Ext.P2 is the letter from opposite party , Ext.P3 is the FIR of Thodupuzha Police, Ext.P4 is the copy of FIS, Ext.P5 is the copy inquest report, Ext.P6 is the copy of post mortem certificate, Ext.P7 is the reply notice of opposite party, Ext.P8 is the copy of legal notice.

 

From the opposite party side, Manager of the opposite party examined as DW1. Ext.R1 to Ext.R11 marked. Ext.R1 copy of claim payment details, Ext.R2 is the policy proposal form, Ext.R3 is the policy bond, Ext.R4 is the claim intimation, Ext.R5 is the copy of claim settlement advice, Ext.R6 is the copy of FIR, Ext.R7 is the copy of FIS, Ext.R8 is the copy of inquest report, Ext.R9 is the copy of post mortem certificate, Ext.R10 is the legal notice, Ext.R11 is the reply to the legal notice.

 

Heard both sides,

 

The point for consideration is whether there was any deficiency in service from the part of the opposite party, and if so, for what relief the complainant is entitled to?

 

The Point:- We have heard the counsel for both sides and have gone through the records. It is an admitted fact that, the deceased Baiju Isaac, husband of the first complainant and father of the second and third complainants was a policy holder having double accidental benefit. When the policy was in active, the said policy holder died due to accident. The cause of death was, while he

(Cont....4)

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was fishing with his friend by using inverter from a stream sustained electric shock from the inverter and died instantaneously. The matter was intimated to the Thodupuzha police, and on the basis of information given by the brother of the deceased Baiju Isaac, police registered a crime and lodged FIR. Police authorities send the FIR to the Sub- Divisional Magistrate, because it is an accidental death and as directed by the SDM, Post mortem was done. Thereafter the wife of the deceased submitted claim application before the opposite party. Opposite party sanctioned Rs.2 Lakhs being the sum assured and denied to pay the accidental benefit as per the policy. Opposite party denied to pay the accidental benefit on the reason that, the life assured was died due to electric shock while he was fishing by using the electricity in a public stream, which is a breach of law. Opposite party further contented that as per the policy condition 10 (b) (iv), the corporation will not be liable to pay the additional sum referred in the policy condition 10 (a) or (b) above, if the disability or the death of the life assured shall result from the life assured committing breach of law. Here the opposite party pointed out a specific reason for the denied of accidental benefit to the legal heirs of the complainant, that is death caused to the life assured is while fishing by using electricity. As per the police records, the deceased policy holder along with some friend were fishing by using inverter and the policy holder sustained electric shock from the inverter and died. As a usual practice, the matter is intimated to the police and acted as per law. In this case it is very pertinent to note that if the deceased Baiju Isaac and his friend committed a breach of law, police will definitely register a crime against the persons who were accompanied with the deceased Baiju Isaac. In the FIS, the name of the friends are specifically stated by the first informant, the brother of the deceased Baiju Isaac. If it is a breach of electricity Act, the concerned electricity authority will also may take necessary action against the other persons who were accompanied with the deceased. Here the deceased and his friends used inverter for fishing , no direct electric current is used from a street line or house connection. Even though the opposite party repeatedly stated that the act of the deceased was a breach of law, opposite party miserably failed to convince the Forum that as per which law and as per which section the above said act is punishable as alleged. While cross examination DW1 stated that the act of the deceased was breach of electricity Act. But the witness miserably failed to produce the relevant provisions of the electricity Act.

 

(Cont....5)

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Here without sufficient materials to prove the version of denied of the accidental benefit, which legally entitled by the legal heirs of the policy holder, Baiju Isaac, the Forum is not in a position to accept the contentions of the opposite party. Hence the forum is of a considered view that, the denial of the accidental benefits to the complainant without a sufficient and valid grounds amount to deficiency in service on the part of the opposite party.

 

Under the above circumstances, the complaint allowed. Opposite party is directed to pay the accidental benefit of Rs.2 Lakhs of the deceased Baiju Isaac, as per the Ext.P2 policy, along with 12% interest from 15/09/16, the date of death of the policy holder to the nominee, the first complainant within 30 days from the receipt of the copy of this order. The opposite party further directed to pay Rs.3000/- as litigation cost to the first complainant.

 

Pronounced in the Open Forum on this the 30^th day of April, 2019.

 

Sd/-

SRI. S. GOPAKUMAR (PRESIDENT)

Sd/-

SMT.ASAMOL P. (MEMBER)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Cont....6)

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APPENDIX

 

Depositions :

On the side of the Complainant :

PW1 - Salini Baiju

On the side of the Opposite Party :

DW1 - Sreedevi S Nair

Exhibits :

On the side of the Complainant :

Ext.P1 - The Renewal Premium Receipt

Ext.P2 - The letter from opposite party

Ext.P3 - The FIR of Thodupuzha Police

Ext.P4 - The copy of FIS

Ext.P5 - The copy inquest report

Ext.P6 - The copy of post mortem certificate

Ext.P7 - The reply notice of opposite party

Ext.P8 - The copy of legal notice

On the side of the Opposite Party :

Ext.R1 - The copy of claim payment details

Ext.R2 - The policy proposal form

Ext.R3 - The policy bond

Ext.R4 - The claim intimation

Ext.R5 - The copy of claim settlement advice

Ext.R6 - The copy of FIR,

Ext.R7 - The copy of FIS

Ext.R8 - The copy of inquest report

Ext.R9 - The copy of post mortem certificate

Ext.R10 - The legal notice

Ext.R11 - The reply to the legal notice.

 

 

Forwarded by Order,

 

 

SENIOR SUPERINTENDENT