DOF.28.8.2010 DOO.26.4. 2011 IN THE CONSUMER DISPUTES REDRESSAL FORUM, KANNUR Present: Sri.K.Gopalan: President Smt.M.D.Jessy : Member Dated this, the 26th day of April 2011 CC.238/2006 Vilasini.C, Chathoth House, Vethilapalil Vayal, P.O.Thana, Kannur 12 Complainant 1.The Branch Manager LIC of India, Kannur. 2. Senior Divisional Manger, LIC of India,Calicut. Rep. by Adv.R.Shyamkumar) Opposite parties O R D E R Sri.K.Gopalan, President This is a complaint filed under sectin12 of consumer protection Act for an order directing the opposite parties to pay double benefit amount `1,07,212 with 12% interest. The case of the complainant in brief is as follows: Mr.Manoharan who was a holder of life Insurance policies died on 10.4.2000 in an accident by hitting something projected from the West cost express while he was walking to his house through the right side of the railway line. The complainant is the sister of deceased Manoharan, who was having three policies. The complainant has already received `1.07, 212 as the policy amount. Double accident benefit is not received since the death was due to an accident the complainant is entitled to get double benefit under the policy. Similarly in O.s.No.279/2002 of Principal Sub Court, Thalassery the opposite party agreed to pay the double benefit, after producing the postmortem report as well as the FIR and final report. Though complainant filed all the documents the opposite party did not pay the claim amount. So lawyer notice was sent to opposite party. In the reply notice dt. 17.3.05 the opposite party requested to produce police inquest report and the final police investigation report so as to pay the benefit.When all documents were produced they turned again with a final reply dated 21.1.2006 stating that the said death is a suicide. The complainant is entitled for the double accident benefit. The allegation of opposite parties that the death was suicide is only intended to deny the double benefit. Hence this complaint. Pursuant to the notice opposite party entered appearance and filed version jointly denying all the claims and allegations. The contention of opposite parities is as follows: Complainant has taken the policies and the basic sum assured has been paid to the complainant. The life assured Manoharan died not as a result of accident but it was a case of suicide. The FIR shows the circumstances of the alleged incident. The time at which the deceased left the house and the back ground of the court verdict indicates that it was a suicide. The final investigation report has proclaimed the death as “suicide’. The double accident benefit was denied as the death was due to suicide. No representations were made by the claimant initially for Accident benefit. Obviously knowing that it is a case of suicide. Though the death took place in the year 2000 and the requirements of consideration of double Accident Benefit were called for but it was not submitted. After five years a lawyer notice served and the documents submitted through an Advocate. The final investigation report in Cr.NO.48/2000 declared the death as suicide. The sub Divisional Magistrate has closed the final investigation report filed by the police, treating it as a death by suicide. The additional sum assured for accidental death was not paid as the life assured had committed suicide by jumping in front of a running train. The complainant is not legally entitled for the double accident benefit hence to dismiss the complaint. On the above pleadings the following issues have been taken for consideration. 1. Whether there is any deficiency on the part of opposite party? 2. Whether the complainant is entitled for the relief as prayed in the complaint? 3. Relief and cost. The evidence consists of PW1, DW1 and Exts. A1 and A2 and B1 to B14. Issue Nos.1 to 3 Admittedly the deceased Manoharan the brother of the complaint held three Life Insurance policies and the complainant received the amount `1,07,212 as basic sum assured from the LIC. The case of the complainant is that opposite party is liable to pay Double accident benefit and she has not been paid yet. Opposite party contended that complaint is not entitled for the amount since the death occurred due to suicide. The crux of the subject matter depends upon the question of cause of death of policy holder. If it is proved that the death is suicide the complainant is not entitled to get the benefit prayed for. Hence the ultimate question is whether the benefit has been denied upon proving the death as suicide or not/ The case of the complainant is that the double accident benefit of all the three policies were excluded when the claim was settled by the opposite party for an amount of `1,07,212 .Several claims were made including lawyer notice but opposite party repudiated the claim on the ground that the death of the policy holder was a suicide. It was only a false invention to avoid the legitimate claims of the complainant. Opposite party contended that the death of the policy holder Mr.Manoharan was not due to accident but because of committing suicide. So the complainant is not entitled for the double accident benefit. Complainant field chief affidavit in lieu of chief examination in tune with the pleadings. She has adduced evidence by way of chief affidavit that the life assured happened to die as a result of accident by a hit with the West cost express while he was walking to his house. The contention of opposite party that Mr.Manoharan has committed suicide because of the reason of the order inM.C.159/1998 has no basis at all. She has further stated that there is no meaning in saying that she has not applied for Accident Claim earlier since opposite party has not informed the complainant to apply for the accident Benefit claim separately. Complainant as PW1 has admitted in cross examination that claim has not been submitted earlier since she was not aware of the necessity of submitting the claim separately. She has also deposed that the LIC has asked her to submit postmortem and final report for consideration of Double Accident claim. She deposed further that Double Accident Benefit was claimed through lawyer notice. She has also denied by deposing that it is not true saying that claim was not given earlier since she was not entitled for the Double Accident claim. The opposite parties by their affidavit evidences stated that no representation was made by the claimant initially for Accident Benefit obviously knowing that it is a case of suicide. It is also stated that the final Investigation report clearly declare the death is suicide and SDM, Thalalssery has closed the report treating it as a death by suicide. This complainant is filed a test case to grab money from opposite party. It can be seen that opposite party relied mainly upon Ext.A1 FIR,Ext.B10 final report so as to establish that the death of his life assured caused as a result of suicide. Ext.B9 FIR recorded thus “ 10.4.2000 XobXn cm{Xn 22.00 aWn-¡pT 22.40 aWn-¡pT CS-bn-ep-f-f tFtXm ka-b¯v I®qAT-iT sh¯n-e-¸-ffn hb F¶-e¯v sh¨v at\m-l-c³, hb-44 F¶-bmA_-²-¯n sh tIm FIvk-{] s{Sbn³ X«n ]cn-t¡-Xns\ XpS#182;v ac-W-s¸«p F¶pT a-ap-f-f-Im-c-yT” The statement given also shows thus:’ cm{Xn F´nt\m sdbnÂ`m-K¯v t]mb-t¸mA_-²-¯n s{Sbn³ X«n ]cn-t¡-Xns\ XpS#182;v ac-WT kT-`-hn-¨-Xm-Wv.” There is absolutely nothing to suspect from the facts that can be taken from FIR to come into a conclusion that the Life assured has committed suicide. Nothing has been seen elaborated supporting with clear evidence by the opposite parties to establish that the death was a suicide. The second important document opposite party relied is Ext.B10 Final report wherein it is stated that Cu tIsâ At\-z-j-W-¯n at\m-l-csâ BZ-y-`m-c-y-¡pT Ipªn-\pT Nne-hn\v sImSp-¡m³ hn[n-¨-Xn-s\-Xp-S#182;v ]dª Xob-Xn¡v ]WT tImS-Xn-b AS-¡m³ Ign-bm¯ am\-knI hnj-a-¯m 10--000 Xob-Xn-bn cm{Xn-bn Dt±-iT 22-.00 aWn¡v sh tIm FIvkv{]kv s{Sbn-\n\p NmSn at\m-l-c³ Bl-X-y-sN-bvX-Xm-sW¶v shfn-hm-Ip-¶p. Bb-Xn-\m Rm³Cu tI s{Sbn X«n-a-c-W-s¸-«Xv (Death due to run over) F¶ \ne-bn Xo#168; dnt¸m#171;v ka#184;n-¡p-¶p. The report did not give any indication how does he derived in such a conclusion that it can be assumed the death as suicide. Common sense does not permit that the report has concluded on the basis of concrete evidence. Even if considered order of the court pronounced against Life assured it is not an incident that fallen on his head all on a sudden.,the close analysis Ext.A1 reveals that Mr.Manoharan had admitted in his counter statement that the 1st complainant therein had been lived together with him and second complainant was his daughter born to her. So the only case of Manoharan was that she was not his legally wedded wife. Under such circumstances even if maintenance is ordered by a court, in the usual course there is no possibility to be boosted the feeling to such an extent, as far as a man of ordinary purulence is concerned to commit suicide as he is a man who is having an employment. Hence there is no meaning in depending on that reason to jump into conclusion that the death is suicide. There is nothing unusual to understand that such sort of recording the statement of police has not been actually backed by convincing evidence that in the natural course leads to conclude that the death is suicide. The circumstances under which the file has been closed if analyzed it can seen that police was interested to close the file in such a way avoiding complications and suspicions and it can never be taken as a finding based on facts and evidences. Thus the argument of learned counsel for opposite parties that the death is a suicidal one cannot be accepted so as to reject the prayer of the complainant. The opposite parties cannot claim that they have proved that the death is suicide showing that statement of final report of police. An insurance claim can only be rejected in cases like this only if opposite party is succeeded in discharging the burden of proving the contention that the death was suicide beyond doubt. No condition empowers the insurance company to repudiate the legitimate claim of the claimant on nearly presuming the death is suicide. It is a fact that the investigation in the alleged death was completed from the very outset itself. So the conclusion also derived without detailed investigation. Hence a finding without such a detailed investigation is not acceptable for the purpose of rejecting the insurance claims. Under the existing circumstances with the available evidence the death has to be treated as Accidental run over as far as the claim is concerned. DW1in his own examination deposed that it is true that the death due to accidental run over by train will come under accident. He has also stated that in such a case the company is liable to pay all benefits including double accident benefit. DW1 further stated that he has sent the claimant letter asking her to submit additional documents and meanwhile somebody else filed suit for the benefit of the said three policies and company also had been waiting for the verdict of the court. He has further stated that incase the case is finding in favour of complainant the company has to pay `85000 more. In the light of the above discussion we are of the opinion that the insurance company is liable to allow the claim of the complainant i.e. Double Accident benefit and to be free from attempting to prevent it on the technical ground of delay etc., forgetting the moral obligation of opposite party to give guidance to act the complainant from the very beginning. The level of understanding of the insured people creates certain degree of over burden without which the equilibrium of natural justice could not be maintained in a developing society as that of ours. Hence we have no hesitation to find that the complainant is entitled for the Double Accident benefit. Policy condition 10-2(b) specifically states that the corporation agrees in his case of death of the Life Assured to pay an additional sum equal to the sum assured under this policy. The amount assured in the above said three policies comes to B1 policy `50000 +B2 policy `25,000 + B3 policy `10000 = `85000. It is therefore the complaint is entitled for 85000 as the benefit of Double Accident Benefit claim. Thus the issues 1 to 3 are found in favour of complainant and order passed accordingly. Complainant is also entitled or an amount of `1000 as cost of this litigation. In the result, the complaint is allowed directing the opposite parties to pay an amount of `85000 (Rupees Eighty Five thousand only) as Double Accident Benefit together with `1000 (Rupees One Thousand only) as cost of this proceedings to the complainant within one month from the date of receipt of this order, failing which the Opposite parties are liable to pay 12% interest from the date of order till payment. The complainant is at liberty to execute the order against opposite parties as per the provisions of consumer protection act. Sd/- Sd/- President Member APPENDIX Exhibits for the complainant A1. Copy of the counter statement filed by Manoharan in M.C.159/1998. A2. Copy of the refer notice. Exhibits for the opposite party: B1. to B3. Copy of the policy No.791492884, 791492948 and 792373484 issued to complainant B4 to B6. Receipts dt.9.5.2000 issued to complainant B7. Copy of the letter sent to complainant. B8. Copy of the petition with order in PJA.NO.21/2000 dt.12.10.00. B9. Copy of FIR in crime No.48/2000 B10. Copy of final report with postmortem certificate in crime No.48/2000 B11. Copy of plaint in O.S.279/02
B12. Copy off written statement of OP. in OS.279/2002 B13. Copy of Decree in O.S.279/2002 dt.15.6.04. B14. Copy of judgment in O.S.279/2002 dt.15.6.04. Witness examined for the complainant PW1.Complainant Witness examined for the opposite party: DW1.B.Subba Naik /forwarded by order/ Senior Superintendent Consumer Dispute Redressal Forum, Kannur.
| | [HONORABLE PREETHAKUMARI.K.P] Member[HONORABLE MR. GOPALAN.K] PRESIDENT[HONORABLE JESSY.M.D] Member | | 
