C.F. CASE No.                      :            CC/2013/70

COMPLAINANT                              Sundari Bibi

                                                W/o Lt. Sk Kalam,

                                                Vill. & P.O. Debkunda,

                                                P.S. Beldanga,

                                                Dist. Murshidabad,

                                                Pin - 742123

• Vs  –

OPPOSITE PARTIES / OPs:   1)     Branch Manager

                                                LICI

                                                Krishnagar Branch -1   

                                                5/1A, D.L. Roy Road,

                                                P.O. Krishnagar, P.S. Kotwali,

                                                Dist. Nadia, Pin – 741101

                                         2)        Branch Manager

                                                LICI, Diamond Harbour Branch

                                                Municipal Market Complex,

                                                P.O. & P.S. Diamond Harbour

                                                 South 24 Parganas

                                                 3)          Divisional Manager,

                                                LICI

                                                Jeevan Tara,

                                                KMDO –II

                                                Diamond Harbour Road,

                                                Kolkata - 700053

PRESENT                : SHRI PRADIP KUMAR BANDYOPADHYAY, PRESIDENT

   : SMT REETA ROYCHAUDHURY MALAKAR, MEMBER

   : SHRI SHYAMAL KUMAR GHOSH,          MEMBER

DATE OF DELIVERY                                             

OF  JUDGMENT                         :  03^rd March, 2014

:    J U D G M E N T    :

The case was filed under Section 12 of the Consumer Protection Act, 1986 on 15^th July, 2013.  The facts of the case, to put, in a nutshell, are as below:-

The complainant, Sundari Bibi, W/o Sk. Kalam is the complainant and the Branch Manager of Krishnagar and Diamond Harbour and the Divisional Manager of LICI are three OPs.   The complainant Sundari Bibi has pleaded that her husband Sk Kalam since deceased had purchased an insurance policy of LICI with sum assured of Rs.1,00,000/- and accidental benefit of the sum assured was Rs. 1,00,000/- vide policy No.579198569 and proposal No.50349 dtd. 29.03.10.   At the time of purchase of the policy Sk Kalam was hale and hearty during the continuation of the policy Sk Kalam died on 30.09.10 due to assault upon him.  The complainant is the nominee of the policy.  The OP No. 2  sent a cheque of Rs.1,15,950.58 to satisfy the sum assured when the claim was lodged through claim form No. B/1 etc.  The complainant again sent an application on 01.04.13 to the OPs with a request to settle her accidental benefit for the sum assured of Rs. 1,00,000/-.  The OPs repudiated her second claim as it was a case of murder.  Thus, the OPs caused physical and mental agony to the complainant and the OPs are guilty of deficiency in service and the complainant has prayed for damages of Rs. 50,000/-.   She has also prayed for accidental benefit of Rs. 1,00,000/- and interest of Rs. 12% from the date of death of the policy holder.  She has also prayed for cost of the suit.

The opposite parties filed written version jointly.  The case of the OPs is as below:-

            Sk Kalam did not die in an accidental murder.  Sundari Bibi was nominee.  She suppressed the cause of death before the OPs.  The Beledanga P.S. case No. 283/10 under Section 324/325/326/304/506/34 IPC and a charge-sheet go to show that there was an altercation between Sk Kalam and the miscreants and that might have led to offence.  There is discrepancy regarding place of occurrence.  The petitioner settled the case as per policy condition and received Rs.1,15,950.58.  Hence, the case should be dismissed. 

            An affidavit was filed by Chief Manager, LICI Krishnagar – I on 10^th December, 2013 serving copy to the complainant.  No affidavit is forthcoming from the side of the complainant.  From the pleadings of the parties the following points are framed for consideration and decision:

POINTS FOR DECISION

1. Can the murderous assault upon the insured be termed as accidental injury as per policy?
2. What relief the complainant is entitled to get?

REASOND DECISIONS

            For the purpose of brevity and convenience both the points are taken up together for discussion.

            Both parties filed written argument to assist the Forum.  The following documents are filed by the parties:-

1. LICI policy along with terms and conditions – annexure –A

Complainant filed the following annexed documents.

1. LICI Insurance Policy – Annexure - 1
2. Death claim letter by Sundari Bibi – Annexure – 2
3. Medical Attendants Certificate – Annexure – 3
4. Certificate of Hospital Treatment – Annexure – 4
5. Status report of policy – Annexure – 5
6. FIR – Annexure - 6
7. Final Report – Annexure – 7
8. Death Certificate – Annexure - 8 & Post Mortem Report Annexure – 8/1

9. Letter of Sundari Bibi to the LICI – Annexure – 9
10. Letter from Sundari Bibi to the LICI – Annexure – 10
11. A lawyer’s notice from complainant – Annexure – 11
12. Letter from Sundari Bibi to the LICI – Annexure – 12
13. Letter from LICI to the complainant’s advocate – Annexure – 13

The following case laws have been referred by the complainant:-

2012 (1) CPR 93, National Consumer Disputes Redressl Commission, New Delhi,  Revision Petition No. 2824 of 2007. 

Ld. Advocate for the opposite party Sri Raj Kumar Mandal has submitted the following case law:-

3 (2006) CPJ 213 NC

 We have gone through the case laws filed by the ld. Advocates for both sides in the background of the annexed documents and one affidavit-in-chief filed by the OP.

In the affidavit-in–chief by the manager, LICI, Krishnagar – I it has been stated that the insured victim was murdered in a pre-planned manner by the miscreants and the miscreants had the intention to murder Sk Kalam.  In the affidavit-in-chief we also find that the ground of repudiation was given by the OP.  The case was settled and the OPs paid Rs.76,763/- to the claimant, it is stated in the affidavit.

            No document is forthcoming to establish the full and final settlement of the claim with the petitioner.  Hence it is clear that the double accident benefit was not settled by the LICI, the OP.

            Now, the question is whether clause 11(b) of the policy document of LICI’s Jeevan Saral covered the present death of the life assured. 

            We have gone through the policy document carefully and we find that in clause 11(b) there is a clause of covering death of the life assured.  It runs:- “To pay an additional sum equal to the Accident Benefit Sum Assured under this policy.  If the Life Assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of its occurrences solely, directly and independently of all other causes result in the death of the Life Assured.  However, such additional sum assured payable in respect of this policy, together with any such additional Sums payable under other policies on the life of the life assured, shall not exceed Rs. 50,000.00.”

            The judgment of revision petition 2824 of 2007 helps the petitioner in the instant case.  We have seen that judgment referred in Halsbury’s Laws of England.

            The meaning of accident an accidental injury as contemplated in Halsbury’s Laws of England is proximate and similar with clause 11(b) of the policy document.

            No murder by design could be established by the OP.   Rather the complainant has proved that Sk Kalam died due to accidental injuries of murderous assault.  The starting of Beldanga P.S Case No. 283/2010 under Section 324/ 325/ 326/ 304/ 506/34 IPC and the Post Mortem report (Annexure-8/1) go to show that the hurt was voluntarily but the intention of the hurt was not of causing murder.  The victim did not die then and there on the spot according to the FIR “annexure – 6”.  The victim was taken to Beldanga Block PHC and he was referred to Berhampore New General Hospital, thereafter and ultimately he was being taken to Calcutta for treatment and on the way Sk Kalam succumbed to his injuries.  The accident took place on 29.09.10 between 5.30 and 6 am and the victim breathed his last on 30.09.10, the next day on the way to Calcutta for better treatment.  Evidence regarding conspiracy or design is not available.  Hence, we are of the opinion that the clause 11 (b) of the policy document protects the victim and, in turn, the complainant as nominee.

            The additional sum of accident benefit shall not exceed Rs. 50,000/- according to the term and hence, the claimant is entitled to get Rs. 50,000/- as an additional sum of accidental benefit.  Thus, we hold that the assault injury was accidental as per policy condition No. 11(b) and the complainant is entitled to get relief. 

            The complainant is entitled to get Rs. 50,000/- and not Rs. 1,00,000/- as per written condition of the policy.  This will go to the claimant as additional benefit as contemplated additional benefit in 11(b) of the policy document.

            The complainant is also entitled to get Rs. 5,000/- as compensation for his mental agony and he is also entitled to get Rs. 1,000/-as litigation cost.

Hence,

Ordered,

That the case CC/2013/70 be and the same is allowed on contest.  The complainant is entitled to get Rs. 50,000/- as additional death benefit along with Rs.5,000/- as compensation for his mental agony and Rs. 1,000/-as litigation cost.  The OPs LICI is directed to pay the decretal amount to the complainant within a period of one month since this day, in default the payment shall carry interest @7% per annum from this date till the date of realization of the full amount. 

Let a copy of this judgment be delivered to the parties free of cost.