Haryana

StateCommission

A/303/2015

MANJU - Complainant(s)

Versus

DR.SANTOSH BISHNOI AND OTHERS - Opp.Party(s)

SURINDER SHEORAN

13 Jul 2015

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :      303 of 2014

Date of Institution:      17.04.2014

Date of Decision :       02.07.2015

 

Life Insurance Corporation of India through, Manager (CRM) LIC of India, Divisional Office, Sector 17-B, Chandigarh.

                                      Appellant-Opposite Party

Versus

 

Balo Devi w/o Sh. Rajbir, Resident of Village Butana Kundu, Tehsil Gohana, District Sonepat.

                                      Respondent-Complainant

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member                                                                                                                                         

Present:              Shri K.K. Doda, Advocate and Shri Rajneesh Malhotra, Advocate for appellant.

Shri Naveen Singh Panwar, Advocate for respondent.

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

This appeal has been preferred against the order dated March 11^th, 2014, passed by District Consumer Disputes Redressal Forum (for short ‘District Forum’), Sonepat.

2.      Brief facts of the case are that Sunil s/o Rajbir (hereinafter referred to as ‘the assured’) purchased a Life Insurance Policy (Annexure R-3) from Life Insurance Corporation of India (for short ‘LIC’) for Rs.3,15,000/-. The respondent-complainant was nominee in the said policy. The policy commenced from July 28^th, 2010 and the date of maturity was July 28^th, 2030. The installment premium payable was half yearly. The assured died on February 12^th, 2011. The respondent filed claim with the LIC but it did not pay the insured amount.

3.      The respondent-complainant filed complaint under Section 12 of the Consumer Protection Act, 1986.

4.      The appellant-opposite party contested the complaint by filing reply. It was stated that the assured committed suicide and therefore the respondent-complainant was not entitled for insurable benefits and the LIC was not liable to pay any amount to the respondent.

5.      After evaluating the evidence of the parties, the District Forum allowed complaint and issued direction to the LIC as under:-

             “………the complainant is legally entitled to get the claim amount alongwith double accident benefit in respect of the policy No.178684969 from the respondents. Thus, we hereby direct the respondents to make the payment of Rs.6,30,000/- (Rs.six lacs thirty thousands i.e. Rs.3,15,000/- sum assured plus Rs.3,15,000/- accidental benefit) alongwith interest at the rate of 09% per annum from the date of filing of the present complaint till realization. The respondents are also directed to compensate the complainant to the tune of Rs.two thousands for rendering deficient services, for causing mental agony, harassment, humiliation and further to pay Rs.five thousands under the head of litigation expenses.

                        With these observations, findings and directions, the present complaint stands allowed with the direction to make the compliance of this order within one month from the date of pronouncement of this order.”

 6.     Learned counsel for the appellant has argued that the sum assured, that is Rs.3,15,000/- has been deposited with the District Forum vide cheque No.82125 dated 13.05.2014 of Axis Bank Ltd. (Annexure-A) and to that extent there is no dispute. Counsel has only disputed the additional sum payable on account of extending the benefit of death in an accident.

7.      Clause 10.2 of the Insurance Policy is reproduced as under:-

10(2) Accident Benefit:  If at any time when this Policy is in force for the full sum assured, the Life Assured before the expiry of the period for which the premium is payable or before the policy anniversary of which the age nearer birthday of the Life Assured is 70, whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation, the Corporation agrees in the case of:

1. xxx
2. Death of the Life Assured: to pay an additional sum equal to the 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 120 days of its occurrence solely, directly and independently of all other causes result in the death of the Life Assured however such additional sum 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.5,00,000/-.

The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the Life Assured shall,

1. Be caused by intentional self injury, attempted suicide, insanity or immorality or whilst the Life Assured is under the influence of intoxicating, drug or narcotic; or”

8.      Counsel for the appellant has referred to the intimation regarding death of assured (Annexure R-4), affidavit (Annexure R-5), writing (Annexure R-6) and Certificate issued by Gram Panchayat (Annexure R-7). In the first letter giving information regarding death, it has been mentioned that Sunil died on account of heart attack. Similar fact has been mentioned in the affidavit (Annexure R-5) and letter (Annexure R-6). Even Gram Panchayat of Village Butana Kundu (Sonepat) has also certified that Sunil Kumar died suddenly on account of heart attack. The plea of death while spraying weedcide was taken for the first time in the complaint. Therefore, this was only a concocted version and is not tenable.

9.      Since it was a natural death on account of heart attack, therefore, certainly the benefit available under Clause 10.2 (b) of the policy regarding payment of additional sum equal to the sum assured was not available to the respondent-complainant. The District Forum has failed to appreciate the above stated cogent and convincing evidence and as such the impugned order cannot sustain.

10.    In view of the above, the appeal is accepted and the impugned order is modified to the extent that the appellant-LIC shall pay only the insured amount of Rs.3,15,000/- to the complainant which has already been deposited by the LIC before the District Forum. Accordingly, the impugned order qua payment of Rs.3,15,000/- on account of double accident benefit is set aside. Rest of the order is maintained.

11.    The impugned order is modified to the extent indicated above and the appeal stands disposed of.

12.    The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the respondent-complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any. This amount shall be adjusted towards the amount payable, that is, basic sum assured.

 

 

Announced 02.07.2015

(Diwan Singh Chauhan) Member

(B.M. Bedi) Judicial Member

(Nawab Singh) President

CL