IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA,
Dated this the 28th day of May, 2014.
Present : Sri. Jacob Stephen (President)
Smt. K.P. Padmasree (Member)
C.C. No. 16/2014 (Filed on 25.01.2014)
Between:
- Krishnankutty,
Pullampallil Thazhethil,
Mannady Muri and Post,
Kadampanadu Village,
Adoor Taluk,
Pathanamthitta District.
- Vinu, S/o. Krishnankutty,
of -do- -do-
- Bindu. R., D/o. Krishnankutty,
of -do- -do-
- Sandhya. R.,
D/o. Krishnankutty,
of -do- -do- … Complainants.
(By Adv. Blesson Sam)
And:
- LIC of India, Divisional Office,
“Jeevan Prakash”,
P.B. No. 1001, Pattom,
Thiruvananthapuram-605 004,
Represented by its Senior-
Divisional Manager.
- The Branch Manager,
LIC of India,
Kilimanoor Branch Office,
Thiruvananthapuram-695 601.
- The Branch Manager,
LIC of India,
Pathanamthitta Branch,
Pathanamthitta – 689 645. … Opposite parties.
(By Adv. K.T. Thomas)
ORDER
Sri. Jacob Stephen (President):
The complainants have filed this complaint against the opposite parties for getting a relief from the Forum.
2. Brief facts of this complaint is as follows: Complainants 1 to 4 are the legal heirs of late Santhosh Kumar, son of the first complainant who died on 31.10.2011 in a road traffic accident occurred at Adoor. The deceased Santhosh Kumar was holder of life insurance policy of the opposite parties vide policy Nos. 785236306 dated 28.12.2010 and 782930049 dated 23.01.2004. The sum assured in the first policy is Rs. 3,00,000 and the second policy is Rs. 30,000. As per the terms and conditions of the said policies, the insured is entitled to get the assured amount and its profits/bonus on its maturity and if the insured dies in an accident, the legal heirs are entitled to get the assured amount plus bonus/profits and an additional sum equal to the sum assured as accident benefit.
3. While so on 31.10.2011, while the above said policies are valid, he met with a road traffic accident at Adoor and died consequent to the injuries sustained to him. Subsequent to the accident, the legal heirs of the deceased approached the opposite parties with all relevant documents for the policy benefits of Rs. 6,60,000 and its bonus/profits. Opposite parties asked for producing the succession certificate as the nominee in the policy is the mother of the deceased who is already died. Accordingly, the complainants obtained the succession certificate and produced the succession certificate. On production of the succession certificate, opposite parties paid Rs. 3,51,000 during November, 2013, the assured amount of Rs. 3,30,000 and its accrued bonus/profits of Rs. 21,000 and denied the accident benefits of Rs. 3,30,000- stating lame excuses. Since the death of the insured was due to a road traffic accident, the complainants are entitled to get the accident benefits also. The delay in giving the policy benefits and the non-payment of the accident benefits and the interest of the whole amount from the date of death are clear deficiency in service which caused financial loss and mental agony to the complainants and the opposite parties are liable to the complainants for the same. Hence this complaint for the realization of Rs. 4,32,435 (the accident benefits and the unpaid interest) and its future interest along with cost of this proceedings.
4. Opposite parties filed their version with the following main contentions: Opposite parties admitted the validity of the policy and death of the policy holder and the complainants’ claim before them. On getting the claim, opposite parties directed the complainants to produce the succession certificate of the deceased along with other required documents. Accordingly, the complainants submitted the documents only on 25.10.2013. Thereafter, opposite parties settled the claim for the basic sum assured plus bonus/profits amounting to Rs. 3,51,500 and paid the amount on 09.11.2013 i.e. within 14 days from the date of receipt of the required documents. However, on the basis of the final report and on the basis of the observations in the post-mortem certificate, the death of the deceased cannot be treated as an accident. So the accident benefit was not given as the complainants have not produced any evidence to show that the death was occurred due to an accident and the deceased was not under the influence of alcohol at the time of accident and death. Therefore, the non-payment of the accident benefits and the delay in settling the claim are not due to any of the fault of the opposite parties and thus they have not committed any deficiency in service as alleged by the complainants. With the above contentions, opposite parties prays for the dismissal of the complaint.
5. On the basis of the pleadings of the parties, the only point to be considered is whether this complaint can be allowed or not?
6. The evidence of this complaint consists of the oral deposition of PW1, DW1 and Exts. A1 to A11 and B1 to B3. After closure of evidence, both sides were heard.
7. The Point: The complainant’s allegation is that the accident benefits of Rs. 3,30,000 entitled to the complainants as per the policies in question was denied by the opposite parties and they have delayed the payments entitled to the complainants which caused financial loss and mental agony to the complainants and hence opposite parties are liable to the complainants for the same.
8. In order to prove the case of the complainants, first complainant filed a proof affidavit in lieu of his chief examination along with 11 documents. On the basis of the proof affidavit, first complainant was examined as PW1 and the documents produced are marked as Exts. A1 to A11. Ext. A1 is the photocopy of the Policy Certificate No. 785236306 dated 28.12.2010. Ext. A2 is the photocopy of the Policy Certificate No. 782930049 dated 23.01.2004. Ext. A3 is the photocopy of the policy conditions. Ext. A4 is the attested copy of Death Certificate dated 21.12.2011. Ext. A5 is the photocopy of FIR in crime No. 1029/2011 dated 01.11.2011 of Adoor Police Station. Ext. A6 is the photocopy of Scene Mahazar dated 02.11.2011 in crime No. 1029/2011 of Adoor Police Station. Ext. A7 is the photocopy of the Post-mortem Certificate dated 01.11.2011. Ext. A8 is the photocopy of the Final Report dated 11.06.2012 in crime No. 1029/2011 of Adoor Police Station. Ext. A9 is the photocopy of the Succession Certificate No. O.P(Succession) 12/2012 dated 05.07.2013. Ext. A10 is the photocopy of the Advocate Notice dated 19.12.2013 issued by the complainants to the second opposite party. Ext. A11 is the postal acknowledgment card of Ext. A10.
9. On the other hand, the contention of the opposite parties is that they have not committed any delay in settling the claim. The delay caused was due to the non-production of the necessary documents in time by the complainants for processing the claim. All the relevant documents are produced only on 25.10.2013 and sum assured along with the bonus was given within 14 days from the date of submission of the required documents. Though the complainants submitted some documents for settling their claim, they have not produced any documents showing the death of the policy holder was due to an accident and he was not under the influence of alcohol at the time of the accident. As per the terms and conditions of the policy in question, the accident benefit is entitled, and can be given only on proving that the death was due to an accident and at the time of the accident, the deceased was not under the influence of alcohol if there is an observation to that effect in the post-mortem certificate. In this case, the post-mortem certificate of the deceased shows that the stomach of the deceased had been 250 ml. of altered blood and a few starchy food materials having a smell similar to that of alcohol and the final report in respect of the crime registered by police showed that the incident led to the death of the deceased is only a motor occurrence. So the death of the deceased cannot be treated as an accidental death as per the terms and conditions of the policy unless it is proved by the claimants. In the circumstances, opposite parties cannot grant the accident benefit to the complainants. Further, the complainants also failed to adduce any evidence to satisfy the opposite parties to come to a conclusion that the death of the deceased is an accidental death in spite of the request of the opposite parties to produce the same. Therefore, the denial of the accident benefit is legal. With the above contentions, opposite parties argued that they have not committed any deficiency in service as alleged by the complainants and hence they prays for the dismissal of the complaint.
10. In order to prove the case of the opposite parties, the Divisional Manager (Legal) of the opposite parties filed a proof affidavit along with 3 documents. On the basis of the proof affidavit, he was examined as DW1 and the documents produced are marked as Exts. B1 to B3. Ext. B1 is the reply dated 19.03.2014 under Right to Information Act issued to the opposite parties by the State Public Information Officer of Chemical Examiner’s Laboratory, Thiruvananthapuram showing that the blood sample of the deceased Santhosh Kumar is not taken for chemical analysis though the sample is received by them. Ext. B2 is the copy of the claim form in respect of the claim in question. Ext. B3 is the copy of letter dated 30.10.2013 issued by the opposite parties to the first complainant demanding the production of chemical analysis report.
11. On the basis of the contentions and arguments of the parties, we have perused the available materials on record and found that the parties have no dispute with regard to the validity of policy in question and the death of the policy holder. The dispute is with regard to the cause of death of the policy holder and with regard to the accident death benefits provided in the policies in question. According to the complainants, policy holder died in an accident and as such the complainants being the legal heirs of the deceased are entitled to get the accident death benefits provided in the policies in question. According to the opposite parties, accident death benefit is allowed only in the case of accidental death of the policy holder and it should be an accident as defined in the terms and conditions of the policy and in this case the death of the insured was not an accidental death as the said death caused while the deceased was under the influence of alcohol which is evident from the observations in the post-mortem report that there was smell of alcohol in the starching food materials found in the stomach of the deceased.
12. In view of the contentions of the parties, the questions to be considered is whether the death of the policy holder was due to an accident and whether the deceased was under the influence of alcohol at the time of the accident?
13. In order to find out the answers of the above questions, we have perused the entire materials on record and found that the deceased died due to the head injury sustained to him and the said head injury was occurred in an accident. The said accident was a road traffic accident which is occurred on 31.10.2011 while he was driving in a motor cycle which hit on the back side of a lorry. All these facts are evident from Exts. A5 FIR, A6 scene mahazar, A7 post-mortem certificate and Ext. A8 final report prepared by Adoor Police. The final finding of the police that the said accident is a motor occurrence as shown in Ext. A8 final report relying by the opposite parties is immaterial for the following reasons. The death of the deceased is not a natural death, suicide or a murder. Further the death of the deceased is an unexpected death consequent to the hitting of his motor cycle with a lorry. So it is clear that the death of the deceased is an accident death and it is covered under the policy in question. The next aspect is whether the accident was occurred under the influence of the alcohol consumed by the deceased. No clear cut evidence has been brought in for establishing the contention of the opposite parties regarding the intoxication of the deceased. At the same time, opposite parties are relying the minor observation seen in the post-mortem certificate that “a few starchy food materials having a smell similar to that of alcohol”. In the said observation, the doctor who conducted the post-mortem has not confirmed that the smell felt by him is the smell of alcohol consumed by the deceased. What he stated is that the smell is similar to that of alcohol and that the said smell is felt from a few starchy food materials found in the stomach of the deceased. Smell similar to that of alcohol can be felt by various means particularly when a post-mortem is conducted after about 12 hours from the time of death and hence such an observation alone is not a ground for a conclusion that the deceased was under the influence of the alcohol at the time of accident. Moreover, there is no whisper in the final report of the police that the accident was occurred due to the influence of the alcohol consumed by the deceased. Moreover in cross examination, DW1 deposed that there is no condition in Ext. A3 policy conditions for producing chemical analysis report by the legal heirs and motor occurrence did not come under the definition of accident. The relevant portion of the deposition is as follows “Ext.A3-യില് chemical analysis report എന്ന ഒരു രേഖ ഹാജരാക്കണമെന്ന് പറഞ്ഞിട്ടില്ലെന്ന് വാദി പറയുന്നു. ശരിയാണ് (A). Motor occurrence ആയി register ചെയ്യുന്നകേസ് accident ന്റെ definition-ല് വരില്ല എന്ന് insurance policy വ്യവസ്ഥയില് ഉണ്ടോ? ഇല്ല(A).”
So the rejection of the claim for accident benefits and the insistence of the opposite parties for the production of Forensic Lab Report cannot be justified. Therefore, we find that the opposite parties have committed deficiency in service and hence this complaint is allowable.
14. In the result, this complaint is allowed, thereby the opposite parties are directed to pay the accident benefits of Rs. 3,30,000 (Rupees Three lakhs thirty thousand only) covered under the policies in question with interest @ 7% per annum from the date of filing of this complaint along with compensation of Rs.10,000 (Rupees Ten thousand only) and cost of Rs.2,500/- (Rupees Two thousand five hundred only) to the complainants within 30 days from the date of receipt of this order, failing which the complainants are allowed to realize the whole amount with 10% interest per annum from today till the realization of the whole amount.
15. However, the claim of interest for the delay in settling the claim is not allowable as the delay was caused due to the delay in producing the required documents by the complainants in time and it is not the fault of the opposite parties.
Dictated to the Confidential Assistant, transcribed and typed by him, corrected by me and pronounced in the Open Forum on this the 28th day of May, 2014.
(Sd/-)
Jacob Stephen,
(President)
Smt. K.P. Padmasree (Member) : (Sd/-)
Appendix:
Witness examined on the side of the complainants:
PW1 : Krishnankutty. V.
Exhibits marked on the side of the complainants:
A1 : Photocopy of the Policy Certificate No.
785236306 dated 28.12.2010.
A2 : Photocopy of the Policy Certificate No. 782930049 dated
23.01.2004.
A3 : Photocopy of the policy conditions.
A4 : Attested copy of Death Certificate dated
21.12.2011.
A5 : Photocopy of FIR in crime No. 1029/2011 dated
01.11.2011 of Adoor Police Station.
A6 : Photocopy of Scene Mahazar dated 02.11.2011 in crime
No. 1029/2011 of Adoor Police Station.
A7 : Photocopy of the Post-mortem Certificate dated
01.11.2011.
A8 : Photocopy of the Final Report dated 11.06.2012 in crime
No. 1029/2011 of Adoor Police Station.
A9 : Photocopy of the Succession Certificate No.
O.P(Succession) 12/2012 dated 05.07.2013.
A10 : Photocopy of the Advocate Notice dated 19.12.2013
issued by the complainants to the second opposite
party.
A11 : Postal acknowledgment card of Ext. A10.
Witness examined on the side of the opposite parties:
DW1: Antony Alex Kavalam.
Exhibits marked on the side of the opposite parties:
B1 : Reply dated 19.03.2014 under Right to Information Act
issued to the opposite parties by the State Public
Information Officer of Chemical Examiner’s Laboratory,
Thiruvananthapuram.
B2 : Copy of the claim form.
B3 : Copy of letter dated 30.10.2013 issued by the opposite
parties to the first complainant.
(By Order)
(Sd/-)
Senior Superintendent
Copy to:- (1) Krishnankutty, Pullampallil Thazhethil,
Mannady Muri and Post, Kadampanadu Village,
Adoor Taluk, Pathanamthitta District.
(2) The Senior Divisional Manager, LIC of India, Divisional
Office,“Jeevan Prakash”, P.B. No. 1001,
Pattom,Thiruvananthapuram-605 004.
- The Branch Manager, LIC of India, Kilimanoor Branch Office, Thiruvananthapuram-695 601.
- The Branch Manager, LIC of India, Pathanamthitta Branch, Pathanamthitta – 689 645.
- The Stock File.
