Punjab

Sangrur

CC/787/2015

Mahabir Sharma - Complainant(s)

Versus

LIC Of India - Opp.Party(s)

Shri J.S. Kaler

03 Jun 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR.

 

                                                               

                                                Complaint No.  787

                                                Instituted on:    06.08.2015

                                                Decided on:       03.06.2016

 

Mahabir Sharma S/o Shri Ram Bhaj Sharma, resident of Pathakwala Mohalla, Mata Modi Road, Near Naina Devi Mandir, Sunam, District Sangrur.

                                                        …Complainant

                                Versus

 

1.     LIC of India, Branch Kaithal (Jeevan Jyoti), Near Geeta Bhawan, Kaithal (Haryana) through its Branch Manager.

2.     LIC of India, Divisional Office, P.O. Box No.106, ‘Jeevan Prakash’, 489, Model Town, Karnal (Haryana) through Sr. Divisional Manager.

                                                        ..Opposite parties

 

For the complainant  :       Shri J.S.Kaler, Adv.

For OPs.                   :       Shri Amit Bedi, Adv.

 

Quorum:   Sukhpal Singh Gill, President

                K.C.Sharma, Member

                Sarita Garg, Member

 

Order by : Sukhpal Singh Gill, President.

 

1.             Shri Mahabir Sharma, complainant (referred to as complainant in short) has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that Smt. Krishna Devi @ Kreshni (hereinafter referred to as DLA in short) obtained one life insurance policy namely Jeevan Saral (with profits) bearing policy number 178376200 from OP number 1 and the policy commenced from 28.09.2013 and date of maturity was 28.09.2034 and the assured sum was Rs.1,34,005/- with the annual premium amount of Rs.6204/-. It is further averred that the complainant was the nominee of the DLA under the policy, as such, the complainant is entitled to get all the benefits under the policy from the Ops.  It is further averred that in the event of death of the policy holder before maturity an amount equal to Rs.1,25,000/- was payable in case of death and further the same amount was payable in case of accidental death.  It is further averred that the DLA died accidently on 21.1.2014 after suffering serious heady injury which resulted due to falling down in the bathroom in her house situated at Sunam and after that she was immediately taken by the complainant to nearby hospital i.e. AP Sharma Hospital, Sunam, where she was declared brought dead. Thereafter cremation of the DLA was performed at native village of the complainant situated in District Kaithal. After that the complainant intimated the OP number 1 about the death of the DLA vide letter dated 19.02.2014 and submitted all the required documents to OP number 1, but the OPs demanded various documents, which were submitted.  It is further averred that the complainant received a letter dated 27.3.2015 from OP number 2 whereby they demanded treatment record of operation of DLA from Dr. Rajiv Singla Hospital, Sunam. It is stated that no such record was available with the complainant, as the DLA never undergone any such operation.  Thus, alleging deficiency in service on the part of the Ops, the complainant has prayed that the OPs be directed to make the payment of Rs.1,25,000/- as basic sum assured and further Rs.1,25,000/- on account of accidental death benefit along with interest @ 18% per annum from the date of death i.e. 21.1.2014 till realisation and further claimed  compensation and litigation expenses.

 

2.             In reply, preliminary objections are taken up on the grounds that this Forum has got no jurisdiction to try and decide the complaint as the death of the DLA took place in Kaithal district, that the complainant has concealed true and material information, that the claim of the complainant amounting to Rs.1,24,999/- has already been credited via NEFT on 28.7.2015 in Oriental Bank of Commerce, A/c. No.06342011002463 of the complainant.  It is stated further that the complainant did not complete the mandatory requirements of the OPs i.e. attested copy of FIR, PMR etc. to enable the Ops to decide the claim of the complainant. On merits, it is admitted that the DLA was insured under the policy in question and the complainant is the nominee under the policy. It is further stated that the complainant has already been paid the basic sum assured. It is denied that the death of the DLA took place at Sunam or that after the DLA fell down, she was taken to AP Sharma Hospital, Sunam.  It is stated that the complainant is not entitled to get the claim under the accidental clause.  However, the other allegations levelled in the complaint have been denied.

3.             The learned counsel for the complainant has produced Ex.C-1 affidavit, Ex.C-2 copy of policy, Ex.C-3 copy of death certificate, Ex.C-4 and Ex.C-5 copies of medical slips, Ex.C-6 copy of claim form, Ex.C-7 and Ex.C-8 copies of applications, Ex.C-9 copy of courier receipt, Ex.C-10 copy of application, Ex.C-11 copy of courier receipt, Ex.C-12 copy of letter dated 27.3.2015 and closed evidence. On the other hand, the learned counsel for the Ops has produced Ex.OP-1 affidavit, Ex.OP-2 copy of insurance policy, Ex.OP-3 copy of delegation letter and closed evidence.

 

4.             We have carefully perused the complaint, version of the opposite parties, evidence produced on the file and also heard the arguments of the learned counsel for the parties. In our opinion, the complaint merits acceptance,                                                                        for these reasons.

 

5.             It is an admitted fact between the parties that the DLA was insured with the OPs under policy number 178376200 for Rs.1,25,000/- with accidental benefits, as is evident form the copy of the policy Ex.C-2 (Ex.OP-2).  It is also an admitted fact that the DLA had died on 21.1.2014 and further the OPs have already paid the claim of Rs.1,24,999/- under normal death to the complainant as mentioned in the reply of complaint vide NEFT on 28.7.2015 in the account of the complainant with Oriental Bank of Commerce. 

 

6.             In the present case, the only question which arises for determination is that whether the complainant is entitled to get the claim of Rs.1,25,000/- under ‘double accidental benefit’ or not as the complainant has alleged that the DLA died an accidental death on 21.1.2014 after suffering serious head injury which resulted due to falling down in the bathroom in her house at Sunam.  To support this contention, the complainant has also produced Ex.C-4 the slip issued on 21.1.2014 by Dr. Arvinder Pal Sharma of Dr. A.P.Sharma Hospital, Near Mata Modi Mandir, Sunam, wherein it has been clearly mentioned that on 21.1.2014 at about 6.00 AM, Smt. Krishna Devi was brought dead in the hospital at 6.00 AM, as she fallen on floor and suffered head injury according to the attendants of the patient.   On the other hand, the learned counsel for the OPs has contended vehemently that the complainant is not entitled to get the claim under accidental benefit, as the complainant has miserably failed to provide the copy of FIR, PIR, PMR etc, enabling them to settle the claim of the complainant. Further it is contended by the learned counsel for the OPs that since the complainant has miserably failed to produce the above documents, as such, the claim of the complainant on account of accidental death benefit has rightly been denied to the complainant. 

 

7.             After hearing the arguments of the learned counsel for the parties and on perusal of the whole case file, we find the document on record Ex.C-6, which is a copy of the claim form B (3784) which is a medical attendant’s certificate (to be completed by the Medical attendant of the deceased in his last illness), which has been got filled by one Shri Hari Prasad, Development Officer, LIC Sunam,  from Doctor of Dr. A.P.Sharma Hospital, Sunam, wherein Dr. A.P. Sharma has clearly mentioned four times that the ‘DLA Smt. Krishna Devi suffered head injury’ on 21.1.2014 at 6.00 AM and in the last of this certificate Ex.C-6 it has been mentioned by Dr. A.P. Sharma “The body was brought dead with head injury. A lot of bleeding on head.”  We may mention that this document clearly goes to prove that the DLA fallen on the floor of the bathroom at about 6.00 AM on 21.1.2014 and by suffering serious head injury, she died at the spot, which is a clear cut accidental death of the DLA.  It is further worth mentioning here that this document i.e. form number 3784 pertains to the OPs, but the Ops intentionally and with malafide intention concealed this document and did not produce the same on record, as it was against the OPs. There is no explanation from the side of the Ops that why they did not produce it on record.  Had they been produced this document Ex.C-6 on record, then the case was very clear and against the Ops, as it is clear from this document that the DLA died an accidental death. It is further worth mentioning here that the Ops have intentionally, wilfully and with malafide intention has withheld/concealed the above said document Ex.C-6 i.e. Medical Attendants Certificate from this Forum, which again clearly reveals that the Ops have not come to the Court with clean hands.  Reliance can be placed on the law laid down by the Hon’ble Supreme Court of India in Gopal Krishnaji Kekar versus Mohamed Haji Latif and others AIR 1968 Supreme Court 1413, wherein it has been clearly held that a party in possession of best evidence which would throw light on the issue in controversy withholding it, the court ought to draw an adverse inference against him not withstanding that onus of proof does not lie on him. Party cannot rely on abstract doctrine of onus of proof or on the fact that he was not called upon to produce it. The learned counsel for the Ops could not explain why they did not produce the above said document before this Forum, more so when the same was in its possession. It is not the case of the Ops that this document Ex.C-6 does not pertain to the Ops. In the circumstances, we are of the considered opinion, that the OPs have deliberately and with malafide intention did not produce the above said document Ex.C-6 on record, as the Ops were bent upon to deny the rightful claim of the complainant under ‘accidental benefit’ to the complainant. As such, an adverse inference is drawn against the Ops for concealing/suppressing of the said document.

 

8.             Another contention of the Ops demanding the documents such as FIR, PIR, PMR etc. for settling the claim on account of accidental benefit also falls flat, as there was no such requirement to lodge FIR or to conduct PMR, as the DLA had died due to head injury by falling down in the bathroom and further there was no dispute with another party, so that the FIR could be lodged. Moreover, the Ops have not produced any rule or regulation on record requiring compulsorily to produce these documents on record in case of accidental death of the DLA.  As such, we feel that there is no statutory requirement of documents such as FIR, PMR etc. for settling the claim, more so when the DLA had died due to head injury as mentioned above.

 

9.             The contention of the learned counsel for the Ops that this Forum has no jurisdiction to try the complaint as the DLA died at Balu (Kaithal) in view of the death certificate Ex.C-3, also does not hold water as it is proved on record from the document Ex.C-6 that the DLA had died at Sunam, more so when the Ops have not produced on record any document showing that the DLA did not die at Sunam and had died at Balu (Kaithal). The death certificate Ex.C-3 might have been issued at Balu (Kaithal) as the cremation of the DLA was done at Balu (Kaithal) being her native village.  As such, we are of the considered opinion that a part of cause of action has arisen within the territorial jurisdiction of this Forum and his complaint is very much maintainable before this Forum.

 

 

10.           In view of our above discussion, we find it to be a clear cut case of deficiency in service on the part of the OPs. As such, we allow the complaint and direct the Ops to pay to the complainant an amount of Rs.1,25,000/- along with interest @ 9% per annum from 28.07.2015 (the date of payment of claim amounting to Rs.1,24,999/-) till realisation. However, the parties are left to bear their own costs. A  copy of this order be issued to the parties free of cost. File be consigned to records.

                Pronounced.

                June 3, 2016.

                                                        (Sukhpal Singh Gill)

                                                           President

 

                                       

                                                           (K.C.Sharma)

                                                                Member                                                     

 

 

                                                                (Sarita Garg)

                                                                    Member