Haryana

Charkhi Dadri

cc/163/2019

Rajender Sharma - Complainant(s)

Versus

Lic of India - Opp.Party(s)

Sh. Anand Singh Dabas

09 Sep 2022

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, CHARKHI DADRI.

 

                                                          Complaint Case No. 618 of 2019

                                                         Date of Institution: 29.7.2019

                                                          RBT Case No. 163 of 7.10.2019

                                                          Date of Decision: 9.9.2022.

 

Rajender Sharma son of Sai Dass Sharma aged about 42 years and permanent resident of H No. 557, Gali No. 8, Ward No. 5, Charkhi Dadri and District Charkhi Dadri.

 

                                                                   ….Complainant.

Versus

1. Life Insurance Corporation of India through Senior Divisional Manager, LIC of India, Rohtak Divisional Office, Sector-1, HUDA, Rohtak.
2. Branch Manager, LIC of India, Branch office, Loharu Road, Charkhi Dadri.

 

•  

 

 

                   COMPLAINT UNDER SECTION 12 OF THE

                   CONSUMER PROTECTION ACT, 1986

 

Before: -     Sh. Vijay Singh, President

                Sh. Om Parkash Tuteja, Member.

 

Present:      Sh. Manjeet Chahar, Adv. for complainant.

                   Sh. Mukesh Jangra, Adv. for OPs.

 

ORDER:-

 

                  Rajender Sharma (hereinafter referred to as “the complainant”) has filed the present complaint against the opposite parties (hereinafter referred to as “the OPs) with the averments that brother of complainant namely Tarsem Kumar was insured vide insurance policy No. 178723133 purchased by him from the OP No.2 with date of commencement 15.7.2010 under table and terms 165-21 for sum assured of Rs. 2,50,000/-. Under the terms and conditions of the insurance policy, the OPs agreed to provide the basic risk of Rs. 2,50,000/-plus bonus in case of natural death and double of the sum assured if death is accidental. It is averred that the brother of complainant was doing private business at Patti District Taran Taran (Punjab) and on 27.12.2018, he while walking along side of a canal with friends, suddenly slipped and fell into the canal and died an accidental death. The complainant being nominee under the said insurance policy, completed the entire requirement for payment of insurance death claim and deposited all the original documents like policy bond, death certificate, police inquiry report and post mortem report and on deposit of the forms and documents, the OPs confirmed that claim will be paid within 7 days in the bank account of complainant through NEFT.  It is averred that despite many requests and visits, the OPs kept pending the claim of complainant and accidental death claim was withhold by the OPs without any valid reasons and justifications and repudiated the accidental claim vide their letter dated 20.6.2019 with the plea that “your brother expired due to mental disturbance and drowning, hence, accident benefits is not payable”. It is averred that non-payment of genuine insurance accidental death claim amounting to Rs. 2,50,000/-by the OPs is unjust, unwarranted and hence, alleging deficiency in service on the part of the OPs, the complainant seeks directions against the OPs to pay Rs. 2,50,000/-as accidental death claim along with interest, compensation and the litigation expenses besides any other cost, which this Commission may found deem fit in favour of complainant.

2.       Upon notice, the OPs appeared and filed the written statement taking some preliminary objections that the complaint is wrong, against law and fats and as such, the same is liable to be dismissed, the complainant has no locus standi to file the present complaint, the complaint is bad for non-joinder of necessary parties because all the legal heirs of deceased Tarseem life assured have not been impleaded as parties to the present complaint etc. It is averred that on having information of death of the life assured Tarsem Kumar holder of insurance policy No. 178723133 for sum of Rs. 2,50,000/-with date of commencement 15.7.2010, nominee Rajender complainant, all claim forms were called for settlement of claims. The matter was investigated and during investigation, it was found that the deceased life assured Tarseem Kumar expired due to mental disturbance and drowning and the cause of death of the life assured was not resulting to an accident and hence, double of the sum assured is not payable under the above said policy. It is averred that death claim liability for Basic Sum Assured had already admitted and an amount of Rs. 3,44,080/-has been paid to the complainant nominee.  As such, it is averred that there is no deficiency in service on the part of the OPs and accordingly, the OPs prayed for dismissal of complaint with costs.

3.                The complainant has tendered into evidence his own affidavit as Ex. CW-1/A and documents as Ex. C-1 to Ex. C-5 and closed the evidence on 6.1.2020.

4.                 On the other hand, the OPs tendered into evidence documents Annexure R-1 and Annexure R-14 and closed the evidence on 18.8.2020.

5.                We have heard the arguments of learned counsel for the parties and have gone through the entire evidence placed on record by both the parties very carefully and minutely.

        During the course of arguments, the counsel for complainant reiterated the contents of his complaint and the counsel of OPs reiterated the contents of written statement filed by OPs and drawn the attention of this Commission towards the documents so placed by them on behalf of the parties.

6.                After hearing the arguments of the counsel for the parties, going through the facts of the case file and perusing the documents so placed on record very carefully and minutely, it has been observed that Tarsem Kumar had purchased an insurance policy No. 178723133 from the OP No.2 for sum assured Rs. 2,50,000/-and was the real brother of complainant Rajender Singh who was recorded as nominee of Tarsem Kumar. As per the terms and conditions of the insurance policy, the OP was to provide the basic risk of Rs. 2,50,000/-+ bonus in case of natural death during the currency of the insurance policy and double the sum assured, if death is accidental. It is also admitted case of the parties that having received the information about the death of Tarsem Kumar, an inquiry was conducted by the OPs at their own level and come to the conclusion that Tarsem Kumar had died by drowning in a canal when he was walking near the canal with his friends and suddenly slipped and fell into the canal. The OPs paid a sum of Rs. 3,44,080/-as death claim liability for Basic Sum Assured to the complainant being nominee but denied to pay double the sum assured on the ground that the death of Tarsem was not accidental but due to suicide. Now the question which arises for our consideration is as to whether the death of deceased Tarsem Kumar took place due to suicide or it was due to accident as slipped suddenly while waking near the canal.

7.                The contention of the learned counsel for the OPs is that there is no violence in death caused by drowning in the river without being pulled in by anyone and therefore, the benefit of double the sum assured is not available to the complainant. It is further argued that if a person standing on river side, all of a sudden loses his balance or otherwise slips inside the river, it cannot be said that his death was caused by way of some violent means. The next arguments of the learned counsel for the OPs was that it has come on record that deceased Tarsem was mentally disturbed and on the relevant day of incident, his dead body was found near Matlawala in Punjab and his wife Geeta Rani has admitted before the police that her husband expired due to mental disturbance and drowning and on the basis of the statement of Geeta Rani, the wife of deceased Tarsem, a DDR No. 19 was recorded on 28.12.2018 with P.S. City Patti, District Taran Taran (Punjab). Geeta Rani got recorded her statement voluntarily without any pressure and thus the same deserves to be relied upon.
                   On the other hand, the learned counsel for complainant has contended that there is nothing on record that deceased Tarsem was mentally disturbed or lost his sense. No doubt, he was a property dealer and keeping in view the nature of his profession, it cannot be denied that he might be temporarily disturbed due to some reasons but it cannot be said that he under any stress, committed suicide by drowning as alleged by the counsel for OPs.

8.                We have gone through the DDR (Annexure C-3) wherein it is clearly mentioned that Tarsem was a property dealer but was mentally disturbed. On 27.12.2018 at about 10.30 AM, he had gone to fetch medicine but did not return to his house, so, if a person himself went to bring the medicine, cannot be said that he was insane or lunatic. Now-a-days, most of the people engaged in business/property dealing suffers from depression. It is admitted, there is no history of deceased that he was suffering from mental disorder or getting treatment for the same from any hospital.

9.                Even for the sake of argument, if it is presumed that Tarsem committed suicide by drowning, the question arises whether as per terms and conditions of the policy (Annexure-F), the complainant was entitled for double the sum assured. We have gone through the terms and conditions of the insurance policy and as per clause 6, an insured if commits suicide, is not entitled for the aforesaid benefit till one year from the date of commencement of policy. The relevant para of clause 6 is reproduced as under:-

The policy shall be void, if the Life Assured commits suicide (whether sane or insane at that time) at any time on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of acceptance of the risk and the corporation will not entertain any claim by virtue of the policy except to the extent of a third party’s……….

 

10.              Admittedly, the policy was purchased on 15.7.2010 thus the risk of deceased commences to run from 15.7.2010 whereas Tarsem Kumar had died on 27.12.2018 i.e. after a period of about 8 years 5 months from the date of commencement of the insurance policy whereas per clause 6, the benefit was not available till the expiry of one year from the date of commencement of the policy. Thus the submission of learned counsel for the OPs is devoid of merit and thus the arguments of learned counsel for OPs that as deceased committed suicide by drowning, he was not entitled for the benefits, is totally baseless.

11.              We have also gone through clause 11 (b) of the policy Annexure-5 which deals with death of life assured…….

“(b) Death of Life Assured : In addition to sum assured under Basic Plan, an additional sum equal to the Accident Benefit Sum Assured shall be payable 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 ...

12.              It is not a case of sustaining any bodily injury to Tarsem as it is a case of death by accident. To deal with this situation, the learned counsel for complainant drawn our attention on a judgment Matngh Vs. Oriental Insurance Co. Ltd. decided by Hon’ble National Consumer Disputes Redressal Commission, New Delhi passed on 5.9.2014. In the reported case, one Narender Singh died on 15.3.2006 when his leg accidentally slipped near river and he got drowned therein. Information of the death was given immediately to the insurance company after obtaining the death certificate and other requisite documents. The insurance company sent a cheque of Rs. 49,940/-to the complainant in full and final settlement of claim, however, no payment was offered to the complainant under the section Personal Accident, which was declined on the ground that the death of insured was not caused by any bodily injury resulting solely and directly from accident caused by external, violent and visible means. The Hon’ble National Commission, after going through the rival submissions of both the sides and documents placed on record, held that death certificate in respect of deceased Narender Singh would show that he died due to drowning. Drowning in the river was held sole and direct cause of his death. Here, it is further held that the death occurred when deceased accidentally fell into the Neel river and got drowned and therefore, his death was definitely covered by the policy under section Personal Accident. Thus, the insurance company was held under a contractual obligation to pay a sum of $ 25,000 to the complainant.

13.              Apart from this, Hon’ble State Commission, Punjab in a case National Insurance Company Vs. Asha Rani wife of Sh. Vijay Kumar, First Appeal No. 899 of 2009, decided on 24.5.2013, wherein Dr. Ramandeep Garg while walking on the shore on 27.10.2005 was washed away by strong sea waves and was drowned. His death body was recovered on 27.10.2005, FIR was lodged on the same day, postmortem was conducted and as per postmortem report, the cause of death was “Cerebral oedema and pulmonary oedema secondary to asphyxia resulting from drowning. It was held that the cause of death was not, at all, due to any intoxication or drug but it was drowning. Similarly, Hon’ble National Consumer Disputes Redressal Commission, New Delhi in Mrs. Padma Ramanathan Vs. National Insurance Company Ltd. Original Petition No. 173 of 2000 held that the death caused to the insured was an accidental death as it was not natural because the insured did not intend to die by drowning.

14               No law contrary to the referred above have been cited by the learned counsel for the OPs. In all the cases, the death by drowning is held to be as accidental death. In this case also, deceased Tarsem died due to drowning as suddenly slipped and drowned. It was not a case of suicide. There is no evidence that the death of deceased Tarsem was due to suicide. Therefore, the OPs has declined the relief of double the sum assured voluntarily and illegally hence can’t be justified which proves deficiency in service on their part.

15.              So, in view of the above discussion, we allow the complaint of complainant and direct the OPs to pay the following:-

1. Pay to the complainant Rs. 2,50,000/-as accidental claim being double the insured amount along with interest @ 9% p.a. from the date of filing of complaint till final payment.
2. Pay Rs. 40,000/-towards cost of harassment, humiliation, financial loss and deficiency in service.
3. Pay Rs. 5500/-towards cost of litigation expenses to the complainant.

 

16.             The present complaint stands allowed accordingly.

17.              The above order be compiled within 30 days from the date of receiving the certified copy of this order, failing which the amount of Rs. 2,50,000/-would carry interest @ 12% p.a. from the date of filing of the present complaint, till realization of payment.

18.             Certified copies of order be supplied to the parties free of costs. File be consigned to the record-room, after due compliance.

Announced.

Dated: 9.9.2022

 

 

            (Om Parkash Tuteja)                                  (Vijay Singh)

                   Member.                                        President,

                                                              District Consumer Disputes

                                                         Redressal Commission, Charkhi Dadri.