Haryana

Yamunanagar

CC/631/2012

Amit Kumar s/o Sh.Mahinder Kumar, - Complainant(s)

Versus

LIC - Opp.Party(s)

Lovekesh Sharma

26 Sep 2016

ORDER

BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, YAMUNA NAGAR AT JAGADHRI.

                                                                                                Complaint No. 631  of 2012.

                                                                                                Date of institution: 14.06.2012

                                                                                                Date of decision: 26.09.2016.

Amit Kumar aged about 30 years son of Sh. Mahinder Kumar, resident of village Damla, Tehsil Jagadhri, District Yamuna Nagar.                                                                                                                                                                                                                                                                                                                       …Complainant.

                                                     Versus

 

1. Life Insurance Corporation of India, through its Branch Manager, SCO 184-185, Sector-17,Ist Floor, 2^nd , Jagadhri District Yamuna Nagar.
2. Life Insurance Corporation of India, through its Branch Manager, Karnal Division, District Karnal.  
3. Life Insurance Corporation of India, through its Branch Manager, Opp. Madu Cinema, Yamuna Nagar.

                                                                                                                                                            …Respondents.

 

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present: Sh. Lovekesh Sharma, Advocate counsel for complainant. 

              Sh. Rajiv Gupta, Advocate, counsel for respondents.  

 

ORDER

 

1.                     The present complaint has been filed under section 12 of the Consumer Protection Act, 1986 praying therein that the respondents (hereinafter referred as OPs) be directed to release only accidental benefits i.e. Rs. 1,00,000/- to the complainant alongwith compensation as well as litigation expenses. 

2.                     Brief facts of the present complaint, as alleged by the complainant, are that brother of the complainant had taken one LIC policy bearing No. 175487343 with half yearly premium of Rs. 1859/- under the plan Term and Table-179-20-20 with the date of commencement 25.05.2007 for a sum insured of Rs. 1,00,000/- and the maturity date was May 2027. In this policy, the complainant Amit Kumar has been shown as nominee. Unfortunately, on 08.12.2010, the policy holder i.e. brother of the complainant namely Ravinder Kumar succumbed to the injuries sustained on 28.11.2010 when he was returning to his home after attending the marriage ceremony and  had a quarrel with some boys dancing on D.J. System. On the intervention of gathering, the matter was patched up and thereafter when the complainant alongwith his nephew Ravinder Kumar was returning to his village after attending the marriage at about 11.00 P.M., 5-6 boys who were in scorpio and were armed with dandas and had proclaimed that Ravinder Kumar should not be spared as he had a dispute with them on D.J and gave severe beating to Ravinder Kumar deceased. Thereafter, injured Ravinder Kumar was taken to Gaba Hospital, Jagadhri from where he was referred to GMCH, Chandigarh but later on succumbed to the injuries on 08.12.2010. After investigation, an FIR bearing No. 165 dated 04.12.2010 under section 148/323/341/506 read with section 149, and later on inserted Section 302 IPC, was registered in the police station, Bilaspur. Postmortem bearing No. SJK/96/2010 dated 9.12.2010 was conducted at Government Medical College Sector-32, Chandigarh.

3.                     A claim was lodged by the complainant with the OPs Insurance Company. The complainant had made so many requests to the OPs Insurance Company for releasing the policy amount to the complainant as he was nominee in the said policy. However, the OPs Insurance Company always kept on lingering on the matter on one pretext or the other. Finally, a few days back the OPs No.1 & 2 had released only basic sum insured amount of Rs. 1,00,000/- and has illegally withheld the accidental benefits i.e. double amount of the basic sum insured whereas only basic sum insured has been paid by the OPs Insurance Company. The complainant has made so many request to the OPs Insurance Company to release the accidental benefits but all in vain. A legal notice was also served on 08.05.2012 despite that no accidental benefits have been released by the OPs Insurance Company. Hence, this complaint.

4.                 Upon notice, OPs appeared and filed its written statement by taking some preliminary objections such as complaint is not maintainable; there is no negligence or deficiency in service. In this case life assured Ravinder Kumar had taken one LIC policy bearing No. 175487343 from the OPs Insurance Company for a sum insured of Rs. 1,00,000/-, date of commencement 26.05.2007 under term table 179-20-20 at a half yearly premium of Rs. 1859/-. Sh. Amit Kumar brother of the deceased life assured was appointed as nominee under the policy in question. On the death of life assured on 08.12.2010, a claim was intimated to the OPs Insurance Company vide intimation letter dated 20.01.2011 and on processing the claim it was revealed vide intimation letter dated 20.01.2011 and on processing the claim it was revealed that life assured Ravinder Kumar was murdered and in this regard an FIR No. 165 dated 04.12.2010 was registered in Police Station Bilaspur (Yamuna Nagar). Thereafter, the OP Insurance Company made the payment of basic sum insured of Rs. 1,00,000/- on 10.02.2011 and demanded a court verdict for deciding the accidental benefits in this case. Since the cause of death was murder, therefore, in order to pay the accidental benefits it was necessary that decision of court is received with a definite finding to the effect that whether it was accidental murder or a murder simplicitor because it has been laid down by the Hon’ble National Commission that the intentional killing i.e. the murder is not accidental death and unless the accidental death is proved the benefit of accidental benefit is not payable by LIC and on merit controverted the stand taken in the complaint and reiterated the stand taken in the preliminary objections and lastly prayed for dismissal of complaint being no deficiency in service or unfair trade practice on the part of OPs.

5.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CX and documents such as copy of Registered AD legal notice as Annexure C-1, Postal receipt as Annexure C-2, Acknowledgement as Annexure C-3, Premium receipt as Annexure C-4, copy of status report of policy in question as Annexure C-5, Copy of death certificate issued by Municipal Corporation, Chandigarh as Annexure C-6, Copy of postmortem report as Annexure C-7 and copy of judgment of sessions case No. 55/2011 decided on 13.02.2012 as Annexure C-8 and closed the evidence on behalf of complainant.

 6.                    On the other hand, counsel for the OPs tendered into evidence affidavit of Sh. P.K. Saxena as Annexure RW/A and documents such as photo copy of insurance policy as Annexure R-1, copy of FIR bearing No. 165 dated 04.12.2010 as Annexure R-2, Copy of postmortem report as AnnexureR-3 and closed the evidence on behalf of OPs.

7.                     We have heard the learned counsel for both the parties and have gone through the pleadings as well as documents placed on file very minutely and carefully.

8.                     It is not disputed that the brother of the complainant Ravinder Kumar deceased life assured had taken one LIC policy bearing No. 175487343 for the basic sum insured of Rs. 1,00,000/- on 25.05.2007 and was paying premium regularly. It is also not disputed that OPs Insurance Company had already paid Rs. 1,00,000/- the basic sum insured to the complainant who is nominee of the deceased Ravinder Kumar life assured on 10.02.2011 and the accidental benefits i.e. double amount of the basic sum insured i.e. Rs. 1,00,000/- were withheld just on the demand of court verdict for deciding the accidental benefits in this case. From the facts mentioned in the written statement filed by the OPs Insurance Company, it is clearly evident that accidental benefits have not been denied or rejected by the OPs Insurance Company and has been only withheld just on the ground of submitting the verdict of the Hon’ble Sessions Court case to ascertain that whether it was accidental murder or murder simplicitor.

9.                     We have perused the copy of judgment of Sessions trial case bearing No. 55/2011 decided on 13.02.2012 and from the contents of this judgment, it is clearly evident that deceased Ravinder Kumar was sustained injuries on 28.11.2010 which later on proved fatal on 08.12.2010 due to sudden quarrel taken place during the dancing on D.J. System in a marriage, so, we are of the considered view that deceased Ravinder Kumar was not having any previous enmity, meaning thereby that there was no intentional murder. Moreover, all the accused have been acquitted by the Hon’ble Addl. Sessions Judge, Yamuna Nagar. The arguments advanced by the counsel for the OPs that there was intentional murder and as per the Hon’ble National Commission, the intentional killing is a murder, is not accidental death and OPs insurance company is not liable to pay accidental benefits is not tenable as we have perused the terms and conditions of the insurance policy carefully and minutely specifically exclusion clause mentioned under the head 11 Accidental Benefits (B) Death of life assured:

                        In addition to sum assured under basic plan, an additional sum equal to the accident benefits sum insured 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 such injuries shall be within 180 days of its occurrence, solely directly or independently of all other causes result in death of the life assured. However, such additional sum payable in respect of the policy shall not in any event exceed Rs. 50 lakhs, taking all existing policies of the life assured and under individual as well as group schemes including policies with in built accident benefit taken with Life Insurance Corporation of India and other insurance companies.

                        The corporation will 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 liquor, drug or narcotic or
2. take place as a result of accident while the life assured is engaged in aviation or aeronautics in any capacity other than that of a fare paying, part paying or non-paying passenger in any air craft which is authorized by the relevant regulations to carry such passenger and flying between established aerodromes, the Life Assured having at that time no duties on board the air craft or requiring descent therefrom.
3. be caused by injuries resulting from riots, riots, civil commotion, rebellion war, (whether war be declared or not) invasion, haunting, mountaineering, steep chasing or racing of any kind
4. result from life assured committing any breach of law or
5. arise from employment of the life assured in the armed forces in the military service of any country. at war (whether was be declared or not) or from being engaged in police duty in any military or police organization.  

The extra premium for this benefit will not be required to be paid after all premiums under this policy have been paid or on or after the policy anniversary on which the age nearer birth day of the life assured is 70 years which ever is earlier.

10.                   From the perusal of above noted terms and conditions of the insurance policy, it is clearly evident that deceased Ravinder Kumar was died due to external visible outward means and such injuries resulted in death of the life assured i.e. within a period of 11 days and case of the deceased Ravinder Kumar does not fall under the above noted exemptions.  

11.                 In the circumstances noted above, we are of the considered view that the Ops Insurance Company had wrongly and illegally withheld the accidental benefits in respect of deceased life assured Ravinder Kumar which constitute deficiency in service on the part of OPs Insurance Company. Hence, the complainant is entitled for relief.

 

Announced: 26.09.2016.        

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

 

                                                                                     

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.