BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BHIWANI.
CONSUMER COMPLAINT NO.234 of 2015
DATE OF INSTITUTION: - 18.08.2015
DATE OF ORDER: -30.03.2017
Rajwanti widow of Late Kuljit Kumar, resident of village Balali PO Adampur Dadri, Tehsil Charkhi Dadri, District Bhiwani.
……………Complainant.
VERSUS
- LIC of India through its Branch Manager, Branch Charkhi Dadri (Bhiwani).
- Senior Divisional Manager, LIC of India, Rohtak Divisional Office, Rohtak.
………….. Opposite Party.
COMPLAINT U/S 12 & 13 OF CONSUMER PROECTION ACT
BEFORE :- Shri Rajesh Jindal, President
Mrs. Sudesh, Member
Mr. Parmod Kumar, Member
Present: - Shri Anand Dabas, Advocate for complainant.
Shri V.P. Dalal, Advocate, for the OPs.
ORDER:-
Rajesh Jindal, President:
The case of the complainant in brief, is that complainant’s husband namely Kuljit Kumar purchased an insurance policy number 174216541 with the date of commencement 19.03.2005, sum assured 105000/- under table term 14-21. It is alleged that the complainant was nominated as legal nominee of the life assured as per policy. It is alleged that the husband of the complainant died and complainant being legal nominee under the policy completed entire requirement for payment of insurance claim including accidental claim but the Ops only paid basic claim and refused to pay accidental claim vide letter dated 12.05.2015 and stated that the complainant husband died due to cold. A legal notice dated 26.06.2015 was also served on the Ops but till dated notice did not replied. The complainant further alleged that due to the act and conduct of the respondent, she had to suffer mental agony, harassment and humiliation. Hence, it amounts to deficiency in service on the part of respondents and as such she had to file the present complaint.
2. On appearance, OPs filed written statement and took preliminary objections and denied the allegations of the complainant. It is submitted that the complainant herself explained and admitted that the husband of the complainant was suffering from cold & fever and he contacted to the Doctor available at Mittal Clinic. It is submitted that the complainant further herself explained that immediately the husband of the complainant moved to civil hospital, Charkhi Dadri but died on the way due to cold waves and due to fever and due to heart attack. It is submitted that the death of the husband of the complainant is not an accidental death and whereas the death of the husband of the complainant is a natural death. Hence, in view of the facts and circumstances mentioned above, there is no deficiency in service on the part of OPs and complaint of the complainant is liable to be dismissed with costs.
3. In order to make out his case, the counsel for complainant has tendered into evidence documents Annexure A-1 to Annexure A-9 alongwith supporting affidavit.
4. On the other hand, counsel for the Ops has tendered into evidence documents Annexure R-1 to Annexure R-4.
5. We have gone through the record of the case carefully and have heard the learned counsels for the parties.
6. Learned counsel for the complainant reiterated the contents of the complaint. He submitted that the husband of the complainant had taken the LIC policy from the OPs for a sum assured of Rs. 105000/- under table term 14-21. The husband of the complainant after retirement from the service re-employed as clerk in the Education Department. On 21.01.2015, the husband of the complainant was coming from school to Treasury Office on motor cycle and contacted cold wave prevailing in the region. Thereafter, he contacted the doctor at Charkhi Dadri. After that when he was returning on his motor cycle from Charkhi Dadri to his village he again contacted the cold wave and he complained for chest pain, fever and cold etc. He was rushed to Civil Hospital, Charkhi Dadri and died due to cold wave. He submitted that the death of the complainant is caused due to cold wave which amounts to accidental death. The Ops have paid the sum assured amount to the complainant but the complainant is also entitled for the accidental benefits. The Ops have wrongly repudiated the claim of the complainant for accidental benefit. He relied upon the following judgment:-
I Rita Devi @ Rita Gupta Versus National Insurance Co. Ltd. etc., Revision Petition No. 973 of 2007 of Hon’ble National Commission, New Delhi decided on 24.10.2007.
7. Learned counsel for the opposite parties reiterated the contents of his reply. He submitted that the death of the husband of the complainant was caused due to cold wave, fever and heart attack. Therefore, the death of the husband of the complainant is not a accidental death but it is a natural death. He further submitted that the death claim of the complainant under the policy in question has been paid amounting to Rs. 1,20,312/- to the complainant on 12.02.2015. The complainant is not entitled to any accidental claim as alleged by her.
8. In the context of the pleadings and arguments of the parties, we have examined the material on record, carefully. The Ops vide letter dated 12.05.2015 has repudiated the accidental claim of the complainant. The relevant portion of the letter is reproduced below:-
This office has received your letter dated 21 Apr. 2015 regarding payment of accidental risk cover under pol. no mentioned above. Basic death claim alongwith bonus has already been paid to you. Further it is clarified that your husband died due to cold, fever and heart attack, hence death was not due to an accident so accidental claim is not payable.
From the contents of the letter of OP, mentioned above, the OP himself has admitted that the husband of the complainant died due to cold, fever and heart attack. The Hon’ble National Commission in Rita Devi’s case (supra) held as under:-
The only question which requires consideration is “whether the death caused by ‘cold wave’ is considered to be an ‘accidental death’ for the purpose of insurance cover”?.
In our view, for the purposes of insurance cover death caused by ‘cold wave’ is accidental death.
Death due to cold wave is not natural and it would be accidental because all the persons may not get the same effect and it is by natural external violent force. Further, ‘cold wave’ is an untoward event which is not expected or designed, and an ordinary man could not expect the occurrence.
In view of the case law laid down by the Hon’ble National Commission as mentioned above and the repudiation letter dated 12.05.2015 of Ops, wherein OP itself has admitted that the husband of the complainant died due to cold wave, fever and heart attack. There is admission on the part of Ops for the cause of death of the husband of the complainant. In these circumstances, we have no hesitation to hold that the complainant death should be considered to be an accidental death for the purpose of insurance cover. Resultantly, we allow the complaint of the complainant against the Ops. The Ops are directed to pay the accidental claim to the complainant. This order be complied with by the Ops within 60 days from the date of passing of this order. Certified copies of the order be sent to the parties free of costs. File be consigned to the record room, after due compliance.
Announced in open Forum.
Dated: 30-03-2017.
(Rajesh Jindal)
President,
District Consumer Disputes
Redressal Forum, Bhiwani.
(Parmod Kumar) (Sudesh)
Member. Member
