O R D E R
SUBHASH GUPTA, MEMBER
The complainant has filed the present complaint against the O.Ps u/sec. 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that Late Sh. Manmohan Goyal husband of the complainant purchased a life insurance policy No.120198259 from O.P-1. The sum assured was Rs.50,000/- with Rs.50,000/- as accident benefit. Further the deceased purchased life insurance policy No.171450087 and No.171450088 from the O.P-2. In both policies the sum assured was Rs.50,000/- and Rs.50,000/- as accident benefit. It is alleged that the deceased was admitted in Sunder Lal Jain Hospital on 17.06.2009 due to accidental burn injuries where he died on 26.06.2009. It is further alleged that the complainant being the wife of deceased intimated the death of policy holder. On 14.01.2010 complainant applied for claim with the O.P and deposited all the original documents as required and instructed by the OP including application, indemnity bond etc. But O.P paid only the amount of sum assured of all the policies to the complainant and did not pay the amount of Rs.50,000/- toward accident benefit which is collectively Rs.1,50,000/- in all the policies. It is further alleged that the complainant has been repeatedly reminding and requesting the O.Ps to reimburse the amount but of no avail. Complainant has also sent a legal notice dated 07.11.2012 but to no avail. On these facts complainant prays that O.Ps be directed to pay the claim amount of Rs.1,50,000/- with interest @ 24% p.a. and also to pay cost and compensation as claimed.
2. O.P appeared and filed written statement. In its written statement O.Ps has not disputed that complainant had taken the policies referred above. It is alleged that the complainant failed to produce the documents asked for by the O.Ps such as FIR and Post Mortem Report. The complainant informed the O.Ps that neither any FIR was registered nor post mortem was conducted by the Hospital or any other authority. It is further alleged that as the complainant failed to cooperate and failed to provide the requisite documents. The claim is under process and pending for want documents from the complainant since the claim has not been repudiated, therefore, the dismissal of the complaint has been prayed for as no cause of action has arisen against the O.Ps.
3. Complainant has filed her affidavit affirming the facts alleged in the complaint. On the other hand Shri D.K. Joshi, Legal Manager has filed affidavit in evidence on behalf of O.P testifying all the facts as stated in the written statement. Parties have also filed their respective written submissions.
4. We have gone through the pleadings and the documents placed on record by both the parties. It is not disputed that the complainant had taken three life insurance policies from the O.Ps. It has also not been disputed that the some assured in all the three policies was Rs.50,000/- and Rs.50,000/- was an accidental benefit. The O.Ps have stated in the written statement that the life insurance cover of Rs.50,000/- + bonus thereon in respect of all the three policies have been paid through cheque to the complainant which has also not been disputed. The contention of the O.P in not releasing the accidental benefit of Rs.50,000/- in all the policies is that the complainant has not provided the copy of the FIR as well as Post Mortem Report and Final Police Inquest report. The O.Ps have argued that these documents are required for clearing of accident benefit claim or to arrive at a conclusion as to whether the cause of death was accidental or otherwise.
5. The complainant in response to the letter of the LIC dated 04.02.2013 has categorically stated that neither FIR was registered nor the post mortem was got conducted. It has also been admitted in the said letter that no Newspaper Report about the accident is with the complainant.
6. In our opinion the accidental insurance benefit can only be given when the accident is proved. In this case admittedly the complainant’s husband with burn injuries was admitted in the Sunder Lal Jain Hospital but neither any FIR nor post mortem report from the Hospital or any other competent authority has been supplied to the O.Ps nor the same has been placed on record, therefore, the O.Ps were justified to ask for these documents to arrive at a conclusion that death occurred due to accident. In view of the above observations, we are of the view that as the claim of the complainant has not been repudiated by the O.Ps so far, therefore, no cause of action has arisen in favour of the complainant and against the O.Ps. The complainant is at liberty to raise the matter with the O.Ps by submitting the relevant evidence regarding death due to accident. In view of the fact that no cause of action has arisen or proved on record the case of complainant is dismissed. Ordered accordingly.
Copy of this order be sent to the parties as per rules.
Announced this 04th day of January,2016.
(K.S. MOHI) (SUBHASH GUPTA) (SHAHINA)
President Member Member
