Before the District Consumer Disputes Redressal Forum, Rohtak.
Complaint No. : 348.
Instituted on : 26.09.2014.
Decided on : 14.03.2016.
Smt. Jyoti wife of Late Manoj son of Balbir resident of village Kharawar Tehsil Sampla Distt. Rohtak.
………..Complainant.
Vs.
Life Insurance Corporation India, through its Divisional Manager, 3,4,5, SCO, Sector-1, Rohtak.
……….Opposite party.
COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT,1986.
BEFORE: SH.JOGINDER KUMAR JAKHAR, PRESIDENT.
MS. KOMAL KHANNA, MEMBER.
SH. VED PAL, MEMBER.
Present: Complainant in person.
Sh.Punit Chahal, Advocate for the opposite parties.
ORDER
SH. JOGINDER KUMAR JAKHAR, PRESIDENT :
1. The present complaint has been filed by the complainant with the averments that husband of the complainant namely Manoj had availed one LIC Policy bearing no.179102806 from the opposite party and the sum assured under the policy was Rs.250000/-. It is averred that complainant was nominated as nominee in the aforesaid policy and as per terms of the policy in the event if the policy holder Manoj is died in a road side accident, the opposite party will be liable to pay double amount of assured amount. It is averred that the husband of the complainant died in motor vehicle accident and FIR No.40 dated 21.02.2013 was got registered in this regard. It is averred that in the post mortem report it has been mentioned that death is occurred in road side accident. It is averred that after the death of her husband, complainant intimated to the opposite party and submitted her claim to get the amount acquired under the policy i.e. double of the sum assured i.e. total Rs.500000/- as per terms and conditions of the policy. It is averred that the opposite party is liable to pay double of assured amount and the complainant deposited all the documents as required by opposite party. It is averred that the opposite party had only disbursed the amount of Rs.250000/- to the complainant on account of death of her husband and has withheld the accident benefit under the policy. It is averred that the act of opposite party of not disbursing the accident benefit accrued under the policy to the complainant is illegal, unjust, against the natural justice and also amounts to deficiency in service. As such it is prayed that the opposite party may kindly be directed to pay the accident benefit of Rs.250000/- alongwith interest, compensation and litigation expenses.
2. On notice opposite party appeared and filed its written reply submitting therein that it is a matter of record that the husband of the complainant has been insured with the opposite party vide policy no.179102806 for a sum assured Rs.250000/- and the complainant stood nominee to the said policy. It is submitted that the basic death claim payment has already been paid for Rs.250000/- in favour of complainant Smt. Jyoti on 30.07.2013. It is averred that as per forensic science laboratory report the Ethyl Alcohol was detected in stomach of insured. Hence the accident benefit is not payable as per terms and conditions of the policy. As such the claim is not covered as per the policy terms and conditions and the same was rightly rejected and has been repudiated. It is averred that the present complaint may kindly be dismissed with costs.
3. Both the parties led evidence in support of their case.
4. Complainant in her evidence has tendered affidavit Ex.CW1/A, documents Ex.C1 to Ex.C7 and closed her evidence. On the other hand, ld. Counsel for the opposite party has tendered affidavit Ex.RW1/A, documents Ex.R1 to Ex.R4 and has closed the evidence.
5. We have heard learned counsel for the parties and have gone through material aspects of the case very carefully.
6. In the present case it is not disputed that as per personal accident insurance cover Ex.R2, husband of the complainant was insured with the opposite party under the LIC’s Jeevan Saral(with profits) with accident benefits for a sum of Rs.250000/- for death benefits and Rs.250000/- for accident benefits. It is also not disputed that as per copy of FIR Ex.C1/Ex.R1 the husband of the complainant was died in an accident. As per copy of PMR Ex.C6 the information furnished by the police is “R.S.A(Roadside accident)”. After the death of her husband, complainant filed the claim with the opposite party but the opposite party vide its letter Ex.C7 has repudiated the claim on the ground that: “As per Forensic Sc. Laboratory report Ethyl alcohol was detected in stomach and accident benefit does not become payable as per policy terms and conditions”.
7. After going through the file and hearing the parties it is observed that the accident benefit under the policy has been repudiated by the opposite party on the ground that as per forensic science laboratory report Ethyl alcohol was detected in stomach of insured. But no such report of Forensic Science Laboratory has been placed on record by the opposite party. As per copy of PMR Ex.R4, the blood sample was sent to the Director, FSL, Madhuban for alcohol examination but no such report of FSL, Madhuban has been placed on record by the opposite party. Hence it is not proved on file that the life assured deceased Manoj had died due to the consumption of Alcohol. In this regard Hon’ble National Commission, New Delhi in 1(2015) CPJ676(NC) titled M.Raja Gangu, M.Sujatha Vs. Life Insurance Corporation of India has held that: “Doctor who performed post-mortem had not sent blood sample from dead body for analysis for blood alcohol concentration-Report from FSL not conclusive-Mere smell of alcohol or presence of ethyl alcohol in the tissue samples cannot lead to inference that person is incapable of taking care of himself”, as per IV(2014) CPJ 126(NC) titled as Matber Singh Vs. Oriental Insurance Co. Ltd. & Anr. Hon’ble National Commission, New Delhi has held that: “Death due to drowning-Personal accident-Claim repudiated-Deficiency in service-Drowning in the river was sole and direct cause of death-Death occurred when deceased accidentally fell into river-Death covered by policy under section ‘Personal Accident’-Insurance company was under contractual obligation to pay sum of $25000 to complainant, being the assignee under policy, without any deduction-Repudiation not justified” and Hon’ble National Commission, New Delhi in 2014(2)CPC 335 titled United India Insurance Co. Ltd. Vs. Sheela & Ors., has held that: “Mere taking of alcohol without proving limit of diet can be a proof of intoxication-No nexus between intoxication and cause of death proved in the present case even from post mortem report”. In view of the aforesaid law which are fully applicable on the facts and circumstances of the case it is observed that the death has caused due to accident and there is no nexus between intoxication and the cause of death. As such the repudiation of claim by the opposite party is illegal and unjustified and the complainant is entitled for the claim amount as per policy.
8. In view of the facts and circumstances of the case, it is directed that the opposite party shall pay the accident benefit under the policy amounting to Rs.250000/-(Rupees two lac fifty thousand only) along with interest @9% p.a. from the date of filing the present complaint i.e. 26.09.2014 till its actual realization and shall also pay a sum of Rs.3000/-(Rupees three thousand only) as litigation expenses to the complainant within one month from the date of decision failing which the opposite party shall be liable to pay interest @ 12% p.a. on the awarded amount from the date of decision. Complaint is allowed accordingly.
9. Copy of this order be supplied to both the parties free of costs.
10. File be consigned to the record room after due compliance.
Announced in open court:
14.03.2016.
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Joginder Kumar Jakhar, President
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Komal Khanna, Member.
……………………………..
Ved Pal, Member.
