The present complaint has been filed by the titled complainant Manpreet Kaur [widow of Hardeep Singh @ Gurdeep Singh the Deceased Life Insured (hereinafter 'the DLI')] through her father Gurdial Singh the holder of her Special Power of Attorney (Ex.C1) executed for the purpose of prosecuting this complaint, only. The DLI (Deceased Life Insured) during his lifetime had on 06.03.2006 purchased one life policy # 300378615  from the titled opposite party2 the LIC of India (for short, the OP2) with a Basic S.A. (Sum Assured) of Rs.15 Lac and double the amount in case of an accidental death. The DLI along with his family had been living in California (Fresno), U.S. working there as a long-haul Trucker making localized country road trips. He died on 14.03.2017 while on one such trip and his dead body was found the next day by the Ohio State Highway Patrol Police near Milepost 134.6 in Henrpetta Township and pronounced dead at the scene duly preceded by the U.S. Norms cum Procedures etc.

2.        The complainant as requisite intimated all the opposite parties and the related death claim (for Basic as well as for Accident Benefit Sum Assured) was duly filed with the OP1's Branch office at Batala. The OP1 sanctioned and paid the Basic Sum Assured along with accrued profits i.e., Rs.15.00 Lac to the complainant but denied/ repudiated Double Benefit Accident DBA Claim SI of Rs.15 Lac negating the DLI's final-exit as accidental death in spite of due certification(s) of cause of death as 'Hypothermia Cause Accident' in the related Coroner Report (Ex.C3), Autopsy Report (Ex.C4) and Death Certificate (Ex.C5) by the designated U.S. Civic Authorities. Thus, aggrieved the complainant has filed the present complaint seeking therein the appropriate directives to the OP1 insurer to release the wrongly withheld DBA sum of Rs.15 Lac along with its collateral accruals having matured by virtue of the policy clause carrying the Accidental Benefit Sum Assured of Rs.15 Lac

3.       The complainant Manpreet Kaur has also filed certified copies of the following documents in evidence to prove her version of the complaint:

            i)          Ex.CW-1 Affidavit by Gurdial Singh, the Attorney (SPA Holder) of the complainant deposing the contents of the complaint;

            ii)         Ex.C1–Special Power of Attorney SPA by Smt. Manpreet Kaur Complainant favoring her father Gurdial Singh authorizing him to prosecute the complaint;

            iii)        Ex.C2 - Renewal Premium Receipt (# 2639325) dated 26.03.2013 for Rs.108,015/- Policy 300378615; Risk Commencing w e f 28.02.2006 and S.A. Rs.15.00 Lac;

            iv)        Ex.C3–Coroner's Verdict dated 08.05.2017- Hypothermia Cause Accident;

            v)         Ex.C4 – Forensic Toxicology Report 23.03.2017; None other to Hypothermia;

            vi)        Ex.C5 – Death Certificate dated 14.03.2017; Accident Hypothermia;           

            vii)       Ex.C6 – Passport dated 08.12.2016 as ID of the Complainant;

            viii)      Rebuttal/ Replication filed to on 21.10.2019.

4.         The titled opposite parties, in response to the commission’s summons/ notice  appeared through their counsel and filed their common written reply stating therein preliminary as well as objections on merit as:

            i)          No cause of action in favor of the complainant as the DLI had died on account of environmental hypothermia & not due to accident in terms of the Karman Coroner's verdict;

          ii)      The circumstances under which the DLI died qua the Fresno Police Report based on investigation (including the complainant's statement) indicate other probable reasons also like audio hallucinations, abandoning the truck in extreme cold conditions and depression on account of cancellation of Driving License etc and as such the DLI's death do not qualify the definition of LIC's Double Accident Rider. Sic!

          iii)     The complainant has received the death benefits policy S.I. of Rs.15.00 Lac plus accruals i.e., Rs.21,83,985/- on 18.01.2019 through NEFT and has not been eligible for the extra DBA of Rs.5.00 Lac as the DLI's death has not been an accidental. Further, the complainant has yet to submit the requisitioned documents in compliance to our letter of 11.01.2018. 

          iv)     On merits, the OP1 has re-stated that the DLI had died of Hypothermia and had not met an accidental death or had died of an accident;

          v)      No deficiency in service on the OP1’s part as the eligible death-claim for the full Sum Assured pertaining to the policy stands paid in totality;

          vi)     Further, on merits, the OP1 in its written statement have either denied or shrugged the remaining contents of the complaint addressing these as matters of records etc.;

          vii)    Finally, the OP1 have sought dismissal of the complaint with costs being bereft of any merit.

The OP1 in support of their version and pleadings in defense have produced the following documents in evidence:

          i)       Ex.OP1,2/A Affidavit Self declaration by Manager (Legal) Sh.Virsa Singh who has deposed the contents of the written reply as well as sanctity of the evidence;

          ii)      Ex.OP1,2/1 Policy: 300378615 Exhibiting SA Rs.15 Lac & DBA SA Rs 5 Lac;

          iii)     Ex.OP1,2/2 Schedule # 300378615; Jeevan Anand (with Profits; with Accident Benefit) with an exhibited S.A. Of Rs.15 Lac;

          iv)     Ex.OP1,2/3 Policy Proposal dated 06.03.2006;

          v)      Ex.OP1,2/4 Fresno Police Report dated 14.03.2017;

          vi)     Ex.OP1,2/5 Death Certificate dated 07.04.2017.

5.       We have examined the available documents/ evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective litigants. We find that the present dispute has arisen on account of the impugned ‘repudiation’ of the Double Accidental Benefit Death-claim pertaining to the Policy in question, by the opposite party insurers, as filed by the present complainant pertaining to the ‘death’ of her late (demised) husband Gurdeep Singh, the DLI (deceased life insured). The complainant has been the legal heir of the DLI besides being the registered nominee. We observe that the one and the only prime eventful logic founding/ supporting the repudiation of the impugned 'DBA claim' in question has been the OP1's understanding of the term as used in the coroner's verdict report (Ex.C3): Cause of Death appearing as: “Environmental Hypothermia Manner Accident” i.e., straightaway sudden death (instant heart-failure/dead-brain) and not preceded by other sub-zero cold related primaries like acute shivering, dumbness, knee-bending, caving-in; succeeded by pneumonia, pulmonary-fits, skin-discoloring, frost bite & finally by recovery or exit.

6.       Somehow, we do not concur with the logic of the LIC's repudiation and are inclined to examine the validity & legality of the impugned repudiation (of the related insurance death-claim) in the back-drop of the preceding and also the succeeding acts & events in the light of the facts on records and current law on insurance vis-à-vis consumer proposition’s subject matter, in issue. We observe that the Accidental Death shall comprise of one or more of such elements qualified by sudden, violent, unexpected and/or unnatural violent measures that are usually found absent in a natural death. We find that the OP1 insurers have deposed that the DLI's death do not qualify the definition of LIC's Double accident rider but they have ignored to produce the text of the definition explaining the 'rider'. There's a clear mention of   (US official investigation reports) the DLI's Truck developing a mechanical snag and he was instructed by the Highway Petrol to pull off the Highway and move to the rest-area off the road. There, the DLI would naturally have moved out of the cold switched-off engine truck to seek rescue, safety and assistance etc. That shows the DLI in normal health and striving to come out alive out of the otherwise a hopelessly sad situation. Further, the medical science of late has been recognizing that deaths due to hypothermia are usually accidental and are the result of exposure to extreme environmental temperatures. Further, the Coroner job is to find the cause of death of people who have died in violent or unusual ways and in most of countries the dead bodies only of persons dying in harness in an unusual/ accidental manner are handed over to the Coroners for their report. So, the very presence of the Coroner's and other Police Reports on the records do evidence an unnatural accidental death. Thus, the OP1 have failed to produce some cogent evidence, to prove its alleged cause of impugned repudiation of the DBA Claim. We find that the OP insurers here have arbitrarily repudiated the present claim merely on the ‘presumption’ that the DLI had not died of an accidental death. The OP insurers must realize that their administrative decisions in settling insurance claims are open to judicial review and thus need be taken with due application of mind and not arbitrarily and these should also be speaking in nature duly explaining the reason and logic of the decision as to how the same has been reached. The facts in issue need be appreciated while awarding sanctity to the current applicable law.

7.       Finally, in the matter pertaining to the present complaint and in the light of the all above, we set aside the OP1’s impugned repudiation of the DBA claim being arbitrary (contra to laws of natural justice) and amounting to ‘deficiency in service’. Thus, we ORDER the OP insurers to pay the impugned ‘DBA Claim’ to the full Sum Insured pertaining to the related Policy, in question, with full accrued benefits, if any, along with Rs.10,000/- as compensation for the undue harassment inflicted upon the widow complainant besides Rs.5,000/- as cost of litigation; within 45 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA form the date of the orders till actually paid.                                     

8.       The complaint could not be decided within the stipulated period due to heavy pendency of Court Cases, vacancies in the office and due to pandemic of Covid-19.

9.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                                                           (Naveen Puri)

                                                               President.   

ANNOUNCED:                                (B.S.Matharu)

MAY 19, 2022.                                       Member.

YP.