Haryana

Yamunanagar

CC/469/2010

Anita Soni W/o Lalit Kumar Soni - Complainant(s)

Versus

Life Insurance Corporation Of India - Opp.Party(s)

Vikram Sheoran

22 Sep 2016

ORDER

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

                                                                                                Complaint No. 469  of 2010.

                                                                                                Date of institution: 14.05.2010

                                                                                                Date of decision: 22.09.2016.

Smt. Anita Soni aged about 54 years wife of late Sh. Lalit Kumar Soni, r/o H. No. 282, Model Colony, Yamuna Nagar, Distt. Yamuna Nagar.                                                                                                                                                            

                                                                                                                                                             …Complainant.

                                          Versus

1. Life Insurance Corporation of India, Branch Office, SCO 184-185, Sector-17,Urban Estate, Jagadhri through its Branch Manager.
2. The Senior Divisional Manager, L.I.C. of India, Unit No.1, 489, Model Town, Karnal-132001.

                                                                                                                                                             …Respondents.

 

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present: Sh. V.S. Sheoran, 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 by Smt. Anita Soni being nominee and widow of deceased Lalit Kumar Soni with the averments that husband of the complainant namely Lalit Kumar Soni was insured with the OPs vide policy No.  172698053 with the date of commencement 28.08.2001 and maturity date was  28.08.2022 under the TT 14-21 for a sum insured of Rs. 5,00,000/- and premium of Rs. 30370/- yearly was payable. The insured was paying insurance premium regularly to the OPs. The husband of the complainant died on 14.03.2009 due to leakage of gas of geyser while taking bath in the bathroom. Immediately, he was taken to hospital but he was declared brought as dead and a certificate regarding the death of Sh. Lalit Kumar Soni, was issued by Dr. R.K. Gupta, M.D. Yamuna Nagar. However, no FIR was registered and no PMR was conducted because the death had occurred due to leakage of geyser gas. After some time complainant submitted claim form with the Op No.1 regarding insurance Claim as well as accidental claim regarding death of her husband, upon which, the OPs have issued the insurance claim of Rs. 5,00,000/- to the complainant, but the accidental benefits claim was not paid, due to the reason best known to the official of the OPs. The complainant made so many requests to release the payment of accidental benefits and a legal notice dated 31.10.2009 was also sent to the OPs but all in vain. Lastly, prayed for directing the OPs to make the payment of accidental claim in respect of death of Lalit Kumar Soni under the policy in question and also to pay compensation as well as litigation expenses. Hence this complaint.  

2.                     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 on the part of OPs. It has been admitted that deceased life assured Lalit Kumar Soni was insured with the OPs for a sum of Rs. 5,00,000/- and on receipt of intimation dated 24.03.2009 from the complainant regarding the death of life assured on 14.03.2009, the claim was duly processed and the basic sum insured amounting to Rs. 5,00,000/- has already been paid to the complainant on 27.03.2009. As far as the accidental benefit is concerned, the claim was not covered under the definition of accident. The accident claim was payable only if it was duly established that the life assured sustained bodily injuries resulting solely and directly from the accident cause by outward violent visible means and the same must be submitted with documentary evidence. In this case, the complainant has sought the accidental benefits and OPs Corporation, vide its letter dated 13.05.2009, had desired the complainant to submit the copy of FIR, PIR and PMR duly attested to substantiate the factum of accident. However, the complainant has failed to submit these documents, therefore, no claim was payable in the absence of proof of accidental death. There was no document to establish that life assured suffered accidental death, therefore, the claim of the complainant was rejected by the OPs. As far as the certificate of Dr. R.K. Gupta is concerned the same merely mentioned the fact that life assured brought dead and the same is not a document to establish the accidental death. The PMR, FIR and PIR were the best documents to establish the accidental death of life assured and on merit it has been specifically denied being wrong that husband of the complainant had died due to leakage of geyser gas as complainant has not submitted any documents to substantiate the accidental death and controverted the plea taken in the complaint and reiterated the stand taken in the preliminary objections. Lastly, prayed for dismissal of complaint.  

3.                     To prove the case, counsel for the complainant tendered into evidence affidavit of complainant as Annexure CW/A and documents such as Death certificate as Annexure C-1, Photo copy of letter dated 13.05.2009 issued by LIC demanding the copy of FIR, PMR and PIR as Annexure C-2, Copy of applications sent to the OPs for releasing the payment of claim dated 23.05.2009, 13.05.2009 and 03.08.2009 as Annexure C-3 to C-5, Photo copy of claim form as Annexure C-6 and C-7, Copy of legal notice dated31.10.2009 as Annexure C-8, Acknowledgement as Annexure C-9, Postal receipts as Annexure C-10 and C-11, Copy of repudiation/denial letter dated 27.07.2009 as Annexure C-12 and closed the evidence on behalf of complainant.     

4                      On the other hand, counsel for the OPs tendered into evidence affidavit of Sh. P.K. Saxena , Manager LIC as Annexure RW/A and documents such as photo copy of repudiation/ denial letter dated 27.07.2009 as Annexure R-1, Copy of letter dated 13.05.2009 for submitting the documents as Annexure R-2, copy of insurance policy with its terms and conditions as Annexure R-3 and closed the evidence on behalf of OPs.

5.                     During the course of arguments, learned counsel for the OPs also tendered photo copy of account statement regarding payment of basic sum insured plus bonus etc. which was ordered to be marked as Annexure R-4.

6.                     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.

7.                     It is  not disputed that husband of complainant deceased Lalit Kumar Soni son of Sh. Sain Dass Soni was not insured under the policy bearing No. 172698053 under TT 14-21 with the date of commencement 28.08.2001 and maturity date is 28.08.2022 for a sum insured of Rs. 5,00,000/- and the premium amounting to Rs. 30,370/- was payable yearly. The only version of the complainant is that the husband of the complainant had died on 14.03.2009 due to leakage of geyser gas while taking bath in the bathroom and immediately he was taken to the hospital but he was declared brought dead and a certificate regarding the death was issued by Dr. R.K. Gupta, M.D. Yamuna Nagar and the OPs paid only basic sum insured of Rs. 5,00,000/- but has wrongly and illegally withheld the accidental benefits i.e. double benefits of the sum insured.

8.                     On the other hand, counsel for the OPs argued that the basic sum insured of Rs. 5,00,000/- plus Rs. 2,18,500/- vested bonus alongwith interim bonus i.e. total Rs. 7,18,500/- had already been paid to the complainant vide cheque No. 0491191 dated 30.03.2009 which is evident from Annexure R-4 but the complainant has failed to file any cogent evidence that the life assured sustained bodily injury resulting solely and directly from the accident caused by outward violent visible means and failed to submit copy of FIR, PIR or PMR, so the accidental benefits was not payable to the complainant. Further, learned counsel for the OPs argued that the alleged certificate issued by Dr. R.K. Gupta is not authenticated document as in that certificate it has been merely mentioned that life assured brought dead and the same is not a document to establish the accidental death. The PMR, FIR and PIR were the best documents to establish the accidental death of the life assured but the complainant has totally failed to submit the same. Hence, the claim of the complainant has been rightly repudiated/denial vide letter dated 27.07.2009 Annexure R-1/C-12. Learned counsel for the OPs also referred the case law titled as Soumya Ranjan Versus Life Insurance Corporation of India & others, Legal Digest, July 2011 Revision Petition No. 3382 of 2006 decided on 29.09.2011, wherein it has been held “that the mother of the complainant taken insurance from the respondent-LIC and she suffered a heat stroke while waiting at bus stop and become unconscious and was taken to a nursing home where she was diagnosed as having suffered from heat stroke and was referred to a hospital, where she died due to heart failure caused by heat stroke. The petitioner filed insurance claim and claimed additional amount as accident claim since the death was caused by an accident. A claim for double accident was repudiated by insurer as death by heat stroke cannot be termed as an accident. A complaint was filed before the District Forum and the same was allowed. Respondent-LIC preferred Frist Appeal before the Hon’ble State Commission and the same was allowed in favour of LIC. Aggrieved by the said decision original complainant preferred Revision Petition before the Hon’ble National Commission.

                        The Hon’ble National Commission dismissed the revision petition by the original complainant stating that there is no ambiguity in what constitutes an accident under this policy and heat stroke is clearly not covered under it. The contention that since insurance policies are one sided, being designed by the insurance company cannot be a reason for the rejection because once a policy is taken by the lifer assured it becomes a contractual agreement under the Indian Contract Act which has to be honoured by both the parties. The respondents were justified in repudiating the two claims”.

9.                     After hearing both the parties and going through the documents, we are of the considered view that there is no deficiency in service or unfair trade practice on the part of Ops as the complainant has totally failed to file any cogent evidence in support of her version that the insured Lalit Kumar Soni died due to any accident caused by outward violent visible means. The complainant has herself admitted that no FIR/DDR and PMR was conducted and in the absence of these documents the cause of death cannot be ascertained. Furthermore, no such certificate issued by Dr. R.K. Gupta, as alleged in the complaint, has been placed on file either by the complainant or the OPs. There is only a claim form Annexure C-6 and C-7 in which Dr. R.K.Gupta has mentioned in para No.11 of the claim form that patient found unconscious in the bathroom filled with gas geyser. Patient declared dead when brought to the hospital. This claim form has been signed by Dr. R.K. Gupta on 02.04.2009 whereas life assured died on 14.03.2009. No death certificate, treatment record or prescription slips issued by any doctor of dated 14.03.2009 i.e. date of death has been placed on file to prove that life assured died due to the leakage of gas from geyser. The claim form which was counter singed by Dr. R.K. Gupta on 02.04.2009 cannot be considered as a death certificate issued by Dr. R.K. Gupta. It seems that this claim form has been counter signed by Dr. R.K.Gupta mere on asking of the complainant. Further, the complainant has also totally failed to place any affidavit of any neighbourer or any respectable persons/ municipal commissioner of their ward in support of her version. The fact of the case law referred by the counsel for the OPs  titled as Soumya Ranjan Versus Life Insurance Corporation of India & others, (supra) is fully applicable to the facts of the present case.  

10.                   In the circumstances noted above and law cited by the counsel for the OPs, we are of the considered view that the complainant has totally failed to prove her case, hence, we have no option except to dismiss the present complaint and the same is hereby dismissed with no order as to costs. Copies of this order be sent to the parties concerned free of costs as per rules. File be consigned to the record room after due compliance.

Announced: 22.09.2016.        

                                                                                   (ASHOK KUMAR GARG )

                                                                                    PRESIDENT,

 

                                                                                     

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.