BEFORE THE DISTRICT CONSUMER DISPUTES
REDRESSAL FORUM, JALANDHAR.
Complaint No.337 of 2017
Date of Instt. 14.09.2017
Date of Decision:19.06.2019
Dharamveer son of Sh. Kundan Lal R/o H. No.B-8, Gazi Gulla, Jalandhar.
..........Complainant
Versus
1. Life Insurance Corporation of India, Branch Office Unit No.-1 Ground Floor, Jeevan Prakash, Model Town Road, Jalandhar through its Senior Branch Manager.
2. Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, Model Town Road, Jalandhar through its Senior Divisional Manager.
3. Manager Claims Life Insurance Corporation of India, Divisional Office, Jeevan Parkash, Model Town Road, Jalandhar-144001.
….….. Opposite Parties
Complaint Under the Consumer Protection Act.
Before: Sh. Karnail Singh (President)
Smt. Jyotsna (Member)
Present: Ms. Nikita Rai, Adv Counsel for the Complainant.
Sh. S. C. Sood, Adv Counsel for the OPs No.1 to 3.
Order
Karnail Singh (President)
1. This complaint has been filed by the complainant, wherein alleged that the wife of the complainant, namely Mrs. Sharda while alive got insurance policy bearing No.132288920 for Rs.1,00,000/- sum assured under Plan LIC’s New Bema Gold Table No.179 for term 20 years through authorized agent of OP No.1 under the Supervisory and Administrative Control of OP No.2.
2. Due to misfortune and ill-luck of the complainant, the wife of the complainant, namely Mrs. Sharda died on 07.02.2012 by an accident, on the fateful day i.e. on 05.02.2012, the insured Mrs. Sharda was sitting on Wooden Bench and all of sudden, she fell down towards backside and sustained spinal injury. The insured was brought to Shri Devi Talab Mandir Charitable Hospital, Jalandhar, where she was hospitalized as patient on 05.02.2012 at night i.e. 09:30 PM and diagnosed Quadupligia due to Cervical Spine Injury and referred the insured to higher centre for Cervical Spine Injury management in serious condition on 06.02.2012. There upon insured was got admitted and hospitalized on 06.12.2012 in Doaba Hospital, Jalandhar. Ultimately, insured succumbed due to Cervical Spine Injury by fall due to accident and died on 07.02.2012. After the death and condition of the insured, the complainant, vide letter dated 05.03.2012 intimated death by accident of insured, being nominee appointed in the said insurance policy, to the OP No.1. The complainant submitted prescribed claim form, certificate of hospital treatment of Shri Devi Talab Charitable Hospital, Jalandhar as well as Doaba Hospital, Jalandhar, Discharge Summary, Death Certificate and also completed and complied with all the requirements for quick settlement and payment of Basic Sum Assured and Double Accident Claim as additional amount of sum assured equal to sum assured covered under Double Accident Benefit (DAB) in respect of policy subject matter of present complaint. The claim by death was registered under death intimation No.D/03/2012/00016 dated 22.03.2012 by OP No.1. The claims for basic sum assured of Rs.1,00,000/- was paid to the complainant, vide cheque No.0208766 dated 24.03.2012. However, OPs have arbitrarily and malafidely withheld DAB claim for Rs.1,00,000/- sum assured or unreasonable and inexcusable despotic and autocratic approach and functioning of OPs till date. OP No.1 referred the claim file of the complainant to Claim Department i.e. OP No.3 to decide and settle the death claim of the insured and accordingly, OP No.3 got conducted claim enquiry/investigation from Paramjit Singh, ABM (S), who firmly and categorically confirmed the factum of sudden fall and spine injury sustained by insured. The investigation and enquiries were also made from the neighborhood. All efforts made to convince and persuade the OPs to pay the remaining amount of the death claim, but all in vain. The OPs dilly dallied accidental claim settlement unnecessary and unwarranted, which tantamount to deficiency in rendering service and unfair trade practice and accordingly, necessity arose to file the present complaint with the prayer that the complaint of the complainant may be accepted and OPs be directed to settle and pay the double accident claim of life insurance policy for Rs.1,00,000/- additional sum assured for Accidental Benefit Claim and further OPs be directed to also pay interest on the aforesaid amount from the date of lodging of the claim till actual payment and further OPs be directed to pay compensation of Rs.50,000/- for causing mental tension and harassment to the complainant and also directed to pay litigation expenses of Rs.10,000/-.
3. Notice of the complaint was given to the OPs and accordingly all the OPs appeared through its counsel and filed joint written reply, whereby contested the complaint by taking preliminary objections that the complaint is not maintainable as there is no evidence of any accident and the contents stated in the complaint does not fall within the ambit of accident. It is further averred that the OP has already paid basic sum assured and the complainant is not entitled for DAB. It is further alleged that the complainant fails to submit the requirement as per Claim Manual Provisions and even the complainant has not supplied any FIR, Postmortem Report or any Medical Report/X-Rays/Scan conducted by the doctor to substantiate the accident, without which no claim can be considered for the purpose of accident. On merits, it is admitted that the wife of the complainant, namely Mrs. Sharda was insured, vide policy bearing No.132288920 for Rs.1,00,000/-. The other allegations as made in the complaint are categorically denied and lastly submitted that the complaint of the complainant is without merits and the same may be dismissed.
4. In order to prove the case of the complainant, the counsel for the complainant tendered into evidence affidavits of the complainant Ex.CA and Ex.CB, Affidavit of Sh. Darshan Lal Ex.CC and Affidavit of Sh. Kishan lal Ex.CD alongwith some documents Ex.C-1 to Ex.C16 and closed the evidence.
5. Similarly, counsel for the OPs tendered into evidence affidavit Ex.OW1/A along with some documents Ex.O-1 to Ex.O-4 and closed the evidence.
6. We have heard the argument from learned counsel for the respective parties and also gone through the case file very minutely.
7. After perusing the file, it reveals that the OP has admitted that the wife of the complainant got insurance policy for sum assured of Rs.1,00,000/- under Plan LIC’s New Bema Gold Table No.179 and it is also not denied that the wife of the complainant was remained admitted in Shri Devi Talab Charitable Hospital, Jalandhar and Doaba Hospital, Jalandhar and also admitted that she died on 07.02.2012 and her claim was submitted by the complainant, wherein numerous document was called from the complainant, but complainant miserably failed to fulfill the requirement and as such, the complainant is not entitled for the DAB claim and accordingly, the complainant came in this Forum and filed the instant complaint for the relief claimed as in the complaint. 8. We have sympathetically considered the entire facts as well as argument put forth by learned counsel for the parties and find that the claim for basic sum assured of Rs.1,00,000/- was already paid by the OP to the complainant through cheque dated 24.03.2012 and this fact is not in dispute rather admitted by the complainant in its complaint in Para No.4. The question before us is only whether the complainant is entitled for DAB i.e. the equal amount of the insured amount i.e. Rs.1,00,000/-. The same has been not settled by the OP simply on the ground that the complainant miserably failed to submit X-Ray report/ Scan conducted by the hospital doctor, Postmortem Report or FIR and these documents have been demanded by the OP number of times from the complainant despite giving a reply by the complainant that these documents are not available and even the OP, vide letter dated 12.07.2013 Ex.O-3 were also demanded the same documents and due to that reason, the claim is lingering on for so many years. The said documents are demanded by the OP on the basis of the terms and conditions and relevant extract of the said terms and conditions is placed on the file Ex.O-4 and relevant Para is 28 ‘Normal Requirements for Claim’. We have gone through these requirements as enumerated in Para No.28 and find that the said Para demanded Inquest Report, FIR, Postmortem Report etc., but at Serial No.viii and ix, when the aforesaid document is not available, then in alternative proofs such as statement of eye witnesses, affidavit of Gramsevak or Govt. official or own enquiry report, attending physician or hospital reports may be sufficient and further hospital treatment record is also sufficient, but these provisions i.e. Column No.viii and ix has been ignored by the OP for the best known reason just to deprive the complainant from eating the fruits of the insurance policy of his wife, if we adjudge the case of the complainant in the light of above Column No.viii and ix and then find that the complainant brought on the file two affidavits of eye witnesses i.e. Darshan Lal Ex.CC and affidavit of Krishan Lal Ex.CD. Apart from that the complainant also produced on the file his own affidavit Ex.CA and additional affidavit Ex.CB. If the aforesaid eye witnesses stated on oath that they had seen the incident when insured Mrs. Sharda fallen from the stool and sustained spine injury. We cannot discard the statements on oath of aforesaid witnesses i.e. complainant as well as Darshan Lal and Krishan Lal and these statements of the eye witnesses is further corroborated by Intimation Letter Ex.C-4, wherein at Para No.2 categorically mentioned that the death claim by accident and further Photostat copy of the claim form Ex.C-5 also proved that the insured Mrs. Sharda was died by accident. Apart from the above document, there is another important document i.e. Investigation Report Ex.C-7, which was got investigated by the OP itself by appointment of investigating officer and in the said investigation, it is also found by the investigator that the death of the insured Mrs. Sharda was caused due to accident i.e. Spinal Injury. The above documents as well as statement on oath of the eye witnesses, report of the doctor of Doaba Hospital, Jalandhar Ex.C-15 also corroborated the version of the complainant that the death of the insured Mrs. Sharda was caused due to accident, by way of Spinal Injury. The said facts has been mentioned by the doctor of Doaba Hospital, Jalandhar in the aforesaid summary report Ex.C-15 at Page 2nd in the footing under the heading Diagnosis:- ‘Cervical Spine Injury’. We find there are sufficient evidence came on the file to establish that the death of the insured Mrs. Sharda was caused due to accident, by way of falling from the Stool and got Spinal Injury and under these circumstances, if the X-Ray Report, Postmortem Report and FIR are not available that cannot create any hindrance in the way to get a DAB from the OP and OP has no right to decline such like benefit simply on the ground that the complainant has no documents i.e. X-Ray, Postmortem Report, FIR etc. and in view of the above detailed, we also gone through the judgments referred by the learned counsel for the OP of Hon’ble National Commission, in Revision Petition No.2427 of 2014, titled as “Life Insurance Corporation of India Vs. Alka Shukla”, and further referred another pronouncement of Hon’ble National Commission i.e. Revision Petition No.689 of 2006, titled as “Life Insurance Corporation of India Vs. Surekha Rudranath Autade”. The facts of the above judgments of the Hon’ble National Commission are not helpful to the OP in the present case, being reason the facts of the aforesaid judgments are not identical to the facts of the case in hand rather we find the facts of the case in hand are totally and almost identical to the facts of the case decided by Hon’ble State Commission of Punjab in First Appeal No.478 of 2018, decided on 22.04.2019, titled as “Bachan Singh Vs. Life Insurance Corporation of India etc.”, wherein similar situation was that the complainant was not having the same documents, but the Hon’ble State Commission categorically held that for want of said documents, when other evidence is available, the OP could not debar the complainant from claiming the DAB claim on account of death of insured. Accordingly, we reached to conclusion that the claim of the complainant qua DAB is illegally and arbitrarily withheld by the OP, whereas the complainant is entitled for the same.
9. In the light of above detailed discussion, the complaint of the complainant is partly accepted and OPs are directed to pay DAB insurance claim of Rs.1,00,000/- to the complainant with interest @ 12% per annum from the date of filing claim i.e. 05.03.2012, till realization. Further, OPs are directed to pay compensation for causing mental tension and harassment to the complainant, to the tune of Rs.20,000/- and further OPs are directed to pay litigation expenses of Rs.5000/- The entire compliance be made within one month from the date of receipt of the copy of order. This complaint could not be decided within stipulated time frame due to rush of work.
10. Copies of the order be supplied to the parties free of cost, as per Rules. File be indexed and consigned to the record room.
Dated Jyotsna Karnail Singh 19.06.2019 Member President
