Life Insurance Corporation of India Senior Divisional Manager
...........Respondent(s)
BEFORE:
Complainant(s)/Appellant(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
OppositeParty/Respondent(s):
ORDER
DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, BATHINDA (PUNJAB) CC. No. 139 of 8-05-2008 Decided on : 17-03-2009 1.Jatinder Kaur widow of Gurmej Singh S/o Sh. Mehtab Singh 2.Parneet Kaur ) 3.Navdeep Singh ) minor children of Gurmej Singh son of Sh. Mehtab Singh, through their natural mother and next friend Smt. Jatinder Kaur widow of Gurmej Singh 4.Gurmit Kaur wife of Mehtab Singh (mother of Gurmej Singh) - all residents of Quarter No. 56, Police Colony, Lal Singh Basti, Bathinda. ... Complainants Versus 1.Life Insurance Corporation of India, Urban Estate, Phase-I, Dugri Road, Ludhiana, through its Zonal Manager. 2.Senior Divisional Manager, Life Insurance Corporation of India, Urban Estate, Phase -I, Dugri Road, Ludhiana. ... Opposite parties Complaint under Section 12 of the Consumer Protection Act, 1986. QUORUM Sh. Pritam Singh Dhanoa, President Dr.Phulinder Preet, Member Sh. Amarjeet Paul, Member Present : Sh. Abhey Singla, Advocate, counsel for the complainants Sh. Sanjay Goyal,Advocate, counsel for the opposite parties O R D E R SH. PRITAM SINGH DHANOA, PRESIDENT 1. This complaint has been filed Smt. Jatinder Kaur widow of Sh. Gurmej Singh and her minor children Parneet Kaur and Navdeep Singh and their grand mother Gurmit Kaur, under Section 12 of the Consumer Protection Act, 1986 (in short called the 'Act') against Life Insurance Corporation of India through its Zonal Manager and Senior Divisional Manager, Ludhiana, for giving them direction to pay double the amount payable under the Insurance Policy secured by deceased Gurmej Singh son of Sh. Mehtab Singh, covering risk of his life with further direction to pay a sum of Rs. 70,000/- on account of damages and compensation and any other additional or alternative relief deemed fit by this Forum. 2. Briefly stated the case of the complainant is that the insured Gurmej Singh had been suffering from cough and cold for several days prior to his death on 26.10.05 and had been taking homeopathic medicine. The deceased insured confused the homeopathic medicines taken by him with tablet meant for killing rats and consumed the said poisonous substance by mistake on 26.10.2005. He died on the way to hospital and on account of his death, F.I.R. was registered and police officials in the course of investigation came to the conclusion that insured had died due to taking poisonous tablets presuming them to be homeopathic medicine taken by him. The deceased had purchase LIC policy bearing Account No. 300237616 from the opposite parties. After his demise, complainant No. 1, lodged claim with the opposite parties for seeking release of amount payable under the policy, but they repudiated her claim vide their letter dated 06-10-2006, on the ground that deceased has committed suicide within a period of one year from the date of issuance of policy. On receipt of intimation, complainant No. 1, made representation on 27-02-2007 to the Zonal Manager of the opposite parties, but he did not pay any heed. However, in terms of letter dated 11-10-2007, written by her, claim was referred by opposite parties to Insurance Ombudsman, Chandigarh, but he too vide order dated 24-01-2008, rejected the same accepting version of the opposite parties although the insured had expired accidental death and had not committed suicide. The complainants have suffered mental and physical agony due to repudiation of their claim by the opposite parties, in arbitrary manner, hence this complaint. 3. On being put to notice, opposite parties filed written version resisting the complaint by taking preliminary objections that complainants have not approached this Forum with clean hands, as such, their complaint deserves to be dismissed; that complaint is not maintainable because earlier representations filed by the complainants before Zonal Level Committee chaired by retired judge of Hon'ble High Court and Insurance Ombudsman, Chandigarh, which is a statutory body, have been dismissed; that complaint is false, frivolous and baseless and there is no deficiency in service on the part of the opposite parties, as such, it is liable to be dismissed. On merits, it is admitted that Insurance policy in question was purchased by the deceased insured in terms of which claim is not payable if insured committed suicide, within the period of one year from the date of issuance of policy. It is submitted that as the insured has committed suicide within a period stipulated in the policy, as such, claim has been rightly repudiated by the opposite parties. It is submitted that representations were filed by the complainants before Zonal Level Committee, which is an independent body and before Insurance Ombudsman, a statutory body for the areas covered by States of Punjab, Haryana, Himachal Pardesh, J & K and Chandigarh. As such they have availed the remedy open to them before the Zonal Level Committee of the opposite parties and orders passed by the said committee and Insurance Ombudsman have become final and are binding upon the parties. It is also contended that the said authorities have accepted the version of the opposite parties and have passed the orders with independent mind without their influence after providing opportunity of being heard to the complainants. It is also submitted that complainants have no cause of action to file the present complaint and this Forum has no jurisdiction to readjudicate the controversy in view of the orders passed by the above said authorities. Rest of the averments made in the complaint have been denied and prayer has been made for dismissal of the complaint. 4. On being called upon, by this Forum, to do so, the learned counsel for the complainants tendered affidavit of Jatinder Kaur, complainant and copies of documents Ex. C-2 to Ex. C-23, before he closed their evidence. On other hand, learned counsel for the opposite parties tendered in evidence the affidavit of Sh. J P Arya, Manager Legal and copies of documents Ex. R-2 to Ex. R-5 and he closed their evidence. 5. We have heard, the learned counsel for the parties and perused the oral and documentary evidence adduced on record by them, carefully, with their kind assistance. 6. At the outset, learned counsel for the complainants Sh. Abhey Singla, Advocate, has submitted that factum of issuance of Insurance policy in the name of deceased insured is not disputed by the opposite parties and cause of death is proved by the copies of documents produced on record by the complainants and affidavit of complainant No. 1 Smt. Jatinder Kaur, but no evidence to the contrary has been adduced on record by the opposite parties, on the basis of which their plea may be accepted by this Forum that deceased insured has committed suicide within a period of one year from the date of issuance of Insurance policy. Learned counsel argued that even the Investigator appointed by the opposite parties Sh. Vikas Aggarwal, has reported after recording the statements of the witnesses that claim of the complainants being genuine may be paid to them, but they preferred to reject the claim on the basis of no evidence. Learned counsel submitted that decisions given by Zonal Level Committee and Insurance Ombudsman on the representations made by the complainants are not binding upon them and complaint filed by them before this Forum, is maintainable. In support of his contentions, learned counsel has placed reliance on 2005(2) CLT 37 Kamleshwari Prasad Singh Vs. National Insurance Co. Ltd., wherein it has been held that decision of Ombudsman is not binding upon the complainant and action of Insurance Company of repudiating the claim is subject to adjudication by Consumer Forum constituted under the Act. Learned counsel has also relied upon 1997(2) CLT 43 Dev Dutt Dhiman and M.R. Dhiman Vs. State Bank of India, wherein it has been held that decision of Banking Ombudsman is only recommendatory in nature and there is no legal sanction for such a decision to get it implemented and thus cannot be a bar for a consumer to approach the authority under the Act. Learned counsel argued that in view of the material placed on record by the complainants and law laid in the authorities cited above, the opposite parties cannot escape liability to release the amount payable under the policy alongwith compensation and costs, as demanded in the complaint. 7. On the other hand, Sh. Sanjay Goyal, Advocate, learned counsel for the opposite parties has submitted that as per documents placed on record by the complainants themselves, deceased has consumed poisonous substance and their plea about consuming of said substance due to confusion created in mind for medicine, which he has been taking earlier, is not supported by any positive evidence, as such, the opposite parties have rightly repudiated their claim as per terms and conditions of the policy because insured had committed suicide within a period of one year after the date of issuance of Insurance policy. Learned counsel argued decisions given by Zonal Level Committee chaired by retired judge of High Court, which is independent body and Insurance Ombudsman, which is a statutory body, are binding upon the parties. Learned counsel argued that proper remedy for the complainants was to file appeal to avail further remedy against the decisions given by the above said authorities, but they have failed to do so and any conclusion drawn by the Investigator appointed by the opposite parties, is not binding upon them as the same is subject to final decision which may be taken by them as per facts and circumstances of the case. In support of his contentions, learned counsel has placed reliance on 2005(2) CPC 440 Rural Postal Insurance through its Postmaster and Another Vs. Chandro Devi and others, wherein insured consumed poison which resulted in his death after which his legal heirs lodged claim for payment of the amount under the policy secured by him, which was repudiated by the petitioners on the plea that he committed suicide, within a period of one year from the date of issuance of policy in terms of decision by by the Hon'ble National Commission in revision petition No. 417 of 1997 titled as Branch Manager, LIC and Another Vs. Ramchander Singh dated 19-09-1994, to the effect that policy in question had become void and no claim could have been entertained by the District Forum, accepting the appeal of the insurer. Learned counsel has further relied upon 2001(1) CPC 633 National Insurance Co. Ltd., Vs. Dinesh (S.C.), wherein it has been held by the Hon'ble Apex court that Insurance company can dispute the correctness of report made by surveyor as his report is not always binding upon, with further observation that State Commission has wrongly ordered that entire amount as suggested by Surveyor should be paid to claimant, whereas Hon'ble National Commission has not considered the said question because of which impugned order was set aside accepting the appeal of the Insurance company. Lastly, learned counsel relied upon 2003(1) CPC 303 Punjab State Electricity Board Vs. M/s. Aneja Food Products, wherein dispute was referred to Dispute Settlement Authority, but complainant was not given the representation. District Forum accepted the complaint and set aside the impugned demand raised by the electricity board with direction to refund the amount paid by the complainant alongwith interest and costs. However, it came into evidence that complainant had acquiesced to the jurisdiction of Dispute Settlement Authority. It was held by the Hon'ble State Commission, Chandigarh, that once the matter was taken up by Dispute Settlement Committee, the District Forum could not sit over its decision as an appellate authority and order passed by District Forum was set aside by allowing appeal filed by Punjab State Electricity Board. 8. There is no dispute regarding settled proposition of law that decision given by Insurance Ombudsman on the reference made at the instance of the complainants, does not debar them from availing remedy under the Act because the same is recommendatory in nature and remedy before Consumer Forum is additional remedy in terms of section 3 of the Act. 9. However, the perusal of Ex. R-2 & Ex. R-3 reveals that appeal No. 4489 preferred by the complainants on account of death of Gurmej Singh, has been dismissed by ZOCRC and repudiation of claim by the opposite parties has been upheld with the direction to inform them in case they are not satisfied with the decision of ZOCRC, then they can file further appeal to COCRC. The complainants have not denied the fact that they had availed remedy before Zonal Level Committee constituted by the opposite parties headed by High Court Judge, for adjudication of insurance claims. There is nothing on record that complainants have availed further remedy of appeal before COCRC or that they invoked the writ jurisdiction of the Hon'ble High Court under Article 226 of Constitution of India. After they have availed the remedy by filing appeal before Zonal Level Committee constituted by the opposite parties and its order has become final binding upon the parties to the complaint, the complainants cannot invoke remedy under the Act. 10. Even otherwise the plea of the complainants that deceased Insured had been suffering from cough and cold is not corroborated by any documentary proof like prescription slip or bill secured by the deceased after purchase of homeopathic medicine. They have also not examined any doctor who treated the deceased prior to the date of his death. They have produced on record copy of report of Investigator namely Sh. Vikas Aggarwal appointed by the opposite parties Ex. C-16 and copies of witnesses recorded by him Ex. C-21 to Ex. C-23 in the course of Enquiry. The report of surveyor or investigator appointed by the opposite parties to verify the factum of cause of death of the insured is not binding on them. It is always subject to approval by competent authority and the insurer can always has liberty to differ with report of Surveyor or Investigator. The statements of witnesses recorded by him are no substitute for the statements made in the course of trial before the Consumer Forum. The complainants have not produced any of the person whose statement has been recorded in the course of Enquiry by the Investigator appointed by the opposite parties or the signatory of Panchyatnama Ex. C-15 relied upon them as to cause of death of insured. It may not be out of place to mention here that deceased insured was employed on the post of a Constable in Police and Investigator appointed by the opposite parties arrived at a conclusion that Insured has not committed suicide on the basis of statements of his colleagues or their wives. Similarly Panchyatnama Ex. R-15 also bears the signatures of police officials alone. As mentioned in the Claimant's statement Ex. C-18, insured had expired after consuming Sulphas tablets. In the copy of postmortem report Ex. C-19, it has been mentioned that exact cause of death can be declared only after seeking report of chemical analyst. The complainants have themselves tendered in evidence the report of Chemical Examiner Ex. C-20, given after analysis of viscera as per which 'Aluminum Phosphate Insecticide' was detected in the Exhibits. In view of different size and shape of homeopathic tablets and Aluminum Phosphate tablets, the plea of the complainants that insured confused the above said insecticide and consumed them by mistake, does sound well to the conscience. 11. The initial onus to prove the above said facts was upon the complainants, but they have failed to discharge the same by producing any reliable and convincing evidence. As such, they cannot succeed on the basis of any weakness in the case of the opposite parties and liability cannot be fastened upon them merely because of non-production of any evidence to the contrary, especially when insured had been living in the police quarters prior to his death and none of his colleagues and their family member has come forward to reveal the truth before the Investigator appointed by the opposite parties, who has given his report without recording evidence of any person having no departmental or personal dealing with the deceased insured. 12. In the light of our above discussion, we have come to the conclusion that the opposite parties were justified in repudiating the claim of the complainants as per terms and conditions of the Insurance policy, which provide that in case of death of insured within one year after the date of issuance thereof, claim can be repudiated if death of the insured has taken place due to suicide. 13. For the aforesaid reasons, we dismiss the complaint and leave the parties to bear their own costs. The copies of this order be sent to the parties, free of costs as per rules, on the subject. File be indexed and consigned. Pronounced : 17-03-2009 (Pritam Singh Dhanoa) President (Dr. Phulinder Preet) Member (Amarjeet Paul ) Member
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