Punjab

Ludhiana

CC/20/27

Kavita Sharma - Complainant(s)

Versus

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

K.G.Sharma Adv.

19 Apr 2023

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, LUDHIANA.

                                                Complaint No:27 dated 20.01.2020.                                                 Date of decision: 19.04.2023.

 

Kavita Sharma Aged about 35 years wife of Late Shri Kamal Sharma, resident of House No.539/55-C, Street No.2-B, New Vishnupuri, Shivpuri Road, Ludhiana-141007.                                                                                                                                                                                  ..…Complainant

                                                Versus

1. Life Insurance Corporation of India, Unit-V, CB)-5, Cock Tower Branch, Ludhiana, through its Manager/Administrator.
2. Life Insurance Corporation of India, Divisional Office: Urban Estate, Phase-I, Dugri, Ludhiana through its Officer Incharge.

…..Opposite parties 

Complaint Under Section 12 and 14 of the Consumer Protection Act.

QUORUM:

SH. SANJEEV BATRA, PRESIDENT

SH. JASWINDER SINGH, MEMBER

MS. MONIKA BHAGAT, MEMBER

 

COUNSEL FOR THE PARTIES:

For complainant            :         Sh. K.G. Sharma, Advocate.

For OPs                         :         Sh. Alok Mohindra, Advocate.

ORDER

PER SANJEEV BATRA, PRESIDENT

1.                Succinctly, the facts of the case are that Sh. Kamal Sharma, husband of the complainant availed one life insurance policy No.302437115 dated 15.01.2014 from the opposite parties for a sum of Rs.6,00,000/- in which the complainant was the nominee. Kamal Sharma had been making the payment of premium regularly to the opposite parties without any default. The complainant stated that unfortunately, during the continuation of the said insurance policy, her husband expired on 10.02.2019 at about 11.30 AM at Rohtak Railway Station in a rail accident. After death of her husband, the complainant lodged a claim with the opposite parties by submitting all the requisite documents and as per requirement of the opposite parties including post mortem report, police report, claim form and all other requisite documents. The claim was lodged on 22.05.2019 for full insured sum of Rs.6,00,000/-. To the utter shock and surprise of the complainant,  her claim has been allowed only for 80% of premium paid on or after revival refunded vide letter Ref. No.Clms/1141 dated 28.11.2019 whereas the claim for the remaining amount has been repudiated which amounts to deficiency in service and unfair trade practice as she is entitled to get the claim in respect of full insured amount after the death of her husband. The complainant got served a legal notice through her counsel Sh. K.G. Sharma but to no avail. Hence this complaint whereby the complainant has sought direction to the opposite parties to grant the entire claim amount of Rs.6,00,000/- to the complainant and also to pay compensation of Rs.2,00,000/- and litigation expenses of Rs.21,000/-.

2.                Upon notice, the opposite parties appeared and filed written statement by taking preliminary objections that the complainant has suppressed the material facts; lack of cause of action; lack of maintainability of the complaint. The opposite parties alleged that it is an established principle of law that the contract of insurance is a contract of uberrimae fidae i.e. of utmost good faith and whosoever commits a breach of the said faith cannot claim any benefit under the policy. The opposite parties further alleged that the complainant has not disclosed that as per the police report, the deceased Sh. Kamal Sharma had committed suicide and the reason of death has also been reported by the police to the Civil Hospital, Rohtak where the post mortem of the deceased was conducted and as such, the complainant is not entitled to any relief and the relief claimed by her is in violation of the clear cut terms of the contract entered in between the insured and the opposite parties.

                   On merits, the opposite parties reiterated the crux of averments made in the preliminary objections. The opposite parties admitted that Kamal Sharma son of Sh. Vinod Kumar availed life insurance policy i.e. New Endowment Plan bearing policy No.302437115 with a sum assured of Rs.6,00,000/- commenced from 15.01.2014 and maturity was due in 01/2034. At the time of availing the insurance policy, the terms and conditions of the policy were fully explained to the insured and after understanding and admitting the terms and conditions of the policy, the insured submitted the proposal form and executed the other documents. The opposite parties stated that after the date of commencement of policy, the insured failed to pay the premium regularly but subsequently he got the policy revived by making payment of two half yearly premiums and at that time, the insured duly submitted declaration of good health on Form-680 on 08.06.2018 as per the terms of revival of policy. The complainant submitted the claim papers by mentioning therein that the insured has died on 10.02.2019 at Rohtak and she also submitted copy of the inquest report of police of P.S. Rohtak Government Railway Police, which had been prepared after completion of investigation, under the Form 25.35 (!) (B) of the police rules in which cause of death of Sh. Kamal Sharma has been clearly written as suicide by writing the words “Rail Gaadi dwara Atam Hatya’. Therefore, the same is unequivocal finding of the police that Sh. Kamal Sharma has died by committing suicide. The opposite parties further stated that the complainant submitted the post mortem report dated 10.02.2019 conducted by Civil Hospital, Rohtak mentioning that the police has informed that Civil Hospital that Sh. Kamal Sharma has died by committing suicide. The policy was revived on 08.06.2018 and the insured Sh. Kamal Sharma died on 10.02.2019 by committing suicide and as such the duration from the date of revival to the date of death was 8 months 2 days and consequently it is evident that the insured died within one year from the date of revival.  The article 7 of the terms and conditions of the policy are highly relevant in respect of the facts of the present case, which are reproduced as under:-

"7. Suicide: (This policy shall be void)

 

(i) If the Life Assured (whether sane or insane) commits suicide at any time within 12 months from the date of commencement of risk and the Corporation will not entertain any claim under the policy except to the extent of 80% of the premiums paid excluding any taxes, extra premium and rider premiums, if any, provided the policy is in force.

(ii) If the Life Assured (whether sane or insane) commits suicide within 12 months from the date of revival, an amount which is higher of 80% of the premiums paid till the date of death (excluding any taxes, extra premium and rider premiums, if any) or the surrender value, provided the policy is in force, shall be payable. The Corporation will not entertain any other claim under this policy."

 

The opposite parties further stated that both the parties are bound by the terms and conditions of the policy and as such the above said Article 7 is also binding upon the parties. The opposite parties alleged that they have fully complied with the said terms and conditions and the due compliance by them is evident from the contents of para No. 5 of the complaint itself and as such they have not committed any violation of the terms and conditions of the policy. As per the terms of the policy, the opposite parties have already released the due amount in favour of the registered nominee i.e. the complainant and the relief claimed by her is in clear cut violation of the terms and conditions of the policy. The opposite parties further alleged that it is a basic principle of law that nobody can go back from the contract after taking benefit under the same and nobody can take a plea that he/she was ignorant of the terms of the contract or that he/she had not read the terms of the contract. The opposite parties had duly conveyed to the complainant that her basic claim has been rejected and the amount is payable to her as per the above said Article of the policy. The said intimation had been given vide letter bearing reference no. Clms/1141 dated 28.11.2019. After the said intimation had been given, there absolutely no reason for the complainant to file the present complaint. The opposite parties have denied that there is any deficiency in service and have also prayed for dismissal of the complaint.

3.                The complainant filed rejoinder reiterating the facts mentioned in the complaint and controverted those mentioned in the written statement filed by the opposite parties. The complainant submitted that  in fact in the police report dated 10.02.2019 sent by the police to PGIMS, Rohtak, it has been clearly mentioend that there is no eye witness of the accident and when there is no eye witness, then how the accident can be presumed or termed to be a suicide. The doctors of Civil Hospital, Rohtak have self presumed an accident to be a suicide and the complaint filed by her cannot be dismissed on the presumptions of Civil Hospital, Rohtak regarding suicide whereas no eye witness to prove that it was a suicide and not an accident. In the post mortem report on page No.5, the doctors of Civil Hospital, Rohtak have given the following finding:

          “OPINION

          Cause of death

Injuries described and its complication leading to haemorrhage and shock possibility of death due to railway rain accident cannot be ruled out.”

The complainant further submitted that there is no mention of word “Suicide” in the said report and the cancellation of her claim by the opposite parties is totally baseless and she is fully entitled to the claim.

4.                In support of her claim, the complainant tendered her affidavit Ex. CA in which she reiterated the allegations and the claim of compensation as stated in the complaint and witness Sh. Vinod Kumar Sharma also tendered his affidavit Ex. CB, affidavit of Sh. Narender Sharma as Ex. CC. The complainant also tendered documents Ex. C1 is the legal notice dated 30.12.2019, Ex. C2 and Ex. C3 are the postal receipts, Ex. C4 is the copy of death certificate, Ex. C5 is the copy of Aadhar card of Kamal Sharma, Ex. C6 is the copy of letter ref. No.Clms/1141 dated 28.11.2019, Ex. C7 is the statement of account of the complainant,  Ex. C8 is the copy of passbook of the complainant, Ex. C9 is the copy of Adhar card of the complainant, Ex. C10 is the copy of LIC’s New Endowment Plan, Ex. C10/1 is the copy of request for conducting post mortem, Ex. C10/2 is the copy of inquest report, Ex. C10/3 is the copy of site plan of the place of occurrence, Ex. C10/4 is the copy of report No.9 dated 10.02.2019 of P.S. GRP Rohtak, Ex. C10/5 is the copy of statement of SHO GRP, Rohtak, Ex. C11/1 to Ex. C11/6 is the copy of post mortem examination report and closed the evidence.

5.                On the other hand, counsel for the opposite parties tendered affidavit Ex. RW1/A of Sh. K.K. Arora, Manager (L&HPF) and Authorized Officer of Life Insurance Corporation of India, Divisional Office, Ludhiana along with documents Ex. R1 is the copy of proposal form, Ex. R2 is the copy of insurance policy, Ex. R3 is the copy of terms and conditions of the policy, Ex. R4 is the copy of personal statement regarding health dated 08.06.2018, Ex. R5 is the copy of revival quotation of policy, Ex. R6 is the copy of complaint for discharge of policy, Ex. R7 is the copy of letter ref. No.Clms/1141 dated 28.11.2019, Ex. R8 is the copy of inquest report, Ex. R9 is the copy of post mortem report, Ex. R10 is the document showing transfer of the amount paid to the complainant and closed the evidence.

6.                We have heard the arguments of the counsel for the parties and also gone through the complaint, rejoinder, affidavit and annexed documents and written reply along with affidavit and documents produced on record by both the parties. We have also gone through the written arguments submitted by the complainant.

7.                The present complaint has been filed by complainant Kavita Sharma being the wife and nominee of the deceased Kamal Sharma availed a LIC’s New Endowment Plan policy dated 15.01.2014 Ex. C10=Ex. R2 and R3 for a sum of Rs.6,00,000/-  which was due to mature on 01/2034. However, due to non-payment of yearly premium, the policy elapsed and it was revived on 08.06.2018 vide letter Ex. R5. Perusal of this letter shows that the deceased paid the half yearly premiums and also submitted Good Health form Ex. R4. Unfortunately, on 10.02.2019, at about 11.30 AM in the area of Railway Station Rohtak, Kamal Sharma died due to collision with the railway train. The SHO of  Government Railway Police P.S. Rohtak initiated the inquest proceedings under Section 174 Cr.P.C. (Ex. C10/2 to Ex. C10/5) on the basis of the report of the driver and guard of the train. Father of the deceased and wife of the deceased were also associated in the inquest proceedings. Post mortem was got conducted from the Civil Hospital Rohtak on 10.02.2019 vide post mortem report Ex. C11/1 to Ex. C11/6=Ex. R9. The investigating agency concluded that Kamal Sharma died due to suicide committed by him. The complainant being nominee lodged the claim on 22.05.2019 and the same was settled on 28.11.2019 vide refund letter Ref. No.Clms/1141 dated 28.11.2019 Ex. C6=Ex. R7, vide which basic claim was rejected. Operative part of the said letter is reproduced as under:-

“Please refer the death claim papers submitted under Policy No.302437115. As the .A. has committed suicide as per the police papers and suicide clause is operative after revival as per terms and conditions of the policy. So liability of Basic Claim is rejected under policy No.302437115.

As per terms and conditions of the policy, we are paying paid up value before revival and 80% of premium paid on or after revival refunded.”

While settling the claim of the complainant, the opposite parties have invoked Article 7 of the terms and conditions of the policy Ex. C10=Ex. R3, which is reproduced as under:-

          "7. Suicide: (This policy shall be void)

 

(i) If the Life Assured (whether sane or insane) commits suicide at any time within 12 months from the date of commencement of risk and the Corporation will not entertain any claim under the policy except to the extent of 80% of the premiums paid excluding any taxes, extra premium and rider premiums, if any, provided the policy is in force.

(ii) If the Life Assured (whether sane or insane) commits suicide within 12 months from the date of revival, an amount which is higher of 80% of the premiums paid till the date of death (excluding any taxes, extra premium and rider premiums, if any) or the surrender value, provided the policy is in force, shall be payable. The Corporation will not entertain any other claim under this policy."

8.                In pursuance of settlement of the claim, the opposite parties have paid the paid up value before revival and 80% of premium paid. Ex. C7 is the statement of account of the complainant which reflects two entries of amount of Rs.34,798/- and Rs.1,83,600/- and the same stands accepted. From the aforesaid facts and circumstances, it is crystal clear that death of Kamal Sharma occurred due to suicide only and not by way of accident. Even at the time of inquest proceedings, the complainant, her father-in-law and others had joined the same and did not put forward any theory of death being occurred due to accident only. The deceased was a resident of Ludhiana and no railway ticket was recovered from his possession by the police which could have established the bonafide of him being a passenger who travelled from Ludhiana to Rohtak in connection with some domestic work. In these circumstances, the opposite parties were justified in revoking the basic claim of the complainant and there is no deficiency in service on their part.

9.                As a result of above discussion, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

10.              Due to huge pendency of cases, the complaint could not be decided within statutory period.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                          Member                            Member                                       President

 

Announced in Open Commission.

Dated:19.04.2023.

Gobind Ram.

 

 

Kavita Sharma Vs LIC of India                           CC/20/27

Present:       Sh. K.G. Sharma, Advocate for complainant.

                   Sh. Alok Mohindra, Advocate for OPs.

        

                   Arguments heard. Vide separate detailed order of today, the complaint fails and the same is hereby dismissed. However, there shall be no order as to costs. Copies of the order be supplied to the parties free of costs as per rules. File be indexed and consigned to record room.

 

(Monika Bhagat)          (Jaswinder Singh)                      (Sanjeev Batra)                       Member                     Member                                       President

 

Announced in Open Commission.

Dated:19.04.2023.

Gobind Ram.