Haryana

Yamunanagar

CC/267/2011

Ramesh Chand s/o Rulia Ram - Complainant(s)

Versus

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

M.C.Saini

22 Apr 2016

ORDER

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

                                                                                                Complaint No. 267 of 2011.

                                                                                                Date of institution: 29.03.2011

                                                                                                Date of decision: 22.04.2016.

Ramesh Chand since deceased now represented through his Legal Representatives:

  1. Amit Kumar
  2. Manish Kumar
  3. Smt. Smila Devi Wd/o Ramesh Chand, resident of H. No. 9, Ward No.11, Old Committee, VPO Buria, Tehsil-Jagadhri, District Yamuna Nagar.                                                                                                                    …Complainants.

                                    Versus

Life Insurance Corporation of India, ( Karnal Division) Jagadhri Branch, SCO No. 184-185,

Sector-17, HUDA, Jagadhri through its Branch Manager.

                                                                                                                               …Respondent.

BEFORE:         SH. ASHOK KUMAR GARG, PRESIDENT.

                        SH. S.C.SHARMA, MEMBER.

 

Present: Sh.  Mir Chand Saini, Advocate, counsel for complainants.

              Sh. S.C.Garg, Advocate, counsel for respondent.

 

ORDER

 

1.                     Complainant  Ramesh Chander (now deceased) filed the present complaint under section 12 of the Consumer Protection Act, 1986. However, during the proceedings complainant expired on 28.06.2012 and his LRs were impleaded as complainants (hereinafter referred as complainants).  

2.                     Brief facts of the present complaint, as alleged by the complainants, are that son of the complainant Sachin Kumar ( now deceased) was insured with the LIC of India for a sum of Rs. 50,000/- vide policy No. 175691186 under table 75 for a term of 20 years which was commenced from 28.6.2007 and an amount of Rs. 826/- was paid as premium. The complainant appointed his father Ramesh Chander as nominee in the abovesaid LIC policy. On 24.03.2008, when Sachin Kumar and Rakesh Kumar were on their way from Ponta Sahib to Buria on a motorcycle bearing Registration No. HR-02P-3562, they met with an road side accident with tractor trolley and due to which Sachin Kumar received multiple grievous injuries including head injuries for which he was admitted in the Jindal Hospital Jagadhri. A criminal case vide FIR No. 23 dated 24.3.2008 under section 279/337/338 IPC was also registered in P.S. Khizrabad.

3.                     Son of the complainant Sachin Kumar remained admitted in Jindal Hospital, Jagadhri from the date of accident i.e. 28.3.2008 to 30.5.2008 under the treatment of Dr. Yogesh Jindal as unconscious and ultimately the deceased felt in COMA due to head injury. Thereafter, on 30.5.2008, deceased Sachin Kumar was discharged from the Jindal Hospital, Jagadhri and was taken to residence at village Buria and was kept under observation regularly by the Dr. Yogesh Jindal, Jindal Hospital Jagadhri and ultimately the deceased Sachin Kumar had died on 28.2.2010 at village Buria in COMA condition. The complainant lodged the claim with the respondent (hereinafter referred as OP) being nominee with all relevant documents for payment of claim amount as per policy schedule but LIC of India Jagadhri has paid only Rs. 55024/- vide Cheque No. 360058 dated 14.5.2010 instead of paying the double amount of the sum assured as per policy schedule. The complainant approached so many times to the officials of the OP but the OP refused to accede the genuine request of the complainant. Lastly prayed for directing the OP to pay the double amount of the sum insured alongwith interest and compensation and litigation expenses etc. Hence, this complaint.

4.                     Upon notice, OP appeared and filed its written statement by taking some preliminary objections such as the claim of the complainant has already been settled by the OP and had paid Rs. 55024/- to the complainant vide cheque No. 360058 dated 14.05.2010. It has been further stated that deceased Sachin Kumar died after one (1) year 11 months 4 days from the date of accident i.e. 24.3.2008. As per clause 10-2(b) of the Insurance Policy (Annexure R-12) no accidental benefit can be paid to the claimants on account of death of life assured Sachin Kumar as the life assured died after more than 180 days i.e. 6 months. Further, it has been stated that no postmortem was conducted on the body of the deceased Sachin Kumar, therefore, in the absence of the postmortem report, no accident is proved of the deceased Sachin Kumar life assured and on merit it has been admitted that policy bearing No. 175691186 was issued to deceased Sachin Kumar on dated 28.6.2007 bearing table No. 75-20-20 and the mode of premium was Rs. 826/- on quarterly basis and the sum insured was Rs. 50,000/-. It has also been admitted that complainant Ramesh Chand (since deceased) was nominee, being father of deceased Sachin Kumar. However, quarterly premium for the month of March 2010, was not paid by the life assured deceased Sachin Kumar. It has been further admitted that complainant has submitted the record of FIR No. 23 dated 24.3.2008 but the complainant has not submitted any postmortem report and in the absence of postmortem report it is not proved as per law that deceased Sachin Kumar died due to road side accident. It has been further admitted that an amount of Rs. 55024/- was paid vide cheque No. 360058 dated 14.5.2010 as basic claim to the complainant but no accidental benefit was given as the deceased Sachin Kumar had died after a period of 1 year 11 months 4 days i.e. after 180 days. Lastly prayed that there is no deficiency in service and the claim of the complainant has rightly been settled and prayed for dismissal of complaint.

5.                     To prove the case, counsel for the complainant tendered into evidence short affidavit of Sh. Ramesh Chand as CA and documents such as  Photo copy of receipt of premium of LIC as Annexure C-1, Photo copy of death certificate as Annexure C-2, Photo copy of report under section 173 Cr.P.C. alongwith statement under section 161 Cr.P.C as Annexure C-3, Photo copy of discharge slip of Jindal Hospital consisting 6 pages as Annexure C-4, Medical certificate issued by Jindal Hospital as Annexure C-5 and closed the evidence on behalf of complainant.

6.                     On the other hand, counsel for the OP tendered into evidence affidavit of Sh. P.K.Sexena, Manager Legal as Annexure RX and documents such as  photo copy of FIR bearing No. 23 dated 24.3.2008 as Annexure R-1, Claim form as Annexure R-2, Statement of account as Annexure R-3, Death certificate as Annexure R-4, Photo copy of cancelled insurance policy with its terms and conditions as Annexure R-5, Treatment chart of Jindal Hospital as Annexure R-6, Copy of application given to LIC on 08.04.2010 as Annexure R-7 & Application as Annexure R-8 and discharge slips of Jindal Hospital as Annexure R-9, Photo copy of repudiation letter as Annexure R-10/11, Photo copy of visible terms and conditions of the insurance policy as Annexure R-12 and closed the evidence on behalf of OPs.

7.                     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. The counsel for the complainants reiterated the averments mentioned in the complaint and prayed for its acceptance whereas the counsel for OP reiterated the averments made in the reply and prayed for dismissal of complaint.

8.                     It is admitted that deceased Sachin Kumar (since deceased) was having an insurance policy issued by the OP i.e. LIC of India bearing No. 175691186 under table 75-20-20 for a term of 20 years for sum insured of Rs. 50,000/- with double benefits which was commenced from 28.6.2007 which is evident from copy of receipt of premium Annexure C-1 and insurance policy as Annexure R-5. It is also not disputed that deceased Sachin Kumar met with a road side accident on 24.03.2008 and received multiple grievous injuries including head injury and remained admitted in Jindal Hospital, Jagadhri from 24.03.2008 to 30.05.2008 which is evident from copy of FIR (Annexure R-1), report under section 173 Cr.P.C. (Annexure C-3) and Discharge slip of Jindal Hospital, Jagadhri (Annexure C-4/R-9).

 9.                    The only plea of the OP Insurance Company is that the complainant is not entitled to get the accidental benefits under the policy in question as the deceased Sachin Kumar died after a period of 6 months i.e. 180 days from the date of accident i.e. died after 1 year 11 months and 4 days. Therefore, as per clause 10.2(B) of the terms and conditions of the insurance policy Annexure R-12, the OP Insurance Company is not liable to pay the accidental benefits and rightly repudiated the claim of the complainant vide letter Annexure R-10/11, but arguments advanced by the counsel for the OP Insurance Company is not tenable as the Op Insurance company has totally failed to convince this Forum that deceased Sachin Kumar died due to other reason not due to the injuries suffered in the accident on 24.03.2008 whereas on the other hand, case of the complainant is duly proved from the treatment chart of the Jindal Hospital, Jagadhri (Annexure C-4), Discharge summary from where it is evident that deceased Sachin Kumar was diagnosed as head injury, firstly remained admitted from 24.3.2008 to 30.5.2008, secondly from 22.11.2008 to 24.11.2008 and after that 8.5.2009 to 10.5.2009 and lastly from 29.7.2009 to 1.8.2009 due to the grievous head injuries suffered in the accident. It is also evident from the treatment chart Annexure R-6 issued by Jindal Hospital, Jagadhri that deceased Sachin Kumar was getting treatment day to day from the Jindal Hospital till the date of death i.e. 28.02.2010. Further, the version of the complainant is also duly proved from the medical certificate issued by Dr. Yogesh Jindal of Jindal Hospital, Jagadhri (Annexure C-5) that deceased Sachin Kumar a case of head injury, remained under regular treatment after discharge till 24.11.2009. To controvert the version of the complainant, OP has not filed any cogent evidence and even did not bother to depute the investigator to prove that deceased Sachin Kumar has not died due to the head injuries suffered on 24.3.2008 in a road side accident and further not remained under COMA as alleged by the complainant in his complaint.

10.                   We have perused the terms and conditions of the insurance policy (Annexure R-5) wherein it was so recorded which is reproduced here as under:

10-2 Accident benefits: If at any time when this policy is in force for full sum insured, the life assured before the expiry of the period of for which the premium is payable or before the policy anniversary on which the age nearer birthday of the life assured is 70 whichever is earlier, is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation the Corporation agrees in the case of :

  1. Disability of the life Assured. ………
  2. Death of the life assured: to pay an additional sum equal to thesum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of its occurrence solely and directly and independently of all other causes result in the death of the life assured.

11.                   From plain reading of above noted para, there is no doubt that accidental benefits are payable if the death or disability occurs  within a period of 180 days but in the present case, it is not disputed that deceased Sachin Kumar remained regularly in COMA since the date of accident i.e. 24.3.2008 till the date of death i.e. 10.2.2010 and was admitted so many times in the Jindal Hospital, Jagadhri and ultimately also died due to that grievous head injuries. Meaning thereby that deceased Sachin Kumar was not died due to the other reasons and remained in coma under treatment continuously. So, we are of the considered view that the terms and conditions of the insurance policy is not applicable in the present case of the complainant.

12.                   In the circumstances noted above, we are of the considered view that the complainants are entitled, being LR’s of deceased father of Sachin Kumar, to get the accidental benefit of the policy bearing No. 175691186 as the OP Insurance Company had already paid the basic claim of Rs. 55024/-vide cheque No. 360058 dated 14.05.2010 to the complainants.

13.                   Resultantly, we partly, allow the complaint of complainants and direct the OP Insurance Company i.e. LIC to also pay the accidental benefit under the policy bearing No. 175691186 to the complainants in equal share alongwith interest at the rate of 7% per annum from the date of filing of complaint i.e. 29.03.2011 till its realization and further to pay Rs. 5000/- as compensation and litigation expenses. Further, the share of the minor, ( If any), will be deposited in the shape of FDR in the Nationalized Bank till attaining the age of majority. Order be complied within 30 days after preparation of copy of this order failing which complainants shall be at liberty to initiate action as per law. The complaint is decided in above terms accordingly. 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: 22.04.2016.        

                                                                                    (ASHOK KUMAR GARG )

                                                                                    PRESIDENT.

                                                                               

                                                                                    (S.C.SHARMA )

                                                                                     MEMBER.

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