Haryana

Karnal

375/2013

Vikram - Complainant(s)

Versus

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

Sh. Surjit Narwal

29 Jul 2016

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM KARNAL.

                                                              Complaint No.375 of 2013

                                                             Date of instt.:05.09.2013

                                                               Date of decision 29.07.2016

 

Vikram son of late Sh. Dilawar Singh resident of village Kheri Naru, District Karnal.

 

                                                                   ……..Complainant.

                                      Vs.

Life Insurance Corporation of India Divisional Office, Jiwan Parkash 489, P.O. no.106, Model Town Karnal.

                                                                    ………… Opposite Party.

 

                     Complaint u/s 12  of the Consumer Protection Act.

 

Before                   Sh.K.C.Sharma……….President.

                   Sh.Anil Sharma…….Member.

 

Present:-      Shri Surjit Narwal Advocate for complainant.

                    Smt. Shakuntla Dagar Advocate for opposite party.

                    

                    

 ORDER:

 

                   This complaint has been filed by the complainant u/s 12 of the Consumer protection Act 1986, on the averments that his father Shri Dilawar Singh(the deceased life assured) obtained Jeevan Chaya policy table no.103 from the opposite party, for an amount of Rs.1,00,000/- and policy no.171312329 was issued in that regard. As per terms of the abovesaid policy, in case of accidental death of the  insured  a sum of Rs.2,00,000/- was payable to the nominee and the nominee would not deposit any amount in the policy for the years 17,18,19 and 20 and opposite party would return the deposited amount alongwith bonus 25% to the nominee. On 31.05.2013 the deceased life assured was spraying pesticides in the paddy (Paneeri) due to which he became unconscious. He was taken to the hospital of G.D. Sharma Karnal, where he died. The death of the deceased life assured was accidental, due to pesticides drugs. Therefore, as per the policy he (complainant) became entitled to recover an amount of Rs.2,00,000/- and other benefits of the policy. After the death of his father, he visited the office of the opposite party time and again and requested for payment of the claim, but his claim was repudiated, vide letter dated 25.7.2013 and only an amount of Rs.1,00,000/- was paid to him. In this way, there was deficiency in service on the part of the opposite party, which caused him mental, physical and emotional harassment apart from financial loss.

2.                Notice of the complaint was given to the opposite party, who put into appearance and filed written statement controverting the claim of the complainant. Objections have been raised that the complainant has no locus standi to file the complaint; that the complainant is estopped from filing the complaint by his own acts and conduct; the contentious issues of law and facts are involved, which cannot be decided by this Forum in summary manner and that there was no deficiency in service on the part of the opposite party.

                   On merits, it has been admitted that policy no.171312329 for a sum of Rs.1,00,000/- was issued in favour of the deceased life assured and the complainant was appointed as nominee and his mother Darshna Devi as appointee. It has been submitted that as per the report of Forensic Science Laboratory, Madhuban, Karnal the deceased life assured had committed suicide by taking organo-phosphorous pesticide and the contents of the same were detected in stomach, small and large intestines, lungs, liver, spleen, kidney and blood from heart. So, no accidental death claim was payable under the policy and the claim of the complainant was declined, vide speaking order dated 25.7.2013. However, the opposite party had already made payment of Rs.45,870/- as basic death claim under the policy on 10.9.2011, vide cheque no.271932 to Smt. Darshan Devi (appointee) after making due deduction of the outstanding loan amount procured by the life assured. The other allegations made in the complaint have been denied.

3.                In evidence of the complainant, his affidavit Ex. CW1/A and documents Ex.C1 to C13 have been tendered.

4.                On the other hand, in evidence of the opposite party, affidavit  of Dr. Sandeep Chaudhary, affidavit of Surinder Kumar A.O. Ex.O1 and documents Ex.O2 to O8 have been tendered.

5.                We have appraised the evidence on record, the material circumstances of the case and the arguments advanced by the learned counsel for the parties.

6.                As per the case of the complainant his father had obtained Jeevan Chaya policy from the opposite party for insured sum of Rs.1,00,000/- and according to terms of the policy, in case of accidental death of the insured a sum of Rs.2,00,000/- was payable to the nominee alongwith other benefits. His father became unconscious while spraying pesticides in paddy (paneeri), he was taken to the hospital of Dr. G.D. Sharma Karnal, but he died on 31.5.2013. He lodged claim with the opposite party regarding accidental death of his father, but his claim was illegally repudiated.

7.                The opposite party has submitted that the deceased life assured had committed suicide, because as per the report of Forensic Science Laboratory, Madhuban organo-phosphorous compound was found in his stomach, small and large intestines, lungs, liver, spleen, kidney and blood from heart. Therefore, the accidental claim of the complainant was declined, vide order dated 25.7.2013.

8.                The policy is the most material document to decide the real controversy between the parties. The opposite party has produced the copy of the insurance policy Ex.O6. There is clause 6 of the policy regarding suicide, which is reproduced as under:

          “This policy shall be void if the life assured commits suicide (whether sane or insane at the time) at any time on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of this policy and the Corporation will not entertain any claim by virtue of this policy except to the extent of a third party’s bonafide beneficial interest acquired in the policy for valuable consideration of which notice has been given in writing to the office to which premiums under this policy were paid last, atleast one calendar month prior to death.”

9.                A bare reading of the said condition makes it quite clear that policy shall be void if the life assured committed suicide after commencement of the policy, but before expiry of one year from the date of the policy. The policy was issued on 28.2.1997 and the deceased life assured died on 31.5.2013. Therefore, the said clause is not applicable to the present case. The policy could not be become void even if the deceased life assured committed suicide

10.              The complainant has claimed that the deceased life assured died due to accident, because he accidentally became unconscious while spraying pesticides in the field and died lateron, therefore, he is entitled to get the amount of Rs.2,00,000/- for accidental death of the deceased life assured alongwith other benefits. We have gone through the entire policy document, but there is no clause or condition for giving any benefit to the nominee or appointee of the deceased life assured in case of his/her accidental death. The complainant could claim benefits as per the terms and conditions of the policy, which was binding contract between the insurance company and the deceased life assured and his nominee/legal heirs. As no benefit was payable to the nominee/legal heirs under the policy in case of the accidental death of the deceased life assured, therefore, the complainant being nominee under the policy could not get any benefit, even if there was accidental death of the deceased life assured.

11.              In view of the terms and conditions of the insurance policy, we need not to decide the question as to whether the deceased life assured had committed suicide or his death was accidental. However, special provision has also been made in the policy, in the event of the death of the life assured prior to the date of maturity. The said provision reads as under:-

          “ Provided the policy is in force for the full Sum Assured. In the event of Life Assured’s death prior to the date of Maturity an additional amount equal to the Sum Assured specified in the Schedule to the policy shall be payable to the Nominees or Assigns or Legal Representatives of the proposer immediately on admission of claim and further that bonus will continue to accrue for the full term on the full Sum Assured and will be paid on the date of maturity as stated above.”

          Shri Baljinder Singh Manager Legal for the opposite party made statement that accidental death claim is not payable as per terms and conditions of the policy, but the opposite party would pay the amount as per terms and conditions of the insurance policy. Even as per the case of the complainant an amount of Rs.1,00,000/- has already been paid by the opposite party. The other benefit under the policy would also be paid as per terms and conditions of the policy.

12.              As a sequel to the foregoing discussion, the complainant is not entitled to get any benefit for accidental death of the deceased life assured under the terms or conditions of the insurance policy. Therefore, repudiation of his claim regarding accidental death benefits cannot be termed as illegal or unjustified.  Consequently, the complaint deserves dismissal. Hence, the same is hereby dismissed. However, the opposite party is bound to give all the benefits to the complainant/legal heirs of deceased life assured as per terms and conditions of the insurance policy. The parties concerned be communicated of the order accordingly and the file be consigned to the record room after due compliance.

Announced

Dated: 29.07.2016

                                                                                      (K.C.Sharma)

                                                                                         President,

                                                                             District Consumer Disputes

                                                                             Redressal Forum, Karnal.

                             (Anil Sharma)

                               Member