Smt.Karamjit Kaur, complainant has filed the present complaint against the titled opposite parties U/S 12 of the Consumer Protection Act, 1986 (hereinafter for short, the C.P.Act.) in which she has prayed that the opposite parties be directed to make payment of insured amount alongwith interest @18% P.A. from the date of  filing the documents before the opposite parties. Opposite parties be further directed to pay Rs.25,000/- as compensation for causing mental agony, physical harassment and deficiency in service on the part of the opposite parties alongwith Rs.3,000/- as litigation expenses, in the interest of justice.   

2.       The case of the complainant in brief is that her husband Sh.Amrik Singh son of Bachan Singh was the holder of the life insurance policy bearing no.473356522 dated.26.4.2011 and its maturity was 26.4.2031. Her husband was insured for a sum of Rs.1,00,000/-. She is nominated in the abovesaid policy. Unfortunately, her husband had expired on 20.5.2012 as natural death only after making payment of one installment at the time of obtaining the policy. Before the death, her husband was hale and hearty and was not suffering from any kind of disease. He never remained under treatment at any point of time from any doctor/hospital before his death. She completed all the formalities and submitted the claim alongwith all the documents to the opposite party for the insured claim amount. She has further pleaded that her mother-in-law (step mother of husband of complainant) filed a false application and the opposite parties are not paying the amount intentionally without any reason and on 17.12.2012 her mother-in-law send a notice to her as well as Life Insurance Corporation of India Branch Batala and claimed the share of insured amount which is pending till date before the Insurance Company, due to this reason insurance company not to make the payment of the insured amount to her till today. She is only the nominee of insurance policy and share of mother-in-law does not arise at all. She approached the opposite parties on May/June 2014 and requested them to hand over the insured amount but they refused to do so.  Thus, there is deficiency in service on the part of the opposite parties. Hence, the present complaint was preferred with the prayed relief as herein above.

3.       Upon notice, the opposite parties appeared and filed the written reply through their counsel by taking the preliminary objections that the deceased life assured Amrik Singh purchased an insurance policy bearing No.473356522 for a sum assured Rs.1,00,000/-, Table Term: 75-20  on 26.4.2011 from Branch Office Batala-II. The deceased Life Assured was paying premium Rs.3263/- (half Yearly). The life assured died on 25.5.2011. The Life assured committed suicide by consuming some poisonous substance and this fact was reported by LA himself to the doctor as per Form No.3816 of Noor Hospital, Qadian. As per the policy conditions no.6, ‘The 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 the one year from the date of commencement of risk under the policy.” The claim has been regretted after carefully considering all the available facts, reasons and evidences and only after proper application of mind, hence, there are no fault, shortcoming and deficiency in service on the part of the LIC of India. Hence the present complaint is not maintainable and is liable to be dismissed on this score only.; the complainant should have approached the office of “Insurance Ombudsman”, Chandigarh for redressal of his grievance, if any; the complainant is estopped to file the instant complaint as there is no deficiency in service on the part of the opposite parties; the complaint against the opposite party is not maintainable and the complaint is bad for mis-joinder or non-joinder for all the necessary parties. On merits, it was submitted that as per death certificate issued by the issuing authority, the date of death of the deceased Life Assured was 25.05.2011 and not 20.05.2011 as mentioned in the copy of complaint. It was denied that the deceased Life assured died due to natural death. As per records of Noor Hospital, Qadian, the deceased life assured died due to ingestion of poisonous substance. It was also denied that the mother-in-aw of the complainant filed false application and the opposite parties are not delivering the amount intentionally without any reason. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.       Complainant has tendered into evidence her own affidavit Ex.C1, alongwith other documents Ex.C2 to Ex.C4 and closed the evidence. 

5.       Sh.Yogender Singh Sisodia Manager Legal L.IC Amritsar  tendered into evidence his own affidavit Ex.OP1 and of Dr.TariqueAhmed, MBBS, Senior Medical Officer, Noor Hospital, Qadian, alongwith other documents Ex.OP2 to Ex.OP10 and closed the evidence.

6.           We have examined all the documents/evidence produced on record and have also duly considered and perused the arguments duly put forth by the learned counsels for both the sides, while adjudicating the present complaint. We find that the impugned insurance ‘death claim’ has been repudiated for the one and the only reason that the DLA (Deceased Life Assured) had died as a result of having committed suicide by ‘ingesting’ some poisonous substance/ material etc and that barred the ‘claim’ by virtue of condition ‘6’ of the related policy reading as: “The 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 the one year from the date of commencement of risk under the policy”. Here in the present case, the ‘risk’ was truly commenced with effect from 26.04.2011 (as per Policy Cover Note Ex.OP10) whereas the Life Assured demised on 25.05.2011 (as per the Death Certificate Ex.C3) i.e., within ‘one month’ of the Policy but the OP insurers have miserably failed to prove on record (through some cogent evidence) that ‘death’ has been the result of and/or was caused by ‘suicide’. It has not been proved/established on record (beyond a reasonable doubt) that the DLA has ‘himself consumed’ the ‘poisonous’ substance thus fulfilling the prime ‘pre-requisite’ of ‘suicide’. There has been no evidentiary document supporting the same. No Police DDR/ FIR (Daily Diary/First Information Report), no medical PMR (Post Mortem Report), no statutory Inquiry Report, no Acceptance Orders (of Untraced Case Report) by the competent Court etc could be produced on the records or its ‘non-production/absence’ was ever attempted to be explained during the present proceedings. Further, there have been serious ‘ambiguities’ amongst the documents produced by the OP insurers. Affidavit Ex.OP11 has been duly deposed (on 22.06.2015) by Dr. Tarique Ahmed SMO at Noor Hospital, Qadian (where the DLA had died on 25.05.2011) confirming ‘ingestion’ of some poisonous substance, a short time ago (as reported by him and the accompanying ‘relatives’) and also confirms the primary cause of death to be ‘Poisoning’ along with the ‘signing’ of exhibits Ex.OP2 & Ex.OP3. However, under the clauses 5’b’ and 5‘d’ of Ex.OP2 it is stated that ‘history’ was reported by patient and relatives (Patient was conscious) to Hospital Staff (Nurses) on duty (deposing Doctor not included); moreover that nowhere proves the theory of ‘suicide’. Further, under the clause 5’b’ of Ex.OP3 responds to the query: ‘Was it (the exact cause of death) ascertained by examination after death or inferred from symptoms and appearance during life?’ as: ‘Inferred from history and symptom’. And to top it all the Ex.OP6 ‘Claim Enquiry Report’ clearly states under paragraph ‘11’ that ‘the family members took DLA to Noor Hospital but they refused to admit the DLA. Moreover, no ‘medical treatment’ chart etc has been produced. Thus these OP exhibits are based on mere ‘hearsay’ and what reliance can be placed upon such callous reports? Except in the Affidavit Ex.OP1 by the OP Manager, the word ‘suicide’ does not even find a mention and finally we conclude that the ‘suicide’ by the DLA as alleged by the OP insurers could not be proved on records by them.

7.       In the light of the all above, we hereby partly allow the complaint and set aside the OP’s theory/allegation of suicide by the DLA along with the succeeding repudiation of the related claim (being arbitrary and in contravention to the laws of natural justice) and also find the resulting ‘delay’ as ‘deficiency in service’ on the part of the OP insurers. Thus, we ORDER the LIC authorities/OP insurers to settle and pay the impugned ‘insurance claim’ pertaining to the Policy in question with accrued benefits etc. if any, along with Rs.3,000/- as compensation for the undue delay and harassment inflicted besides Rs.2,000/- as cost of litigation; within 30 days of receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA from the date of order  till actually paid.

8.       Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

                  (Naveen Puri)

                                                                                     President.

ANNOUNCED:                                                   (Jagdeep Kaur)

August 27,2015.                                                            Member               

*MK*