BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION:HYDERABAD.
C.D.No 11 Of 2007
Between:
1. P.Chandrasekhar
S/o.Somayya.
2. Smt.P.V.Subbamma,
W/o.Somayya.
Both are residing at D.No.13/133,
Tagore street,
Backside of Venkateswaraswamy Temple,
Gudur, Nellore District. ..Complainants.
And
1. Life Insurance Corporation of India Ltd.,
Rep. by its Senior Divisional Manager,
Regional Office, Nellore.
2. Life Insurance Corporation of India Ltd.,
Rep. by its Zonal Manager, Zonal office,
Opp.Secretariat, Saifabad,
Hyderabad.
3. The Chairman,
Life Insurance Corporation of India Ltd.,
Central Office, Jeevan Bheema Marg,
P.B.No.19953, Mumbai. ..Opp.parties.
Counsel for the Complainants: Mr.M.Subrahmanyam.
Counsel for the Opp.Parties: Mr.Srinivas Karra.
CORAM: THE HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.
SMT.M.SHREESHA, MEMBER
AND
SRI G.BHOOPATHI REDDY, MEMBER.
FRIDAY, THE THIRD DAY OF OCTOBER,
TWO THOUSAND EIGHT
Oral Order:(Per Smt.M.Shreesha, Hon’ble Member)
***
The brief facts as set out in the complaint are that the complainant No.1 is the brother and complainant No.2 is the mother of the insured i.e. Pattabhi Venkata Chalapali Rao, who was running Medical store in the name and style of M/s.Sri Vishnu Medical Stores, C/o.Modern Eye Hospital and Research Centre, Nellore, who obtained a insurance policy bearing No.841445501 dated 28-12-2003 Jeevan Mitra (Triple cover) Endowment Plan with profits (with accident benefit) for Rs.5,00,000/- and another Policy No.841264688 dated 28-5-2003, Endowment Assurance Policy with profit and accident benefit for Rs.2,00,000/- from Life Insurance Corporation of India Ltd., Nellore and Atmakur respectively. The first complainant is the nominee under Jeevan Mitra policy and the second complainant is the nominee under Endowment Assurance Policy. The mode of payment of premium for Jeevan Mitra policy is quarterly i.e. March, June, September and December and the insured paid the premiums in respect of the two policies. The insured i.e. P.V.Chalapathi Rao met with an accident on 8-2-2004 at about 22.00 hours while he was crossing the Railway track to go to Satyasai Temple which is on the eastern side of Railway Track at Nellore and was hit by Train No.7030 Hyderabad-Ernakulam, Sabari Express. Due to the said accident, the insured died on 8-2-2004 and copy of death certificate is enclosed. The police registered F.I.R. No.13/04 on 9-3-2004 and after investigation, police filed report mentioning that the death is an “accidental death” and therefore action was dropped on 21-2-2004.
Under the above policies, the first complainant is entitled to an amount of Rs.20,00,000/- and the 2nd complainant is entitled to an amount of Rs.4,00,000/- and the total comes to Rs.24,00,000/-. The complainants submitted applications on 12-3-2004 to the Branch Manager, Life Insurance Corporation of India informing the death of the insured and after receipt of the claim forms, the complainants submitted claim in the prescribed format. The first complainant by letter No.MKTG/Claims dated 30-3-2005 repudiated the claim on the ground that the insured committed suicide within one year from the date of policy and the policy has become null and void and therefore nothing is payable. The complainants thereafter submitted representations to 2nd opposite party on 22-7-2005 and first opposite party by letter dated 12-12-2005 informed that the Zonal Office expressed their inability to reconsider the decision conveyed earlier and further informed that a written representation be made to the Chairman. The complainants submitted a representation to third opposite party on 8-2-2006 which was rejected by letter dated 26-9-2006 and further informed that written representations to the Insurance Ombudsman be submitted. The complainants accordingly submitted representations to Insurance Ombudsman on 13-10-2006 and the Insurance Ombudsman by letter dated 19-10-2006 expressed their inability to process the complaint since the claim exceeds Rs.20 lakhs. Therefore the complainants approached this Commission alleging that the repudiation of the claim by the opposite parties on the ground that the deceased committed ‘suicide’ has no basis and submitted that there are no compelling circumstances to the deceased to commit suicide and as per the Police report, the death of the insured is an accident and ignoring the said fact, opposite parties rejected the claim of the complainants under Policy Nos.841445501 dated 28-12-2003 and 841264688 dated 28-5-2003 which is deficiency in service. Hence the complaint for a direction to the opposite parties to pay a sum of Rs.24,00,000/- together with interest at 18% p.a. from the date of rejection of the claim i.e. 30-3-2005 till the date of realization together with costs.
Opposite parties filed counter contending that there are several questions of fact involved in the above complaint regarding suspicious nature of death of the deceased policy holder, which requires extensive cross examination of the witnesses. Hence the present complaint cannot be maintained before the Consumer Forum in which enquiry is of summary nature. They admitted that One Mr.P.V.Chalapathi Rao obtained two insurance policies bearing Nos.841264688 and 84145502 for Rs.2 lakhs and Rs. 5 lakhs respectively. The date of commencement of Policy bearing No.841264688 was 28-5-2003 and the date of commencement of policy bearing No.841264688 was 28-12-2003 and admitted that the second complainant is nominee under policy bearing No.8412264688 and first complainant is nominee under Policy bearing No.841445502. They submitted that the first complainant informed the Corporation by letter dated 1-3-2004, that the insured died on 8-2-2004 in a train accident and requested for issuance of claim forms and they accordingly issued the claim forms to the complainants. They submitted that since it was an early claim, they called for enquiry report from its Manager (CRM), Nellore and during the course of enquiry, it came to light that the life assured had some personal problems and committed suicide. Along with the claim enquiry report, the enquiry officer also enclosed news clipping of Andhra Jyothi Newspaper dated 10-2-2004 wherein it was reported that the life assured committed suicide due to family problems. Further the contents in the F.I.R. and Post Mortem Report and inquest report together with place and time of occurrence of death of life assured creates strong suspicion regarding cause of death of life assured. They submitted that taking into consideration the enquiry report and other material on record, they had taken a decision to repudiate the claim of the complainants and communicated the same vide letter dated 30-3-2005. They admitted that the complainants made representations to Zonal office and Central office but they too confirmed the decision of repudiation. They submitted that as per condition No.6 of Insurance Contract, the contract becomes void if the policy holder commits suicide before expiry of one year from the date of policy and the relevant portion of condition No.6 is as follows:
“6 SUICIDE: This policy shall be void if the Life Assured commits suicide,
(whether sane or insane at the time) at any time or an 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”.
Opposite parties submitted that as per the enquiry report, the life assured started Medical Shop business in July, 2002 and his annual income was Rs.60,000/- per annum from Medical Shop and he is not an income tax assessee and he is unmarried. His family members were staying at Gudur and he has two brothers. They submitted that the life assured had taken two policies for Rs.2,00,000/- and Rs.5,00,000/- respectively and the annual premia on two policies is Rs.30,408/- and that there is no need for 7 lakhs insurance on his life. Further as per the inquest report, the life assured met with train accident while crossing railway track to attend the natural call at 22.00 hrs and they submitted that the Medical shop of the life assured was in Modern Eye Hospital, near to Railway track and there is no need to cross the railway track as the toilets are available in that hospital. Further the body of the life assured was found on the line track and if it is to be believed that the life assured trespassed into railway track for his natural call, there is no reason to believe as to why he crossed lower track and went to up line track. The reason for trespassing the Railway track at the time of 22.00 hrs. is not convincing and further as per the news appeared in Andhra Jyothi Newspaper, it appears that the life assured had committed suicide because of his love affair and it is reported in the newspaper that because of this affair, he developed some difference of opinion with his family members and left the house at that odd time threatening that he is going to commit suicide.
They further submitted that trespass of railway lines is an offence punishable under the provisions of Indian Railways Act and hence under no circumstances, Accident benefit is payable as tress pass amounts to Breach of law, which is specifically excluded for payment of Accident Benefit. They submitted that they repudiated the claim of the complainants taking into consideration the suspicious circumstances regarding the cause of death of the life insured and submitted that there is no deficiency of service and prayed for dismissal of the complaint.
Complainant No.1 filed affidavit in lieu of evidence and got marked Exs.A1 to A17 and opposite parties filed affidavit of the Secretary (L& HPF) at Zonal Office in lieu of evidence and got marked Exs.B1 to B4.
The point for consideration is whether the opposite party has committed any deficiency of service and if the complainant is entitled to any relief sought for in the complaint?
Complainant No.1 filed affidavit reiterating the facts stated in the complaint and contended that the insured had no love affair and the paper news in Andhra Jyothi daily dated 10-2-2004 is a distracted version and submitted that in “Zamin Rythu” weekly newspaper, it is reported as an accident. He submitted that on 8-2-2004 the deceased closed his medical shop at 5.30 p.m. and informed the administrative officer of the hospital that he was going to Satya Sai Baba Temple which is on the eastern side of railway track in order to participate in the arrangements for opening of the temple on the next day and while returning home at 10-00 clock, the deceased met with a train accident on the railway track. He submitted that as per the Police report, the cause of death of the deceased is an accident and ignoring the said report, the act of the opposite parties in rejecting the claim is illegal.
The first complainant filed reply affidavit stating that his brother had no necessity nor had any compelling circumstances to commit suicide and submitted that he was a devotee of Sri Satya Sai Baba and a new temple of Satya Sai Baba was constructed on the eastern side of the railway tract and on the western side of the railway track, he was running the medical store. The opening of the temple was scheduled on 9-2-2004 and arrangements were being made one week before the said date. On 8-2-2004, the deceased, closed his medical shop at 5.30 p.m. and went to the temple to participate in the arrangements at about 10-00 clock while he was returning to his room, which is at Danduvari Street, he met with a train accident, while crossing the railway track at about 10-00 p.m. He submitted that in the news clipping in Andhra Jyothi Newspaper dated 10-2-2004 that the deceased committed suicide due to family problems is without proper verification of the facts. He also submitted that it is reported in the said newspaper that after the death of the deceased, his family went there in search of him and found him dead on the railway track, which is not correct and submitted that they were residing at Gudur and the deceased was residing alone in a rented room and they came to Nellore after knowing the incident in the early hours of 9-2-2004 and the Police after conducting post mortem and after investigation submitted a report that the death of the deceased is an ‘accidental death’. He further submitted that condition No.6 of the policy is not applicable to the facts of the case as the life assured died due to train accident and there is no compelling circumstances to commit suicide.
Ex.A1 are copies of policies bearing Nos.841445501 dated 28-12-2003 i.e. Jeevan Mitra (Triple cover) Endowment Plan with profits (with accident benefit) for Rs.5,00,000/- and 841264688 dated 28-5-2003 Endowment Assurance Policy with profit and accident benefit for Rs.2,00,000/-. Ex.A2 is the premium receipt dated 31-12-2003. Ex.A3 is the Certificate of death dated 20-2-2004. Ex.A4 is copy of F.I.R.No.13/2004 dated 9-2-2004. Ex.A5 is the copy of post mortem certificate dated 20-2-2004. Ex.A6 is the copy of enquiry report of Police dated 27-2-2004. Ex.A7 is letter of the complainant to the opposite party. Ex.A8 is letter dated 30-3-2005 from opposite party to the complainant repudiating the claim of the complainants. Ex.A9 are representations of complainants to the Zonal Manager, L.I.C. of India dated 22-7-2005. Ex.A10 is letter dated 12-12-2005 from opposite party to the complainants stating that the Zonal Office expressed their inability to reconsider the earlier decision and informing the complainant to send a representation to Chairman. Ex.A11 is the representation dated 8-2-2006 of the complainants to the Chairman. Ex.A12 is the letter dated 26-9-2006 of the opposite party to complainants stating that the Chairman, Central Office, Mumbai, expressed their inability to reconsider the earlier decision and informing the complainant to send a representation to the Insurance Ombudsman. Ex.A13 is the representation dated 13-10-2006 of the complainants to Insurance Ombudsman. Ex.A14 is letter dated 19-10-2006 from Insurance Ombudsman stating that since the disputed amount under the above policies exceeds 20 lakhs, rgarding their inability to process the complaint. Ex.A15 is copy of invitation for opening of Sri Satya Sai Bajana Mandir. Ex.A16 is copy of Zameen-Ryut weekly newspaper. Ex.A17 is sketch.
Opposite parties filed affidavit of the Secretary (L&HPF) at Zonal office reiterating the facts stated in the counter and submitted that 1st complainant is one of the witness, who was examined by the Police authorities and submitted report in Cr.No.13/2004 whereunder the reason for the deceased crossing the railway track was mentioned for nature call, whereas in the affidavit filed in support of chief examination, it is mentioned that the deceased was crossing while returning to his room after participating in the arrangements for opening of Satya Sai Baba Temple, which is contradictory. He submitted that the reasons given in the complaint or inquest report for crossing the railway line at night 10.00 p.m. are not convincing and the invitation card filed by the complainant, Ex.A15 does not disclose the name of the deceased policy holder and the same has no applications to the facts of the case. Further the rough sketch prepared by the complainant and filed as Ex.A17 has no evidentiary value. He submitted that the complaint involves several disputed questions of facts, which cannot be decided in summary proceedings and submitted that they are filing such documents, which are not filed by the complainant and are relevant to the issue involved in the complaint and prayed to dismiss the complaint.
Ex.B1 is the Endowment Assurance Policy with profit + accident benefit bearing No.841264688 dated 28-5-2003. Ex.B2 is Jeevan Mitra (Triple Cover Endowment Plan) With Profits (WITH ACCIDENT BENEFIT) No.841445502 dated 28-12-2003. Ex.B3 is the Claim enquiry report with paper news item and letter dated 24-1-2005. Ex.B4 is the report of the Police stating that after due investigations, this case has been treated as an ACCIDENTAL DEATH and further action was dropped on 21-2-2004.
On perusal of the material on record, we observe that two contentions are mainly raised by the opposite parties justifying their repudiation. The first contention of the opposite parties is that the life assured had taken two policies for Rs.2,00,000 and Rs.5,00,000/- respectively and the annual premia on these two policies is Rs.30,408/- and that there is no need for the life assured to take Rs.7,00,000/- policies on his life. We find the contention of the opposite parties unsustainable on the ground that before issuance of the policies, the opposite parties ought to have seen his income tax assessment instead of raising this ground belatedly after the death of the life assured. The statement of the opposite parties in page 3 para 3 of their affidavit that there is no need for Rs.7,00,000/- insurance on his life is unjustified on the ground that any preliminary enquiry with respect to the life assured’s income has to be done prior to the issuance of the policies. Having accepted the premia of Rs.30, 408/- from the life assured, who was admittedly running a medical shop and according to the opposite parties whose annual income is Rs.60,000/- per annum, they cannot raise the ground after his death that he is not an income tax assessee. Whether the life assured is an income tax assessee or not ought to have been ascertained by the opposite parties prior to the issuance of the policies. The question of whether ‘ there is a need or not of the policies’ is not a substantial ground for repudiation since it is the discretion of the life assured to take the policies and for the opposite parties to verify them prior to the issuance of the policies. Therefore, for the aforementioned reasons, the contention of the opposite parties that the policies, taken by the life assured, is on the high side, he not being an income tax assessee is a justifiable ground for repudiation, is unsustainable.
The second contention of the opposite parties is that the life assured committed suicide within one year of the issuance of the policies and therefore the policies are void. For this the opposite parties rely on the newspaper item dated 10-2-2004 that the life assured had committed suicide because of his love affair and that he developed some difference of opinion with his family members and left the house at an odd time. We find force in the contention of the complainants that a mere newspaper report could be taken as evidence. The Apex Court in AIR 1994 SC 1733 in QUAMARUL ISLAM v. S.K.KANTA AND OTHERS held that:
“Newspaper reports by themselves are not evidence of the contents
thereof. Those reports are only hearsay evidence. These have to
be proved and the manner of proving a newspaper report is well settled. Since, in this case, neither the reporter who heard the speech and sent
the report was examined nor even his reports produced, the production
of the newspaper by the Editor and Publisher P.W.4 by itself cannot amount
to proving the contents of the newspaper reports. Newspaper, is at the best secondary evidence of its contents and is not admissible in evidence without proper proof of the contents under the Indian Evidence Act. The learned trial Judge could not treat the newspaper reports as duly ‘proved’ only by the production of the copies of the newspaper”.
This contention of the opposite parties is not substantiated by any documentary evidence or third party affidavits and they did not choose to lead any evidence to prove that the life assured had a failed love affair and therefore he committed suicide. Exs.A4 and A5 are the F.I.R. and the Post Mortem Reports filed by the complainants. The F.I.R. states that there was a male dead body lying on the tracks at around 1.30 hours on 9-2-2004. The post mortem report states that the cause of death was hemorrhage with shock to multiple organs. Ex.A6 is the certificate issued by the Inspector of Police wherein it clearly states that ‘after due investigation this case has been treated as an accidental death and further action was dropped on 21-2-2004’ itself. Since the Police themselves have closed the case that the life assured was accidentally hit while he was trespassing the track on 8-2-2004 at about 10.00 p.m. and read together with the invitation of the opening of Sri Satya Sai Baba Mandir, Ex.A15 and also the map (Ex.A17) which shows that Satya Sai Baba Temple is on the other side of the railway track, we are of the considered view that the complainants’ have been able to establish that the death of the life assured was accidental and not suicide. On the other hand to reiterate, the opposite parties did not file any documents except for a newspaper report to prove their case that the death of the life assured is not accidental and is because of suicide. Taking into consideration the material on record and the pleadings put forward, we are of the considered that the act of the opposite parties in repudiating the claim on the ground that the death is suicide without any evidence on record, is an act of deficiency of service. Hence we allow this complaint in part directing opposite parties to pay the policy amounts together with benefits under Jeevan Mitra Policy and Endowment Assurance Policies to the respective nominees within a period of four weeks from the date of receipt of this order together with costs of Rs.5,000/-.
In the result this complaint is allowed in part directing opposite parties to pay the amount under Endowment Assurance Policy with profit + accident benefit bearing No.841264688 and also pay the amount under Jeevan Mitra (Triple Cover Endowment Plan) with profits (with accident benefit) bearing No.841445502 to the respective nominees together with costs of Rs.5,000/- within a period of four weeks from the date of receipt of this order, failing which, the amounts awarded would attract interest at 9% p.a. thereafter.
PRESIDENT. LADY MEMBER. MALE MEMBER.
JM Dt. 03-10-2008
//APPENDIX OF EVIDENCE//
Witnesses examined for
Complainants: Opposite Parties:
-Nil- -Nil-
Exhibits marked on behalf of the complainants:
Ex.A1-Copies of policies bearing Nos.841445501 dated 28-12-2003 i.e. Jeevan Mitra
(Triple cover) Endowment Plan with profits (with accident benefit) for
Rs.5,00,000/- and 841264688 dated 28-5-2003 Endowment Assurance Policy
with profit and accident benefit for Rs.2,00,000/-.
Ex.A2-Premium receipt dated 31-12-2003.
Ex.A3-Certificate of death dated 20-2-2004.
Ex.A4-Copy of F.I.R.No.13/2004 dated 9-2-2004.
Ex.A5-Copy of post mortem certificate dated 20-2-2004.
Ex.A6-Copy of enquiry report of Police dated 27-2-2004.
Ex.A7-Letter of the complainant to the opposite party.
Ex.A8-Letter dated 30-3-2005 from opposite party to the complainant repudiating the
claim of the complainants.
Ex.A9-Representations of complainants to Zonal Manager, L.I.C. of India dt.22-7-05. Ex.A10-Letter dated 12-12-2005 from opposite party to the complainants stating that
the Zonal Office expressed their inability to reconsider the earlier decision and
informing the complainant to send a representation to Chairman.
Ex.A11-Representation dated 8-2-2006 of the complainants to the Chairman.
Ex.A12-Letter dated 26-9-2006 of the opposite party to complainants stating that the
Chairman, Central Office, Mumbai, expressed their inability to reconsider the
earlier decision and informing the complainant to send a representation to the
Insurance Ombudsman.
Ex.A13-Representation dated 13-10-2006 of the complainants to Insurance
Ombudsman.
Ex.A14-Letter dated 19-10-2006 from Insurance Ombudsman stating that since the
disputed amount under the above policies exceeds 20 lakhs, regarding their
inability to process the complaint.
Ex.A15-Copy of invitation for opening of Sri Satya Sai Bajana Mandir.
Ex.A16 -Copy of Zameen-Ryut weekly newspaper.
Ex.A17 is sketch.
Exhibits marked on behalf of the opposite parties:
Ex.B1-Endowment Assurance Policy with profit + accident benefit bearing
No.841264688 dated 28-5-2003.
Ex.B2-Jeevan Mitra (Triple Cover Endowment Plan) With Profits (WITH ACCIDENT
BENEFIT) No.841445502 dated 28-12-2003.
Ex.B3-Claim enquiry report with paper news item and letter dated 24-1-2005.
Ex.B4-Report of the Police stating that after due investigations, this case has been
treated as an ACCIDENTAL DEATH and further action was dropped on
21-2-2004.
PRESIDENT. LADY MEMBER. MALE MEMBER.
Dated. 03-10-2008
