IN THE CONSUMER DISPUTES REDRESSAL FORUM, PATHANAMTHITTA,
Dated this the 29th day of January, 2013.
Present : Sri. Jacob Stephen (President)
Sri. N. Premkumar (Member)
Smt. K.P. Padmasree (Member)
C.C.No. 141/12 (Filed on 01.09.2012)
Between:
1. Maya Anilkumar,
W/o. Late Anilkumar. T.A,
Tharayil Veedu,
Varyapuram,
Elanthoor East Muri,
Elanthoor Village.
2. Parthan. A (Minor),
Rep. by his mother and guardian
Maya Anilkumar, -do. –do.)
(By Adv. T. Harikrishnan) …. Complainant
And:
1. LIC of India,
Rep. by its Manager,
Pathanamthitta Branch,
Pathanamthitta.
(By Adv. Thomas Puthukulam)
2. Radhamani. T.A.,
W/o. Sasidharan Chettiyar,
Mangalathu Veedu,
Prakkanam Muri,
Chenneerkkara Village.
(By Adv. Bindu. N. Rajan) …. Opposite parties
O R D E R
Sri. N. Premkumar (Member):
Complainant filed this complaint against the opposite parties for getting a relief from the Forum.
2. Fact of the case in brief is as follows: 1st complainant is the wife of deceased Anilkumar and 2nd complainant is the son of them. 1st opposite party is the LIC of India Pathanamthitta Branch and 2nd opposite party is the sister of the deceased Anilkumar. The said Anilkumar died due to accident on 19.03.2010 at Sultanate of Oman. During the life time, the Anilkumar has taken three insurance policies numbered as 390934483, 391964128, 393365141. The above three policies are double accident benefit coverage. 2nd opposite party is the nominee in policy No.390934483 and the life insurance benefit was given by 1st opposite party. But as per Hindu Succession Act 1st and 2nd complainants are the legal heirer of the deceased Anilkumar and 2nd opposite party has no legal right to accept the said policy benefit. For that complainant filed O.S 488/11 before the Hon’ble Munsiff’s Court, Pathanamthitta for realizing the amount and the same has been pending before the said court.
3. In policy No.390934483, 2nd opposite party accepted ` 6,20,101. In policy No,.3911964128 and policy No.393365141 1st complainant accepted ` 25,417 and ` 1,15,200 respectively. The above said policies 1st opposite party had given death insurance claim only. Accident death benefit has not been given to them. For getting the accident death benefit complainant approached the 1st opposite party several times, but they failed to resolve the matter. It is a clear deficiency of service on the part of 1st opposite party. Hence this complaint for getting the accident death benefit from the three policies with compensation and costs.
4. Opposite parties entered appearance and filed separate versions.
5. 1st opposite party admitted the issuance of three double accident benefit to the deceased Anilkumar. The death life assured occurred in a foreign country allegedly in a road traffic accident.
Details of the policies are as follows:
Policy No. | Date of Commencement | Sum Assured | Nominee | Claim Amount | Policy Status on date of death |
390934483 | 10/12/1999 | 25,000 | T.A. Radhamani (sister) | 62,010 | In-force |
391964128 | 05/06/2003 | 50,000 | P.A.Maya (wife) | 25,417 | LAPSED |
393365141 | 28/04/2006 | 1,00,000 | P.A.Maya (wife) | 1,15,200 | In-force |
1. Policy No.390934483
The sum assured is ` 25,000 and the policy was in force as on the date of death. Upon receipt of a death claim relevant records were called for. On verification and satisfaction of the factum of death, sum assured with accrued benefits amounting to ` 62,010 was paid to T.A Radhamani, nominee in the policy and sister of life assured on 05.05.2010. Since the records sufficient to prove that the death of the policy holder had occurred solely out of the alleged accident were not furnished the claim for accident benefit of ` 25,000 could not be settled.
2. Policy No. 391964128
The said policy for an amount of ` 50,000 also had double accident benefit but on the date of death, the policy was lapsed due to non-payment of premium from 05.02.2009 onwards. The paid up value along with applicable bonus totaling ` 25,147 was paid to the complainant on 27.02.2010. The claimant, complainant is not entitled for any further amount as accident benefit or otherwise, since policy in question was not valid as on date of death.
3. Policy No.393365141
This policy for ` 1,00,000 was valid as on the date of death and it also carried double accident benefit. On receipt of claim the basic sum assured together with accrued bonus amounting to ` 1,15,000 was paid to complainant on 05.05.2010. Since sufficient records to prove that the death of the Life Assured occurred due to the alleged accident were not furnished accident benefit of ` 1,00,000 could not be settled.
6. In order to quality for accident benefit in death arising out of accidents, it must be proved that the death occurred is solely due to an accident. In a case of Motor Accident, Road traffic accident the required documents are First Information Report. Police Inquest Report and postmortem report whereby the cause of death of the person is confirmed as to the injuries suffered in the accident.
7. In this case, the alleged accident had occurred in a foreign country and postmortem was not conducted, production of postmortem report and police inquest report were not insisted by LIC on confirmation of the same from the Attache, Embassy of India, Muscat. However a detailed report of the accident is called for by a letter dated 25.11.2011 to ascertain the circumstances that lead to the accident and also to rule out that the life assured was not under the influence of intoxicating liquor or drugs or not involved in any breach of law at the time of the accident. Usually we get this report in case of accidents that had taken place in foreign countries. The opposite party is ready and willing to consider payment of double accident benefit in two in-force policies numbering 390934483 and 393365141 provided they are required to submit a detailed report of the accident obtained from any office in the foreign country or any other legal documents as to confirm the cause of death as accident. Therefore, there is no deficiency of service in their part. Hence they canvassed for the dismissal of the complaint with cost.
8. According to 2nd opposite party complaint is filed not having good faith and it is false. 1st complainant has no locus standi to file this complaint on behalf of the 2nd complainant. This opposite party is not a necessary party to the proceeding. This complaint is filed only to make loss and hardship to the 2nd opposite party.
9. According to them, a civil suit is pending before the Munsiff’s Court, Pathanamthitta which is related to this complaint. Therefore, they canvassed for the dismissal of the complaint with cost.
10. From the above pleadings, the following points are raised for consideration:
(1) Whether the complaint is maintainable before the Forum?
(2) Whether the relief sought for in the complaiant are allowable?
(3) Reliefs & Costs?
11. Evidence of the complaints consists of the oral deposition of PW1 and marked Exts.A1 to A5. After the closure of evidence, both parties were heard.
12. Point Nos. 1 to 3:- In order to prove the complainant’s case, 1st complainant filed proof affidavit along with six documents. She was examined as PW1 and the documents produced were marked as Exts.A1 to A5. Ext.A1 is the copy of death certificate of Anilkumar. Ext.A2 is the copy of notification of death form of Anilkumar. Ext.A3 is the copy of certificate regarding contents of coffin and sealing of the container issued from Sultanate of Oman, Royal Oman Police. Ext.A4 is the letter from Embassy of India, Muscat, Sultanate of Oman dated 26.04.2011. Ext.A5 is the copy of O.S.No.488/11 filed by the complainants against 2nd opposite party before the Munsiff’s Court, Pathanamthitta.
13. Apart from version, opposite parties would not adduced oral or documentary evidence to prove their contention. After the closure of evidence, 1st opposite party filed argument notes.
14. On the basis of the contention and arguments of the parties, we have perused the entire material on record. Complainant’s case is that 1st opposite party has denied double accident benefit to complainants in three policies issued by them.
15. 1st opposite party admitted that deceased Anilkumar has taken three double accident benefit policies, in which one is lapsed due to non-payment of premium. The policy holder died in a foreign country. The claimants were given sum assured with accrued benefits in two forced policies. Claimants failed to produce records to prove that the death of life assured occurred due to the alleged accident. Therefore double accident benefit is not settled in two policies. According to them, they are ready and willing to consider payment of double accident benefit in two policies as and when the complainants produced detailed report of the accident from foreign country to confirm the cause of death as accident.
16. 2nd opposite party’s contention is that they are not the necessary party in this proceedings and a civil suit is pending against them which is filed by the complainants and is related to this complaint.
17. Since O.S.No. 488/11 is pending before the Munsiff’s Court, Pathanamthitta between the complainants and 2nd opposite party with regard to the amount of ` 62,010 only, we are not inclined to interfere in the said matter. Since complainants are the legal heirs of the deceased Anilkumar, they are entitled to get the remaining amount if any and the matter relating to the said amount is triable before this Forum. Moreover, from the facts and circumstances of this case, we are of the view that 2nd opposite party is not a necessary party to this complaint.
18. It is not disputed that the insured has two valid policies. The only dispute is that whether the life insured died due to accident or not. On a perusal of Ext.A1, it is learned that the life insured died on 19.03.2010. Ext.A2 is the notification of death form dated 20.03.2010. Ext.A3 is the certificate regarding contents of coffin and sealing of the container. Ext.A4 is the letter from Embassy of India, Sultanate of Oman stating that as per local rules, the dead bodies of road accident victims are not subjected to postmortem, the Embassy is not in a position to obtain postmortem report from the concerned authorities. They send Ext.A2 for this purpose.
19. From the above facts and circumstances, it is revealed that in Sultanate of Oman the dead bodies of road accident victims are not subjected to postmortem. Therefore, 1st opposite party cannot compel the complainants to produce the same. The law prevailing is Sultanate of Oman is different in nature compared to India with regard to the road accident victims. On a perusal of Exts.A1 to A4 it is evident that the life insured died due to road accident. Therefore, complainants are entitled to get double accident benefit in policy Nos. 390934483 and 393365141.
20. Moreover, 1st opposite party filed argument notes stating that they adopt a human approach in this case and they offered to pay the accident benefit (balance amount with interest in policy No.390934483 and 393365143. Evidence on record shows that claimants received death insurance benefit in the said policies. At the time of oral evidence, 1st complainant also stated that they are willing to accept the double accident benefit in the above two policies and not pressing for interest or compensation and claim in policy No.391964128. Hence complaint is disposed as follows:
21. 1st opposite party is directed to pay the accident benefit (balance amount) in policy Nos. 39094483 and 393365141. In the facts and circumstances of this case, no compensation, interest or cost is allowed. 1st opposite party is directed to give the said amount within 10 days from the date of receipt of this order, failing which the whole amount will follow 10% interest from this date till the realization of the whole amount.
Declared in the Open Forum on this the 29th day of January, 2013.
(Sd/-)
N. Premkumar,
(Member)
Sri. Jacob Stephen (President) : (Sd/-)
Smt. K.P. Padmasree (Member) : (Sd/-)
Appendix:
Witness examined on the side of the complainant:
PW1 : P.G. Maya
Exhibits marked on the side of the complainant:
A1 : Photocopy of death certificate of Anilkumar.
A2 : Photocopy of notification of death form of Anilkumar.
A3 : Photocopy of certificate regarding contents of coffin and
sealing of the container issued from Sultanate of Oman,
Royal Oman Police.
A4 : Photocopy of the letter dated 26.04.2011 issued from
Embassy of India, Muscat, Sultanate of Oman to the
complainant.
A5 : Photocopy of the complaint in O.S.No.488/11.
Witness examined on the side of the opposite parties: Nil
Exhibits marked on the side of the opposite parties: Nil
(By Order)
(Sd/-)
Senior Superintendent
Copy to:- (1) Maya Anilkumar, W/o. Late Anilkumar. T.A,
Tharayil Veedu, Varyapuram, Elanthoor East Muri,
Elanthoor Village.
(2) Manager, LIC of India, Pathanamthitta Branch,
Pathanamthitta.
(3) Radhamani. T.A., W/o. Sasidharan Chettiyar,
Mangalathu Veedu, Prakkanam Muri,
Chenneerkkara Village.
(4) The Stock File.
