BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD.
OF 2008 AGAINST C.C.NO.1 OF 2007 DISTRICT CONSUMER FORUM PRAKASAM DIST. AT ONGOLE
Between
1. The Manager
LIC of India, Markapur Branch
Markapur
2. The Divisional Manager
LIC of India,
Divisional Office, Nellore
Appellants/opposite parties
A N D
Sureddy Malleswari W/o late S.S.N.Reddy
Akkapalli Post, Bestavari Mandal
Prakasam District
Respondent/complainant
Counsel for the Appellants Sri AVS Ramakrishna
Counsel for the Respondent Served
QUORUM:
SRI SYED ABDULLAH, HON’BLE MEMBER
&
SRI R.LAKSHMINARSIMHA RAO, HON’BLE MEMBER
TUESDAY THE NINETEENTH DAY OF OCTOBER
TWO THOUSAND TEN
Oral Order ( As per R.Lakshminarsimha Rao, Member)
***
1. The opposite party insurance company is the appellant. The District Forum allowed the complaint of the respondent awarding an amount of Rs.2lakh with interest @9% p.a. together with a sum of Rs.1,000/- towards compensation and costs of Rs.1,000/-.
2. The respondent’s husband during his life time obtained insurance policy bearing number 840982033 for a sum of `1,00,000/- apart from the accident benefits with its commencement from 15th May,2001. The premium was biannual and payable in the months of May and November each year. The premium was due for the period of November, 2003. The respondent’s husband died on 9th January,2004. The respondent filed the complaint stating that the appellant paid only the sum of `1,00,000/- and sought for the benefits such as accident benefit, bonus, totaling to `2,04,498/- .
3. The respondent insurance company defended the claim on the premise that that the sum assured was paid as the respondent’s husband expired due to natural death and the amount of `1,00,000/- towards the sum assured and `16,800/- towards interest was paid on exgratia basis as the policy was in lapsed condition. It was stated that the respondent had received the amount towards full and final satisfaction of her claim.
4. The respondent filed affidavit and got marked ExA1 to A3. On behalf of the appellant insurance company ExB1 to B4 had been marked.
5. The counsel for the appellant filed written arguments.
6. The points for consideration are:
1. Whether the respondent was entitled to the benefits under the
insurance police as sought for?
2. Whether the appellant insurance company rendered deficient
service in repudiating the claim of the respondent?
3. To what relief?
7. POINTS NO.1 and 2: The appellant issued the insurance policy in favour of the respondent’s husband on 15th May,2001. The premium was payable every half year in the months of May and November. The appellant insurance company contended that the last premium due fallen on 15th May ,2003 was paid on 19th August,2003 and the next premium due on 15th November,2003 was not paid by the time of death of the deceased on 9th January,2004 and as such the policy was not lapsed position. It was stated that though the policy was in lapsed condition, the appellant relaxed the conditions basing on the duration of two and half years from the date of issuing of the policy up to the date of death of the insured. The aspect of the lapse of the insurance policy is to be considered in the background of receipt of the premium on 19th August,2003 which was due fallen on 15th May ,2003. The appellant had received the premium after the grace period which expires by the 15th June,2003. The appellant had not raised any protest when it received the premium in the month of 19th August,2003. In the back drop of this situation, the grace period for payment of the premium due on 15th November, 2003 would extend till the 15th December,2003.
8. The appellant could receive the earlier premium without any protest after a period of three months, there is no reason for the appellant to state that the amount was not payable as the policy was in lapsed condition by the date of death of the insured. Another fact to be considered is the relaxation of the conditions of the insurance policy by the appellant insurance company. As the condition relating to the lapse of the policy was relaxed and also in view of the acquiescence of the appellant insurance company for receiving the premium after a period of three months after the due date, the other conditions pertaining to payment of the benefits come in to force on the date of death of the insured.
9. The appellant insurance company paid an amount of Rs.1,16,800/-on 5th May,2004 towards the sum assured. It was stated that the amount was paid towards full satisfaction of the claim as also on account of the death of the insured being not accidental death. The respondent lodged complaint with the police, Prakasham on 9th January,2004 that Konda Venkat Reddy and 14 others murdered her husband by axing him to death on 9th January,2004 when her husband returning from Bestavaripet got down the bus at 1.30 p.m. at the bus station, Prakasham. She expressed suspicion that the accused might have killed her husband in view of his rendering help earlier to a faction in the village. Basing on the suspicion expressed by the respondent, it was contended on behalf of the appellant that the cause of death is intentional murder due to earlier riot in the village. The appellant had not filed any document nor the judgment in the case and finding of the Court in support of its contention. The mere help rendered by the respondent’s husband to a faction in the village does not lead to the inference that he was destined to be attacked by the members of another faction particularly when he is not a member of any faction in the background of the fact whatsoever stated by the respondent is only a suspicion.
10. It is not the case of the appellant that the deceased had made provocation which led to the attack by the accused and ultimately resulted in his death. In the case reported in 2004(5) ALT 525.the Honorable High Court of Andhra Pradesh, dealt with a case wherein the Insurance company repudiated the claim on the ground that the deceased was involved in several cases, he was a faction leader and a group of persons out of criminal grudges with him, murdered him. The High Court held " since the expression " accident " was not defined in any of the statutes, the general established principle is that murder shall be treated as an accident, provided that same is not designed or intended by the person suffered accident and is an untoward and unexpected incident " . It was further held " Murder, which is an unexpected event from the standpoint of victim, is an accident". The High court concluded that the allegations with regard to the involvement of the policy holder subsequent to his death, does not amount to violation of provisions of the policy and the repudiation of the claim without any basis cannot be accepted. The law laid down in the above case is applicable to the facts of the case on hand as such, the murder of the respondent’s husband is accidental.
11. The respondent in her affidavit has stated that she is illiterate, the appellant had misled her by obtaining her signature on the receipt that the amount so paid was towards part satisfaction of her claim and the receipt issued was not given with her consent. It is stated that there is discrepancy in the amount paid to her . An amount of Rs.1,12,302/- was shown to have been received by her while a sum of Rs.1,16,800/- was shown to be paid to her through the receipt. As per the letter dated 20th October,2005 her claim is still pending before the Zonal Committee and the Zonal Committed has not given its decision. It was submitted that the amount of Rs.1,16,380/- was not received towards full satisfaction of her claim. There was no denial of this statement of the respondent by the appellant.
12. The learned counsel for the appellant has relied upon the decisions of the Hon’ble High Court of Jammu and Kashmir in “Salima Jabeen vs National Insurance Company Ltd and others” reported in 2000 CCJ 971 and the decision of the Kerala State Commission in “New Thread Equipments vs National Insurance Company Ltd and another” 2000 CCJ 417 to contend that the respondent had received the amount towards full satisfaction of her claim.
13. The facts of Salima Jabeen’s case (supra) are that the complainant executed discharge voucher along with a consent letter in presence of her husband and she failed to examine her husband before the District forum, in support of her contention that she has received the amount from the insurance company not towards full satisfaction of her claim. The facts of that case are not similar to those of the present case. In the case on hand the appellant insurance company claims that the respondent executed discharge voucher in presence of its agent but not an independent witness. Even the agent has not been examined by the appellant insurance company in support of its contention that it had paid the amount towards full satisfaction of the respondent’s claim. The respondent is an illiterate lady and the pendency of her claim before the zonal committee discharge the initial burden on her and shifts the onus of proof on to the appellant which the appellant failed to prove whereby the irresistible conclusion drawn is that the respondent is entitled to the other benefits that had been withheld by the appellant. The points are answered against the appellant.
14. POINT 3 The appellant insurance company failed to pay all the benefits covered under the insurance policy without any valid reason. The appellant had rendered deficient service by withholding the amount that the respondent is legitimately entitled to. The District Forum has rightly allowed the complaint. We do not see any infirmity in the impugned order. The appeal is liable to be dismissed.
In the result, the appeal is dismissed confirming the order dated 9th March,2007 of the District Forum. Costs of the proceedings quantified at `2,000/-. For compliance four weeks.
Sd/-
MEMBER
Sd/-
MEMBER
Dt.19.10.2010
Kmk*
