Per Shri Atul Alsi, Hon'ble President.

1. The complainant has filed the present complaint u/s.35 of Consumer Protection Act., 2019 against the denial of accidental death benefit for the sum assured and thereby claiming accidental death benefit which is equal to sum of Rs.24,24,500/- alongwith the compensation and cost of litigation.
2. The complainant is wife and legal heir of deceased insured late Bhupender Singh Makan, who insured himself under several  policies from O.P. bearing Nos.97445990, 975375395, 976313552, 975375394, 974459901, 971253456, for the sum assured alongwith death benefit rider for the accident death in which double amount was to be paid. The insured was murdered and FIR to that effect u/s 302 of IPC was registered under FIR No.719/2019. The complainant has filed insurance claim with O.P. alongwith relevant documents.  The O.P. has disbursed the sum assured under the policies in her bank account but did not pay the accidental benefit under the policies. The complainant after inquire told by O.P. that a person who become victim of violence and dies such death is not an accidental death, therefore complainant is not entitled for accident benefit equal to sum assured. The complaint further submitted that the O.P. failed to supply the copy of policies to the complainant. The complaint issued the legal notice to disburse the accidental benefit under the policies but O.P. failed to comply the notice therefore the present complaint has been filed.
3. O.P.No.1 to 3 had filed their reply and denied all allegation and further submitted that  as per clause considering accidental benefit upon death of policy holder says “ to pay an additional sum equal to sum assured under this policy if life assured shall sustain any badily injury solely and directly from the accident passed by outward violence and visible means and such injury shall within 180 days of its occurrence solely, directly and independently of all other cause result in death of life assured. However, such additional sum payable in respect of this policy bearing No.976313552 shall not be exceed Rs.5,00,000/-.  If disability or death shall not cause by intentional self injury attempted suicide insanity or immorality or whilst the life or under influence of liquor, drugs etc. or cause from riot, civil commotion, rebellion, war, racing etc. or resulted from committing any breach of law arose from employment in armed forces of any country at war, on perusal of these clauses the diseased life assured was clearly breach of these causes therefore claim of accidental benefit has been rightly rejected by O.P. The deceased life assured was involved in several activities which are in contravention with the clauses which resultantly do not entitled for receiving any accident benefit. Life insurance contract are based on principal of utmost best faith. As per charge sheet filed by the police in December 2015 the deceased life assured had enmity with accused persons and since then there was rivalry the insured was actively involved in getting police raid conducted in the office of accused Manjeet Singh Wade and was pro active in discouraging people not to pay the outstanding money to the accused Manjeet Singh wade due to which there was extreme enmity between decease and accused  which eventually laid to preplan murder of deceased life assured. Therefore as per exclusion clause the accident benefit denied by O.P. does not amount to deficiency of service.
4.  Advocate Mr. Amit Khare, counsel for the complainant argued that complainant got married to Late Bhupender Singh Makan who was murdered by some anti social element and crime u/s.302 of IPC has been registered against the accused.  As regards the wife of the murderer, complainant is entitled for accidental death benefit equivalent to sum assured. It is a clear case of accident death. As per the judgement of Hon’ble Supreme Court of India, in the matter of Royal Sundaram Alliance Insurance Company Limited. Vs. Pawan Balram Mulchandani, in the year 2018, “ it has been held that murder for victim is an accidental death., therefore complainant is entitled for double benefit that is accidental benefit”. The denial of accidental benefit is mental harassment. The MOCCA-1999 was invoke against accused person and not against the decease husband.  There is no self injury no riot, no war, or there is no breach of law, hence the insured is entitled for accidental life benefit. The judgement in the case of Royal Sundaram Alliance Insurance Company Limited. Vs. Pawan Balram Mulchandani, oversight the Judgement of Smt. Reetadevi Vs. New India Insurance as sighted by O.P. The O.P. cannot deny the contract of insurance and is liable to pay the benefit arising therefore. complaint may be allowed.
5. Advocate Mr. Badhe, counsel for the O.P. denied the allegation and submitted that there was enmity between and decease and accused and eventually accused persons are criminal minded led to preplan murder. The murder is not accidental death as the injury sustains from accident cause by outward violent visible means and such injury shall 180 days of it occurrence solely result in the death of life assured.  The deceased life assured was involved in several activities which are in contravention of existing law and clauses which life insured do not entitled to receive any accidental benefit. In the matter of Rita Devi Vs. New India Assurance Co. Ltd., Hon’ble SSC 2000(5)113, if the dominant intention of the act of the felony is to kill any particular person then such killing is not an accident murder but it is a murder simpliciter.  The case in his hand is based on the same circumstances.  The deliberate and wilful act on the part of insured which provoke the accused persons to commit murder of the insured and thus the murder simplify does not fall under the category of accidental murder. Therefore denial of claim does not amount to deficiency of service.

REASONING.

6.  The complainant raised the claim pertaining to six police of deceased for non payment of accident death benefit but out of 6 polices 3 policies were opted with accident benefit. Such as policy Nos. 974459900, 976313552, 974459901,with regard to policy No.976313552, the maximum limit for the accidental benefit is of Rs.5,00,000/- was payable against the sum assured of Rs.9,30,000/-.  In respect of all policies of deceased the sum assured under the policy have already been paid to the complaint and there is no dispute for the sum assured payable. The policy bearing No. 971253456 is in lapsed condition. The deceased life assured was murdered by anti social element and offence registered u/s.302 of IPC along with Mocca-1999 against the accused. The counsel for O.P. argued that by eliminating the life assured that he was middling affirms of accused person and provoking them by causing disturb and deceased was actively involved and instrument in provoking the commission of crime by his immoral activities and the murder in the instant case is murder simplifier and fall under the category of pre meditated and pre plan murdered and therefore murder is not an accident.
7. The basic disputes and reason for denial of accidental benefit under the policy is not an accident. The complainant is a wife of insured and prayed for accidental death benefit under the policies.  The complainant is not accused in commission of crime u/s.302 of IPC of the deceased. The insured has been killed by some other persons. As per judgement of Hon’ble Supreme Court of India, Royal Sundaram Alliance Insurance Company Limited. Vs. Pawan Balram Mulchandani, it has been held that murder is an accidental death. The accused has not killed the insured to get the benefit of policy amount as nominee or legal heir of insured, therefore the murder is not for getting monetary income, hence it is not simplifier murder. When the O.P. paid the sum assured amount under the 5 policies holding that the murder is an accident then O.P. can’t deny the accidental benefit for the reason of murder is not accident. Therefore judgement passed in the matter of Royal Sundaram Alliance Insurance Company Limited. Vs. Pawan Balram Mulchandani, the Hon’ble Supreme Court of India, passed in the year-2018 is applicable to the present case,   therefore complainant is entitled for accidental benefit under the three policies bearing Nos. 974459900, 976313552, 974459901, which is payable according to the terms of policy payable alongwith compensation of Rs.30,000/- and cost of litigation of Rs.20,000/- as per following order.

ORDER

1. Complaints partly allowed.
2. The O.P.No.1 to 3 is directed to pay the  accidental benefit-under three policies bearing Nos. 974459900, 976313552, 974459901, which is payable according to the terms of policy to the complainant within 45 days.
3. The O.P.No.1 to 3 is directed to pay the  compensation for mental torture amounted to Rs.30,000/- alongwith cost of litigation of Rs.20,000/-
4. The O.P.No.1 to 3 is directed to comply the order jointly and severally within 45 days from the date of order.
5. Copy of the order be furnish to the parties free of cost.