STATE CONSUMER DISPUTE REDRESSAL COMMISSION

BIHAR, PATNA

Appeal No. 366 of 2017

1. The Branch Manager, LIC of India, Saharsa

2. The Marketing Manager, LIC of India, Bhagalpur

3. The Sr. Divisional Manager, LIC of India, Begusarai

4. The Zonal Manager, LIC of India, Bhagalpur

5. The Zonal Manager, LIC of India, Patna

                                                                                                                                                 … Opposite parties/Appellants

Versus

Ragini Devi, Wife of Late Jai Prakash Chaudhary, Resident of Mohalla- Gandhi Path, Ward No. 21, Thana and District- Saharsa

                                                                                                                                                    …. Complainant/Respondent

Counsel for the Appellant: Adv. Ajay Kumar

Counsel for the Respondent: Adv. Raju Kumar Singh

Before,

Hon’ble Mr. Justice Sanjay Kumar, President

Mr. Ram Prawesh Das, Member

Dated 19.07.2023

As per Sanjay Kumar, President.

O r d e r

1. Present appeal has been filed on behalf of appellant/opposite party /LIC for setting aside the order dated 06.11.2017 passed by the Ld. District Consumer Forum, Saharsa in Complaint Case no. 34 of 2016 whereby and whereunder the complaint case has been allowed and appellants have been directed to pay accidental benefit of Rs. 5,00,000/- within 60 days from the date of passing of the order  failing which interest @7% p.a shall become payable and has further directed to pay Rs. 5,000/- as compensation for physical and mental harassment within 60 days.
2. Briefly stated the facts of the case is that husband of complainant namely Jay Prakash Choudhary had taken one LIC policy for a sum assured amount of Rs. 5,00,000/- bearing policy no. 525855506 for the period from 10.08.2010 to 10.08.2026 from appellants through their LIC agent in which complainant being the wife was made nominee in the LIC policy. Annual premium paid was Rs. 39,100/-
3. Husband of complainant died on 22.02.2012 near Matigara Police Station in an road accident for which FIR was lodged giving rise to Matigara PS case no. 511 of 2012 on 23.02.2012,
4. After investigation the police submitted report stating therein that death was due to road accident and complainant filed her claim before the appellants/insurance company on 20.05.2015 and after enquiry basic sum assured amount of Rs. 5,00,000/- was paid on 15.03.2016 to the complainant as nominee but accidental benefit claim was rejected on 07.03.2016 on the ground that during the course of investigation it has not been established that death of insured was due to accident.
5. Aggrieved by repudiation of claim complainant filed the consumer compliant case before the District Consumer Forum, Saharsa for payment of accidental benefit claim with interest, compensation and cost of litigation. Notices were issued to the opposite parties who appeared and filed their written statement.
6. It was stated in the written statement that that in the post mortem report 800 gm of digested food was found in the stomach of deceased insured from which smell of alcohol was coming as such deceased died due to consumption of alcohol and in such cases where insured dies under influence of alcohol, accidental claim is not payable. There is no cogent evidence that the deceased insured died in accident as such complainant is not entitled for accidental claim benefit.
7. The District Consumer Forum framed one issue for adjudication (i). Whether insured deceased Jay Prakash Choudhary met an accidental death.
8. District Consumer Forum after hearing both the parties and considering the evidences on record held that husband of complainant proceeded for Darjeeling in relation to his business and on 22.07.2012 in the night at Martigara he met an accidental death which is apparent from FIR, Inquest report, Postmortem report, enquiry report submitted U/s 174 of Cr. PC. in which cause of death has been stated to be accident. In the postmortem report the bladder was empty without any smell of alcohol, so deceased was not under influence of alcohol at the time of death and cause of death in postmortem report has been stated to be antemortem injuries. The accident took place in the night as such there was no eye witness of the occurrence. Subsequently, police arrived at the place of occurrence and from the inquest report and postmortem report cause of death was stated to be accident as such complainant was entitled for accidental death benefit which was wrongly repudiated by the insurance company.
9. Aggrieved by order dated 06.11.2017 passed by District Consumer Forum, Saharsa in Consumer Complaint case no. 34 of 2016 LIC through its Branch Manager has preferred this appeal.  
10. It is submitted on behalf of counsel for the appellant that it is evident from the postmortem report prepared by North Bengal Medical College in which at Sr. no. iv item no. 4 under the heading of stomach and its content it has been observed as M-M Pale, 800 gm digested food with smell like alcohol which disentitles complainant for payment of accidental death benefit as deceased insured was under the influence of alcohol at the time of death. It was submitted that incident is of 2012 and complaint case was filed in the year 2016 as such claim was time barred.
11. On the other hand it is submitted on behalf of counsel for the respondent that insured met with road accident near Martigara thana (West Bengal) and died on 22.07.2012 while going to Dhulabary (Nepal) for business purpose for which Martigara PS UD case no. 511 of 2012 dated 23.07.2012 was registered in Martigara police station, District- Darjeeling, West Bengal.
12. Police prepared inquest report under section 174 Cr.PC of deceased insured and FIR of accidental death case was also sent to Magistrate under section 174 of Cr.PC on 23.07.2012. Postmortem was conducted at North Bengal Medical College hospital on 23.07.2012 and postmortem report dated 23.07.2012 was prepared and after due enquiry of the accidental death case police forwarded its final report to the Magistrate on 28.11.2012 in which cause of death was stated to be road accident.
13. Heard the parties
14. It is an admitted fact that insured died on 22.02.2012 near Martigara Police station for which FIR was registered as Martigara PS U/D case no. 511 of 2012 on 23.02.2011 and inquest report was prepared by the police and subsequently dead body was sent to North Bengal Medical College, where postmortem was conducted and cause of death was stated to be antemortem injuries as such death of insured in an accident is well established and complainant is entitled for accidental benefit claim.
15. In a query made by the police from North Bengal Medical College with respect to insured deceased if he was under influence of alcohol at the time of accident it was replied that in the postmortem report the bladder was empty without any smell of alcohol so he was not under influence of alcohol at the time of death. Accidental benefit claim was repudiated on 07.03.2016 and complaint case was filed in 2016 as such complaint case was not time barred.
16. For the reasons as stated above this Commission does not find any infirmity or error in the order passed by the District Consumer Forum requiring any interference in this appeal accordingly, the appeal is dismissed.

(Ram Prawesh Das)                                                                                                                     (Sanjay Kumar,J)

       Member                                                                                                                                      President

Md. Fariduzzama