STATE CONSUMER DISPUTE REDRESSAL COMMISSION

BIHAR, PATNA

Appeal No. 379 of 2019

1. The Branch Manager, LICI, Saharsa

2. The Divisional Manager, LICI, Begusarai

3. The Zonal Manager, LICI, Bhagalpur

                                                                                                                                       … Opposite Parties /Appellants

Versus

Ragini Devi, Wife of Late Jay Prakash Choudhary, Sakin- Gandhi Path, Ward no. 21, Thana & 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 07.08.2023

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 21.10.2019 passed by the Ld. District Consumer Forum, Saharsa in Complaint Case no. 32 of 2018 whereby and whereunder the complaint case has been allowed and appellants have been directed to pay accidental benefit for Rs. 1,00,000/- (policy No. 522203651 dated 05.12.2003, Saharsa Branch)  and for Rs. 1,10,000/- (policy no. 521639465 dated 28.03.2005, Bhagalpur Branch) and has further directed to pay Rs. 10,000/- for physical and mental harassment and Rs. 5,000/- as cost for litigation within 45 days from the date of order, failing which interest @9% p.a shall become payable.
2. Briefly stated the facts of the case is that husband of complainant namely Jay Prakash Choudhary had taken two LIC policies for a sum assured amount of Rs. 1,00,000/- and Rs. 1,10,000/- on 05.12.2003 and 28.03.2005 from appellants through their LIC agent in which complainant being the wife was made nominee.
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 U/D PS case no. 511 of 2012 on 23.02.2012,
4. After investigation the police submitted report stating therein that death was due to accident and complainant filed her claim before the appellants/insurance company and after enquiry basic sum assured was paid to the complainant as nominee but accidental death benefit was not paid.
5. The complainant thereafter send a legal notice to the appellants for paying the accidental benefit claim but accidental benefit claim was not paid.
6. Aggrieved by non-payment of accidental claim death benefit 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.
7. It was stated in the written statement that complainant had received the sum assured amount of Rs. 1,00,000/- and Rs. 1,10,000/- in the year 2012 and has filed present complaint case in the year 2018 as such her claim is time barred. On merit of claim it was stated 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.
8. The District Consumer Forum framed two issues for adjudication (i). Whether deceased insured Jay Prakash Choudhary met an accidental death (ii). Whether complainant being nominee of deceased insured is entitled for accidental death benefit.
9. 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 and enquiry reports 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.
10. Aggrieved by order dated 21.10.2019 passed by District Consumer Forum, Saharsa in Consumer Complaint case no. 32 of 2018 LIC through its Branch Manager has preferred this appeal.   
11. It is submitted on behalf of counsel for the appellant that complaint case was time barred as the complainant received the basic sum assured amount of both the policies in the year 2012 and the complaint case for accidental benefit amount has been filed in the year 2018.
12. It is further submitted that it is evident from the postmortem report given by the 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 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.
13. That so far the policy no. 521639465 is concerned, it is submitted that the said policy was in lapsed condition at the time of death of the policy holder. The date of commencement was 28.03.2005 and First unpaid premium was 28.03.2012 (at the time of death of the policy holder) as the date death was 23.07.2012 and date of intimation was 15.07.2015. The sum assured was Rs. 1,10,000/-
14. That now since at the time of death of policy holder the policy was not in force, so death claim (BSA+VB) was paid under extended claim concession. As per the rules of extended claim concession only BSA and VB (if any) subject to deduction of outstanding premium is payable and DAB is not payable as per the letter dated 15.03.2018.
15. 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.
16. 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.
17. The claim is not time barred as claim was submitted in the year 2012 and insurance company paid sum assured amount in 2012 itself but did not take any decision with respect to accidental benefit claim.
18. Heard the parties
19. It is an admitted fact that insured died in an accident 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.
20. 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.
21. Complainant informed the appellant/insurance company about the accidental death of her insured husband in the year 2012 and submitted her insurance claim but the insurance company paid the sum assured amount in both policies in 2012.
22.  Decision with respect to payment of accidental death claim of LIC policy no. 522202651 dated 05.12.2003, Saharsa Branch remain pending before the insurance company as such complaint case with respect this insurance policy was not time barred.
23. As far as accidental claim with respect to policy no. 521639465 dated 28.03.2005, Bhagalpur Branch for sum assured amount of Rs. 1,10,000/- is concerned same was repudiated by letter dated 15.03.2018 assigned by Bhagalpur Divisional office, Claims department (annexure-A of supplementary affidavit) for following reasons.

To,                                                                                                                    Dated-15.03.2018

     The Manager (Legal & HPF)/DM.

     LIC of INDIA

    Divn. Office, Bhagalpur

Sir,

RE- Pleader Notice by Sri Ashok Kumar Choudhary, Advocate, Civil Court, Saharsa for non payment of DAB under Pol no.- 521639456 on the life of Late Jai Prakash Choudhary Servicing Branch- Bhagalpur Branch-1

With reference to the above we have to inform you that we are in receipt of a pleader notice for non payment of DAB. In this connection our comments are as follows.

(1) This death claim was Non early in nature.

(2) DOC- 28.03.2005. FUP-28/03/2012 (At the time of Death of Policy Holder).

Date of Death- 23.07.2012. Date of Intimation of death- 15.07.2015. T/T-.I 19/16.SA-1,10,000/-

(3) Since, at the time of death of policy holder policy was not In-force, death claim (BSA+VB) was paid under extended claim concession.

(4) as per the rules of extended claim concession. Only BSA and VB (if any) subject to deduction of outstanding premium, is payable and DAB IS NOT PAYABLE.

Therefore Branch did not paid DAB in this aforesaid policy.

This is for your information.

24. Neither the reasons for repudiation of claim has been controverted nor repudiation letter dated 15.03.2018 has been challenged by the complainant in her complaint petition or in her reply filed by her in appeal as such she is not entitled for accidental benefit claim for Rs. 1,10,000/- (policy no. 521639465 dated 28.03.2005, Bhagalpur Branch) for the reasons assigned in repudiation letter dated 15.03.2018 which are valid and lawful.
25. As such appeal is partly allowed and direction issued by District Consumer Forum for payment of accidental benefit of Rs. 1,00,000/- (policy No. 522203651 dated 05.12.2003, Saharsa Branch) is upheld, however, direction issued for payment of for Rs. 1,10,000/- (policy no. 521639465 dated 28.03.2005, Bhagalpur Branch) is set aside.

(Ram Prawesh Das)                                                                                                                  (Sanjay Kumar,J)

       Member                                                                                                                                   President

Md. Fariduzzama