Complainant Kunan Lal has filed the present complaint against the opposite parties U/S 12 of the Consumer Protection Act (for short, C.P. Act.) to seek a directions to the opposite party no.1 to pay the claim and further be directed to pay compensation of Rs.50,000/- for causing harassment and Rs.20,000/- for deficiency in services alongwith Rs.10,000/- as litigation expenses, in the interest of justice.

2.       The case of the complainant in brief is that his son namely Raman Kumar doing job in 78 Bn. BSF. He died in an accident due to Bullet injury and on 6.12.2015 admitted in GMC Hospital, Jammu, but during treatment he expired on 6.12.2015. Inquest proceedings u/s 174 Cr.P.C. vide DD No.17 dated 6.12.2015 has been registered. The deceased Raman Kumar was maintaining his salary account no.311 85896139 at State Bank of India, Branch Gurdaspur. He was covered under Group Personal Accident vide policy no.1111342914000038 and claim no.2161003159 raised. The policy is of Reliance General Insurance Co. and he is nominee under the policy. All the formalities have been duly complied, but the opposite party no.1 repudiated his claim vide letter dated 27 October, 2016. The insurance company has wrongly repudiated the claim without any reasonable cause. The insurance company in the said letter was wrongly alleging that from FIR and PMR, it was observed that the death of suicide. The above facts are totally wrong. The deceased never committed any suicide and died in an accident due to bullet injury. Even the said terms and conditions never provided at the time of policy and as such no binding over the complainant. Even all the dues have been duly paid by the BSF. Thus, there is deficiency in service on the part of the opposite party. Hence this complaint.

3.     Notice of the complaint was issued to the opposite parties. Opposite party no.1 appeared through its counsel and filed its written reply by taking the preliminary objections that complainant has no cause of action to file the present complaint; the complainant has no locus standi to file the present complaint; there is no deficiency in service on the part of the opposite parties; the policy of insurer is a contract between the two parties; the suicidal death is not covered as per exclusion clause 6 (b), as such the action of the company is totally in accordance with the provisions of the contract of insurance. On merits, it was submitted that the claim has been repudiated as the death is not accidental, but suicidal in nature. The report of police clearly shows that Constable Raman Kumar committed suicide. As per police report from the call details made by Raman and message box of the mobile number, given in the police report clearly shows that he committed suicide due to failure in love and further the father of deceased told on phone that Raman Kumar had love with one girl namely Munna and was intending to marry with her and before two months from the said incident, the said girl was engaged at some other place and due to which he has committed the suicide by killing himself with the bullet. So, there is no liability of the insurance company and exclusive clause 6 (b) clearly provides that the company is not liable to give compensation in respect of death from suicide. So, the claim has been duly repudiated as per letter dated 27.10.2016 as per terms and conditions of the policy. It was further submitted that the Group Accidental Policy was issued in favour of State Bank of India and the liability and coverage is only as per terms and conditions of the policy.  The claim has been filed and intimation has been given, but from the perusal of the documents submitted it become clear that the death is suicidal in nature. It is correct that the claim has been repudiated as per terms and conditions of the policy. All other averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

4.        Opposite party no.2 appeared through its counsel and filed its written reply by taking the preliminary objections that the complaint is not maintainable in the present form; no cause of action has accrued to the complainant against the opposite parties and the complainant has filed the present false complaint by concocting a false story and dragged the opposite party in false litigation, as such the complainant is liable to be burdened with special costs. On merits, all averments made in the complaint has been vehemently denied and lastly prayed that the complaint may be dismissed with costs.

5.     Counsel for the complainant tendered into evidence affidavit of complainant Ex.C1, alongwith other documents Ex.C2 to Ex.C12 and closed the evidence. 

6.       Counsel for the opposite parties tendered into evidence affidavit of Survadeep Singh Thakur Ex.OP-1/1 alongwith other documents Ex.OP-1/2 to Ex.OP-1/14 alongwith Mark A and Mark B and closed the evidence.

7.     Counsel for the opposite party no.2 tendered into evidence affidavit of Sh.Dalip Singh, Branch Manager Ex.OP-2/1 and closed the evidence.

8.       We have thoroughly examined the available documents/evidence on the records so as to statutorily interpret the meaning and purpose of each document and also the scope of adverse inference on account of some documents ignored to be produced by the contesting litigants against the back-drop of the arguments as put forth by the learned counsels for their respective contestants. We find that the present dispute has arisen on account of the impugned ‘repudiation’ (Ex.C2/ Ex.OP1/3) of 27.10.2016 of the insurance/accidental death-claim (Ex.C5 to Ex.C9/Ex.OP1/4 & Ex.OP1/5) pertaining to determination of DLA’s death as suicide by the OP1 insurers, on the strength of the related FIR and PMR. We further observe that the DLA Raman Kumar Constable BSF posted at the Jammu Div. was found lying on the ground with the Gun Shot Injury (on his stomach) while on the Guard duty and he was covered under the Group Insurance Policy through the OP2 Bank.

9.       Further, we find that there had been no eye witness to the alleged suicide/ self-inflicted injury or otherwise throughout the investigation by the BSF Inquiry and also by the local police whose investigating officer has expressed his opinion in the FIR (Ex.OP1/6) of ‘the suicide committed at frustration in love’ on the basis of simple hearsay evidence as collected from the cell-phone history and also from the complainant otherwise there has been exclusive evidence of the same. Even there has been no ‘examination/affidavit’ on records of that police investigator. Also, the PMR has been simply an opinion précis of the Doctor (conducting autopsy) that the injury causing can be self-inflicted but that does not say that it cannot be accidental. In fact, the DLA has been on guard duty with a live-bullet weapon and as such an accidental injury cannot be ruled out. It has been a trite law by the time that ‘suicide’ can be proved only through exclusive evidence and not otherwise.          

10.     We find that the complainant has successfully proved the contents of his present complaint pertaining to the purchase of the policy and the subsequent accidental death of the DLA through the documentary evidence on records, as produced by him during the instant proceedings. However, the OP insurers have failed to prove the alleged suicide through some all exclusive evidence on record. The FIR and the PMR on records do not prove ‘suicide’ in itself and an otherwise a valid accidental death claim cannot be repudiated on the strength of deviated conjectures. We are strengthened in our above legal proposition vide virtue of a plethora of senior court judgments/verdicts on the subject in issue.

i) Oriental Insurance Co. Ltd. vs. Satpal Sing; (NCDRC): 2014(2) CPR 357;

ii) Balwinder Kaur vs Kribhco; (PSCDRC): 2013(3) CLT  534;

iii) Kotak Mohindra Life Ins. Vs Veena Rani; (PSCDRC): 2015(4) CPJ 37.

11.     Further, we find that the OP insurers have not proved the very ‘delivery’ or even communication of the related Policy along with its applicable ‘terms’ etc to the insured DLA (during his life time)/complainant that has been vital under the circumstances. Even, its very dispatch (of the Policy etc) has not been attempted to be proved, either. And as such the OP insurers are also barred from availing any benefit of the ‘undisclosed’ terms of the related contact of insurance and that in turn also proves adoption of ‘unfair trade practice’ to turn down an otherwise a routine claim. To remove all ambiguity, it may be clarified here that an ‘insurance claim’ and for that matter any ‘issue’ can be neither legally ‘favored’ nor legally ‘ousted’ on the basis of mere ‘presumption’ how strong it might appear to be. We further find that the present policy in question was purchased through the services of the OP2 intermediaries and thus it had been their duty to clearly disclose and make the insured understand all the applicable ‘terms’ of the Policy but no such agent’s declaration/deposition has been put forth during the present proceedings.  

12.     Lastly, the OP insurers must realize that their administrative decisions in settling insurance claims are open to judicial reviews and thus need be taken with due application of mind and not arbitrarily and these should also be speaking in nature duly explaining the reason and logic of the decision as to how the same has been reached.

13.     In the matter pertaining to the present complaint and in the light of the all above, while partly allowing the present complaint we set aside the OP’s impugned repudiation being arbitrary (contra to laws of natural justice) and amounting to ‘deficiency in service’ etc. Thus, we ORDER the OP insurers to pay the impugned ‘insurance claim’ in full pertaining to the Policy in question with full accrued benefits etc if any, along with Rs.5,000/- as compensation for the undue harassment inflicted besides Rs.3,000/- as cost of litigation; within 30 days of the receipt of the copy of these orders, otherwise the entire awarded amount shall attract interest @ 9 % PA form the date of the orders till actually paid.

14.     Copy of the order be communicated to the parties free of charges. After compliance, file be consigned to record.

     (Naveen Puri)

                                                                    President     

ANNOUNCED:                                             (Jagdeep Kaur)

December 29, 2017.                                        Member.

*MK*