Madhya Pradesh

StateCommission

A/17/295

LIC - Complainant(s)

Versus

SMT.PUSHPALATA SHARMA - Opp.Party(s)

SH.D.SHUKLA

01 Jun 2023

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,                         

                             PLOT NO.76, ARERA HILLS, BHOPAL

 

FIRST APPEAL NO. 295 OF 2017

(Arising out of order dated 06.01.2017 passed in C.C.No.199/2015 by District Commission, Morena)

 

LIFE INSURANCE CORPORATION

OF INDIA THROUGH ZONAL MANAGER,

ZONAL OFFICE- 60 B HOSHANGABAD ROAD,

M.P.NAGAR, BHOPAL (M.P.)                                                                                     … APPELLANT.

              Versus

SMT. PUSHPLATA SHARMA,

W/O LATE SHRI VISHNU BHAGWAN SHARMA,

R/O WARD NO.8, ADVOCATE COLONY,

TALAB ROAD, AMBAHA, DISTRICT-MORENA (M.P.)                                             … RESPONDENT.                

         

FIRST APPEAL NO. 757 OF 2017

(Arising out of order dated 06.01.2017 passed in C.C.No.199/2015 by District Commission, Morena)

 

SMT. PUSHPLATA SHARMA,

W/O LATE SHRI VISHNU BHAGWAN SHARMA,

R/O WARD NO.8, ADVOCATE COLONY,

TALAB ROAD, AMBAHA, DISTRICT-MORENA (M.P.)                                              … APPELLANT.

                       Versus

LIFE INSURANCE CORPORATION

OF INDIA THROUGH BRANCH MANAGER,

RADHIKA HOTEL CAMPUS,

ABOVE STATE BANK OF INDIA, NALA NO.2.

GANDHI COLONY, DISTRICT-MORENA (M.P.)                                                        … RESPONDENT.

 

BEFORE :

            HON’BLE SHRI JUSTICE SHANTANU S. KEMKAR   :  PRESIDENT

            HON’BLE DR. (MRS) MONIKA MALIK                         :  MEMBER              

 

COUNSEL FOR PARTIES :

                Shri Hemant Sharma, learned counsel for the complainant.

           Shri Deepesh Shukla, learned counsel for the opposite party-LIC.             

                

                                             O R D E R

                                       (Passed on 01.06.2023)

                   The following order of the Commission was delivered by Dr.(Mrs) Monika Malik, Member:

 

                   Aforesaid two appeals arise out of a common order and are taken up together.  For convenience facts of the case are taken from the First Appeal No.295/2017 unless otherwise stated.  

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2.                Aforesaid appeals assail the order dated 06.01.2017 passed by the District Consumer Disputes Redressal Commission, Morena (For short ‘District Commission’) in C.C.No.199/2015 whereby the District Commission has allowed the complaint filed by the complainant. First Appeal No.295/2017 has been filed by the opposite party-LIC for setting aside the impugned order whereas First Appeal No.757/2017 has been filed by the complainant for enhancement of the compensation.

3.                Briefly put, facts of the case are that the complainant’s husband- Late Shri Vishnu Bhagwan Sharma (hereinafter referred to as ‘deceased-insured’), during his life time had taken a policy no. 100877821, uptill 15.12.2015 from the opposite party-Life Insurance Corporation of India (hereinafter referred to as ‘LIC’). Premium on half yearly basis was to be paid under the subject policy. Rs.1,00,000/- towards accidental benefits were also payable under the subject policy in case of death due to an accident.  It is alleged that on 09.03.2007, the deceased-insured slipped from the staircase of the roof of his house, due to which he sustained grievous injuries and consequently he died.  Since the complainant was nominee under the said policy, she approached the LIC seeking sum insured along with accidental benefits, which she was denied.  Therefore, alleging deficiency in service against the LIC, the complainant approached the District Commission, seeking relief.

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4.                The opposite party-LIC resisted the complaint before the District Commission and stated that the sum insured that was claimed by the complainant had already been paid to her.  The complainant did not submit appropriate evidence with regard to her entitlement for accidental benefits, stipulated under the subject policy.  Due to lack of enough evidence her claim was denied vide letter dated 01.02.2013.  It was therefore prayed that the complaint be dismissed.

5.                The District Commission partly allowed the complaint and directed the LIC to pay Rs.1,00,000/- towards accidental benefits under the subject policy, to the complainant with interest @ 8% p.a. from the date of repudiation of claim i.e. 01.02.2013 till payment. In addition, Rs.1,500/- as costs is also awarded.

6.                Heard.  Perused the record.

7.                Learned counsel for the complainant argued that although the District Commission has given directions regarding payment of accidental benefits stipulated under the subject insurance policy but rate of interest as has been awarded by the District Commission is less, which deserves to be enhanced.  He argued that the complainant also deserves to be compensated with a sum of Rs.10,000/- and Rs.3,000/- as costs ought to have been awarded in place of Rs.1,500/-.  He argued that on the above

 

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basis, the appeal regarding enhancement of compensation deserves to be allowed.

8.                Learned counsel for the opposite party-LIC argued that the District Commission has erred in not appreciating the fact that the insurance company had sent multiple reminders to the complainant regarding documentary proof with respect to alleged accidental death of deceased-insured such as FIR, post-mortem report, MLC etc, which were required to be submitted by the complainant. These documents were not supplied by her and it comes under the violation of principle of utmost good faith.  Since the complainant failed to supply any documents with regard to accidental death of the policy holder, benefit of accidental death cannot be provided to the complainant and therefore, the impugned order deserves to be set-aside. Learned counsel placed reliance on the decision of the Hon’ble National Commission in Sima Devi Vs New India Assurance Co. Ltd. & Anr III (2020) CPJ 90 (NC) to support his arguments.

9.                The District Commission while deciding the case in favour of complainant has held that the opposite party-LIC has not been able to point out any such policy condition, according to which it is mandatory to lodge an FIR and to get post-mortem done in order to avail accidental benefits. It has been observed by the District Commission that the complainant has, along with her affidavit placed on record the affidavits of several witnesses

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to substantiate her contentions but the opposite party-LIC has not been able to lead any contrary evidence.

10.              It is pertinent to mention that no investigation report has been put forward by the opposite party-LIC from which it could be ascertained that the deceased-insured had died of some other cause and his was not an accidental death. It appears that the LIC has adopted a hyper technical view and has rejected the complainant’s claim merely on the basis of non-submission of certain documents viz. FIR, FR and post-mortem report, without concluding it to be non-genuine, on the basis of some exploration or inquiry.

11.              The judgment relied upon by learned counsel for the LIC specifies the scope of cover of  an insurance in the referred matter as  intended to provide payment of compensation in the event of death only resulting solely and directly from accident caused by external violence and any other visible means. It has been specified further in the matter that there was no categorical averment in the case that the insured died due to an accident during the course of discharge of election duty in the complaint. Considering this, we find that the facts of the referred case are distinguishable from the facts of the case in hand as in the instant case, there has been categorical averment that the deceased-insured had died

 

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due to an accident.  We therefore conclude that the referred judgment has no applicability in the instant case and the LIC is not benefitted from it.

12.              In our considered view, the District Commission has rightly made an observation that the complainant deserves accidental benefits on account of accidental death of deceased-insured, as stipulated in the subject policy and therefore we do not find any irregularity or immateriality in the impugned order, which is hereby upheld.  Also, we find that the District Commission has adequately compensated the complainant on account of loss suffered by her.

13.              As a result, both the appeals are dismissed. No order as to costs.

14.             This order be placed in First Appeal No.295/2017 and a copy be placed in First Appeal No.757/2017.

 

    (JUSTICE SHANTANU S. KEMKAR)       (DR. MONIKA MALIK)                     

                         PRESIDENT                                    MEMBER