ORDER

HON’BLE MR. DINESH SINGH, PRESIDING MEMBER

1.    This Appeal has been filed under Section 19 of The Consumer Protection Act, 1986, challenging the Order dated 20.12.2012 in C. C. No. 20 of 2011 passed by The State Consumer Disputes Redressal Commission, Haryana.

The Appellants, Mrs. Kamla Devi and Mr. Rajesh Bansal, the widow and son of the deceased assured, were the Complainants before the State Commission.

The Respondents No. 1 and No. 2, TATA AIG Life Insurance Corporation Ltd. and its Branch Manager, were the Opposite Parties No. 1 and No. 2 before the State Commission.

The Respondent No. 3, Mr. Raj Kumar, Agent of the Insurance Co., was the Opposite Party No. 3 before the State Commission.

The Respondents No. 4 and No. 5, Mr. Mukesh Bansal and Mr. Sandeep Bansal, sons of the deceased assured, were the Opposite Parties No. 4 and No. 5 before the State Commission.

2.    Heard arguments from learned counsel for the Complainants and the learned counsel for the Insurance Co. and perused the material on record including inter alia the impugned Order dated 20.12.2012 of the State Commission and the Memorandum of Appeal. 

3.    Brief facts, shorn of unnecessary rhetoric, are that late Shri Jai Prakash, the life assured, husband / father of the Complainants had obtained four insurance policies from the Insurance Co. through its Agent. He met an unnatural death on 04.01.2010 on coming under a running train while crossing some railway tracks. The Insurance Co. did not query three of the four policies. In respect of the fourth policy, the subject policy in question here, it objected to the claim on ground that the death was not accidental but a case of suicide, falling under the exceptions to the policy, and declined the claim.

4.    The first argument made by the Insurance Co. was that the other three policies were concealed while taking the fourth policy i.e. the subject policy.

The subject policy was taken through the same Agent. The details of the other three policies were in the records of the Insurance Co. The State Commission placed reliance on this Commission’s judgment rendered in Revision Petition No. 4502 of 2010 Life Insurance Corporation of India vs. Smt. Shahida Begum decided on 06.07.2011. This Commission’s  said judgment inter alia quoted Hon’ble Supreme Court’s judgment in M/s Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd. – 1 (2000) CPJ 1 (SC). The State Commission, giving valid reasons for the same, concluded that “the non-disclosure of the previous policies by the life assured is not fatal to the claim of the complainants”.

The fourth policy, the subject policy, was taken through the same Agent, from the same Insurance Co., details of the other three policies were in the records of the Insurance Co., there is not an iota of evidence to suggest any malafide on the part of the life assured, the facts of the instant case are covered by Hon’ble Supreme Court’s judgment in M/s Modern Insulators Limited. Vs. Oriental Insurance Co. Ltd.

This Commission agrees with the appraisal and reasoning of the State Commission on this issue and endorses the State Commission’s findings that in the instant case non-disclosure of the previous policies by the life assured is not fatal to the claim.

5.    The second argument made by the Insurance Co. was that the life assured had committed suicide, which falls under the exception clause of the policy, that it was not a case of accidental death.

The State Commission, in its appraisal, has principally relied on a medico-legal opinion dated 19.01.2011 from one Adroit Consultancy Medico Legal Services and concluded that the life assured had committed suicide, his death was not accidental.

Based on the papers and documents submitted on file by the Insurance Co. to this agency, the agency, a private agency, in its report to the Insurance Co., concluded that the injuries on the deceased are possible only in cases of suicide death. The relevant portion of its opinion, quoted by the State Commission in its impugned Order, is reproduced below:

       “Reconstruction of scene

        Considering the above facts it can be deduced as follows

Deceased Must have laid himself in between the tracks perpendicular to tracks-passing of wheel multiple times would have led to dragging, crushing and mutilation of body with complete separation at the level of chest & upper abdomen from lower body parts.”

“Conclusion based on the facts mentioned in the documents submitted

●      From the facts mentioned in the documents submitted, such injuries are possible only in cases of Suicide deaths

●      Therefore the claim is not payable as per terms and conditions of the policy.

On the other hand, but, DD No. 29 of 04.01.2010 at the GRP Police Station, Inquest u/s 174 Cr.P.C. of 04.01.2010, Post Mortem Report of 05.01.2010 and Police Inquiry Report of 25.04.2010 are also on record as part of the evidence.

The DD entry mentions “as per guard memo of 5 LJH pass that one unknown person has been run over at KM 79 / 6-7 between RPHR – Hsr. Dead body lying in track and track is not clear”.

The Inquest, in response to “In what way or how the above injury marks appears to be sustained” states that “Appears to be a train accident”. 

The Post Mortem Report concludes that “Possibilities of these injuries by Railway Accident cannot be ruled out and sufficient to cause death”.

The Police Inquiry Report concludes that “Therefore from the above mentioned depositions of the witnesses and heirs of deceased verification of circumstances, I have come to this conclusion that deceased Jaiprakash, in accordance with the statement of witnesses deposed by them, that while crossing the railway line was coming from one colony to another in a hurry and due to hurry might have fallen on railway line and due to fall died by coming beneath the speedy train. Therefore the cause of this accident due to rail accident cannot be denied. The cause of death in this case railway accident cannot be ruled out.”

The Post Mortem Report has been made by the Medical Officer concerned, a government doctor.

The Police, after inter alia making a site visit and recording the depositions of eye witnesses, has, in its Inquiry Report concluded that - - - the cause of this accident due to rail accident cannot be denied. The cause of death in this case railway accident cannot be ruled out.

There is nothing on record that the Insurance Co. had questioned the other three policies re the fact that the death was accidental. It then, but, raised the objection of suicide based principally on  a “medico-legal” report of a private agency, prepared on perusal of the documents on record, after about one year of  the incident.

Inquest is conducted as mandated under the Cr.P.C., Post Mortem is conducted by the concerned government Medical Officer, Investigation is conducted by the Police (a private agency engaged by the Insurance Co. does not substitute for the Police).

There is no evidence on record that the life assured was under pecuniary difficulty debts etc., or was having family problems etc., or was having psychological disorders etc.

There is no evidence on record that the Insurance Co. made a police complaint or filed a complaint before the competent judicial magistrate that a false case of accidental death has been made out for wrongful gain when the death was by suicide, or that any remedial action in case of the other three policies settled earlier was subsequently undertaken, or any disciplinary action against its functionaries responsible for settling the earlier three policies was taken.

In a case of unnatural death, where a DD entry is duly made, an Inquest is duly carried out, a Post Mortem is duly conducted, a private agency providing “medico-legal services” does not wholly substitute for and replace Investigation by the Police. And, in the instant case, there is nothing out of the ordinary or palpably erroneous in the Investigation conducted by the Police as may cause to place principal reliance on a private agency’s report.

Weighing the evidence in its totality, the eventuality of the death being accidental cannot be ruled out. In the facts of the given case, the benefit of preponderance of probability goes to the Complainants.

The State Commission erred in placing reliance principally on the report of a private agency engaged by the Insurance Co. and ignoring the complete spectrum of evidence in the matter, especially the DD entry, Inquest, Post Mortem Report and Police Inquiry Report.

This Commission does not agree with the appraisal and reasoning of the State Commission on this issue and does not endorse the State Commission’s findings that in the instant case the death was due to suicide and not accidental.

6.    It is clear that the Insurance Co. has wrongly withheld the claim in respect of the subject policy. It is also clear that there has been inconsistency and arbitrariness in decision-making by the Insurance Co., in identical facts and same points of law a different decision has been taken in respect of the first three policies and a different decision has been taken in respect of the fourth subject policy.

7.    The Insurance Co. through its chief executive is directed to settle the claim of the subject policy with interest at the rate of 9% per annum from the date of filing of the Complaint before the State Commission till realization within a period of four weeks from today, failing which the State Commission shall undertake execution against the Insurance Co. through its chief executive (by name and by designation) as per the law.

8.    For the undue harassment and the loss and injury caused to the Complainants and for the inconsistency and arbitrariness in decision making, a cost of Rs. 1 lakh is imposed on the Insurance Co. through its chief executive, of which Rs. 50 thousand shall be paid to the Complainants and Rs. 50 thousand shall be deposited in the Consumer Legal Aid Account of the State Commission within a period of four weeks from today, failing which the State Commission shall undertake execution against the Insurance Co. through its chief executive (by name and by designation) as per the law. The Insurance Co. through its chief executive (by designation) is also advised to inculcate and imbibe systemic improvements for future, in that there is no inconsistency or arbitrariness in decision-making in identical facts and same points of law.

9.    The Registry is requested to send a copy each of this Order to all parties and their learned counsel as also to the chief executive of the Insurance Co. and the State Commission within three days of its pronouncement. The stenographer is requested to upload this Order on the website of this Commission immediately.