The Complainant has filed this complaint against the O.P. under the Provisions of Consumer Protection Act 1986 and praying for following Order / Relief :-                                           

1. Direction against the O.P. No. 1 & 2 to pay the accidental benefit under the Policy mentioned in the Complaint and directing them to pay a sum of Rs. 2,00,000/- (Rupees Two Lakhs Only) for immense mental agony,
2.  Direction against the O.P. No. 1 & 2 to pay a sum of Rs. 1,00,000/- (Rupees One Lakh Only) for the negligence and deficiency in service,
3. Direction against the O.P. No. 1 & 2 to pay a sum of Rs. 15,000/- (Rupees Fifteen Thousand Only) to the Complainant towards cost of litigation.

The case of the Complainant in brief is that, the Complainant is mother of the deceased Kariul Haque who met with an accident while he was returning back to his residence by one Motor Cycle Bearing No. WB-72-K-8617, on 21.10.2016 at about 10.30 p.m. /  at that time near Ghugudanga Bazar Under P.S. Kotwali, District- Jalpaiguri one Maruti Swift Bearing No. WB-74-AH-4598 coming at high speed from the back side , dashed the Motor Cycle of the deceased and as a result the deceased sustained serious injuries on his person / after the accident he was taken to Sadar Hospital Jalpaiguri / From the said Hospital he was transferred to Dr. Malay’s Nursing Home, Siliguri where he died on 27.10.2016 / Post-Mortem Examination was done at N.B.M.C. & H, Matigara, District- Darjeeling. The further case is that there were four numbers of L.I.C.I Policies in the name of deceased Kariul Haque vide Police No. (i) 457590966, (ii) 457590963, (iii) 457590969 & (iv) 457590964 and in those policies the name of the Complainant being mother of the deceased has been mentioned as Nominee of the said deceased / Life Assured / after the death of Kariul Haque the Complainant being a Nominee of the deceased claimed for accident benefit from the L.I.C.I. in respect of the above mentioned policies. The further contention of the Complainant is that, on 17.11.2018 the Complainant received a letter vide reference no. JDO/ D.Claim/ Repdn./ mngr dated 17.11.2018 and in the said letter it was informed to the Complainant that the D.L. A. died in an alcoholic condition and therefore, the O.P. No-2 repudiated the claim for accident benefits on the grounds of DLA’s Death due to consuming alcohol while riding a bike / though it is stated by the O.P. No. 2 that the deceased / DLA’s Death due to consume alcohol while driving a bike but nowhere in FIR .
Final Police Report & case history sheet Dr. Malay’s Hospital, Siliguri there is any evidence that the deceased consumed alcohol and without any cogent ground the O.P. No. 2 repudiated the claim for accident benefit of the Complainant / there was no credible or sustentative evidence behind repudiating the claim for accidental benefit of the Complainant / if there was any whispering of merely  consuming alcohol by the deceased/ DLA’s., does not mean that the Complainant is not entitled to get accident benefit and even if the Post-Mortem Report stating that the deceased / DLA had consumed alcohol is accepted this is not adequate proof that the deceased was intoxicated, in the absence of any evidence regarding the quantity of alcohol consume. The further case of the Complainant is that the O.P. had not been able to produce any credible evidence to repudiate the claim and the Complainant on several occasions approached the O.P’s. for processing the payment of Accident Benefit but the O.P’s. did not pay any heed to request of the Complainant and repudiate the claim for accident benefit and the reasons for repudiating the claim was more illogical, baseless / the cause of action arose on 17.11.2018 at Jalpaiguri where the claim has been processed by the O.P. No. 2 and where the claim of the Complainant repudiated illegally and the O.P. No. 2 having its office within the Jurisdiction of the Forum.

Ld. Advocate of the Complainant in support of this case has filed some documents by a firisti which are as follows:-

1. One Photocopy of Policy vide Policy No- 457590966 issued by LICI of India ( Matured amount Rs. 50,000/-),
2. One Photocopy of Police vide Policy No- 457590963 issued by LICI of India, Jalpaiguri Division (Matured amount Rs. 50,000/-),
3. One Photocopy of Police vide Policy No- 457590969 issued by LICI of India, Jalpaiguri Division (Matured amount Rs. 1,00,000/-),
4. One Photocopy of Police vide Policy No- 457590964 issued by LICI of India, Jalpaiguri Division (Matured amount Rs. 50,000/-),
5. One Photocopy of Letter sent to Hamida Khatun i.e. the petitioner vide Ref. No.- JDO/D. Claim/ Repdu./ Mngr. Dated 17^th November, 2018.

Notice was issued from this Commission for the O.P’s. On receipt of notice the O.P’s have appeared before this Commission through Vokalatnama , filed Written Version , denied all the material allegations of the Complainant and has stated that the Complainant has filed this case on some false allegations suppressing the material facts to harass the O.P’s and she is not entitled to get the relief as prayed for.  The O.P’s have also stated in his Written Version that, the contents of Para No. 1 – 18 of the Complaint are not at all true and they also denied that they illegally repudiated the claim. The O.P’s. have also stated in the W/V that the deceased or the DLA was under the influence of liquor when he was driving the Motor Cycle and that’s why the present Complainant is not entitled to get the Death Benefit though she is Nominee of the deceased Policy Holder late Kariul Haque / the total sum assured of all the 4 (Four) Policies Being in No. (i) 457590966, (ii) 457590963, (iii) 457590969 & (iv) 457590964)  issued from LICI Jalpaiguri-2 and total sum assured was of Rs. 2,50,000/- (Two Lakhs Fifty Thousand Only) and all the policies were added with Accident Benefit equal to the sum assured of all the polices, with certain specific conditions which are clearly printed in the back side of each polices and point no 10(B)(i) and (iv) of the privileges and conditions of polices where it is specifically mentioned that accident occurring out of influences of alcoholic intoxication and breach of law is excluded from Accident Benefits. The O.P’s. have also stated that the Complainant has suppressed / concealed the material information / actual truth before this Forum to mislead this Forum by putting up some vexatious and unfounded allegations which are far from the truth, the deceased Kariul Haque expired on 27.10.2016 after 7 (Seven) days meeting with an accident while he was driving a Motor Cycle being no. WB-72K-8617 which was not owned by the deceased and the same has been admitted in Para No.1 of the Plaint / the deceased person was firstly taken to Jalpaiguri Sadar Hospital, then shifted to Dr. Malay’s Nursing Home, Siliguri in a critical condition where he died / in the case history from the said Nursing Home dt. 22.10.2016 it was categorically stated that the person brought with critical injuries and was in alcoholic state /  Kariul Haque expired after 6 (Six) day of treatment in the Nursing Home/ P.M. was done on 7^th day of the accident which clearly proves that the presence of alcohol could not be traced in P.M. Report which does not proved the fact that the person was not alcoholic while driven the Motor Cycle / LIC could not get a trace of any valid Driving License of the deceased during the course of its own investigation of the case / The Complainant has filed this case suppressing the material facts and they have already received the Basic Death Claim Benefit of the insured late Kariul Haque on 14.03.2017 to the recorded Nominee i.e. the plaintiff  / the allegation of deficiency in service as alleged in Para No. 12 & 13 are not correct / only Accident Benefit portion was repudiated due to violation of policy conditions which proves the ill intention of the Complainant to grab money of the people in large by filing false complaint and therefore, the instant Complainant is liable to be dismissed with cost.

To falsify the case of the Complainant the O.P’s. have filed the following documents by a firisti namely:-

1. Admission summery of Kariul Haque dated 22.10.2016 of Dr. Malay’s Nursing Home,
2. Original LICI Policy of Kariul Haque being No. 457597741.

By filing the Written Version the O.P’s. have prayed for dismissal of this case.

Having heard the Ld. Advocate of both the side and on perusal of the Complaint, Written Version as well as documents filed by the parties, the following points are taken to be decided by this Commission.

                             Points for consideration                 

1. Whether the complainant is a consumer?
2. Whether the case is maintainable under the C.P. Act ?
3. Whether there is any deficiency in service on the part of the O.P. as alleged by the Complainant?
4. Is the Complainant entitled to get any award and relief as prayed for as per the prayer of his Complaint?

Decision with reasons

All the points are taken up together for discussion to avoid unnecessary repetition and for the sake of convenience and brevity of this case.

Both the parties are given liberty to adduce evidence on their behalf. The Complainant intending to prove its case filed Written Deposition in the Form of an Affidavit. In the Written Deposition the Complainant has corroborated her case.

To falsify the Case of the Complainant the OP has filed their Written Deposition in the Form of an Affidavit. In the Written evidence the OP’s they have denied the allegations of Complainant.

Ld. Advocate of the Complainant during argument has stated that, the Complainant has been able to prove the case against the O.P’s. by adducing Evidence in the Form of an Affidavit and also by producing documents in support of it’s case. He also argued that the O.P. with a view to falsify the case of the Complainant has adduced evidence and produced some documents but has failed to disprove the case of the Complainant. It is also the argument of the Complainant that there are four numbers of LICI Policies in the name of the deceased Kariul Haque where the name of the Complainant has been mentioned as Nominee of the Life Assured and after death of Kariul Hoque the Complainant being Nominee of the deceased claimed for Accident Benefit from the O.P’s but by sending a letter the O.P’s informed that they had Repudiated the claim for Accident Benefits as the DLA died in an alcoholic condition. Ld. Advocate of the Complainant further argued that though the O.P. No. 2 claimed that, the death of the DLA was due to Consuming alcohol while driving the Motor Cycle but nowhere in the FIR, Final Police Report, Case History Sheet of Dr. Malays Hospital, Siliguri there is any evidence that, the deceased Consumed alcohol at the relevant time of accident. He also argued that, without any cogent grounds the O.P. No. 2 repudiated the claim of Accident Benefit of the Complainant and there is no substantive evidence behind repudiating the claim and in the absence of any evidence regarding quantity of alcohol consumed it does not mean that the deceased was intoxicated. He also argued that, the O.P’s. have not been able to produce any credible evidence to repudiate the claim and the reasons mentioned behind repudiating the claim is more illogical, baseless and preposterous and the Complainant has been able to prove its case and she is entitled to get the relief as prayed for.

Ld Advocate of the Complainant during argument has referrd decisions reported in 2012(2) CPR467(NC) & SLP (CIVIL) No- 12489/2020 dated 12/04/2021 .

Ld. Advocate of the O.P’s. during argument submits that, the Complainant has failed to prove its case and she is not entitled to get any relief as she filed this case suppressing the material facts. It is also argument of the O.P’s. that, all the policies were added with Accident Benefits equal to the Sum Assured of all policies with certain specific conditions which are clearly mentioned/printed in the back side of each policies and in point No. 10(B) (i) and (iv) of the privileges and conditions of polices where it is specifically mentioned that, accident occurring out of influences of alcoholic intoxication and breach of law is excluded from Accident Benefits which the Complainant has purposely suppressed the material information before this Commission with an intention to mislead the Forum. He further argued that, the Complainant has stated in her plaint that, after the accident the deceased was firstly taken to Jalpaiguri Sadar Hospital and then to Dr. Malays Nursing Home, Siliguri in a critical condition where he breathed his last but she suppressed the fact that, in the case history of that Nursing Home dated 22.10.2016 it was pointed out that “ the person brought with critical injuries and was in alcoholic state” and that the said Koriul Hoque expired after six (6) days of treatment and Post Mortem done on 7^th days of the accident which proves that, the presence of alcohol could not be traced in the Post Mortem Report and it does not prove the fact that, the person was not alcoholic while was driving the Motor Cycle and during investigation of the case the LICI could get a trace of any valid Driving License of the deceased. Ld. Advocate of the O.P’s. also argued that, the Complainant has failed to prove that there was deficiency in service on the side of the O.P’s. and the LICI had only Repudiated the Accident Benefit portion due to violation of policy conditions and therefore the Complainant is not entitled to get any relief as prayed for and the Complaint is liable to be dismissed. Ld. advocate of the O.P. No. 1 during argument referred decision of the Hon’ble National Commission passed in LICI -VS- Priyanka Singh { 111(2007) C P J- 436 (NC)}and stated that, the decision to repudiate an accident claim was upheld in a similar case.

Having heard the Ld. Advocate of both the sides and on perusal of the plaint, Written Version, Evidence of the Parties, Questionnaires, Reply, Documents filed by the Parties it is admitted fact, the deceased Kariul Hoque was the Policy Holder of four LICI Policies. It is also admitted fact that, the Complainant is the Nominee of the deceased Policy Holder Late Kariul Hoque. It is also admitted fact that, the total Sum Assured of all the Polices are Rs. 2,50,000/- ( Rupees Two Lakhs Fifty Thousand Only). It is also admitted fact by the O.P’s. that, those four policies were added with Accident Benefit equal to the Sum Assured of all the policies.

It is also admitted fact that, the said Accident Benefit has not been given to the Complainant/ Nominee and the Death Benefit Claim was repudiated by the O.P’s. The O.P. No. 1 has claimed that, they had rightly repudiated that Death Benefit Claim of the Complainant as on the back side of the policies it is printed the privileges and conditions in point No. 10 (B) (i) and (iv) where it is specifically mentioned that accident occurring out of influence of alcoholic intoxication and breach of law is excluded from Accident Benefits. But on the other hand the Complainant has claimed that, nowhere in the F.I. R , Final Police Report, Case History Sheet of Dr. Malay’s Hospital, Siliguri there is any evidence that, the deceased consumed alcohol at the relevant time of accident while he was driving the Motor Cycle.

In the case in hand it is fact that, the deceased was firstly taken to the Sadar Hospital Jalpaiguri where from he was transferred to Dr. Malay’s Hospital Siliguri and in the case history it is narrated that, the person brought with critical injuries and was in alcoholic state. Apart from that statement there is no whisper / evidence that, the deceased consumed alcohol at the relevant time while he was driving the Motor Cycle. Mere statement narrated in the case History of the Hospital regarding the patient was alcoholic state does not ipso facto proves that the deceased was intoxicated while driving the Motor Cycle.

It is needless to mention here that to prove the intoxicated condition of a person it needs some specific evidence regarding quantity of alcohol consumed. But in this case the O.P. has failed to produce any evidence either oral or documentary regarding quantity of alcohol consumed by the deceased while driving the Motor Cycle. No medical examination of the deceased was got conducted in order to ascertain the quantity of alcohol in his blood at the time when he was driving the Motor Cycle and met with an accident. Therefore, the insurer has failed to prove that the insured had committed a breach of the terms of the Polices, the driver being under influence of liquor.

In view of the above we came to the conclusion that, the O.P’s. have not been able to produce any credible evidence to repudiate the Accident Benefit Claim.

The decision referred by the Ld. Advocate of the O.P. No. 1 is not applicable to the facts and circumstances of this case.

Ld. Advocate of the Complainant has argued that the Complainant has been able to prove the case against the O.P’s. and she is entitled to get the relief as per the prayer of the Complaint.

Considering all we are of the view that the Complainant has been able to prove it’s case against the O.P’s andOP No-1 & 2 are jointly and severally liable to pay the awarded amount as directed by this Commission as the Complainant has been able to prove that there was clear deficiency in service on the part of the OP No-1 & OP No-2 .

Hence, it is therefore,

 O R D E R E D

That, the instant Consumer Case being in No. 41/2019 is hereby allowed in part on contest. The O.P’s No-1 & 2 are   directed to pay a sum of Rs. 2,00,000/ (Rupees Two Lacs ) only to the Complainant towards Accidental Benefit of the Four LICI Policies .       The O.Ps No-1 & 2 are also directed to pay the Complainant litigation cost of Rs. 5,000/-(Rupees Five Thousand Only) and Rs. 10,000/- (Rupees Ten Thousand Only) to Consumer Legal Aid Account of this Commission.

The OP No-1 & 2 are directed to pay the above amount of money within one month from this day , failing which they will have to pay interest @ 9 % per annum to the Complainant with effect from this day till making payment of the entire amount . Complainant is at liberty to file execution case after one month from this day in default of payment by the OP No-1 & 2 .

 Let a copy of this order be given to parties free of cost.