State Consumer Disputes Redressal Commission
Sri Subho Debnath vs The Branch Manager, Lici, Raiganj ... on 27 October, 2009
State Consumer Disputes Redressal
Commission
State Consumer Disputes
Redressal Commission
West Bengal
BHABANI BHAVAN (GROUND
FLOOR)
31, BELVEDERE ROAD, ALIPORE
KOLKATA
700 027
S.C. CASE NO.: FA/2009/211 DATE: 27.10.2009
DATE OF FILING: -08.06.2009
APPELLANT
: Sri. Subho Debnath,
S/o Gopal Debnath,
Milanpara, Raigunj, Uttar
Dinajpur.
RESPONDENTS
: 1. The Branch Manager,
LICI, Raiganj Branch,
Uttar Dinajpur.
2. The Manager (Claim), LICI,
Jalpaiguri
Division Office,
Jeevan Prakash Building,
Jalpaiguri-735101.
BEFORE: HONBLE JUSTICE : Sri. Aloke Chakrabarti, PRESIDENT.
MEMBER :
Sri. A.K. Ray.
MEMBER : Smt. Silpi Majumder.
FOR THE APPELLANT : Sri. Barun Prosad, Advocate.
FOR THE RESPONDENTS : Miss Sumita Roychowdhury, Advocate.
-ORDER-
S. Majumder, Member.
This appeal has been directed against the judgment passed by the Ld. District Forum, Uttar Dinajpur at Raigunj, on 24.04.2009 in its case no-52/2006, wherein the Forum below has dismissed the complaint on contest without any cost.
Being aggrieved by the above-mentioned judgment the Complainant-Appellant has preferred this appeal before this Commission contending the same fact in the memorandum of appeal as stated by him in the complaint petition before the Forum below. According to the Appellant as the Forums judgment suffers from infirmity the same is liable to be set aside and he has prayed for allowing this appeal.
The brief facts of the complaint are that the wife of the Complainant executed a LIC policy on 10.12.2003 and the sum assured was of Rs.40,000/-. The Complainant paid quarterly premium of Rs.555/- to the OP. The policyholder got severe burn injury i.e. 100% on 19.01.2004 at her fathers residence and she was admitted at the Raiganj District Hospital forthwith. After attending the patient and considering the serious condition the doctors of that Hospital referred her to the North Bengal Medical College and Hospital. Co-incidentally the Hospital Authority informed the Police and accordingly Surathal was performed. According to the Surathal Report the burn injury was extensive about 95%. Being the nominee the Complainant claimed the sum assured from the LICI Authority, but the OP refused to entertain the claim stating that the deceased had committed suicide well within one year from the date of commencement of risk and the OP held that nothing is payable under the policy. Challenging the said repudiation letter the Complainant has filed a complaint petition against the OP-LICI before the Forum below praying for direction upon the OP to pay him double amount of sum assured along with interest @12% till payment, compensation amounting to Rs.10,000/- due to harassment, cost and other reliefs.
The OP took the plea before the Forum below that as the insured since deceased got 100% burn injury and such type of injury can only possible in case of suicide. Based on the police report dated 20.04.2004 the OP has repudiated the claim of the Complainant and the Complainant did not challenge the said police report neither filed any petition for holding fresh enquiry by the police authority.
Before the Commission the Ld. Counsel for the Respondents has submitted that as per policy condition no-6 the Complainant is not entitled to get any amount because as per policy condition the assured or the nominee is not entitled to get back the assured sum if the policy holder commits suicide before one year from the date of taking out the policy. According to her the Ld. Forum below has passed a quite reasonable judgment which is liable to be sustained and has prayed for dismissal of this appeal.
On careful consideration of the record it is seen by me that there is no doubt that the insured since deceased got 95% burn injury and due to that injury she expired. After her death the sole nominee of the policy her husband had lodged claim before LICI, but LICI has repudiated his claim based on the police report where it has been stated that extensive burn injury was about 95% and it was due to suicide. But we are unable to accept such repudiation as it is neither clear in the said police report nor no clarification has been made to the extent that from which source the police authority came to know that the deceased committed suicide. It is the settled principle that in case of unnatural death postmortem is done by a doctor to know the cause of the death. In the instant case after Dr. S.N. Guchhait, who opined that the death was due to, did her death P.M. examination shock and antimortem burn injury. But nowhere the doctor has stated that the insured committed suicide. From which source the police authority came to the conclusion that the deceased actually committed suicide, the LICI has failed to give any cogent explanation. In the Surathal report filed by the Respondent there is also no averment to the extent that the policyholder committed suicide. In the said report it has been mentioned that at the time of preparing milk for her kid, the policyholder got burn injury and she was admitted to the Hospital by her relatives where doctor has declared her as dead. No case has been made out in the Surathal report that it was a case of suicide. During hearing the Ld. Counsel for the Respondent has argued that the Appellant-Complainant did neither challenge the police report nor approached for holding fresh enquiry by the police authority. But in my view if the LICI alleges that it was a case of suicide, then onus lies upon the LICI to prove its case. Before the Forum below the said Doctor has adduced evidence and in the cross examination the doctor has expressed that such type of burn injury might have been caused due to suicide, but the doctor has not confirmed that the death was due to suicide. It is true that before the Forum below the Complainant could not produce any evidence that it was an accidental death, but on the contrary the LICI has failed to adduce any evidence to prove that it was a case of suicide and the before the Forum below the OP did not file any evidence on affidavit and verified written version was filed. The Respondent has filed the policy condition no-5, where it has been clearly stated that the policy shall be void if the life assured commits suicide (whether sane or insane at the time) at any time on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of this policy and the Corporation will not entertain any claim by virtue of this policy except to the extent of a third partys bonafide beneficial interest acquired in the policy for valuable consideration of which notice has been given in writing to the office to which premiums under this policy were paid last, at least one calendar month prior to death. But as the Respondent has failed to prove that the insured had committed suicide, the policy condition is not applicable here. Therefore in my opinion the Complainant-Appellant is entitled to get the assured amount as per the policy condition from the LICI along with interest @8% p.a. from the date of filing the complaint before the Forum below till realization. Regarding payment of cost I am of the opinion that it was the duty of the LICI to repudiate the claim of the Complainant after perusal of the postmortem report given by the doctor, but without doing so the claim has been repudiated arbitrarily based on the police report which was not prepared based on the postmortem report. There is no whisper in the Surathal report or in the opinion of the performing doctor that the insured died due to suicide. Therefore where the death did not related with suicide and the claim of her nominee has been refused by the LICI and after getting refusal the Complainant was compelled to approach before a Court of Law, in that case the Complainant-Appellant is entitled to get some cost. It will meet justice if I direct the OP-Respondent-LICI to pay a sum of Rs.1000/- towards cost to the Complainant.
Going by the foregoing discussion it is ordered that the appeal is allowed in part on contest with cost and the judgment passed by the Forum below is hereby set aside. The Respondent shall pay the amount as per direction mentioned above within 60 days from the date of passing this judgment; in default the entire amount shall carry interest @9% p.a. for the default period. The office is directed to send down the copy of this judgment to the Ld. Forum below and issue the same upon the recorded Advocates/Parties free of cost forthwith.
(S.Majumder) (A.K. Ray) (Justice. A. Chakrabarti) MEMBER MEMBER PRESIDENT