State Consumer Disputes Redressal Commission
Bachan Singh vs Life Insurance Corporation Of India on 22 April, 2019
Cause Title/Judgement-Entry Punjab State Consumer Dispute Redressal Commission Dakshan Marg, Sector 37-A , Chandigarh First Appeal No. A/478/2018 ( Date of Filing : 29 Aug 2018 ) (Arisen out of Order Dated in Case No. 184/2016 of District Jalandhar) 1. Bachan singh House no 1579,ward no 8,near akali Gurudwara,village and post office Begowal ...........Appellant(s) Versus 1. Life Insurance Corporation of India LIC jeevan parkash model tower road ,jalandhar ...........Respondent(s) BEFORE: J.S.Klar PRESIDING MEMBER Rajinder Kumar Goyal MEMBER For the Appellant: For the Respondent: Dated : 22 Apr 2019 Final Order / Judgement FIRST ADDITIONAL BENCH STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB SECTOR 37-A, DAKSHIN MARG, CHANDIGARH. First Appeal No.478 of 2018 Date of Institution : 29.08.2018 Order Reserved on: 09.04.2019 Date of Decision : 22.04.2019 Bachan Singh S/o Sh. Arjan Singh, R/o House No.1579, Ward No.8, near Akali Gurudwara, Village and post office, Begowal, District Kapurthala. .....Appellant/complainant Versus 1. Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, Model Town Road, Jalandhar, through its Senior Divisional Manager. 2. Manager (Claims), Life Insurance Corporation of India, Divisional Office, Jeevan Prakash, Model Town Road, Jalandhar. .....Respondents/opposite parties First Appeal against order dated 24.07.2018 passed by the District Consumer Disputes Redressal Forum, Jalandhar. Quorum:- Shri J. S. Klar, Presiding Judicial Member
Shri Rajinder Kumar Goyal, Member Present:-
For the appellant : Sh. Munish Goel, Advocate For the respondents : Sh. Piyush Sharma, Advocate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J.S. KLAR, PRESIDING JUDICIAL MEMBER :-
Challenge in this appeal by appellant is to order dated 24.07.2018 of District Consumer Disputes Redressal Forum Jalandhar (in short the 'District Forum'), dismissing his complaint. The respondents of this appeal are opposite parties (in short 'OPs') in the complaint before the District Forum below and appellant of this appeal is complainant therein and they be referred as such hereinafter for the sake of convenience.
2. The complainant filed the complaint u/s 12 of the Consumer Protection Act, 1986 (in short, "the Act") against OPs on the premise, that his son Inderjit Singh obtained life insurance policy bearing No.132063073 for assured amount of Rs.8,00,000/- under plan Jeevan Anand with accident benefits (Table No.147) for term of 16 years from OPs. Assured Inderjit Singh died in car road side accident in Bemsheim (Germany) in foreign country on 11.03.2015. He succumbed to his accidental injuries in prime of his age being 39 years old only. The complainant was his nominee being father of assured Inderjit Singh and lodged the insurance claim with OPs for sum assured and benefits of double accident benefit (DAB) claim, as additional amount covering accidental benefit under the policy, because cause of assureds' death was road side accident. The death claim was registered in the branch office Kartarpur and he supplied the death certificate with requisite documents to OPs and a claim for sum assured of Rs.11,76,000/- was paid on 07.05.2015 to him by them, but they withheld the double accident benefit claim of Rs.5,00,000/- arbitrarily. The documents were duly submitted by him to insurance company to claim the above DAB claim, but OP no.2 sent letter bearing reference claim/D/1061 dated 06.02.2016 asking him to submit attested copy of Post Mortem Report of life assured for considering the claim for double accident benefit under the policy being subject matter of the complaint. He had not received any above referred letter from OP no.2 previously. OP no.2 just to cover up its inaction, laxity and delaying tactics sat over the double accident benefit claim settlement to save its skin and to shift the blame to the complainant. Post mortem report is not the only document to prove the death of DLA, which took place in accident and it is not essential and necessary document in itself. It has been laid down clearly in instructions/guidelines of OPs that double accident benefit claim cannot be denied of the assured and his postmortem report and FIR are not obligatory in every case for settling the claim. He served legal notice upon OPs in this regard, but to no effect. He challenged the act of OPs in not granting the DAB claim to him arbitrarily despite road side accidental death of assured. He prayed for direction to OPs to allow the accidental claim benefits to him, being nominee and father of assured. He also prayed for interest @12% per annum from the date of lodging the claim till actual payment of DAB claim of Rs.Five Lah. He also sought compensation of Rs.Two lakh and Rs.10,000/- as cost of litigation from OPs.
3. Upon notice, OPs appeared and filed written reply and contested the complaint of the complainant vehemently. It was averred in preliminary objections that the complainant is estopped by his act and conduct from filing the complaint. The complaint is alleged to be pre-mature. The OPs have already requested the complainant and also sent letters to him to provide hospital treatment record, postmortem report and other documents relating to the alleged accident of DLA, but he failed to provide the same to enable OPs to decide the matter. The above documents were required to make the payment under double accident benefit claim. As per terms of the policy, the OP corporation would not be liable to pay the additional sum referred in Section 10 (a) or (b) of the policy, "if the disability or death of the life assured shall; i) be caused by intentional self injury, attempted suicide, insanity and immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic; ii) take place as a result of accident, while the life assured is engaged in aviation or aeronautics in any capacity other than that of a fare paying, part paying, non paying passenger in any aircraft, which is authorized by the relevant regulations to carry such passenger and flying between established aerodromes, the life assured having at that times no duties on board, the aircraft or requiring descent therefrom; or iii) be caused by injuries resulting from riots, civil commotion, rebellion, war (whether war be declared or not), invasion, hunting, mountaineering, steeple chasing or racing or any kind; or iv) result from the life assured committing any breach of law; or v) arise from employment of the life assured in the armed forces or military service of any country at war (whether was be declared or not)" and further submitted that the OP is a public undertaking and posses a public money and is to make the payment after considering the genuine claim. The complaint was contested by OPs even on merits on the above referred grounds. The claim of the complainant to the extent of basic claim of the insurance i.e. Rs.11,76,000/- has been already paid to him, but the remaining amount is not paid for want of supply of some necessary documents by him. The OPs controverted the other averments of the complainant and prayed for dismissal of the complaint by denying any deficiency in service on their part.
4. The complainant tendered in evidence his affidavits Ex.CA and Ex.CB along with other documents Ex.C-1 to Ex.C-43 and closed the evidence. As against it, OPs tendered in evidence affidavit of Hari Shankar Gupta, Manager Ex.OP/A with copies of documents Ex.OP/1 to Ex.OP/3 closed the evidence. On conclusion of evidence and arguments, the District Forum below dismissed the complaint of the complainant. Aggrieved by order of the District Forum, the complainant now appellant has directed this appeal against the same.
5. We have heard the learned counsel for the parties at considerable length and also examined the record of the case. So far as the assured amount of Rs.11,76,000/- is concerned, the OPs have already paid this amount to complainant, as nominee of DLA Inderjit Singh on 07.05.2015. This controversy dies down with payment of the assured amount for the basic sum assured by OPs. The claim of the complainant is confined with regard to DAB claim for assured amount of Rs.Five Lakh, which has not been granted by OPs to him in this case for want of post mortem report of DLA to prove the DAB claim, as per version of OPs. OPs also avowed in the written version that there are some clauses in policy, wherein the claim is inadmissible. The OPs have not granted the DAB claim to him primarily on the ground of non-production of post mortem report by the complainant. Evidence on the record has been scanned by us. The complainant swore his affidavit Ex.C-A stating on oath that DLA has expired in road side accident on 11.03.2015 in Bemsheim (Germany), but OPs declined the DAB claim to him. He also relied upon his supplementary affidavit Ex.C-B in support his claim. Ex.C-1 is the copy of claimant's statement form no.3783 (A). He served legal notice upon OPs, vide Ex.C-2, fortified by postal receipts Ex.C-3 to Ex.C-5. Ex.C-6 is the copy of letter dated 07.03.2016 by him to OPs with regard to his DAB claim, supported by postal receipts Ex.C-7 to Ex.C-9. Vide letter dated 03.03.2016 Ex.C-10, OPs advised him to contact the servicing Branch Office Kartarpur with regard to DAB claim. Vide Ex.C-11 letter dated 11.02.2016 by OPs to complainant asking him to supply the attested copy of the post mortem report of DLA. EX.C-12 is the copy of RTI Application dated 10.02.2016 by counsel for complainant to OPs and Ex.C-13 Letter of Authority. Ex.C-14 is the copy of driving license of complainant. Ex.C-15 is reply to RTI Application of the complainant. Ex.C-16 is the copy of letter dated 16.11.2016 to Police Directorate, Bergstrassee PST, Bensheim, Wilhemstrassee 52, 64625, Bensheim (Germany) regarding post mortem report of DLA Inderjit Singh and Ex.C-17 is the postal receipt. Ex.C-18 and Ex.C-19 are English Translation of Ex.C-20 and Ex.C-21. Ex.C-22 is the document received in Dutch Language from the Germany and Ex.C-23 is copy of envelope. Ex.C-24 is Death Information by Islamisches Bestattungsinstitut Cenaze Nakil VE Defin Firmash dated 15.03.2015. Ex.C-25 is no objection certificate by consulate general of India Frankfurt regarding transportation of mortal remains of Inderjit Singh DLA to India for cremation. Ex.C-26 is the copy of Dead Body Clearance Certificate dated 18.03.2015. Ex.C-27 is the copy of the Passport of DLA Inderjit Singh. Ex.C-28 is the confirmation regarding traffic accident death of Inderjit Singh. Ex.C-29 is the copy of Map of Place of accident. Ex.C-30 to Ex.C-37 are the copies of photographs of alleged accident. Ex.C-38 is the copy of letter dated 19.06.2015 to OPs for payment of DAB. Ex.C-39 is copy of another letter dated 07.03.2016 by complainant to OPs for payment of DAB, supported by postal receipts Ex.C-40 to Ex.C-42. Ex.C-43 is the copy of IRDAI Regulations 2015. The OPs relied upon affidavit of Hari Shankar Gupta, Manager of OPs Ex.OP-A in support of their case. He stated that in the absence of post mortem report, the cause of death of assured is not sufficient to be explained by the complainant. He further stated that the accident occurred due to violation of rules and regulations thereby making the claim inadmissible, as per exclusion clauses of the policy. The OPs relied upon reminders for submission of attested copy of post mortem report of DLA Inderjit Singh, vide Ex.OP-1 to Ex.OP-3 on the record.
6. On evaluation of above referred evidence, we have come to this conclusion that death of life assured Inderjit Singh, being son of complainant has been proved on record by means of affidavits of complainant Ex.C-A and C-B as well as by the death certificate issued by the authorities in Germany in that regard. The complainant made efforts to receive the post mortem report from Police Directorate of Bensheim (Germany), through his counsel Sh.K.C. Malhota, vide Ex.C-16 supported by postal receipt Ex.C-17. The vital document on the record is Ex.C-18, the provisional death certificate of Inderjit Singh DLA, recording the cause of death as non natural death due to multiple injuries. The death certificate issued by German authorities in this case is Ex.C-19, wherein the road accident has been recorded as cause of his death. Ex.C-18 and C-19 are the English Translation of Ex.C-20 and C-21 on the record. The copies of photographs of accidental vehicle and DLA are Ex.C-30 to Ex.C-37 on the record to corroborate the version of the complainant. The dead body of Inderjit Singh DLA was received by Indian Airport for performance of his last rites of the mortal remains vide Ex.C-26 in his native country. The death information supplied by Islamisches Bestattungsinstitut Cenaze Nakil VE Defin Firmash dated 15.03.2015 of Inderjit Singh is Ex.C-24 recording the cause of death of Inderjit Singh as road accident. The OPs failed to make a dent to these documents, which proved the death of DLA Inderjit Singh in road side accident. The counsel for OPs strongly contended that DAB claim is not admissible under Section 10(a) or (b) of the policy, as DLA Inderjit Singh violated the terms and conditions of the policy. This contention of OPs is based on surmises and conjectures only, as they have not produced on record any cogent evidence in this regard, which could debar the complainant from claiming the DAB claim on account of above death of his son DLA Inderjit Singh in road side accident. The onus is on the OPs to prove the violation of terms and conditions of policy by DLA Inderjit Singh, but they failed to do so. Moreover, the OPs have not appointed any IRDA approved surveyor in this matter. The OPs intentionally deprived the complainant by not giving his claim of DAB on account of accidental death of his son DLA Inderjit Singh in road side accident, which is sheer deficiency in service and unfair trade practice on the part of OPs and complainant is entitled to DAB claim and compensation on this count. The District Forum Jalandhar has oversighted the matter by ignoring the important aspects of the case and letter to German Authority by Sh. K.C. Malhotra Advocate on behalf of complainant demanding the post mortem report Ex.C-16 and straightway dismissing the complaint.
7. The vital point for adjudication in this appeal is whether the fact of accidental death of life assured cannot be proved without post mortem report or can be proved by other evidence on the record. The matter is not res integra. The National Commission has held in "Life Insurance Corporation of India Vs. Amar Lal Jai Singh (dead)" III(2014)CPJ-578 as under:
"Double Accident Benefit- Dispute whether death of insured due to accident- Death certificate showing cause of death as cardio respiratory arrest- Insured had a fall on while opening an almirah in her house. Fracture suffered- Evidence of fracture and treatment was fully considered by Fora below- There is clear nexus of fall and fracture with death of insured- Double accident benefit rightly granted."
This Commission also took the view in C.C. no.199 of 2014 titled as "Harpal Singh & another Vs. Bajaj Allianz General Insurance Co. Ltd." decided on 10.04.2017 that no FIR and post mortem reports are mandatory to prove the fact of accidental death of assured. The fact of accidental death can be proved by other evidence, which is admissible on the record. It was further observed that non-production of post mortem report and FIR and final report would not tantamount to this fact that death was not due to injuries received in the accident by the insured. Herein, there is no reason to discard the death certificate of DLA Inderjit Singh issued by the authorities in German country with regard to fact of his road side accident and due to injuries received in the accident, whereby he died thereat. This Commission also held in "Parkash Kaur & others Vs. ICICI Lombard General Insurance Company & another" 2009(1) CLT-74 and in "Manager, Health Administrator Team, Bajaj Allianz General Insurance Co. Limited Vs. Ravinder Kaur & others" 2012(1)CPC-100 that claim cannot be repudiated for want of post mortem report and FIR, if this fact is otherwise proved on the record. Resultantly, we have come to this conclusion that the order of the District Forum Jalandhar in dismissing the complaint of the complainant with regard to DAB claim of Rs.Five Lakh is not sustainable in the eyes of law. The order of the District Forum Jalandhar deserves to be reversed in this appeal.
8. As an upshot of our above discussion, appeal the appellant is accepted and the order of the District Forum Jalandhar dated 24.07.2018 is hereby set aside and complaint of the complainant is accepted. The OPs are directed to pay the DAB claim of Rs.Five Lakh to complainant with interest @9% per annum from 07.05.2015 till actual payment, besides to pay Rs.30,000/- as compensation for mental harassment and Rs.15,000/- as cost of litigation as well. These amounts shall be payable by OPs to complainant within 45 days from the date of receipt of certified copy of the order.
9. Arguments in this appeal were heard on 09.04.2019 and the order was reserved. Certified copies of the order be communicated to the parties as per rules.
10. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(J. S. KLAR) PRESIDING JUDICIAL MEMBER (RAJINDER KUMAR GOYAL) MEMBER April 22, 2019 MM [ J.S.Klar] PRESIDING MEMBER [ Rajinder Kumar Goyal] MEMBER