State Consumer Disputes Redressal Commission
Smt.Varsha Ben vs Lic Of India on 27 October, 2009
APPEAL NO: 1465/2005 Smt. Varsha Ben w/o Lt.Sh.Suresh B.Patel r/o 3-A, Shree Niketan Society, Sumul Dairy Road, Surat Hall, Pratham Marudhar Nagar, Pali Marwar (Rajasthan) Complainant-appellant Vs. Life Insurance Corporation of India, through Br. Office at first Jeevan Raksha, Post box no. 32, Mandiya Road, Pali. Opposite party-respondent Date of judgment 27.10.09 Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethia-Member
Mr.Rajesh Mootha counsel for the appellant Mr.Ashok Chaturvedi counsel for the respondents BY THE STATE COMMISSION 2 This appeal has been filed by the complainant appellant against order dated 26.5.05 passed by the District Forum, Pali in complaint no. 22/04 by which the complaint of the complainant appellant was dismissed.
2. It arises in the following circumstances-
That the complainant appellant had filed a complaint before the District Forum,Pali on 3.3.04 inter alia stating that her husband Suresh B.Patel now deceased had taken LIC policy alongwith accidental benefit from the respondents for a sum of Rs.3 lacs bearing policy no.100840648 on 28.3.99 and the maturity date of the policy was 28.3.2019. It was further stated in the complaint that the deceased had gone to his in-laws house and in the night of 12.1.01 there was a noise of "
Chor-Chor" and after hearing that sound the deceased came outside from the house and a blow of axe was given by some unknown persons who might be thieves and as a result of which the deceased had become unconscious and thereafter he was taken to the hospital. It was further stated in the complaint that for that incident a report was lodged with the Police Station and information about the illness of the deceased was also given to the office of the respondents LIC on 19.2.01, 20.8.01 and 19.10.01 and ultimately the deceased had died on 28.12.01. It was further stated in the complaint that in respect of the insured amount of Rs.3 lacs alongwith interest and bonus to the tune of 3 Rs. 3,63,900/- had been paid by the respondents LIC on 28.3.02 but in respect of accidental benefit, the claim of the complainant appellant was repudiated by the respondents through letter dated 18.7.02 on the ground that the death of the deceased was not as a result of accident and further the death had taken place after 180 days of the incident. Thereafter the present complaint was filed. claiming accidental benefit to the tune of Rs. 3 lacs.
A reply was filed by the respondents on 14.5.04 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 18.7.02. Apart from that it was stated in the reply that from the record, the fact that the deceased had received injury in an accident and thereafter he had died because of that injury had not been proved and thus it could not be said that the death of the deceased was accidental death and it was prayed that complaint of the complainant be dismissed as claim of the complainant was rightly repudiated by the respondents.
After hearing the parties, the District Forum, Pali through impugned order dated 26.5.05 had dismissed the complaint inter alia holding-
(i) That since in the present case it is not proved that the death of the deceased was an accidental death 4 and thus the complainant is not entitled to claim accidental benefit.
(ii) That the respondents were justified in repudiating the claim of the complainant appellant in respect of accidental benefit.
Aggrieved from the said order dated 26.5.05 passed by the District Forum, Pali, this appeal has been filed by the complainant appellant.
3. In this appeal, the main contention of the learned counsel for the appellant complainant is that the deceased had received head injury in the night of 12.1.01 when he was hit by some weapon by some persons and since the report of that incident was lodged with the Police Station and the deceased was admitted in the Shree Mahavir General Hospital, Surat and from the discharge card of that hospital it appears that the deceased was got admitted in the hospital on 13.1.01 and was discharged on 24.2.01 and in the column diagnosis the word " Head injury" was mentioned and threfore, the fact that the deceased had received head injury in an accident is well established and hence, repudiation of claim of the complainant appellant by the respondents was wholly illegal and arbitrary and in view of this the findings of the District Forum dismissing the complaint of the complainant appellant could not be sustained as they suffer from basic infirmity, illegality and perversity and it was prayed that appeal be allowed.
54. On the other hand, the learned counsel appearing for the respondents has supported the impugned order of the District Forum.
5. We have heard the learned counsel for the appellant as well as for the respondents and have gone through the entire materials available on record.
6. There is no dispute on the point that the deceased had taken LIC policy alongwith accidental benefit from the respondents for a sum of Rs.3 lacs bearing policy no.100840648 on 28.3.99 and the maturity date of the policy was 28.3.2019.
7. There is also no dispute on the point that deceased had died on 28.12.01.
8. There is no dispute on the point that the insured amount of Rs.3 lacs alongwith interest and bonus to the tune of Rs. 3,63,900/- had been paid by the respondents LIC on 28.3.02 to the complainant appellant.
9. There is no dispute on the point that the claim in respect of accidental benefit of the above mentioned policy was repudiated by the respondents through letter dated 18.7.02 on the grounds mentioned therein.
10. On file there is a certificate of Dr.Ashit Desai dated 13.2.01 in the following manner-
6" This is to certify that Mr. Suresh Bhai B.Patel is under my treatment at Shree Mahavir General Hospital,Surat from 13.1.01. He had massive Lt. Temponparietal Extrodyrul haematoma for which he was operated upon the same day. He is still unconscious."
11. On file there is a copy of FIR of the incident which shows that the incident had taken place on 12.1.01 in the manner as stated by the complainant in her complaint.
12. On file there is a Discharge Card of Shree Mahavir General Hospital, Surat which shows the following facts-
(i) That the deceased was admitted in the hospital on 13.1.01 and was discharged on 24.2.01 and the date of operation was 13.1.01.
(ii) That in respect of incident it was written that there was assault by somebody in his house on
13.1.01.
(iii) Further in the diagnosis the word " Head injury" was mentioned.
13. On file there is a letter addressed to the respondents LIC by the complainant appellant which was received by the LIC on 20.8.01 and in that letter the same incident was re-iterated.
14. From the record it further appears that the deceased 7 remained unconscious for the long time and he was not in a position to speak.
15. On file there is a certificate dated 12.7.01 given by Dr. Ashit Desai in the following manner-
" This is to certify that I have examined Mr.Sureshbhai Bhikhabhai Patel today. He is spoutaneously opening eyes. At times localising pain with Rt. side. There is very less movements of Lt. upper limb and Rt. lower limb. There is generalised spusticity. He is on Ryle's Tybe feeding and he is with tracheostomy and condom catheter. He is totally disabled at present."
16. On file there is a postmortem report of the dead body of the deceased dated 29.12.01 though the incident had taken place on 12.1.01 and no doubt in the postmortem report no evidence of injury was mentioned but the deceased had received injury on 12.1.01 and he was operated on 13.1.01 but in the column of External injuries, head injury is mentioned .
17. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was dismissed could be sustained or not and whether the repudiation of the claim of the complainant appellant by the respondent in respect of accidental benefit was justified or not or whether 8 the death of the deceased in the pesent case could be treated as accidental one or not.
18. In this case the learned counsel for the respondent has further stated that since in the postmortem report, no injury was mentioned, therefore, it could be taken for granted that the deceased had not received any injury and in our considered opinion this argument has got no meaning because of the simple reason that the incident had taken place on 12.1.01 and the deceased had died on 28.12.01 and the postmortem of the dead body of the deceased was done on 29.12.01 and since as per hospital record the fact that the deceased was operated on 13.1.01 is well proved, therefore, the fact that he had received head injury by some external force is also well proved and when he had received external injury by external force and the deceased had died later on 28.12.01 and thus, it would be presumed that the injury which was received by the deceased on 12.1.01 was the direct proximate cause of death of the deceased.
19. It may further be stated here that in the final opinion after receiving the FSL report, the cause of death of the deceased was mentioned "Septicaemia " but that too on the basis of the postmortem report dated 29.12.01 as the deceased had died on 28.12.01 though the injury was received by him on 12.1.01, therefore, if the immediate cause of death of the deceased would be " Septicaemia "
but the proximate cause of death of the deceased would be head injury which had 9 received on 12.1.01 from an attack by some one on his head and thus from every point of view the death of the deceased could be accidental death and not natural death.
20. For the reasons stated above, it is held that the death of the deceased in the present case was accidental one and thus repudiation of claim of the complainant appellant by the respondent in respect of accidental benefit could not be justified and the respondents were not justified in repudiating the claim of the complainant appellant and the findings of the District Forum dismissing the claim of the complainant appellant could not be sustained as they are not based on correct appreciation of entire materials and evidence available on record and they suffer from basic infirmity or illegality or perversity and the same are liable to quashed and set aside and the appeal deserves to be allowed.
Accordingly, the appeal filed by the appellant is allowed and the impugned order dated 26.5.05 passed by the District Forum, Pali is quashed and set aside and the complaint of the complainant appellant stands allowed in the manner that the respondents are directed to pay to the complainant appellant a sum of Rs. 3 lacs as amount of accidental benefit in respect of policy in question alongwith interest @ 9% p.a. from the date of 10 filing of the complaint till the payment is made and the respondents would further pay a sum of Rs. 5000/- as costs of litigation to the complainant appellant.
(Vimla Sethia) (Justice Sunil Kumar Garg) Member President