State Consumer Disputes Redressal Commission
Ifco Tokia General Insurance Company ... vs Sheela Devi & Another on 20 March, 2012
H H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, SHIMLA. First Appeal No: 139/2011. Date of Decision: 20.03.2012. . IIFCO Tokio General Insurance Co. Ltd., through its Authorized Signatory, 5th Floor, IIFCO Tower, Plot No.3, Sector 29, Gurgaon, Haryana. Appellant. Versus 1. Sheela Devi, Wd/o late Sh. Tej Singh @ Prakash Chand, Resident of Village Rau (Bhiyarta), Post Office Chunahan, Tehsil Sadar, Distt. Mandi, H.P. 2. Punjab National Bank, through its Branch Manager, Branch Office Village and Post Office Baggi, Tehsil Sadar, Distt. Mandi, H.P. Respondents. Coram Honble Mr. Justice Surjit Singh (Retd.), President Honble Mr. Chander Shekhar Sharma, Member Whether approved for reporting?[1]Yes. For the Appellant: Mr. Dinesh K. Sharma, Advocate For the respondent Mr. Abhishek Lakhanpal, No.1: Advocate For the respondent Mr. Karan Thakur, Advocate No.2: vice counsel O R D E R:
Justice Surjit Singh (Retd.), President (Oral)
1. This is an appeal under section 15 of the Consumer Protection Act, 1986, by the opposite party against order dated 15.3.2011 of learned District Consumer Disputes Redressal Forum, Mandi, whereby a complaint filed by respondent-Sheela Devi seeking a direction to the appellant to pay a sum of Rs.4,00,000/- on account of accidental death of her husband, Tej Singh, who was insured with the appellant, has been allowed and the appellant has been ordered to pay the amount of Rs.4,00,000/- with interest @ 9% per annum from the date of institution of the complaint till the payment of the aforesaid amount of money.
2. Respondent-Sheela Devi filed a complaint under section 12 of the Consumer Protection Act against the present appellant and Punjab National Bank, impleaded as respondent No.2 herein, seeking issuance of a direction to the appellant to pay Rs.4,00,000/- on account of insurance claim for the death of her husband, late Tej Singh, in an accident. It was stated in the complaint that Tej Singh, the husband of respondent-Sheela Devi, had raised a loan of Rs.2,50,000/- from Punjab National Bank and the said bank had insured him with the present appellant for personal accident to secure the repayment of loan raised by him and an amount of Rs.1,684/- paid on account of premium was debited to the loan account of said Tej Singh. Tej Singh was alleged to have died as a result of fall from a tree on 14.9.2007. He died instantaneously and his dead body was cremated on the very day of his death without informing the police or getting postmortem conducted.
3. Respondent-Sheela Devi informed the bank about the death of her husband a few days later. Bank, in turn, informed the appellant. Investigator engaged by the appellant submitted report, Annexure:O-I(iii). As per this report, there was no FIR or the postmortem report and the evidence gathered during investigation suggested that the insured had committed suicide by hanging himself. Appellant repudiated the claim. Respondent-Sheela Devi then filed complaint under section 12 of the Consumer Protection Act.
4. Appellant contested the claim and pleaded that FIR and the postmortem report having not been submitted despite demand, claim had rightly been repudiated. Appellant placed reliance upon the following general condition in the policy in support of its plea:
General conditions:
Claim Procedure and Requirements.
An event which might become a claim under this section must be reported to the Company as soon as possible. In case of death, written notice of death must, unless reasonable cause is shown, be given before internment/cremation and in any case within one calendar month after the death, and in the event of loss of sight or limbs, written notice thereof must also be given within one calendar month after such loss of sight or limbs. A written statement of the claim will be required and a Claim Form will provide for completion and submission.
All certificates, information and evidence from a medical attendant or otherwise required by the Company shall be furnished by the Insured Person or his/her representative in the manner and form as the company may prescribe. In such claims, the insured person or his/her representative will allow the Company to carry out examination and ascertain details if and when required. In the event of death it is essential to get the Post Mortem-examination done in respect of the body of Insured Person and submit the Pot Mortem Report as a supporting document in respect of the claim.
5. Respondent-Sheela Devi filed a rejoinder, in which it was stated that since the deceased died instantaneously with fall from the tree which he had climbed to lop its branches, police were not informed and the cremation was arranged and carried out the same day.
6. Learned Forum allowed the complaint holding that there was enough evidence indicating that it was a case of accidental death and that there was no material suggesting that the deceased had committed suicide.
7. We have heard learned counsel for the parties and analyzed the evidence and other material on record. It is true that the above reproduced condition in the policy says that it is essential in the case of the death of insured to submit postmortem report to support the claim for insurance, but in our considered view, failure to comply with the condition cannot ipso facto be a ground for rejection of claim, if it is otherwise established that the death was accidental. This is especially so when the claimants were placed in a situation where the postmortem of the dead body may not be considered essential.
8. Admittedly the deceased and his wife, respondent-Sheela Devi lived in rural area. Their village is stated to be 15 kms. from the station, where facility for conducting postmortem examination is available, and the terrain is hilly. Deceased fell from a tree which he climbed to lop its branches and died instantaneously. Residents of the village, including the respectables like Nambardar and Ward Member saw the accident and advised the family to cremate the dead body. Respondent-Sheela Devi, being a lady of rural background, was not supposed to be knowing the implications of cremating the dead body without postmortem and without informing the police, when the death was accidental, and people had seen the accident taking place. Also, there is nothing in the record indicating if the insured or the respondent-Sheela Devi were made aware of the condition in the policy that the submission of postmortem report was essential for claiming insurance benefit.
9. No doubt, the investigator engaged by the appellant, in his report, Annexure:O-I(ii), stated in the conclusion part that it appeared that the deceased had committed suicide by hanging, but while giving detail of investigation at insureds place and referring to the facts stated revealed by the residents during the course of inquiry he did not mention that any one of the persons associated by him in the investigation told that the deceased had ended his life by hanging, as stated in the conclusion. Thus, the conclusion drawn by the surveyor deputed by the appellant, is unfounded and hence of no avail to the appellant.
10. Matter regarding the death of insured was looked into by the revenue authorities for deciding whether any money on account of ex gratia grant could be paid to the dependants one of the deceased. During the course of inquiry the Patwari, the Kanungo, the Naib Tehsildar and the Tehsildar found that the deceased had climbed a tree in the village to lop its branches to be used as fodder for the cattle and one of his feet slipped, as a result of which fell head-long and died instantaneously. On the aforesaid reports/findings, District Revenue Officer sanctioned ex gratia grant of Rs.1,00,000/- for the death of the husband of respondent-Sheela Devi. These reports and the ex gratia grant orders sufficiently prove that this was a case of accidental death and not of suicide.
11. As a result of the above discussions, we find no merit in the present appeal.
The same is, therefore, dismissed.
However, keeping in view the fact that the policy was purchased by the bank {from which the deceased had taken the loan} to secure repayment of the loan in the event of the deceased dying on accidental death, we direct that the appellant shall deposit the entire amount of insurance money together with interest at the rate, as ordered by the learned District Forum, with the Punjab National Bank, and the said bank shall debit the amount into the loan account of the deceased and after adjusting the loan amount, if some amount remains surplus, the same shall be paid to respondent-Sheela Devi.
12. One copy of this order be sent to each of the parties, free of cost, as per Rules.
(Justice Surjit Singh) {Retd.} President (Chander Shekhar Sharma) Member March 20, 2012.
[1] Whether reporters of the local papers may be allowed to see the order?