State Consumer Disputes Redressal Commission
1 Life Insurance Corporation Of India vs 1 Bassa Pushpalatha on 14 March, 2017
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL FORUM Telangana First Appeal No. FA/1012/2013 (Arisen out of Order Dated 30/03/2013 in Case No. Complaint Case No. CC/64/2012 of District Nalgonda) 1. 1 Life Insurance Corporation of India Branch Office II Sri Laxmi Complex R.P. Road, Nalgonda Town 508 001 Rep by its Manager 2. 2.Life Insurance Corporation of India, Branch office, Jeevan Jyothi, 1-7-125/11/1/A1, LIC Road, Suryapet Town, Nalgonda District. Rep. by its Branch Manager. 3. 3.Life Insurance Corporation of India, Secunderabad Divisional Office, Jeevan Sagar, Behind NTR Stadium, Near Indira Park, Hyderabad-500 080. Rep. by its Senior Divisional Manager. ...........Appellant(s) Versus 1. 1 Bassa Pushpalatha Wife of Late Venkata Swamy Aged 35 Years Occ Govt Employee 2. 2.Bussa Navadeep S/o. Late Venkata Swamy, age: 17 Years, Occ: Student, R/o. D.No.12-155, Srinivasa Nagar, Near Perika Hostel Kodad Town, Nalgonda District-508 206. 3. 2.Bussa Navadeep S/o. Late Venkata Swamy, age: 17 Years, Occ: Student, R/o. D.No.12-155, Srinivasa Nagar, Near Perika Hostel Kodad Town, Nalgonda District-508 206. 4. 3.Bussa Sandeep S/o. Late Venkata Swamy, Age: 15 Years, Occ: Student, R/o. D.No.12-155, Srinivasa Nagar, Near Perika Hostel Kodad Town, Nalgonda District-508 206. ...........Respondent(s) BEFORE: HON'BLE MR. JUSTICE B. N. RAO NALLA PRESIDENT HON'BLE MR. Sri. PATIL VITHAL RAO JUDICIAL MEMBER For the Appellant: For the Respondent: Dated : 14 Mar 2017 Final Order / Judgement BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD FA NO.1012 OF 2013 AGAINST CC NO.64 OF 2012 ON THE FILE OF DISTRICT FORUM, NALGONDA Between: 1) Life Insurance Corporation of India, Branch Office-II, Sri Laxmi Complex, R.P. Road, Nalgonda Town-508 001, Rep. by its Branch Manager. 2) Life Insurance Corporation of India, Branch Office: Jeevan Jyothi, 1-7-125/11/1/A1, LIC Road, Suryapet Town, Nalgonda district. Represented by its Branch Manager. 3) Life Insurance Corporation of India, Secunderabad Divisional Office, Jeevan Sagar, Behind NTR Stadium, Near Indira Park, Hyderabad - 500 080. Rep. by its Senior Divisional Manager. ...Appellants/Opposite parties And 1) Bussa Pushpalatha W/o late Venkata Swamy, aged 35 years, occ: Government employee, 2) Bussa Navadeep S/o late Venkata Swamy, aged 17 years, Occ: Student, 3) Bussa Sandeep S/o late Venkata Swamy, aged 15 years, Occ: Student, (Respondents 2 and 3 being minors, Rep. by their mother and natural guardian Bussa Pushpalatha i.e., Respondent No.1) All are R/o D.No.12-155, Srinivasa Nagar, near Perika Hostel, Kodad Town, Nalgonda district-508 206. ...Respondents/Complainants Counsel for the Appellants : Sri N.Mohan Krishna Counsel for the Respondents : Sri Vakkanti Narsimha Rao Coram : Hon'ble Sri Justice B.N.Rao Nalla ... President and Sri Patil Vithal Rao ... Member
Tuesday, the Fourteenth day of March Two thousand Seventeen Oral Order : (per Hon'ble Sri Justice B.N.Rao Nalla, Hon'ble President) *** This is an appeal filed by the Opposite parties aggrieved by the orders of District Consumer Forum, Nalgonda dated 30.03.2013 made in CC No.64 of 2012 in allowing the complaint and directing the Opposite parties to deposit a sum of Rs.1,50,000/- towards accidental benefit and a sum of Rs.5,000/- towards deficiency of service with interest @ 9% p.a. from the date of complaint till realization and costs of Rs.2,000/- within one month and on such deposit, the entire amount shall be paid to the complainant No.1, being the nominee.
2) For the sake of convenience, the parties are referred to as arrayed in the complaint.
3) The case of the complainant, in brief, is that the Complainant No.1 is wife and complainants 2 and 3 are the sons of deceased Bussa Venkata Swamy, who died on 02.02.2008 by homicidal. During the lifetime of the deceased life assured, he was worked as police constable and had secured two policies on his name bearing No.643112182 for a sum of Rs.50,000/- commenced on 28.10.1991 and another policy No.601982642 for a sum of Rs.1,00,000/- which commenced on 28.11.2003. Both the policies were obtained with accidental benefit coverage. As on the date of death, the policies were in force.
4) That, on 01.02.2008 at about 1930 hours, the life assured left the house on his motorcycle bearing No.AP24B6692 and did not return on the night and on the following day i.e., 02.02.2008 he found dead under mysterious circumstances in Mukthyala Branch canal near Kodad-Huzurnagar road in the limits of Chilkur P.S. Immediately, complainants went to the scene of offence and found the dead body of deceased on the edge of the canal with ligature mark on the throat. As such, a complaint was lodged with the Police, Chilkur who in turn registered a case in Cr.No.12/2008 and investigated into the matter.
5) The dead body of the deceased was subjected to post mortem examination and the doctor who conducted autopsy over the corpse of the dead body opined the cause of death as due to "strangulation", upon which, the section of law was altered to 302 IPC. Thereafter, police filed the charge sheet that in spite of all possible and sincere efforts made to detect the case, no clues came forth and there is no scope to detect the case in future and prayed to refer the case as "U.N".
6) On making claim for payment of policy benefits, the Ops paid the sum assured along with vested bonus amounting to Rs.3,23,082/- on 22.01.2009 in respect of policy No.601982642 and Rs.1,56,096/- in December 2008 in respect of policy bearing No.643112182. Further, it was informed by the Ops that they would pay the accidental benefit after laying of the final report by the police. Immediately after filing of final report by the police in December 2011, the complainant made representation to the Ops for payment of the accidental benefits, to which, by letter dated 16.08.2012, the Ops repudiated the claim in so far as claim under policy No.601982642 is concerned on the premise that "since the life assured was under the alcoholic intoxication and this is clear breach of law, as per policy conditions 10.2(b)(i)" and in respect of policy No.643112182, no reasons were assigned.
7) The Opposite parties failed to assign any reasons in declining the payment of accidental benefit. As per the final report filed by police, the cause of death was strangulation, which is a murder and there is no nexus between the presence of mixed alcohol in food, as such, the decision of the Ops in non-considering the accidental benefit is against the settled principles of law and amounts to deficiency of service. Hence the complaint praying to direct the Ops to pay Rs.3,00,000/- towards accidental benefit covered by policy No.601982642 and Rs.1,00,000/- covered by policy No.643112182 along with compensation of Rs.50,000/- towards mental agony, together with interest @ 12% p.a. from the date of death of the life assured till payment and costs of the litigation.
8) Opposite parties resisted the claim by way of written version contending that the complaint is not maintainable either in law or on the facts and that the complainant had not come with clean hands. They admitted to have issued the policy bearing No.601982642 and 643112182 for a sum of Rs.1,00,000/- and Rs.50,000/- respectively. As per condition No.10(b) of terms and conditions of the policy, in the event of death of the life assured due to accident, an additional amount equal to the sum assured is payable towards accident benefit, as such, complainants are not entitled to claim more than Rs.1,00,000/- and Rs.50,000/- under above two policies.
9) As per the report of FSL, Hyderabad, it is opined that Organophosphate and insecticide poison along with ethyl alcohol was found in stomach, liver and kidney. Thus, it is clear that the deceased life assured (DLA) was under alcoholic intoxication at the time of death. It is also clear from the final report filed by the Police, Chilkur that the murder of deceased could not be ascertained as there are no clues to detect. Hence, the suicide of life assured cannot be ruled out and payment of accident benefit is subject to policy conditions. Per condition No.10(b)(i) they are not liable to pay accident benefit. There is no deficiency in service on their part and the Opposite parties are not liable to pay any sum as claimed by the complainants. Hence, prayed to dismiss the complaint with costs.
10) During the course of enquiry before the District Forum, in order to prove their case, the Complainants got filed the evidence affidavit of Bussa Pushpalatha and Exs.A1 to A7 and on behalf of the Opposite parties, got filed the evidence affidavit of one K.Madanmohan Rao, its Manager and Ex.B1 to B4.
11) The District Forum after considering the material available on record, allowed the complaint bearing CC No.64/2012 by orders dated 30.03.2013, as stated, supra, at paragraph no.1.
12) Aggrieved by the above orders, the Appellants/Opposite parties preferred this appeal contending that the forum below (a) erred in allowing the complaint without properly appreciating the basic facts of the case and proposition of law; (b) failed to see that the life assured has committed suicide by consuming poison which does not amount to accident, since there are no external violent visible injuries; (c) failed to see that there is no proof that the life assured died in an accident and the cause of death is unknown; (d) failed to see that as per APFSL report, there is deposit of organ phosphate and insecticide poison along with ethyl alcohol in the stomach, liver and kidney of the life assured; (e) failed to consider the condition No.10(b)(i) of the policy. Hence, prayed to allow the appeal by setting aside the orders of the forum below.
13) The point that arises for consideration is whether the impugned orders as passed by the District Forum suffer from any error or irregularity or whether they are liable to be set aside, modified or interfered with, in any manner? To what relief ?
14) It is not in dispute that the deceased Bussa Venkata Swamy, the husband of Respondent No.1 and father of Respondents 2 and 3 obtained the policies covered by Ex.B1 and B2 on his life carrying accidental benefit. It is also not in dispute that on 02.02.2008 the deceased was found dead under mysterious circumstances on Kodad-Huzurnagar near canal and on the complaint, the Police, Chilkur registered a case in Cr.No.12/2008 U/s 174 Cr.P.C. and later filed charge sheet altering the same to 302 of IPC. It is also not in denial that on consideration of the claim, the Ops paid the amounts covered by the policy towards natural death but denied to pay the accidental benefit on the premise that the deceased committed suicide by consuming poison.
15) It is to be seen whether the death of the deceased is an accidental death or natural death. The Appellants would contend that the deceased life assured committed suicide, as such, no accidental benefit is payable under the policies. In England, law on the subject is settled. In Halsbury's Laws of England Vol. 25 Pg.307 Para 569, 4th Edition (2003 reissue), as to the meaning of the word 'accident', it is stated as under:
"Meaning of 'accident'. The event insured against may be indicated in the policy solely by reference to the phrase 'injury by accident' or the equivalent phrase 'accidental injury', or it may be indicated as 'injury caused by or resulting from an accident'. The word 'accident', or its adjective 'accidental', is no doubt used with the intention of excluding the operation of natural causes such as old age, congenital or insidious disease or the natural progression of some constitutional physical or mental defect; but the ambit of what is included by the word is not entirely clear. It has been said that what is postulated is the intervention of some cause which is brought into operation by chance so as to be fairly describable as fortuitous. The idea of something haphazard is not necessarily inherent in the word; it covers any unlooked for mishap or an untoward event which is not expected or designed, or any unexpected personal injury resulting from any unlooked for mishap or occurrence. The test of what is unexpected is whether the ordinary reasonable man would not have expected the occurrence, it being relevant that a person with expert knowledge, for example of medicine, would have regarded it as inevitable. The stand point is that of the victim, so that even willful murder may be accidental as far as the victim is concerned."
From the above quotation, it is clear that 'even the willful murder' of the assured is accidental as far as insured is concerned and such murder is to be described as 'by chance' or 'fortuitous'. Now, the question is, under which circumstances the 'willful act' of the third party can be held to be 'accidental'? This is discussed in Halsbury's Laws of England Vol. 25 Pg.311 Para 575, 4th Edition (2003 reissue), as under:
"Injury caused by a willful act. An injury caused by the willful or even criminal act of a third person, provided the insured is not a party or privy to it, is to be regarded as accidental for the purpose of the policy, since from the insured's point of view it is not expected or designed. Injuries sustained by gamekeeper in a criminal attack upon him by poachers, by a cashier who was murdered by a robber, and by a master at an industrial school who was murdered by the boys, have been held to be accidental. However, if the immediate cause of the injury is the deliberate and willful act of the insured himself, there would seem to be no accident, and no claim will lie under the policy, at any rate if the insured is not mentally disordered at the time of his act."
16) As per the Post Mortem Examination report Ex.A5, the cause of death is mentioned as "unknown poisoning" and the final opinion was reserved pending report from the APFSL, Hyderabad. Admittedly, neither of the parties has chosen to file the FSL report to come to a conclusion. However, in the final report marked as Ex.A6 filed by the Circle Inspector of Police, Kodad there is a mention as "LW-11/M.Sanjeev Kumar, Assistant Director, APFSL Hyderabad examined the viscera and opined that organophosphate an insecticide poison along with ethyl alcohol was found in stomach, liver and kidney ," which do not amount to accident at all. Though the role of the Respondent/Complainant No.1 and her brother was suspected on account of some family grudges, the same could not be elicited/detected inspite of subjecting those persons to Lie Detection Test. The burden of proving the case lies on the part of the Respondents that the cause of death of the deceased life assured is due to accident. No single paper is filed to that effect. Though there is a mention in Ex.A6 at page No.4 as "LW-13/Dr.P.Ramachandra Rao, C.A.S., Govt. C.H.C. Kodad who held autopsy and opined that anti mortem factures in hyoid cartilage and contusions in the soft tissues and suggestive of death due to strangulation," but on perusal of the Ex.A5 P.M.E. the same does not find place as such. It is clearly mentioned in Ex.A6 that all possible efforts have been made for trace-out the accused, but no useful information came-out and there is no hope to detect the case in the near future, accordingly sought permission to refer the case as U.N.
17) The best possible evidence in this case was avail the possibility of filing the report obtained from Forensic Science Laboratory, Hyderabad to come to a deciding factor, which both the parties failed to file. Nothing prevented the Respondents from filing the same. Be that as it may, no evidence is brought on record to show that the death of the deceased was on account of strangulation which is a murder and that the same took place without the knowledge of the deceased life assured which the life assured had not anticipated. Without proving their own case, the Respondents are not entitled for any claim of accidental benefit under the above two policies which are the subject matter of this appeal.
18) Even otherwise, the post mortem examination report does not disclose any evidence of strangulation except presence of alcoholic smell and the cause as unknown poisoning. Viewed from any angle, the poisoning would amount to accident. It is the case of the police that the deceased life assured died under mysterious circumstances. In such a circumstance, the heavy burden lies on the respondents to prove that it is a case of accidental death, which is not forth-coming in the present case. From the aforesaid findings, we are of the opinion that the forum below erred in holding that the cause of death of the deceased is an accident. Accordingly, we answer the point framed for consideration at paragraph No.12, supra, in favour of the Appellants and against the Respondents.
19) In the result, we allow the appeal and set aside the orders dated 30.03.2013 passed in Consumer Complaint No.64 of 2012 by the District Consumer Forum, Nalgonda, but in the circumstances of the case, the parties to bear their own costs.
PRESIDENT MEMBER Dated 14.03.2017 [HON'BLE MR. JUSTICE B. N. RAO NALLA] PRESIDENT [HON'BLE MR. Sri. PATIL VITHAL RAO] JUDICIAL MEMBER