State Consumer Disputes Redressal Commission
Lic vs Smt.Shalini Jain on 10 January, 2019
M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PLOT NO. 76, ARERA HILLS, BHOPAL (M.P.)
FA No.1386/2017.
Life Insurance Corporation of India,
through Divisional Manager,
60 -A, Arera Hills, Bhopal,
Madhya Pradesh. .... Appellant.
Versus
Smt. Shalini Jain,
w/o Late Shri Rajesh Kumar Jain,
R/o - D/19-A, B.D.A. Colony,
Koh-E-Fiza, Bhopal (M.P.). .... Respondent.
BEFORE:
HON'BLE SHRI JUSTICE SHANTANU S. KEMKAR, PRESIDENT
HON'BLE SHRI S. D. AGARWAL, MEMBER
COUNSEL APPEARING FOR THE PARTIES :
Shri Jatin Rohit Gupta, learned counsel for the appellant.
Shri Yash Vidhyarthi, learned counsel for the respondent.
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ORDER
(Passed on 10 /1/2019) The following order of the Commission was delivered by Shantanu S. Kemkar, J :
This appeal at the instance of opposite party / Life Insurance Corporation of India (for short "LIC") is directed against the order dated 14.6.2017 passed by the District District Consumer Disputes Redressal Forum, Bench No.1 Bhopal (for short the 'Forum') in CC No.407/2016.
2. Briefly stated the respondent - complainant filed a complaint alleging therein that on 12.5.2013 her husband Rajesh Kumar Jain, who was insured with the appellant - LIC under 4 policies taken for availing the Double Accidental Benefit (for short "DAB") suffered accidentally death due to drowning in the swimming pool of the Hotel at Bangkok. He was immediately taken to Bumrungrad International Hospital, Bangkok where he remained unconscious and ultimately died on 17.5.2013. His body was brought to India and cremated.
3. The case of the respondent / complainant was that in order to avail the benefit of accidental claim policies she submitted the claim along with all the relevant medical papers to the appellant - opposite party on 2.6.2014. On 10.6.2014 she was informed by the opposite party that the accidental death is not confirmed from the documents and as such the benefits of DABs cannot be extended in her favour. The complainant pleaded that she had informed the -3- appellant / LIC that other Insurance Companies viz. Star Health and Allied Insurance Company Ltd. with which also complainant's husband was insured under the Foreign Travel Policy has accepted the claim of accidental death of her husband and paid compensation of Rs.5,47,645/-. Similarly, New India Assurance Company Ltd. has also paid accidental death claim to the complainant amounting to Rs.7,95,000/- for the death of her husband. However, the complainant's claim was rejected by the appellant - Insurance Company on the ground that accidental death is not confirmed from the documents. Feeling aggrieved the complainant filed the complaint seeking insured amount and compensation for deficiency in service.
4. On being noticed the appellant / opposite party denied the claim and alleged that in the absence of the evidence to support that the death was accidental the claim has rightly been rejected.
5. The Forum after considering the evidence led by the parties vide impugned order allowed the claim and directed the appellant / opposite party to pay the amount of Rs.11,25,000/- in all towards all the four DABs as aforesaid and Rs.1,00,000/- for deficiency in service and mental agony, and Rs.2,000/- towards costs. Feeling aggrieved the appellant / LIC has filed this appeal.
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6. We have heard learned counsel for the parties at length and perused the record.
7. We find on record autopsy report Ex. D -2 showing the cause of death as "Brain death due to history of drowning". The said autopsy report remained unchallenged. The report of the Hospital where the claimant's husband was admitted on 12.5.2013, Ex. C - 6 in which the findings about the patient are stated as under :-
"The patient was admitted to Bumrungrad International Hospital since 12 May 2013 due to drowning. He is now in ICU & unconscious."
8. In the certificate of the Bumrungrad International Hospital issued on 17 th May 2013 the cause of death of complainant's husband Rajesh Kumar Jain is mentioned as 'drowning'. The complainant's case finds support from her affidavit in which she has categorically made a statement that her husband has died due to drowning in the swimming pool of the Hotel. There is no contra material available on record to suggest that the death was not accidental.
9. In the circumstances, when it is clear that the insured was died due to drowning and when there is uncontroverted affidavit to the factual aspect of the matter stated by the complainant that her husband died due to drowning -5- in the swimming pool of Hotel, the appellant/s / opposite party's contention that the complainant had failed to prove that deceased died due to accidental death cannot be accepted. There is no other evidence or any investigation report of any Investigator appointed by the appellant / opposite party to indicate contrary. In the circumstances, the Forum in our considered view has rightly appreciated the evidence and reached to a correct finding that the death of the complainant's husband occurred due to drowning in the swimming pool and the same is an accidental death.
10. As a result, the appeal fails and is hereby dismissed.
(JusticeShantanu S. Kemkar) S.D.Agarwal)
PRESIDENT MEMBER
Phadke