State Consumer Disputes Redressal Commission
1.Kamla Devi Wife Of Late Jai Prakash Son ... vs 1.Tata Aig Life Insurance Corporation ... on 20 December, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA Complaint No. 20 of 2011 Date of Institution: 17.05.2011 Date of Decision: 20.12.2012 1. Kamla Devi wife of late Jai Prakash son of Shri Sat Narain 2. Rajeh Banal son of late Sh. Jai Prakash Both residents of H.No.198, Sunder Nagar, Hisar. Complainants Versus 1. Tata AIG Life Insurance Corporation Ltd. (Registration No.110) through its Managing Director, Registered & Corporate Office: 6th Floor, Peninsula Tower-I, corporate Park, Ganpatrao Kadam Marg, Lower Parel (W), Mumbai-400013. 2. Branch Manager, Tata AIG Life Insurance Corporation Ltd. (Branch Code HS01) SCO No.13-25, Ist Floor, Red Square Market, Hisar-125001. 3. Raj Kumar (Agent Code 0001771234), Agent of Tata AIG Life Insurance Corporation Ltd., R/o 168, Lajpat Nagar, near Hanuman Mandir, Hisar. Opposite Parties 4. Mukesh Bansal 5. Sandeep Bansal Both sons of late Shri Jai Prakash, Residents of H.No.198, Sunder Nagar, Hisar. Opposite Parties BEFORE: Honble Mr. Justice R.S. Madan, President. Mr. B.M. Bedi, Judicial Member. For the Parties: Shri Anurag Jain, Advocate for Complainants. Shri S.C. Thatai, Advocate for Opposite Parties. O R D E R
Justice R.S. Madan, President:
This complaint has been filed by the complainants seeking directions to the opposite parties to pay the insurable benefits in respect of Life Insurance Policies which were obtained by Jai Prakash son of Sat Narain Resident of H.No.198, Sunder Nagar, Hisar (hereinafter referred to as the Life Assured who has since expired on 04.01.2010).
Complainant No.1-Kamla Devi is the wife of deceased life assured and complainant No.2-Rajesh Bansal, opposite party No.4 Mukesh Bansal and opposite party No.5 Sandeep Bansal are the sons of deceased life assured. Opposite Parties No.1 and 2 are carrying the business of Insurance of issuing Life Insurance Policies, opposite party No.3 is an agent of opposite party No.1.
The facts of the present in a narrow compass are that Jai Prakash-life assured had obtained following four Life Insurance Policies from the Opposite Parties No.1 and 2 through Opposite Party No.3:
1. Policy No.170160564 dated 28.03.1989 for Rs.1,00,000/-
2. Policy No.175808989 dated 28.03.2008 for Rs.5,00,000/-
3. Policy No.178514855 dated 30.10.2009 for Rs.6,50,000/-
4. Policy No. U-123757457 dated 31.10.2009 for Rs.24,96,000/-.
Unfortunately, the insured Jai Prakash died on 04.01.2010 while crushing down under the running train. According to the complainants the life assured suffered accidental death while crossing the Railway Line. DDR No.29 dated 04.01.2010 (Annexure C/3) was recorded at Police Station, General Railway Police, Hisar. The inquest proceedings (Annexure C/5) were carried out. Post Mortem of the deceased (Annexure C/5) was carried out on 05.01.2010 at General Hosp Hospital, Hisar. The police of GRP carried out a detailed investigation. On being submitted claims with respect to the above said policies obtained by the life assured- Jai Prakash, the opposite parties No.1 and 2 vide their letter dated 25.02.2011 declined to settle the claim in terms of the policy Annexure C-2 on the ground that it was not an accidental death but was a case of suicide. Opposite Parties No.1 and 2 issued a cheque for Rs.6876.05 in favour of the complainant No.2 as total fund value. A cheque bearing No.314546 dated 25.02.2011 for the said amount as full and final settlement of complainants claim under Policy Annexure C/2 was issued by the opposite parties No.1 and 2 which was delivered to the complainant No.2 on 09.03.2011 but the complainant returned the said cheque to the opposite parties No.1 and 2. The opposite parties repudiated complainants claim vide letter dated 25.02.2011 for Rs.24,96,000/- (Annexure C-2) towards the insured amount alongwith Rs.24,96,000/- towards the accidental death benefit, on the ground that the life assured had committed suicide by jumping in front of the running train within one year from the date of obtaining the policy and as per the Terms and Conditions of the Insurance Policy, the complainants were not entitled for any insurable benefits. Challenging the repudiation of their claim, the complainants have invoked the jurisdiction of this Commission by filing the instant complaint seeking direction to the opposite parties to pay the insured sum of Rs.24,96,000/- towards the insured amount alongwith Rs.24,96,000/- towards the accidental death benefits alongwith interest @ 18% per annum payable from the date of submission of claim till its realization; Rs.5,00,000/- on account of harassment, humiliation and mental agony faced at the hands of the opposite parties No.1 and 2 alongwith litigation expenses of Rs.44,000/- with costs.
Initially the complainants had arrayed Opposite Parties No.1 to 6 but the name of opposite party No.6 Branch Manager, Life Insurance Corporation, SCO No.105-108, Sector-14, Hisar was struck off vide order dated 26.05.2011.
Upon notice, the opposite parties No.1 and 2 appeared and contested the complaint by filing written statement inter alia taking the plea that the death of the life assured was not an accidental death but was a result of suicide committed by the life assured as per the investigation report submitted by General Railway Police as well as the Medical Report of doctors who had conducted the postmortem on the dead body of the deceased life assured. It is also stated that the life assured had concealed the fact with respect to the previous policies and therefore the complainants are not entitled for any insurable benefits on the ground of concealment. Thus, while justifying repudiation of complainants claim on the above stated ground as per repudiation letter dated 25.02.2011, the opposite parties prayed for dismissal of the complaint. Opposite Parties No.3 to 5 did not contested the complaint and they were proceeded exparte vide order dated 17.08.2012.
Complainants in their evidence tendered affidavit of Kamla Devi (complainant No.1) Ex.CW1/A and documents Ex.C-1 to Ex.C-10. On the other hand in evidence of the opposite parties affidavit of Rahul Dhanotia, authorized representative of TATA AIA Life Insurance Ltd. has been tendered as Ex.OP1/A besides documents Ex.OP-1 toEx.OP-7.
We have heard learned counsel for the parties and perused the case file.
It is admitted case of the parties that the Insurance Policy bearing No.U-123757457 for Rs.24,96,000/- was purchased by the life assured on 31.10.2009 and he died on 04.01.2010. While repudiating complainants claim, the opposite parties have taken the plea that the life assured had not disclosed about three previous policies while obtaining the policy in question and also that the life assured had committed suicide while jumping before the running train. On the other hand, it is the case of the complainant that the life assured suffered an accidental death while crossing the railway track.
While dealing with the contention raised on behalf of the opposite parties with respect to non-disclosure of three previous policies, we do not find force in the arguments raised on behalf of the opposite parties in view of our earlier decision rendered in First Appeal No.1942 of 2007 The Divisional Manager, Life Insurance Corporation of India Versus Jasmail Kaur decided on 28.05.2012 wherein this Commission relied upon the judgment rendered by Honble National Commission in Revision Petition No.4502 of 2010, Life Insurance Corporation of India Vs. Smt. Shahida Begum decided on 06.07.2011 and held that non-disclosure of the previous policy in the second policy by the life assured cannot be a ground to deprive the claimant from insurable benefits. The observation of the Honble National Commission in LIC vs. Smt. Shahida Begum (supra) is as under:-
Perusal of the impugned orders shows that these aspects have been carefully considered by the for a below while returning their concurrent finding in favour of the complainant. In this context, the following observations of the State Commission in its impugned order are quite relevant:-
8.
On the plea of the appellant regarding observance of the utmost good faith by the contacting parties, Honble Supreme Court in case of M/s Modern Insulators Ltd. Vs. Oriental Insurance Co. Ltd 1 (2000) CPJ 1 (SC) has held that it is fundamental principal of insurance law that utmost good faith must be observed by the contacting parties and good faith forbids either parties from non-disclosure of the facts which the parties know. The assured has a duty to disclose and similarly, it is material facts in their knowledge since obligation of good faith applies to both equally.
9. Applying the ratio of above said decisions in the present case it can be safely concluded that the assured person cannot be held liable for non-disclosure of the previous policies as mentioned in Schedule-A while taking the policies as mentioned in Schedule B especially when there is not even an iota of evidence to suggest that there was malafide intention on the part of the assured person to do so.
There is no material on record to prove the fact that assured person was not keeping good health at the time of taking insurance policies in large number but paying huge sums of insurance premium. We are, therefore, of the considered view that applying the exclusion clause to repudiate claim of the respondent in this case was unjustified, because simply saying that had the appellant/corporation known the fact of previous policies they would not have issued subsequent insurance policies in this case.
11. In the present case, the officials of the insurance company were well-aware of the earlier policy being held by the assured person when the subsequent policies were issued. We fully agree with the Ld. District Forum, as held in the case of Bhagani Bai Vs. LIC AIR, 1984, SC 125 referred to in the impugned order that the insurer cannot repudiate the liability by showing some in accuracy or falsity of statement nor can it avoid the liability for immaterial misrepresentation or for material mis-representation which had no bearing on the risk.
Similarly, mere non disclosure of some immaterial facts would not prese give right to rescission. In other words, a misrepresentation would not IPO-facto and be a ground available to the aggrieved party to avoid the contract unless it is found that consent of opposite party was secured by practicing some deception. Thus, on every misrepresentation or concealment of a fact, a contract cannot be avoided merely on trival or inconsequential misstatement or non-disclosure.
In view of the above cited case LIC vs. Smt. Shahida Begum (supra), the non-disclosure of the previous policies by the life assured is not fatal to the claim of the complainants.
The other question for consideration is whether the life assured Jai Prakash had committed suicide or it was a case of accidental death. It is contended by the learned counsel for the opposite parties that in case of suicide by the life assured within a period of one year from the date of obtaining the policy, the opposite parties cannot be held liable to pay insurable benefits to the claimants. The relevant portion of general provisions of the policy is as under:-
SUICIDE If the Insured, whether sane or insane, commits suicide within one year from the Issue Date or Commencement Date, whichever is later, our liability shall be limited to the Total Fund Value at the applicable Unit Price as specified in the section Cut-off time for determining the appropriate valuation date: under Fund Provisions.
Recovery Memo (Ex.
OP-2) prepared by ASI Ram Phal of GRP (General Railway Police) on 04.01.2010 shows that nothing was recovered from the dead body of the deceased. Meaning thereby, the life assured had gone from his house with the intention of committing suicide. Posture of the dead body lying at the Railway Track clearly indicates that it was a case of suicide and not an accidental death. The copy of the Posture Plan Annexure OP-3 which was prepared at the place of incident, is duly signed by the engine driver of the train, reflects that the life assured had intentionally jumped in front of the running train on 04.01.2010. The clippings (Ex.OP-4) of the news papers i.e. Dainik Bhaskar, Hisar and Dainik Jagran, Hisar dated 05.01.2010 and 06.01.2010 published news about the suicide committed by the deceased life assured by jumping before the running train. Photographs of the dead body (Ex.OP-5) taken by GRP clearly indicate that one portion of the dead body of the DLA i.e. head was lying on one side of the railway track and the other portion of the body was lying in between the railway track which shows that it was an intentional suicide and not an accidental death. The General Railway Police had submitted the Report dated 28.01.2010, Ex OP-6, stating it a case of suicide is on the file. During the investigation, opinion (Ex.OP-7) was taken from the ADROIT CONSULTANCY MEDICO LEGAL SERVICES which submitted its Medico Legal Opinion according to which the injuries which were found on the body of the life assured (deceased) are possible only in cases of suicidal death and not otherwise. The relevant part of the opinion ADROIT CONSULTANCY MEDICO LEGAL SERVICES is as under:-
Reconstruction of scene Considering the above facts it can be deduced as follows Deceased Must have laid himself in between the tracks perpendicular to tracks-passing of wheel multiple times would have led to dragging, crushing and mutilation of body with complete separation at the level of chest & upper abdomen from lower body parts.
Conclusion based on the facts mentioned in the documents submitted From the facts mentioned in the documents submitted, such injuries are possible only in cases of Suicide deaths Therefore the claim is not payable as per terms & conditions of the policy.
In view of the above evidence, it is established on the record that the life assured Jai Prakash had committed suicide and it was not an accidental death. The statement of Railway Engine Driver (Ex.OP-3) cannot be discarded who is an eye witness to the scene and had no interest adverse to the claimants. Thus, the instant case falls under the exclusion clause of the terms and conditions of the Insurance Policy whereby the claimants are not entitled to any insurable benefits as the life assured had committed suicide within one year from the date of obtaining the policy.
For the reasons recorded above, this complaint is dismissed.
Announced: Justice R.S. Madan 20.12.2012 President B.M. Bedi Judicial Member