State Consumer Disputes Redressal Commission
Lic Of India, Ongole vs Y. Vijaya Kumari, Prakasham Dist. on 18 January, 2010
A BEFORE THE A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. F.A. 733/2007 against C.C. 50/2007, Dist. Forum, Ongole. Between: The Divisional Manager LIC of India Rep. by its Branch Manager Ongole. *** Appellant/ Opposite Party. And Y. Vijaya Kumari W/o. Late Samuel R/o. ABM Palem Markapur Mandal Prakasham Dist. *** Respondent/ Complainant Counsel for the Appellant: M/s. G. Venugopal Rao Counsel for the Resps: Mr. GVL Murthy CORAM: HONBLE SRI JUSTICE D. APPA RAO, PRESIDENT SMT. M. SHREESHA, MEMBER
& SRI K. SATYANAND, MEMBER MONDAY, THIS THE EIGHTEENTH DAY OF JANUARY TWO THOUSAND TEN Oral Order: (Per Honble Justice D. Appa Rao, President) *****
1) This is an appeal preferred by the opposite party insurance company against the order of the Dist. Forum directing it to pay Rs.
2,27,531/- with interest @ 9% p.a., from 28.3.2006 till the date of realization together with compensation and costs of Rs. 1,000/- each.
2) The case of the complainant in brief is that she is the wife of late Samuel who worked as Headmaster of Elementary School, Kandivaripalle of Markapur mandal in Prakasham Dist. He took the following four policies keeping his wife the complainant as his nominee.
S.No Policy No. Amount
1. 670563718 50,000/-
2. 670561781 40,000/-
3. 841946410 50,000/-
4. 841946313 25,000/-
While so, he died on 11.4.2005 in a train accident. When the claim was made the insurance company gave only death benefits without giving accidental death benefit, which was covered by the policies. It amounts to deficiency in service and therefore prayed that the accidental benefit plus, bonus amounting to Rs. 2,27,531/- be paid with interest, compensation and costs.
3) The appellant insurance company resisted the case. While admitting that it had issued four polices as mentioned in the complaint alleged that her claim was admitted for basic sum assured since the cause of death was suicide an amount of Rs. 2,81,624/- was paid under the above policies. The assured was in the habit of taking alcohol. Two of the policies were treated as early claims basing on the duration of the policies up to death. Suicide clause- Section 45 of the Insurance Act is applicable and nothing is payable as if it was an accident. She was not granted benefits due to the death of the assured under suspicious circumstances. She was paid ex-gratia amount on humanitarian grounds under Chairmans discretionary jurisdiction and the inquest report shows that he died by standing opposite to the coming train, having consumed alcohol. After explaining these things to the complainant she having agreed for the same issued valid vouchers towards full and final settlement of the claims. She was not entitled to any amount whatsoever and therefore prayed that the complaint be dismissed.
4) The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A9 marked, while the insurance company filed the affidavit evidence of its A.A.O and got Exs. B1 to B10 marked.
5) The Dist. Forum after considering the evidence placed on record opined that the death was accidental. There is no evidence to show that the death was suicidal. Since the policies cover the accidental death benefits accrued, it had to be paid to the nominee. Therefore it directed the insurance company to pay Rs. 2,27,531/- with interest @ 9% p.a., from 28.3.2006 till the date of realization together with compensation and costs of Rs. 1,000/- each.
6) Aggrieved by the said decision, the insurance company preferred the appeal contending that the Dist. Forum did not appreciate the facts in correct perspective. It ought to have seen that the complainant had received the amount towards full and final settlement of the claim. The assured being in the habit of consuming alcohol the double accident benefit was not paid but the assured sum along with accrued bonus were paid. Even if death could be taken as accidental death she would be entitled to equal to the sum assured viz., Rs. 1,55,000/-. The accidental benefit and bonus were already paid and in view of the fact that the entire amount was received by her towards full and final settlement of the claim it prayed for dismissal of the complaint.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the complainant is the nominee under the four policies taken by her husband late Samuel who died in a train accident. When she made the claim, she was paid the sum assured along with accrued bonus. She was not paid accidental benefits.
9) The insurance company alleges that since the death was suicidal and at any rate he being alcoholic the complainant was not entitled to the benefits. Admittedly Sri CH. Ramakrishna, Deputy Station Manager, South Central Railway, Markapur gave a report to the police about the accident wherein Samuel died. Basing on which the police registered a case in Crime No. 32/2005 on 11.4.2005 vide Ex. A2 FIR. An inquest was conducted wherein Inequestadars were of the opinion that the deceased died in a train accident. Post Mortem Examination was conducted wherein the doctor opined that the cause of death was injury to vital organs brain and due to multiple injuries. vide Ex. A4. The inspector of police, Guntakal requested the Deputy Superintendent of Police, Railways, Guntakal to treat the case as accidental death and drop further investigation under report Ex. A1.
10) Evidently, the insurance company did not report or address a letter to the railway authorities alleging that the death was not accidental but it was suicidal. The insurance company did not appoint any investigator to find out the real cause for the accident. In Ex. A1 which we have already referred to there was a stray sentence that the deceased was habituated to drinking.
Since there was no eye witness account, the Inspector of police opined that the deceased might have been run over by unknown train and died on the spot due to multiple injuries and that no foul play was suspected.
This fact was confirmed by the mediators. Importantly, the presence of alcohol was not noted in the Post-mortem Report. The fact remains that he died in a rail accident, wherein she was entitled to accident benefits. At no stretch of imagination, it can be assumed that it is a case of suicide. It is stretching too far. It is unfortunate that the insurance company having received all the premia agreed to pay death benefit, did not extend the same, obviously taking advantage of the fact that the complainant is a widow. Admittedly the insurance company paid the basic sum assured along with accrued bonus. The complainant naturally having received the amounts issued discharge vouchers. No doubt there was a mention that it was towards full and final settlement and discharge of all claims. They did not mention that the complainant was not entitled to accident benefit, in view of the fact that the death was a suicide. When the insurance company intended to deny a particular benefit, it ought to have stated that she had waived the claim towards the accident benefit. By taking the signatures under the discharge vouchers wherein the terms are printed, the complainant should not be denied payment on the premise that she admitted that it was towards full and final settlement. Such a contention could have been accepted had it been a death by murder or suicide. It could be assumed that the complainant having satisfied that she was entitled only to basic sum assured + bonus she had taken the amount. However, the entire record shows that death was accidental. The insurance company ought not to have taken an unholy defence by taking her signatures on the discharge vouchers and contend that she was not entitled to the benefits. At the cost of repetition, we may state that the deceased died in the accident as such the complainant being the nominee entitled to all the benefits that accrued under the policies.
11) A perusal of the insurance policies issued by the insurance company shows that the complainant was entitled to additional sum equal to sum assured under the policies if the life assured died in accident. The relevant clause is excerpted for benefit:
Death of life assured:
To pay an additional sum equal to the Sum Assured under the policy if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of its occurrence solely, directly and independently of all other clauses result in the death of the Life Assured. However, such additional sum payable in respect of this policy, together with any such additional sums payable under other Policies on the Life Assured involved in accident shall not exceed Rs.25,00,000/-.
(emphasis supplied) From the above, it is clear that the complainant was entitled to accident benefit viz., Rs. 1,55,000/-. The Dist. Forum had granted Rs. 2,27,531/- original sum that was granted to the complainant on the death of the deceased which includes bonus and benefits under the policy. By virtue of above clause she was only entitled to sum assured towards accident benefit. Therefore, we are of the opinion that the complainant is entitled to the said amount. The order of the Dist. Forum in this regard had to be modified.
12) In the result the appeal is allowed in part modifying the order of the Dist. Forum instead of paying Rs. 2,27,531/- it is directed to pay Rs. 1,55,000/.
The insurance company is directed to pay Rs. 1,55,000/- with interest @ 9% p.a., from 28.3.2006 till the date of payment. The order awarding compensation and costs is confirmed.
The respondent/complainant is also entitled to costs of Rs. 1,000/- in the appal. Time for compliance four weeks.
1) _______________________________ PRESIDENT
2) ________________________________ MEMBER
3) __________________________________ MEMBER Dt. 18.
01. 2010.
*pnr UPLOAD O.K.