Before the District Consumer Disputes Redressal Forum, Mandi, camp at Sundernagar,HP.
Complaint Case No.253/2009
Date of Institution 1-9-2009
Date of Decision 29-12-2009
Chaman Lal son of Sh.Gian Chand Brari, ( minor ) through mother Smt. Phoola Devi widow of Sh.Gian Chand Brari resident of village and Post Office Leda , Tehsil Sadar, District Mandi, H.P. at present c/0 Sh.Roop Lal son of Sh. Hari Ram village Nal post Office Churd, Tehsil Sundernagar, District Mandi, H.P.
…Complainant
V/S
1. Life Insurance corporation of India through its Branch Manager, Branch Office Bhojpur, Sundernagar, District Mandi, H.P.175002
2. Divisional Manager, Life Insurance Corporation of India Division Shimla, SDA complex 14 and 15 Shimla-9 District Shimla, H.P.
…..Opposite parties
For the complainant Sh. Prem Singh Thakur, Advocate
For the opposite parties Sh. A.C. Chandel, Advocate
Complaint under Section 12 of the
Consumer Protection Act, 1986.
ORDER
This order shall dispose of a complaint under Section 12 of the Consumer Protection Act, 1986( hereinafter referred to as the “Act”) instituted by the complainant against the opposite parties . The complainant stated that his father Sh.Gian Chand expired in a huge cloud burst on 14-8-2007 at place Ganavi, Rampur ,District Shimla while he was employed in a private company at Ganavi. The deceased has been survived by the complainant , Smt. Phoola Devi ( widow ) and Smt. Kala Devi ( mother) .In this tragic incident whole of the village flushed away and more than 50 persons have lost their lives and no remains of the area had left behind . That the deceased had purchased insurance policy No.15178630 dated 20-3-2006 in the sum of Rs.50,000/- which was valid with effect from 19-3-2006 to 20-3-2026 and the complainant is nominee in the policy. The complainant averred that all the premiums for the policy had been paid by the life assured during his life time. The complainant further averred that the Department of Health and Family Welfare of the Govt. of H.P. has confirmed the death of Sh.Gian Chand Brari and death certificate Annexure C-3 had been issued by Registrar Death and Birth of concerned area and death was entered in the Panchayat of the life assured as per Annexure C-4, the incident was reported to the Police Station concerned as per Annexure C-6. The complainant also averred that ex-gratia / compensation vide Annexure C-7 had been given to legal heirs on the death of the deceased keeping in view the massacre caused by the nature . That on the death of the life assured, the complainant being minor had approached the opposite party No.1 through his mother for claiming the insurance amount but neither the claim has been settled nor payment was made despite repeated requests which is deficiency in service on its part. The complainant further alleged that he had submitted all the requisite documents etc with the opposite party No.1 and had also completed all the codal formalities as and when required but of no avail and now the claim had been declined on the ground that the dead body of the deceased has not been traced which is illegal and amounts to deficiency in service on the part of the opposite parties. With these allegations , the complainant had sought a direction to the opposite parties to pay the accidental benefits equivalent to the basic sum assured Rs.50,000/- in lieu of accidental death of his deceased father to him alongwith interest . Apart from this Rs.10,000/- had also been claimed from the opposite parties as amount spent for claiming the benefits of insurance policy and a sum of Rs.35,000/- has also been claimed as compensation for causing undue harassment to the complainant and for deficiency in services .
2. The opposite parties No.1 and 2 have contested the complaint by raising preliminary objections that the complaint is not maintainable ,that the complaint is misconceived as the complainant had failed to comprehend and understand the terms and conditions of the policy which had been duly conveyed to the life assured as per IRDA regulations , that as per the policy, in case of death, the sum assured plus accrued bonus up to maturity is payable on maturity even though the death occurs during the policy terms and the said sum is to be paid in lump sum or in ten half yearly instalments at the option of the beneficiary, that the complainant has no cause of action to file the present complaint because the date of maturity would fall in the year 2026 and also the corporation has already admitted the claim of the complainant under the policy with respect to basic sum assured and that the accident benefit could not be paid in the absence of proof of death caused due to alleged accident , that the complicated facts are involved in the complaint which can be decided by civil court only , that the complaint is misconceived , that the complainant is estopped to file and maintain the present complaint on account of acts of omission , commission and conduct and that the complaint is vague and it lacks material particulars . On merits , the opposite party had admitted the death as per the death certificate but denied that the life assured died due to an accident as alleged by the complainant. It has further been submitted that , that as per the policy, in case of death, the sum assured plus accrued bonus up to maturity is payable on maturity even though the death occurs during the policy terms and the said sum is to be paid in lump sum or in ten half yearly instalments at the option of the beneficiary. The opposite parties had admitted the death of the life assured in view of certificate of death Annexure C-3 but denied that the death is accidental one . It has been denied that the claim has not been settled . It has been averred that the basic sum assured under the claim has been admitted by the competent authority on 22-12-2007 which is payable at the time of maturity as per the terms of the plan 90 and there is no deficiency in service . It has been stated that the double accident benefit is not payable as the dead body was not traced and the death of the life asured by the alleged accident has not been established by the claimant on whom the onus lies . They prayed for dismissal of the complaint.
4. The complainant had filed rejoinder reiterating the averments made in the complaint and controverting the averments made in the reply by the opposite parties.
5 We have heard ld. counsel for the parties and have carefully gone through the entire case file.
6. The ld. counsel for the complainant had vehemently contended that the complainant is entitled to be indemnified by the opposite parties in the sum of Rs.50,000/- as double accident benefit claim apart from the basic sum assured on account of death of his father Sh.Gian Chand but the legitimate claim has not been paid by the opposite parties which tentamounts to deficiency in service on their part.
7. On the other hand, the ld. counsel for the opposite parties had argued that the double accident benefit claim of the life assured is not payable to the complainant as the dead body of life assured was not traced and the death by alleged accident has not been established .
8. Therefore, the matter has to be scrutinized and examined with respect to the aforesaid contentions of the ld. counsel for the parties. Be it stated that the opposite parties have admitted the death of the deceased and also stated that the basic sum assured under the claim is admitted by the Competent Authority on 22-12-2007 which is payable at the time of maturity as per the terms and conditions of the policy with respect to plan No.90. However, the case of the opposite parties is that the complainant is not entitled to double accident benefit as the dead body of the life assured was not traced and his death by the alleged accident has not been established by the complainant. It is significant to mention here that the opposite parties have taken contrary stand in their reply. On one hand in the reply filed by the opposite parties ,the claim for basic sum assured under the policy has been stated to be admitted by the competent authority on 22-12-2007 and in the same breath the death of life assured by alleged accident has been denied. The opposite parties have not explained as to on what basis the death of the life assured has been admitted by them . Now adverting to documentary evidence adduced by the complainant . The complainant has adduced in evidence death certificate Annexure C-3 which reflects that life assured Gian Chand had died on 14-8-2007, Apart from this copy of Pariwar Register has also been adduced as Annexure C-4 which further reflects that Sh.Gian Chand life assured had died on 14-8-2007. Not only this a certificate from Pradhan Gram Panchayat Berkot Annexure C-5, copy of Rapat No. 5 dated 22-8-2007 Police Post Jeori under Police Station Rampur Annexure C-6 has also been adduced in evidence . Copy of letter dated 7-4-2008 Annexure C-7 sent by Tehsildar ,Rampur enclosing therewith cheque of Rs.1,00,000/- as exgratia grant to the legal heirs of the deceased has also been adduced in evidence by the complainant The complainant has also filed the insurance policy Annexure C-1 .We have carefully gone through the terms and conditions of the insurance policy. At this juncture it would be relevant to reproduce the relevant clause 10 2(b) of the insurance policy which reads as under:-
DEATH OF THE LIFE ASSURED
To pay an addition sum equal to the sum assured under the policy if the life assured sustain any bodily injury resulting solely and directly from the accident caused by outwards , violent , and visible means and such injuries shall be within 120 days of the occurrence solely , directly and independently or all other caused result in the death of the life assured .
The opposite parties have repudiated the double accident benefits claim of the complainant vide letter dated 15-10-2008 annexure C-9 on the ground that the dead body of life assured had not been traced . However, in our opinion aforesaid condition No. 10(b) of the policy provides that for getting the double accident benefit claim the complainant has only to prove and establish that the life assured had died in an accidental death. The complainant has annexed daily diary report No.5 dated 22-8-2007 of Police Post Jeori under Police Station Rampur Annexure C-6 wherein it has been categorically mentioned that various persons had flown away in the flood due to the cloud burst and the name of the life assured Gian Chand also find mention in the same . The Tehsildar Rampur had also sent Rs.1,00,000/- through cheque to the Tehsildar Sundernagar for its disbursement to the legal heirs of Sh.Gian Chand as an exgratia grant vide letter dated 7-4-2008 Annexure C-7 Both the aforesaid documents prove and establish that the life assured Sh.Gian Chand had died due to massive flood in river Beas on 14-8-2007 and had flown away. Daily dairy report is a credible piece of evidence as it has been recorded by Investigating Agency of the State in the discharge of official duty. Moreover, the disbursement of ex-gratia payment of Rs.1,00,000/- to the legal heirs of the deceased also establish that the life assured had died in a massive flood on 14-8-2007 . There is no evidence to the contrary that the life assured Gian Chand had died a natural death and not an accidental death. In our opinion , the cloud burst on 14-8-2007 was an accident and in view of the evidence led by the complainant ,it can safely be held that the life assured had died in the flood and his body had washed away and could not be traced and the same can be termed as an accidental death within the meaning of clause 10.2 (b) of the insurance policy Therefore , the repudiation of the claim of the complainant by the opposite party on the ground that the dead body of the life assured was not traced amounts to deficiency in service . In Life Insurance Corporation of India vs Smt. Asha Goel and another AIR 2001, Supreme Court 549 it has been held by the Hon’ble Apex Court in para No.16 as under :-
“In course of time the Corporation has grown in size and at present it is one of the largest public sector financial undertaking. The public in general and crores of policy holders in particulars look forward to prompt and efficient service from the Corporation. Therefore the authorities in charge of management of the affairs of the corporation should bear in mind that its credibility and repudiation depend on its prompt and efficient service .Therefore the approach of the corporation in the matter of repudiation of a policy admittedly issued by it should be one of extreme care and caution. It should not be dealt with in a mechanical and routine manner.”
9 Therefore having regard to the facts and circumstances of the case, we are of the considered opinion that the opposite parties have miserably failed to prove and establish that the life assured Sh. Gian Chand had not died an accidental death. The doors of justice cannot be shut down on the basis of mere assertion . As a matter of fact , on such a frail plea , just and legitimate claim to which the complainant otherwise is entitled cannot be declined. The Act has been enacted for the welfare of the consumers . The very purpose of the Act will frustrate if the legitimate claim of the complainant is rejected on such flimsy ground .In nut shell , we have no hesitation to conclude that the opposite party had repudiated the claim of the complainant illegally and arbitrarily.
10. In the light of above discussion, the complaint is allowed and the opposite parties No.1 and 2 are directed to pay to the complainant Rs.50,000/- i..e. the double accident benefit claim arising out of the insurance policy of his deceased father alongwith interest at the rate of 9% p.a. from the date of institution of the complaint till realization of the amount and all the other maturity benefits of the policy as per the plan and also to pay Rs.5000/- as compensation for harassment besides costs of litigation at Rs.2000/-. Since the complainant is minor , the awarded amount be deposited initially for a period of five years in the name of complainant Chaman Lal in some Nationalized Bank and be further invested till he attains the age of majority.
11 Copy of this order be supplied top the parties free of cost as per Rules.
12. File, after due completion be consigned to the Record Room.
Announced
29-12-2009 (Sushil Kukreja ) President
*DKM* ( Lal singh) ( Alkananda)Members