ADDITIONAL BENCH

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

PUNJAB, CHANDIGARH.

Consumer Complaint No.628 of 2019 Date of Institution : 21.08.2019 Date of Reserve : 07.12.2021 Date of Decision : 22.12.2021

1. Sunita Rani aged about 41 years, wife of Late Suresh Kumar son of Ved Parkash Gagneja, resident of street No.1, 6^th Chowk, New Suraj Nagri, Abohar, District Fazilka, Punjab.

2. Mahesh Inder Gagneja aged about 9 years, minor son of Suresh Kumar son of Sh. Ved Parkash Gagneja, through his mother and natural guardian namely Sunita Rani wife of Suresh Kumar son of Ved Parkash Gagneja resident of Street No.1, 6^th Chowk, New Suraj Nagri, Abohar, District Fazilka, Punjab.

3. Lawrance Gagneja aged about 4 years, minor son of Suresh Kumar son of Sh. Ved Parkash Gagneja, through his mother and natural guardian namely Sunita Rani wife of Suresh Kumar son of Ved Parkash Gagneja resident of Street No.1, 6^th Chowk, New Suraj Nagri, Abohar, District Fazilka, Punjab .….Complainants Versus

1. Life Insurance Corporation of India, Divisional Office 4-5, District Shopping Complex, Ranjit Avenue, Amritsar through its Divisional Manager. Email ID:

customerzone_amritsar@licindia.com.

2. Life Insurance Corporation, Branch Office, NHh-15, Krishna Nagri, Abohar, Punjab through its Branch Manager. Email ID:bo_149@licindia.com.

..…Opposite Parties

1

Consumer Complaint under Section 17 of the Consumer Protection Act, 1986. Quorum:-

Mr. Rajinder Kumar Goyal, Presiding Member Mrs. Kiran Sibal, Member Present:-

For the complainants : Sh. Rahul Arora, Advocate For the opposite parties : Sh. Piyush Sharma, Advocate KIRAN SIBAL, MEMBER:- The complainants have filed this complaint under Section 17 of the Consumer Protection Act, 1986 (in short "the Act"), against the opposite parties (in short "OPs") seeking following directions to them to pay:-

i) Sum of Rs.20,000,00/-(Rs. Twenty Lakhs) along with interest @ 12% p.a. from the date of death till its realization.

ii) Sum of Rs.10,000,00/-(Rs. Ten Lakhs) as compensation on account of causing financial loss, harassment, mental pain and agony.

iii) Sum of Rs.25,000/- (Rs. Twenty Five Thousands) towards litigation expenses;

iv) Any other relief to which the complainants are found entitled may also be granted.

2. Brief facts, as set out in the complaint, are that Suresh Kumar, since deceased (DLA), husband of complainant no.1 and father of complainants no.2 and 3, bought a Life Insurance Policy No.474032216( LIC's Jeevan Lakshya, with profits) from OP No.2 in the month of March 2016 with a yearly premium of Rs.44,873/- and the said policy commenced on 01.04.2016. Suresh Kumar (DLA) was insured for the sum assured of Rs.10,000,00/- under the said policy. The said policy was also covering Accident Benefit

2

Rider, meaning thereby if the life assured died in an accident during the subsistence of the policy then an additional sum equal to the accidental benefit sum assured shall be payable according to terms, which comes to Rs.20,000,00/-. Unfortunately, Suresh Kumar died on 06.03.2017 due to drowning in Usman Khera Canal in the area of Tehsil Abohar, District Fazilka, Punjab on account of accidental slip. After the death of DLA, the complainants submitted the claim along with requisite documents to the OPs through agent namely Sh. Alok Grover. The exact date of submission of claim to OPs not known to the complainants as the same were handed over to LIC Agent for further submission. However, immediate intimation was given to the agent. When no response came from the OPs, the complainants served a legal notice upon the OPs and it is only thereafter, the OPs vide letter dated 30.03.2019 have repudiated the insurance claim on the ground that DLA had committed suicide within the restrictive period of one year from the date of acceptance of risk. The said letter has been issued without any substance and on the basis of assumptions with the ill motive to repudiate the genuine claim. No investigation whatsoever has been conducted by the OPs in reaching to the conclusion. The post-mortem report dated 06.03.2017 nowhere suggests that it is the case of suicide. The act and conduct of the OPs amounts to deficiency in service and unfair trade practice on their part. Hence, this complaint.

3

3. Upon notice, OPs appeared and filed written reply raising preliminary objections that the complaint is not maintainable as this commission has no pecuniary jurisdiction to entertain the present complaint. The complaint is bad for non- joinder of necessary parties. The complainant have not approached this Commission with clean hands, rather suppressed the material facts. On merits, the OPs stated that after understanding the terms and conditions of the policy in question, the DLA submitted his duly filled and signed proposal form to purchase the policy in question, wherein the DLA made a declaration that the information contained in the proposal is correct and true and if any information is found to be false or incorrect the contract between the insured and insurer shall be void. After the death of DLA the claim was lodged, which was looked into promptly and it was found that the DLA had committed suicide within 12 months of purchasing the policy, which makes the complainants disentitled for the benefits under the policy in question in view of Part-F Clause-4 of the terms and conditions. The DLA left his house on 04.03.2017 and his dead body had been recovered on 06.03.2017. The complainants have also not fulfilled the requirements mentioned in clause-6 of Part-F of the terms and conditions, which requires the claimants to submit chemical analysis report, Sub-Divisional Magistrate's Final verdict about death etc. The postmortem report clearly reflects that it has been opined that "The cause of death will be given after the report

4

of chemical examination" but the complainant have deliberately concealed and suppressed the said chemical examiner report. It has been admitted by the complainant No.1 before the police that the DLA was a drug addict, which had also made him mentally unfit. Thus, the claim of the complainants have been rightly repudiated vide letter dated 30.03.2019. There is no deficiency in service or unfair trade practice on the part of the OPs. After denying the other averments made in the complaint, the OPs prayed for dismissal of the present complaint.

4. To prove their claim, the complainants, along with the complaint filed affidavit of Complainant No.1 Ex. CW-1/A along with copies of documents Ex. C-1 to C-10. On the other hand, OPs filed on record affidavit of Jai Bhagwan Bansal, Manager Legal along with copies of documents i.e. Annexure OP-1/1 to OP-1/3.

5. We have heard learned counsel for the parties and have carefully gone through the record of the case and written arguments filed by both the parties.

6. Learned counsel for the complainants vehemently contended that unfortunately DLA Suresh Kumar died on 06.03.2017 due to drowning in Usman Khera Canal on account of accidental slip during the subsistence of the policy. The complainants lodged the claim with OPs, but OPs wrongly and arbitrarily repudiated the genuine claim, vide repudiation letter dated 30.03.2019, on the ground that life assured had committed suicide within the restrictive period of one year from the date of

5

acceptance of risk i.e. 13.04.2016. The OPs withholding the claim for considerable period of about 3 years without any communication from their side, which itself amounts to deficiency in service and unfair trade practice. The learned counsel for the complainant contended that the claim of the complainants cannot be repudiated by the insurance company on the ground that insured has committed suicide without proving the same on file. The OPs failed to get any material to prove/show as to the insured had committed suicide. In support of his contention, the Ld. Counsel relied upon the following judgments:-

1) Branch Manager, HDFC Standard Life Insurance Co. Ltd. Vs. Pradosh Mandal, (NCDRC) New Delhi,

2017(3) C.P.R.170: 2017(3) CLT457.

2) SBI Life Insurance Co. Ltd. V. Sudesh Khanduja,

(NCDRC): 2016(2) C.P.R.395

3) IDBI Federal Life Insurance Co. Ltd. V. Anuva Ghosal (NCDRC) 2015(14)R.C.R.(Civil)37.

Learned counsel for the complainants prayed for acceptance of the complaint.

7. Learned counsel for the OPs argued to the contrary that the DLA has committed suicide within 12 months of purchasing the policy, which makes the complainants disentitled for the benefits under the policy, in view of Clause-4 of Part-F of the terms and conditions. The complainants have also not fulfilled the requirements regarding submission of Chemical Analysis report and Sub-Divisional Magistrate's final verdict about death etc. The perusal of the postmortem report clearly reflects that it has been opined that " the cause of death will be given after the report of chemical examination" but the complainants have

6

deliberately concealed and suppressed the above said chemical examiner report from the OPs and this Commission as well. The chemical examiner's report is also important to ascertain if the DLA consumed any intoxicant at the time of committing suicide or not. The claim of the complainants has been rightly repudiated vide letter dated 30.03.2019. The Ld. Counsel for the OPs prayed for dismissal of the complaint.

8. We have given thoughtful consideration to the contentions raised by the parties.

9. It is not in dispute that DLA Suresh Kumar was insured under the insurance policy issued by the opposite parties, for which the premium amount was paid by the insured. The case of the complainants is that DLA died on 06.03.2017 due to drowning in Usman Khera Canal on account of accidental slip. On the other hand, the claim of the complainants has been repudiated by the OPs only on the ground that it was a case of suicide, not of natural death. Disputed question is with regard to the fact, whether death is on account of accidental injury or whether the insured has committed suicide? To determine this controversy we have examined the pleadings and evidence on record. From the perusal of postmortem report Ex. C-1, it shows that there are injuries on the body of the DLA, the relevant portion of the report is reproduced as under:- Sr.No. Injuries

1) Fracture right parietal bone 6x1cm, lacerated wound right parietal region 4x1cm

7

2) Bruise 5x6cm on both hands dorsal aspect, nose and face, Eyes and mouth closed.

3) Abrasion 2x2cm on left knee

4) Multiple abrasion on both feet.

5) Ulcer 2x2cm on dorsal aspect of left foot. It is further revealed from the postmortem report that the probable time between injury and death cannot be ascertained. Therefore, it cannot be presumed that the DLA had committed suicide, as there were injuries on the body of DLA. The Insurance company has repudiated the claim of the complainants, vide repudiation letter dated 30.03.2019, Ex.C-7, stating that, "Sh. Suresh Kumar, had committed suicide within the restrictive period of one year from the date of

acceptance of risk i.e.13.04.2016 and Suicide clause was

operative under this policy. Therefore, the policy has

become null and void in terms of the policy contract.

The committee further recommends for refund of 80% of

premiums deposited excluding any taxes, riders and

extra premium under policy No.474032216.

We have therefore carefully considered all the facts

available on file and it is only after proper application of

mind that the decision to reject all liability under the

policy has been taken".

No investigation report whatsoever either done by OPs privately or done by any authority has been placed on record by the OPs. Simply by saying that the DLA had committed suicide by jumping into the river is not sufficient to rebut the claim of the claimants. Nothing has come in the police report to show that the DLA committed suicide. Rather, the postmortem report Ex. C-1 shows that the DLA had suffered sufficient injuries on the body, which corroborates the version of the complainants that an accident took place. Reliance is placed on the Judgment relied upon by the Ld.

8

Counsel for the complainant in the case of IDBI Federal Life Insurance Co. Ltd Vs. Anuva Ghosal (NCDRC)

2015(14)R.C.R.(Civil)37 wherein it has been held by the Hon'ble National Commission as under:- "Consumer Protection Act, 1986 Sections 15,17,19 & 21- complaint against repudiation of death claim

on the ground of commission of suicide-

Complaint allowed by the District Fora - Appeal

against order of Forum affirmed- Revision Petition-

Neither post-mortem report nor final report

submitted by police to Magistrate under Section

174 of Cr.P.C.,1973 on which reliance has been

placed by Insurance Company to conclude that

Insured had committed suicide- No other evidence,

primary or secondary, produced on record by the

insurance company to discharge the onus to prove

that the DLA had committed suicide, so as to bring

the claim under the "Suicide Exclusion Clause"

Repudiation of claim not justified- Revision

Petition Dismissed".

In the present case, the issue of alleged suicide is one of the fact and burden to prove this fact is on the Insurer. The OPs failed to prove on record by leading any cogent evidence that the DLA had committed suicide. Hence, we are of the opinion that the OPs have wrongly repudiated the claim of the complainants on the ground that the DLA had committed suicide.

10. Another plea of the OPs is that the DLA was a drug addict and was mentally disturbed. In support of this contention the OPs had merely relied on statements made by one Sonu and wife of DLA before the police authority but nothing has been brought forward as evidence to establish that the DLA died on account of

9

overdose of any drug or any other intoxicant. Therefore we do not agree with this contention of the OPs and reject the same.

11. One of the objections taken by the OPs is that the complainants have not fulfilled the requirements regarding submission of Chemical Analysis report and Sub-Divisional Magistrate's final report about death to the insurance company. It has been further pleaded by the OPs that in the postmortem report, it has been opined that the cause of death will be given after the report of Chemical Examination but the complainants have deliberately concealed and suppressed the above said Chemical Examiner report, from which it would be ascertained whether the DLA had committed any intoxicant at the time committing suicide or not. In this regard, we are of the view that the said defence of the OPs is an after thought as no such plea is taken in the repudiation letter dated 30.03.2019, Ex. C-7. In the case of accidental or unnatural death, it is very convenient for the insurance company to take bald plea that the DLA was drug addict without any evidence. Even the basis for repudiation the claim is not on account of drug abuse. Therefore, we reject this contention of the OPs.

12. Now we proceed to decide the question regarding quantum of insured amount, which is due to be released to the complainants. The plea of the complainants is that the claim filed by them fall under Accident Benefit Rider in the policy, vide clause No.3(b), whereby double of the sum assured is to be disbursed. To

10

determine the said point, Clause 3(b) of the policy terms and conditions. Ex.C-4, is relevant, which is reproduced as under: "3.Rider Benefit

(b) Death of the Life Assured:-

In addition to Death Benefit under the Basic Plan, an additional sum equal to the Accidental Benefit Sum Assured shall be payable under this policy. However, the policy shall have to be in force at the time of accident irrespective of whether or not it is in force at the time of death.

The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or death of the Life Assured shall:

(i) be caused by intentional self injury, attempted suicide, instantly or immorality or whilst the Life Assured is under the influence or consumption of intoxicating liquor, narcotic or drug(unless prescribed by doctor as a part of treatment); or

(ii) be caused by injuries resulting from taking any part in riots, civil commotion, rebellion, war (whether war be declared or not), invasion, hunting, mountaineering, steeple chasing, racing or any kind, paragliding or parachuting, taking part in adventurous sports; or

(iii) result from the Life Assured committing any criminal act with criminal intent; or

(iv) (a) arise from employment of the Life Assured in the armed forces or military service. This exclusion is not applicable if the Life Assured was involved in an accident when he is not on duty or was involved in any rescue operations while combating natural calamities in our country; or

(b) arise from being engaged in police duty( which excludes administrative assignments) in any police organization other than paramilitary forces. This exclusion is not applicable where the option to cover Accidental Death and Disability Benefit arising on accident while engaged in police duty, has been chosen; or

(v) occur after 180 days from the date of accident of the Life Assured.

From the perusal of policy Ex. C-3, it shows that the basic sum assured was Rs.10,00,000/- and DLA also opted for Additional rider to the sum assured of Rs.10,00,000/-, therefore the DLA was

11

covered under Accident Benefit Rider. As per above said clause 3(b) of policy terms and conditions, Ex.C-4,, the Claimants are entitled for additional sum assured only in case of accidental death of the DLA. As the OPs failed to prove on record that the DLA had committed suicide, as discussed above, therefore it cannot be ruled out that the death of the DLA is accidental. Accordingly, we find force in the averments made in the complaint. Moreover, the reason of repudiation of claim as put up by the opposite parties has not been proved on the basis of any cogent and convincing evidence. When the OPs are alleging that this is a case of suicide, they should have been vigilant and should have produced the solid and unflappable evidence. It is a clear-cut case of 'deficiency in service' on the part of the opposite parties.

13. A sequel of our above discussion, we are of the view that the claim of the complainants has been wrongly and illegally repudiated. The claim of the complainants has also been supported by the terms and conditions of the policy. Accordingly, the claimants/complainants are held entitled to the benefits under the insurance policy.

14. It is pertinent to mention here that the complainants have sought claim of Rs.10,00,000/- on account of sum assured + accidental rider benefit of 10,00,000/-, totaling Rs.20,00,000/-. Since, Additional Rider Benefit has been taken by the DLA and the OPs have not denied the same in their reply, therefore, the

12

claimants are entitled to accidental death rider benefits, along with sum assured on account of death of the DLA.

15 Accordingly, we allow the complaint filed by the complainants and the opposite parties are directed to release the claim amount of Rs.10,00,000/-(Ten Lakh) being sum assured on account of death and also accidental death rider benefits of Rs.10,00,000/-(Ten Lakh), as per terms and conditions of the insurance policy, to the complainants within a period of 60 days from the receipt of certified copy of the order. The opposite parties are further directed to pay Rs.20,000/- towards litigation expenses to the complainants. In case, the payment of claim is not made within the aforesaid period, the claimants/complainants shall be entitled to interest at the rate of 9% per annum with effect from expiry of aforesaid period of 60 days till realization. It is also directed that an amount of Rs.5 lacs each out of total amount of compensation be deposited in Fixed Deposit in the names of both the minor children (complainants No.2 & 3) till attaining the age of majority in any nationalized Bank attracting maximum interest through mother being natural guardian.

16. The complaint could not be decided within the statutory period due to heavy pendency of work and less staff.

(RAJINDER KUMAR GOYAL) PRESIDING MEMBER

(MRS. KIRAN SIBAL)

MEMBER

December 22^nd, 2021. (Dv)

13

14