HARINDER ANAND v. LIFE INSURANCE CORPORATION OF INDIA
2010-02-16
C.C.PANT, IRSHAD HUSSAIN, KUSUM LATA SHARMA
body2010
DigiLaw.ai
ORDER (Per : C.C. Pant, Member): This is complainant’s appeal against the order dated 15.01.2004 passed by the District Forum, Dehradun in consumer complaint No. 233 of 1997. Vide the impugned order, the District Forum has dismissed the consumer complaint. 2. The facts of the case in brief are that one Lt. Col. P.P.S. Anand had taken a life insurance policy for sum of Rs. 25,000/- on his own life from the Life Insurance Corporation of India, Branch Office Chandigarh (for short “LIC”). The policy also carried person accidental benefit. The insured fell down from the roof of his house in Dehradun on 30.01.1994 and died on the same day in the hospital. The wife of the insured Smt. Harinder Anand, the complainant submitted claim with the insurance company. The opposite party – LIC settled the claim and paid a sum of Rs. 44,550- on 07.05.1996, but the opposite party did not pay the accidental benefit. The complainant pursued the matter with the opposite party, but the opposite party did not agree to pay the amount of accidental benefit. The reasons narrated by the opposite party were that the complainant had not initially submitted the claim for accidental benefit, no FIR, police inquest report, postmortem report was submitted in proof thereof. Upon this, the complainant filed a consumer complaint before the District Forum, Dehradun, which was dismissed by the District Forum vide impugned order dated 15.01.2004. Aggrieved by the said order, the complainant has filed this appeal. 3. We have heard the learned counsel for the parties and perused the material placed on record in the light of the legal aspects of the case. 4. The District Forum has dismissed the consumer complaint mainly on the ground of territorial jurisdiction. We can not support the said view taken by the District Forum. What is the date on which the cause of action has arisen? Is it the date of death of the insured or the date of repudiation of the claim? The Hon’ble Apex Court in the case of Kandimalla Raghavaiah & Co. Vs. National Insurance Co. Ltd. and another; III (2009) CPJ 75 (SC), has held that the cause of action in the case had arisen on the day, when the fire had broken out.
The Hon’ble Apex Court in the case of Kandimalla Raghavaiah & Co. Vs. National Insurance Co. Ltd. and another; III (2009) CPJ 75 (SC), has held that the cause of action in the case had arisen on the day, when the fire had broken out. With the same analogy, we can say in this case that the cause of action had arisen on the day, when the insured had died. Section 11(2)(c) of the Consumer Protection Act, 1986 states that a complaint shall be instituted in a District Forum within the local limits of whose jurisdiction the cause of action, wholly or in part, arise. Since the insured had died in Dehradun, the complainant had rightly instituted the consumer complaint before the District Forum, Dehradun. Thus, the finding of the District Forum that it had no territorial jurisdiction to entertain and decide the consumer complaint, is liable to be set aside. 5. Now we come to the merits of the case. The District Forum’s view is that in the case of accidental death, an FIR, police inquest report and postmortem report are necessary, which is the plea taken by the LIC. The District Forum has even extended its imagination that without an FIR and postmortem report, it could not be ascertained whether the death was natural, accidental or suicidal. So far as the possibility of suicidal death is concerned, it is certainly now out of place because LIC has already settled the death claim, although it has treated the case as a case of natural death and has not given accidental benefit. The reasons given by the LIC are that the initial claim was not submitted for accidental death. Further, in case of accidental death, submission of the copies of FIR, police inquest report and postmortem report were also must. The LIC has also taken the plea that the claim for accidental benefit was filed very late after receiving the amount of Rs. 44,550/- on 07.05.1996. 6. The complainant’s stand is that she had informed the LIC on 26.02.1994 regarding the death of her husband due to an accident and had requested to register the claim. This contention of the complainant is supported by Paper No. 16kha/16 of the original record.
44,550/- on 07.05.1996. 6. The complainant’s stand is that she had informed the LIC on 26.02.1994 regarding the death of her husband due to an accident and had requested to register the claim. This contention of the complainant is supported by Paper No. 16kha/16 of the original record. Then there is another letter dated 27.07.1994 sent by the complainant to LIC, in which she has referred to her earlier letters dated 26.02.1994, 22.03.1994, 21.04.1994 and 20.05.1994 and requested to settle the claim at the earliest. The LIC has responded to this letter vide its letter dated 29.07.1994 (Paper No. 16kha/8). The LIC has said in its letter that it had not received complainant’s letter dated 26.02.1994, but has not said anything in respect of letters dated 22.03.1994, 21.04.1994 and 20.05.1994. The LIC has, vide this letter, asked the complainant to complete certain formalities mentioned at SI. Nos. 1, 2, 4, 5 and 10 of the said letter. These points include submission of certified copies of Police Inquest Report, Report of Court of Enquiry and Postmortem Report. The complainant completed all the formalities except the submission of the certified copies of the FIR, Police Inquest Report and Postmortem Report, but the Paper No. 27kha/3 creates some confusion, which is a letter dated 02.05.1996 of the complainant addressed to Senior Branch Manager, LIC of India, Branch Office-II, Chandigarh. The letter states that she came to know about the policy recently. She has requested to settle the death claim at the earliest. Of course, as pleaded by the LIC, there is no mention of an accidental death and also no claim for that. The LIC has taken most prompt action on this application, which we have not seen in other cases. We are also surprised to note if the said letter dated 02.05.1996 was the first letter of the complainant, whether the claim was made within the limitation period as the death of the insured had taken place on 30.01.1994. On 03.05.1996, the complainant’s statement was taken on Form No. 3783 (Paper Nos. 27kha/7 to 27kha/8). On 07.05.1996, the claim was settled and the cheque for sum of Rs. 44,550/- was handed over to the complainant. It appears that the complainant had valued the policy for Rs. 50,000/- for it being including the accidental benefit and, therefore, she requested the LIC to pay the balance amount of Rs.
27kha/7 to 27kha/8). On 07.05.1996, the claim was settled and the cheque for sum of Rs. 44,550/- was handed over to the complainant. It appears that the complainant had valued the policy for Rs. 50,000/- for it being including the accidental benefit and, therefore, she requested the LIC to pay the balance amount of Rs. 5,450/- vide her letter dated 06.08.1996 (Paper No. 27kha/4). Then, in between documents/correspondence is silent regarding the death claim. But we find a letter dated 17.02.1997 of the Senior Branch Manager, LIC addressed to the complainant (Paper No. 16kha/2), stating that: “The death claim under the above policy for Basic Sum Assured was settled by our Branch Office on 7.5.96. You have represented for payment of Accident Benefit Claim under the policy. Please reply to the following queries to enable us to consider further in the matter: 1. The Life Assured died on 30.1.94 and death claim was lodged on 2.5.96. Please explain as to why there was delay of more than two years? 2. Why was the Police not informed of this accident? 3. In every unnatural death, Postmortem is conducted. If it is not conducted, it has to be waived by the competent authority. In the instant case neither the Postmortem was conducted not was waived. Please explain, why? 7. Interestingly, the first query had no relevance at this stage, because in pursuance of complainant’s claim letter dated 02.05.1996, the LIC had already settled the claim. It had to ask this question before settling the claim. Further, in the said letter, the Senior Branch Manager has not clearly stated as to when the complainant had requested for the death claim. However, the complainant replied this letter on 17.03.1997, i.e., exactly after one month (Paper No. 16kha/1). In her letter, she has said that: “(1) Accidental death claim was lodged on 26.2.94 and not on 2.5.96. (2) Police was not informed as the accident took place in the house and there was no foul play and no third party involved. (3) A Panchnama was submitted earlier. (4) No postmortem was held as it was not a roadside accident.” 8. After considering all these documents and evidences, we have come to the conclusion that the case involves some contradictory facts, particularly complainant’s letter dated 26.02.1994 and 02.05.1996.
(3) A Panchnama was submitted earlier. (4) No postmortem was held as it was not a roadside accident.” 8. After considering all these documents and evidences, we have come to the conclusion that the case involves some contradictory facts, particularly complainant’s letter dated 26.02.1994 and 02.05.1996. Though, the requirement of FIR, Police Inquest Report and Postmortem Report may not be necessary in certain cases depending on the circumstances of the case, but in the instant case, we feel that these formalities were necessary. The immediate cause of death of the insured was cardio respiratory arrest. So the deceased may have fallen from the roof after a cardiac arrest. A possibility can not be ruled out that someone had been quarrelling with him and may have pushed him down. So, in the instant case, a police inquest and postmortem was necessary. The deceased was a retired army person and was leading an active life because he was doing the job of a surveyor. An army person, who is trained to live in most adverse and precarious conditions, would not suddenly fall from the roof without any reason. Therefore, under these circumstances, if the LIC did not pay the claim for accidental benefit in absence of FIR/Postmortem Report, it will not amount to deficiency in service. 9. As a result, the appeal is dismissed. No order as to costs.