BRANCH MANAGER LIFE INSURANCE CORPORATION OF INDIA vs Raj Kumar Mishra

THIS is an appeal against the judgment and order dated 17.11.1997 passed by the learned District Forum, Shahjahanpur in Complaint Case No. 38 of 1995. The complainant had filed the complaint for recovery of Rs. 50,000/- as amount of the policy and Rs. 10,000/- as damages on account of economic loss and mental tension etc.

THE facts of the case stated in brief are that Smt. Shanti Devi, the deceased, took a policy of accident and disability (Policy No. 220676507) for a sum of Rs. 25,000/-. THE premium was paid in accordance with the rules. She died on 19.11.1992 on account of accident. THE complainant, Raj Kumar Mishra, is the only heir of Smt. Shanti Devi. He submitted a claim after completing all the formalities to the Life Insurance Corporation on 14.12.1992. Several times requests were made to the appellant for payment of the amount of the death claim and he was informed that the claim is pending with the Competent Authority. He received two letters dated 3.3.1993 and 19.3.1993 from the Insurance Company. He was intimated that vide Clause 4(b) he will only be paid the amount of the insurance premium deposited and not the amount of the policy. Hence complaint had to be filed. In the written statement it was alleged that the death of the deceased took place on account of ''Saree'' being caught in the wheel of motor cycle and sustained head injuries. She died on 19.11.1992. As this death is not natural, the complainant was asked to submit the First Information Report and the post-mortem examination report, but they were not supplied to the Insurance Company. On account of lack of these documents, it cannot be proved that the death was on account of some accident. Clause 4(b) of the policy was applicable in the present case. Hence the claim was repudiated by the appellant on 3.3.1993 as the death took place only after a period of 9 months and 18 days.

The parties filed evidence before the learned District Forum and after hearing the learned Counsel for the parties, learned Forum came to the conclusion that the complainant is entitled to claim a sum of Rs. 50,000/- as insurance amount and interest at the rate of 12% per annum till the date of payment.

AGGRIEVED against this order the appellant has come in appeal and has challenged the correctness of the order passed by the District Forum. The learned Counsel for the parties have been heard. Learned Counsel for the appellant has argued that there is no evidence on record to prove that the death of Smt. Shanti Devi, the deceased, took place on account of some accident. "1. an event that is without apparent cause or is unexpected (their early arrival was just an accident), 2. an unfortunate event, esp. one causing physical harm or damage, brought about unintentionally..." The word ''accidental'' has also been defined as under : "happening by chance, unintentionally or unexpectedly."

THUS from the perusal of the dictionary meaning of ''accident'' and ''accidental'' it will be clear that any event which happens without any cause or is not expected to be caused in normal circumstances is covered under it. It is also an unfortunate event causing physical harm or damage caused by some unintentional act. Thus the event which happened in the present case was merely an accident. It is not a routine or a normal course that the Saree will be caught between the spokes of a moving vehicle and will cause fall of a person sitting on the motor cycle or any other two wheeler. It does not occur in the normal course of life. Thus the event which occurred in the present case is merely by chance and is covered by the word ''accident''. A word is to be given its normal meaning by which it is understood by a common man. Even a common man will say that if such an event happens, it is by chance accident and not a natural phenomenon occurring so often. Thus the repudiation of the claim of the claimant on this ground is totally baseless and devoid of any reasoning which has been adopted by the Insurance Company merely to cause harassment to the complainant. Non-furnishing of First Information Report and post-mortem examination report will not mean that no accident has taken place. In such cases when there was no collusion between the two vehicles or an incident of this nature, it was not necessary for the complainant or anybody else to have lodged a report. No post-mortem examination was also necessary in the present case. No offence was committed under the provisions of Indian Penal Code or any other enactment. Therefore, there was no necessity of lodging any F.I.R. and getting post-mortem examination done. It has further been argued that if an accident takes place it has immediately to be reported to the Insurance Company so that it may enquire into whether the accident has taken place in the public place. According to learned Counsel for appellant, in the present case immediate information was not sent by the complainant or any other person about the death of the deceased. In the present case as the facts revealed the accident took place on 26.10.1992 and on account of the injuries sustained in this accident the death took place on 19.11.1992. Thus the death took place about one month seven days after the accident. The complainant or anybody else in the family of the deceased could not have foreseen that the death will take place in the present case on account of the accident which took place on 26.11.1992. Thus the Insurance Company was informed only after the death took place. The claim is payable only after the death takes place on account of some accident in the public place. It is an admitted fact in the written statement that the deceased was going on a motor cycle when this accident took place. Therefore it can be safely presumed that he was going in some public place and not in a private place. Moreover, it was the duty of the Insurance Company to have elicited these facts from the complainant if it was not mentioned in the claim form. It is normal practice for the Insurance Company that it issues queries to the claimant to elicit information on certain facts which are required for proof of a claim, but in the present case the facts on record do not reveal that the Insurance Company even asked the complainant as to the place where the accident took place and whether any First Information Report was lodged and post-mortem examination was got done and report obtained. No adverse presumption can be drawn against the complainant on the basis of absence of these facts from the complainant as the Insurance Company has also failed in its duty to elicit these information. It is a well known fact that in India most of the public is not aware of these fine technicalities which are to be supplied at the time of submitting claim form. The duty is of the Insurance Company to call for all these information particularly in view of the prevailing illiteracy and social conditions of this country. This responsibility has not been discharged by the Insurance Company in the present case and it cannot take advantage out of its own mistakes in order to deny the benefits of the policy to the claimant. Thus we find that the appeal has no force and is liable to be dismissed. Order The appeal is dismissed with cost of Rs. 1,000/-. The judgment and order of the learned District Forum are confirmed. Let the order of the learned District Forum be complied with within two months. The interest which has been awarded by the Forum shall be paid upto the date of payment three months next from the submission of the claim. Let copy of the order be made available as per rules to the parties. Appeal dismissed.