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Judgment
The present revision petition under Section 21 (b) of the Consumer Protection Act is filed against the impugned order dated 05.01.2016 passed by the State Consumer Disputes Redressal Commission, U.P., Lucknow (for short the State Commission) in First Appeal No.1255 of 2012.
The brief facts relevant in this revision petition are that, Smt. Nisha Singh (since deceased), the wife of Dr. A. B. Singh, the complainant, on 28-08-2002, took two insurance policies from the LIC of India-the OP. The insured passed away on 01.05.2003, i.e. within seven months and ten days of taking the said policies. The complainant, Dr. A. B. Singh filed a death claim before the OP, which was rejected by the OP. Therefore, the complainant filed a complaint before Mainpuri District Consumer Disputes Redressal Forum (for short the District Forum) in August 2007.
The District Forum vide its order dated 10-05-2012 allowed the complaint and directed the OP to pay Rs.10,00,000/- with interest at the rate of 8% per annum from the date of filing of the complaint, along with Rs.10,000/- as compensation and Rs.2,000/- towards costs.
Aggrieved by the order of the District Forum, first appeal was filed by the LIC, OP, before the State Commission, which was dismissed. Hence, this revision petition.
The counsel for the opposite party made the following submissions. The deceased''s policy bears No.262799064 under table plan 90-25 for marriage endowment/educational plan and its maturity date was 28-08-2027. It was issued under which payment to be made and events on the happening of which they are to be made payable:-
The proposer or the assignee or nominees have an option in lieu of sum assured 10 half yearly installments at such dates as may be prevalent at the date of maturity,
Surviving on date of maturity - sum assured + vest Bonus Thus, it is clear that sum assured will be payable to the nominee on the death of the insured on the date of maturity which is 28.08.2027.
The counsel further submitted that, the policy was continued for 7 months 10 days. The insured expired due to suicide, as per the District hospital''s information given to concerned police station. The postmortem(PM) of deceased was also conducted wherein it was found that there were 5 injection marks on the body of deceased and she expired after staying 15 minutes in the hospital. As per the terms and conditions of policy, the claim of policy was rejected, hence there was no deficiency in service of insurance company.
We have perused the PM report, it mentions the following Ante mortem injuries;
needle prick mark on right hand 2 cm below wrist,
needle prick on dorsum of foot - 1 cm away from lateral malleolus right side,
needle prick on dorsum of left foot - 1 cm away from lateral malleolus,
needle prick mark on front and left elbow joint,
needle prick mark on outer surface of left wrist
It is an admitted fact that, deceased was admitted in the hospital in emergency for the epileptic fits. She was given a number of intravenous medications for emergency treatment, the sites (i) to (v) are the sites usually IV pricks are given. Those medicines will not cause death. It is
a ridiculous submission made by the counsel, that the deceased committed suicide by taking multiple pricks of poison. As per Modi''s forensic medicine textbook, just one single prick of lethal poison is enough to cause death.
The PM report categorically specifies that, during epilepsy attacks, the food and liquid got stuck in her breath-pipe and the same got blocked and due to asphyxia, she passed away. Thus, it is pertinent to note that, OP made the payment of first insurance policy for Rs.1 lac, but the payment of policy for Rs.10 lacs has been rejected on the basis of wrong facts, and frivolous grounds, that the policy holder had committed suicide which is not payable as per terms and conditions of policy.
The main question swirls around is, whether the death of insured was a Suicidal or not? As per the medical certificate produced by LIC (Annexure P-4) the patient was admitted in the emergency ward at District Hospital, Mainpuri and it is recorded the she had epileptic fits and asphyxia as a result of aspiration. Even the reports from Sitaram Heart Care and Maternity Research Centre issued by Dr. Rajiv Mangal on three occasions (07-12-2003, 09-03-2004 and 20-07-2006) revealed that, the patient was not suffering from any disease, before her death and the epileptic fits occurred for the first time, leading to her death. He further stated that ante-mortem injuries (needle pricks) must be either produced in effort to give IV injection by doctor or patient herself and it has no relation to epileptic fits. The OP- LIC without any basis, just on technical ground, repudiated the genuine claim. It is pertinent to note that, the repudiation was conveyed almost 41/2 years after application, without any explanation. The repudiation letter is reproduced as below: On your claim of the above mentioned policy of late Smt. Nisha Singh, it is to inform you that, on the basis of proof, the death of the above insured person is occurred due to injection taken by herself or injection given by some other person. Police have not named any person during investigation. This proves that the insured herself injected her to commit suicide. Hence, this is a case of suicide. Clause of suicide (condition No.6) is applicable to this policy. Therefore, we are denying your claim as per terms & conditions of the Corporation and we will not be responsible for making any payment under present policy and the sum paid by the insured person is not refundable .
The OP should know that it was the OP and nobody else who is to carry the ball in proving that it was a case of suicide. Due to lack of evidence the factum of suicide hardly stands proved. It must be borne in mind that courts decide the case on solid and unflappable evidence and not on presumptions. This view dovetails from a recent case, titled IDBI Federal Life Insurance Co. Ltd. Vs. Anuva Ghosal, II (2015) CPJ 503 (NC) (RP No. 1786 of 2014, decided on 05.01.2015) , in which this Commission, held as under :- " 11. ....... It is trite that the issue of suicide is one of fact and burden to prove this fact is on the Insurer. The exact nature of the burden of proving suicide varies from case to case and is undoubtedly, a difficult exercise, particularly when deceased''s family and their friends in the normal course, would be reluctant to co-operate. More so, when there is a presumption of law against a normal and sane person committing
suicide. Hence, the allegation of suicide has to be established from surrounding circumstances, like evidence of recent psychiatric care, treatment for depression, unhappiness, change in employment circumstances, interpersonal disruptions at home or at work place, unusual behavior, etc.".
Therefore, we are of considered view that, the OP failed to prove that, it was a suicide. Thus repudiation is unjustified, and also the repudiation was intimated after a longtime of lapse of 41/2 years. Thus, it''s a deficiency in service on the part of the OP. In the instant case, both the fora allowed the complaint and observed that the complainant is entitled to the insured amount from the date of filing of the complaint. But, in our view, the complainant is entitled to receive the insured amount of Rs.10,00,000/- from the date of death of the insured person. Therefore, we modify the order with the following direction; "the OP shall pay Rs.10,00,000/- (insured amount) with interest at the rate of 9% per annum from the date of death of the insured person i.e. from 01.05.2003. We further impose costs of Rs.30,000/- towards mental agony and Rs.10,000/- as litigation costs. The revision petition is dismissed. OP is directed to comply the entire order within 6 weeks, otherwise entire amount will carry further interest @ 9% per annum, till it''s realization".