Life Insurance Corporation of India vs Raj Bala

THIS appeal is directed against the order dated 12.1.2006 passed by the District Consumer Disputes Redressal Forum, Jind whereby while accepting the complaint of the respondent-complainant, direction has been given to the appellant-opposite party to pay the insured sum of Rs. 2,00,000 along with interest @ 9% per annum from 1.3.2003 till the date of realization. The opposite party has also been directed to pay all the other benefits payable under the policy to the complainant and Rs. 3,000 additionally has been awarded as litigation expenses.

PUT shortly, the facts of the case are that Ramesh Kumar had taken life insurance policy bearing No. 172870911 for a sum of Rs. one lac with double accident benefit on 28.10.2001. The said Ramesh Kumar died on 19.10.2002 in a rail accident. The complainant being the widow and nominee of the deceased Ramesh Kumar assured, approached the opposite party to pay the sum assured. The claim was repudiated by the opposite party on the ground that the deceased was suffering from mental disorder which fact was not disclosed at the time the policy was taken by the deceased on 30.10.2001. Challenging the action of the opposite parties, the complainant invoked the jurisdiction of the District Forum. The opposite party contested the claim. In the written statement filed it was served that the matter was investigated and it was found that Ramesh Kumar had not died in a rail accident. It was also stated that the deceased was suffering from brain disorder which fact he had concealed and thereby violated the terms and conditions of the policy. Thus they justified that the claim has been rightly repudiated by them. On appraisal of the pleadings of the parties and evidence adduced on record, the District Forum did not accept the version of the opposite party and accepted the complaint in its order dated 12.1.2006. It is against this order the present appeal has been filed. Learned Counsel representing the appellant has been heard at length.

During the course of arguments learned Counsel representing the appellant while assailing the order of the District Forum has contended that though according to the case set up by the complainant Ramesh Kumar deceased had died in rail accident, but no report was lodged about this accident to the Railway Authorities and for that reason the complainant had failed to establish the exact cause of death of Ramesh Kumar. He has further contended that the District Forum has relied upon hearsay evidence by taking into consideration the affidavit of Sarpanch and resolution passed by the Gram Panchayat. He has also pointed out that the deceased at the time when he took the policy on 30.10.2001 had answered the question contained in Para No. 11(d) in negative and 11(i) in affirmative in the proposal form while factually he was suffering from mental disorder on the date of taking of the policy and for that reason suicide clause as per terms and conditions of the policy will operate and for that reason the opposite party was justified in repudiating the claim. There is hardly any merit in the stand taken from the side of the appellant in this regard. So far as the death of Ramesh Kumar in rail accident is concerned, there is report of the Branch Manager, Narwana to the Divisional Office, Karnal wherein in Para No. 18 of the report it has been clearly stated that the Ramesh Kumar died due to Rail Crossing. It is the definite stand of the complainant that the driver of the train did not stop the train as a result of which her husband met with accident and consequently died. No doubt it has also been admitted that the dead body of Ramesh Kumar was cremated without any post-mortem report but in this case death of the deceased Ramesh Kumar is fully established on record in an accident caused by the train. The stand of the complainant is fully supported by the evidence as well as copy of the resolution of the Gram Panchayat Ghaso Kalan. There is no justification whatsoever to disregard the statement of the complainant. More so, the opposite party has not been able to produce any acceptable medical evidence to establish that the deceased was suffering from mental agony and had taken treatment in any hospital. No doubt in the inquiry report Ex. O.P. 4 it has been stated that the deceased was not maintaining good health and was suffering from brain problem for the last many years. The source of this information has not been brought forthwith on record. No person has been examined to support the conclusion drawn in the report. Under the circumstances of the case, the District Forum has rightly accepted the affidavit of Sarpanch and resolution of the Gram Panchayat so as to come to the conclusion that the opposite party has failed to establish that the deceased was suffering from any ailment at the time of taking policy. Under the circumstances of the case the findings of the District Forum are well based and do not call for any interference.

FOR the aforesaid reasons, there is no merit in the appeal and the same is accordingly dismissed. Appeal dismissed.