NIRMAL KOCHHAR vs Life Insurance Corporation of India

BRIEFLY, the facts of the case are that complainant No. 1 is the widow and complainants Nos. 2 & 3 are the daughters of Shri Sat Pal Kochhar deceased who got himself insured with the Life Insurance Corporation of India respondent and obtained three policies bearing No. 23660004, 24573793 & 50173675 for Rs. 10,000/-. Rs. 5,000/- & Rs. 75,000/- respectively. The policies were ''Double Accident Benefit'' policies according to which the heirs of the policy holder in case of his death by accident were entitled to get double the amount of the basic sum assured. The deceased had paid extra premiums of the said policies which were required to be paid for ''Double Accident Benefit'' policy. That on 25th October, 1985 at about 11.15 p.m. Shri Sat Pal Kochhar was found lying with severe bodily injuries on the road side in front of Police Station Tilak'' Nagar, New Delhi. He was removed from there and admitted to Dr. Ram Manohar Lohia Hospital on 26th October, 1985, by the Police Control Room Van in an unconscious condition. He remained unconscious throughout his stay in the hospital and ultimately died on 26th October, 1985. His post-mortem examination was conducted by Dr. A.K. Sen of the Civil Hospital on 27th October, 1985 at 9.30 p.m.

THE police initially registered a case under Section 279/337 I .P.C. vide F.I.R. No. 481 dated 25.10.85 at Police Station, Tilak Nagar, West District, Delhi. Later Sections of I.P.C. were amended from 279/337 to 279/304 A I.P.C. In the first instance the investigation of the case was conducted by the local police but later the case was transferred to the Crime Branch vide order dated 8th November, 1985. Complainant No. 1 informed the defendant about the death of the assured and requested it to send the relevant documents to be executed by her for settlement of the claim agjainst the policies. After receiving the documents, the same were duly filled in, executed and submitted to the defendant alongwith the original insurance policies. The defendant paid a sum of Rs. 13.415.40P vide cheque dated 10.12.1985 and Rs. 84.844.50P vide cheque dated 31st January, 1986, against the claim of the complainants on account of basic sum assured, bonus, interim bonus only. For the payment of the claim of ''Double Accident Benefit'' under the policies, the defendant required complaint No. 1 to submit copies of the F.I.R., Post-Mortem Report, Final Police Investigation Report and the Driving Licence of the assured. The complainant No. 1 submitted all the documents. The defendant after receipt of the documents from complaint No. 1 refuted the claim of ''Double Accident Benefit'' vide letters dated 17.11.1988 for policy No. 23660004, and dated 8.11.1988 for policies Nos. 24573793 and 50173675 on the ground that the assured was under the influence of liquor at the time of accident. That the complaints it is alleged suffered a loss of Rs. 90,000/- towards the amount payable against the claim of'' Double Accident Benefit'', and of Rs. 85,000/- on account of interest @ 18% per annum from 27th Oct. 85.

The claim has been contested by the defendant. However, it is admitted by them that the claimant had taken three ''Double Accident Benefit'' policies. It is pleaded that the complainants were not entitled to ''Double Accident Benefit'' for the reason that the assured was under the influence of liquor at the time of accident and that all other benefits under the policies have been paid. The police Inquest Report revealed that the assured was a habitual drunkard and had fallen earlier from a running vehicle under the influence of liquor. It is also pleaded by them that this Commission should decline to exercise jurisdiction and refer the party to the ordinary remedy by way of civil suit as issues of fact involved in the case require taking of elaborate oral and documentary evidence and detailed scrutiny and assessment of the same.

IT is contended by Mr. Gupta, learned Counsel for the complainants that the deceased suffered injuries in an accident on 25th October, 1985 and was found lying in an injured condition on the road side in front of Police Station Tilak Nagar at 11.15 p.m. He was removed to the hospital (Dr. Ram Manohar Lohia Hospital, New Delhi) at about 12.15 a.m on 26th October, 1985 by the police, control van in an unconscious condition. The Doctor who examined him did not mention in the report that he was under the influence of liquor. The Insurance Company did not make any independent enquiry in this regard. IT on the basis of the police investigation, refused to pay the insurance money on the ground that the deceased was under the influence of liquor. He further submits that the case does not require any oral or other documentary evidence. On the other hand, the learned Counsel for the respondent has submitted that once the Insurance Company declined the claim on the ground that the deceased was under the influence of liquor, it will not be proper for the Commission to adjudicate upon this matter, as it will require elaborate trial. In support of his contention he has placed reliance on a decision of the National Commission in M/s Janta Machine Tools v. Oriental Insurance Co. I (1991) CPJ 234 (NC) Original Petition No. 13/1990, decided on 21st August, 1990. I have duly considered the matter, the police report shows that the deceased met with an accident and was lying on the road side in an injured condition at about 11.15 p.m. on 25th October, 1985. He was removed in a police van to Dr. Ram Manohar Lohia Hospital, New Delhi, where he was admitted at about 12.15 a.m. on 26th October, 1985. He was medically examined in the hospital on the night intervening 25th & 26th October, 1985. The Hospital authorities on the L.I.C. Formate gave a certificate in which the diagnosis was head injury. There is nothing in the Certificate to establish that the deceased was under the influence of liquor. In case he had consumed liquor before he met with the accident and he was under its influence. The doctors who examined him would have mentioned it in the report. So on the basis of the report, it cannot be said that the deceased was under the influence of liquor at the time of accident

THE complainants have produced investigation report of the police. It is stated therein that a number of local persons were examined to ascertain if any quarrel took place with the deceased or he met with an accident with some vehicle on that date. A number of bus drivers and conductors plying on that route was also examined. But none could tell about the incident quarrel or accident that the deceased had on that day and time. From the investigation conducted nothing came to light that the above case was a case of murder. It is further stated therein that the investigation conducted, other circumstances and medical reports indicated that that was purely a case of load-side accident. However, despite best efforts, the vehicle and the accused could not be traced. The case was already one year old. In the circumstances final untraced report had been prepared. It is requested that the case be ordered to be filed as untraced at present and be re-opened again in future if some clues come to notice. However, in the report a para was added by the police that the deceased was in the habit of taking liquor and it came to light that he had consumed liquor on that day. The relevant para is as follows : "During investigation this came to light that deceased was habitual drunkard and used to drink daily. He had consumed liquor on the day of incident also. This also came to light that on earlier occasions, under the influence of liquor, while going to his house in a four seator etc. he fell down from the running vehicle and sustained injuries. Also it was his habit to give unnecessary and baseless complaints against any one and police officials." From the perusal of the above para, it is not clear at what time the deceased consumed liquor. It is also not mentioned there that he was under the influence of liquor at the time when he was found lying on the road-side. The Insurance Company did not investigate the matter but on the basis of stray observations of the police in its report dated 16.12.1986 came to the conclusion that the deceased was under the influence of liquor. It was the duty of the Insurance Company to have investigated the matter if it wanted to refute the claim of the complainants, However, for the reasons best known, it did not adopt that course. In the letter dated 17th November, 1988 issued by the Insurance Company to the complainants, they have mentioned the ''Double Accident Benefit'' was not payable as per terms and conditions of the policy as the assured was under the influence of liquor at the time of accident. They are silent regarding holding of any independent enquiry by them.

IT is true that there is a clause in the Insurance Policy that the Corporation would not be liable to pay ''Double Accident Benefit'' if the death of the life assured was caused when he was under the influence of intoxication liquor, drug or narcotic. In the written statement in reply to para No. 8, the respondent pleaded Police Inquest Report revealed that the assured was a habitual drunkard and fell from a running vehicle under the influence of liquor and as such ''Double Accident Benefit'' was denied as per terms and conditions of the contract/policy bond. IT is thus evident from the said reply that the benefit under the ''Double Accident Benefit'' was denied to the complainants because on the date of accident, the deceased under the influence of liquor fell from the running vehicle. However, the report of the police which has been re-produced above is to the contrary. The police referred to some such earlier accidents. After taking into consideration all the abovesaid circumstances, I am of the view that the plea of the respondent that the deceased was under the influence of liquor at the time of accident is without any basis and has been taken, malafide, with a view to repudiate the claim of the complainants.

FACTS in a case Janta Machine Tools v. Oriental Insurance Co. (supra) which reference has been made by the Counsel for the respondent are distinguishable. In that case, the Insurance Company had made full investigation into the claim of the complainants, got surveys conducted and thereafter came to the conclusion that the claim was false. In the present case, as already observed no surveys were got conducted by the respondent and the claim has been repudiated on the basis of police investigation report For the aforesaid reasons I accept the claim of the complainant, and direct the respondent to pay to them an amount of Rs. 90,000/- with interest @ 15% per annum from 27.10.85 till the date of payment. The respondent shall also pay costs of the claimants. Costs Rs. 2,000/-. The said amount be paid within 3 months from the date of the order. B.L. Anand, Member - I have gone through the above discussed findings by the Worthy President of the Commission but I am not inclined to agree to the above conclusions. 2. A careful scrutiny of the records reveals that there was close resemblance of the facts involved in this case viz-a-viz the views expressed by the Hon''ble National Commission in "Janta Machine Tools v. Oriental Insurance Co. reported as I (1991) CPJ 234". 3. For the same of proper appreciation and clarity the operative parts of those findings are reproduced : - "Held thus this is not a case where the Insurance Company did not take prompt and necessary steps for deciding the claim under the policies of insurance. It may be that the complainant is not satisfied with the said rejection of this claim by the Insurance Company. Having regard to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a Civil Court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out Commission for local inspections etc. and have an elaborate trial of the case. Without prejudice to the right of the complainant to take resort to the remedy by way of civil suit before the proper Court. We dismiss this petition."

In the instant case cause of action had "arisen on 26lh October, 1985 when the deceased Sh. S.P. Kochar died. The complainant were paid a sum of Rs. 13,415/- vide cheque dated 10.12.1985 and Rs. 84,844/- vide cheque dated 31st January, 1986. It was obviously a prompt disposal of the case and in my view due credit goes to the Insurance Company for this speedy settlement of claim. 5. The claimants however expressed dissatisfaction with this payment after having received the above cheques. It is however not made out from the records as to whether they had raised any protest or objection while accepting the above two cheques and in that situation the present claim could amount to be an act of after thought. 6. The complainant however continued their correspondence with the Insurance Company for their further claim for "Double Accident Benefit" for which the defendants required the complainant to furnish copies of FIR, Post Martum Report, Final Police Investigation and driving licence etc. of the deceased. After examining all their vital documents the defendants rejected the claim of the "Double Accident Benefit" vide their letter dated 8.11.1988 & 17.11.1988. It is pertinent to note that this case was investigated by the local police and later by the Crime Branch independently and it is finding of the Crime Branch dated 16.12.1986 produced and relied upon by the complainants themselves where it was revealed that the "deceased was a habitual drinker and that he had consumed liquor on the day of the incident also". When such elaborate and detailed investigations were available from an independent agency like the Crime Branch in my view there was no requirement to entrust further enquiries/investigations to a surveyor which would have resulted in more delay. 7. The Insurance Company the defendants have relied on the documents and reports furnished to them by the complainants themselves and repudiated this additional claim for the "Double Accident Benefit". 8. In the light of the above discussed factual position I am of the considered view that findings of the Hon''ble President and Members of the National Commission in the above quoted case Janta Machine Tools v. Oriental Insurance Co. are exactly applicable to the facts of this case and as such this Commission has no jurisdiction to further adjudicate the matter at this stage when part of the claim has already been accepted, paid and acknowledged by the complainants and the other parts has been rejected in the light of the reports and detailed investigations submitted and relied by the complainants particularly so when these investigations were made by a third independent agency like the Crime Branch. 9. This complaint therefore merits rejection.

Complaint rejected.