RADHA BAI vs LIC of India

THIS appeal, under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 31.10.2003 in Complaint No. 3/2003 by Consumer Disputes Redressal Forum, Rajnandgaon (hereinafter called the ''District Forum'' for short), dismissing the complaint of the complainant/appellant with the liberty to her to approach the Civil Court for appropriate remedy.

UNDISPUTABLY, the deceased Narendra Kumar Indoria was in the employment of respondent No. 2/Bank. The respondent No. 2 had obtained a Life Insurance Money Back Policy (with profits) No. 381321230 from the respondent/insurer. The premium of the policy was to be paid by deduction of the same from the salary of the deceased/insured. The policy was for assured sum of Rs. 50,000/- with accident benefit. It is also not in dispute that the insured Narendra Kumar Indoria died on 14.10.1996. It is further not in dispute that though the respondent No. 3 Smt. Nirmala Bai, the widow of the deceased insured Narendra Kumar Indoria was a nominee under the said policy, but complainant/appellant the mother of the deceased insured obtained succession certificate in her favour. It is also not in dispute that respondent No. 3 Nirmala Bai, the wife of the deceased/insured and her father as well as brothers were charge-sheeted for the murder of insured Narendra Kumar Indoria and tried in Sessions Court, Balod, in Sessions Trial No. 59/97, by the Addl. Sessions Judge. However, by judgment dated 12th February, 1999, all the accused were acquitted. The complainant averred that her son, the deceased insured Narendra Kumar Indoria was murdered by respondent No. 3, his wife and others. She has further averred that she laid claim for payment of the amount under the policy on the death of the deceased with the respondent/insurer, but her claim was repudiated by the insurer/respondent No. 1. The complainant, therefore, prayed that the amount of Rs. 1 lac along with interest and bonus payable under the accident benefit policy, be directed to be paid to her by respondent No. 1/insurer.

The complaint was resisted by the respondent No. 1. It was averred by the respondent No. 1/insurer in its written version that as the deceased committed suicide within one years, therefore, the amount under the policy was not payable by the insurer/respondent No. 1. The claim of the complainant was, therefore, repudiated.

IT appears that respondent No. 2 also filed its written version. However, respondent No. 3 did not appear in the District Forum despite notice. The District Forum, in the impugned order held that in all probability the deceased committed suicide by consuming pesticide. Therefore, in view of Clause 6 of the policy, the insurer was not liable to pay any amount to the complainant under the policy. Consequently, the complaint was dismissed.

LEARNED Counsel for the appellant and respondent No. 1 were heard. Record was perused. Undisputably, the breach of terms of policy or availability of exemption clause under the policy, under which they claim exoneration from liability of payment under the policy has to be proved by the insurer. In the instant case, as noticed above, the basic contention of the respondent No. 1/insurer is that as the insured committed suicide within one year from the date of commencement of risk, the amount under the policy is not payable, in view of Clause 6 of the policy. The said Clause 6 reads: "Suicide-The policy shall be void if the Assured commits suicide (where sane or insane at the time) on or after the date on which the risk under the policy has commenced but before the expiry of one year from the date of this policy and the Corporation will not entertain any claim by virtue of this policy except to the extent of a third party''s bona fide beneficial interest acquired in the policy for valuable consideration of which notice has been given in writing to the office to which premiums under this policy where paid last, at least one calendar month prior to death."

Therefore, it was the obligation and burden of the respondent No. 1/insurer to prove that the deceased committed suicide. Needless to say that the respondent No. 1/insurer to discharge its onus or obligation as above was required to place adequate material on record of the complaint to show that the insured committed suicide. We find that no material whatsoever regarding cause of death has been placed on record by respondent No. 1/insurer except the judgment dated 12th February, 1999 in Sessions Trial No. 59/97. In the above context, it is noticed that the District Forum in the impugned order, mainly relied upon the observations in the judgment dated 12.2.1999 in Sessions Trial No. 59/97. It is clear that the said judgment or observation made therein cannot form the basis for recording a finding in the instant complaint. The finding in the complaint will have to be given on the basis of material placed on record by the parties. As pointed out above, no material whatsoever has been placed by the insurer to show that the deceased committed suicide. Even the First Information Report, the post-mortem report or the opinion of the doctor has not been placed on record to substantiate the above averments. It may also be mentioned that in judgment in Sessions Trial No. 59/97 dated 12.2.1999, no definite finding has been recorded regarding cause of death. It has only been observed therein that it does not appear to be a case of homicidal death but may have been a case of suicide. The observation as above, even if taken into consideration, does not constitute definite finding regarding cause of death of the deceased.

IN view of above, it is clear that no reliable material has been placed on record by respondent No. 1/insurer, to show that the deceased committed suicide. Therefore, the finding of the District Forum, as above cannot be sustained. Clearly, therefore, the respondent No. 1 is liable to pay to the complainant/appellant Rs. 50,000/- the sum assured under the policy.

NOW the next question that arises for consideration is: as to whether the complainant/appellant is entitled to the amount under the accident benefit also as per stipulation under the policy, as was the submission of the learned Counsel for the complainant/appellant? It has not been disputed that the policy obtained by the insured, provides for accident benefit also i.e., in case of death by accident, double the assured sum was payable, by the respondent No. 1/insurer. In this connection Clause 10-2(b) is relevant which reads: "10-2 (b) : Death of the life assured: to pay an additional sum equal to the sum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violence and visible means and such injury shall within 120 days of its occurrence solely, directly and independently of all other causes result in the death of the life assured. However, such additional sum payable in respect of this policy, together with any such additional sums payable under other policies on the life of the life assured shall not exceed Rs. 5,00,000/-. The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the life assured shall (i) be caused by intentional self-injury, attempted suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic, or (ii) take place as a result of accident while the life assured engaged in aviation or aeronautics in any capacity other than that of a fair-paying, part-paying or non-paying passenger in any aircraft which is authorised by the relevant regulations to carry such passengers and plying between established aerodromes, the life assured having at that time no duties on board the aircraft or requiring decent therefrom, or (iii) be caused injuries resulting from riots, civil commotion, rebellion, war (whether war be declared or not), invasion, hunting, mountaineering, steeple chasing or racing or any kind, or (iv) result from the life assured committing any breach of law; or (v) arise from employment of the life assured in the armed forces or military service of any country at war (whether war be declared or not) or from being engaged in policy duty in any military, naval or police organisation."

Since complainant/appellant is claiming the above special benefit under the policy, it was for her to prove the existence of pre-requisite necessary facts entitling her to the said benefit as per Clause 10-2(b) reproduced above. It was thus the burden of the complainant/appellant to have proved that the life assured i.e., deceased Narendra Kumar Indoria sustained bodily injury resulting solely and directly from the accident, caused by outward violent and visible means and such injury within 120 days of the said occurrence was the cause and resulted in his death. In the above context the complainant/appellant in his complaint has averred that the deceased was murdered by his wife/respondent No. 3 and others. It may be mentioned that the complainant has not placed any material on record to substantiate her averments as above. The only material available on record is the judgment dated 12.2.1999 in S.T. No. 59/97, of the Court of Additional Sessions Judge, Balod. However, as noticed above also, Additional Sessions Judge in Sessions Trial No. 59/97 in the said judgment, did not find that the deceased died of homicidal death and the accused were acquitted. Therefore, the said judgment does not support the averments of the complainant that the deceased was murdered by his wife respondent No. 3. Thus there is no material on record to show that the deceased met with a violent death by outward means.

THEREFORE, the complainant having failed to place adequate material to show even prima facie that the deceased died in the circumstances entitling him to the additional sum under the accident benefit under Clause 10-2(b) of the policy. The result of the foregoing discussion is that though the complainant is entitled to the assured sum of Rs. 50,000/- under the policy, but she is not entitled to the accident benefit under the same.

IN view of the above, the appeal is allowed. The impugned order is set aside. The complaint is allowed to the following extent: The respondent No. 1/Life INsurance Corporation is directed to pay to the complainant a sum of Rs. 50,000/- (fifty thousand) only with interest @ 10% per annum thereon, from the date of complaint. The respondent No. 1 shall also pay to the complainant/appellant cost of this litigation including of this appeal which is quantified at Rs. 2,000/- (two thousand) only. The complaint so far as respondent Nos. 2 and 3 are concerned stands dismissed. Appeal allowed.