IMPORTANT POINT
Common order based on complete and correct appreciation of evidence led before Fora below cannot be disturbed.

Vinay Kumar, Member—By a common order, the Chhatisgarh State Consumer Disputes Redressal Commission has decided a set of four appeals arising from two different complaints. All four appeals were dismissed and the order of District Consumer Forum, Raipur in the Complaints was confirmed. The decision of the State Commission has now been challenged by the Life Insurance Corporation of India in both cases. As the two revisions are filed against a common impugned order, they are taken up together for disposal. Revision Petition No.1627 of 2014 arises from the Consumer Complaint of Shri Amarlal Jaisingh (since deceased and represented by his legal heirs) and Revision Petition No.1628 of 2014 from the Consumer Complaint filed by Smt. Namrata Wadhwa. Both complainants were nominees under different life insurance policies taken by Smt Meena Jaisingh.

2. As seen from the record, the insured, Meena Devi had a fall on 8.4.2008 while opening an almirah in her house. She was in acute pain. X-Ray taken at Patel Nursing Home showed that in this fall she had fractured her left hip ball. She was admitted to Rama Krishna Care Hospital where hip bone surgery was performed on 9.4.2008. Her left hip ball was replaced by an artificial one and she was discharged on 13.4.2008. On 3.5.2008 she again had unbearable pain in her left leg. After a fresh x-ray doctor reported that her hip ball had got dislocated. It was reset in a surgical operation on 4.5.2008 and she was discharged on 6.5.2008. Thereafter, she was able to move around with a walker. But, her leg pain returned again on 7.6.2008 and she was readmitted to the hospital. The left hip ball was again found to be dislocated. On 10.6.2008 she was shifted to the ICU. Her condition did not improve due to continuous bleeding and she died on the same evening.

3. We have perused the records and heard Ms Jaya Tomar, counsel for the Petitioner/LIC of India. The matter was reserved for orders after hearing at admission stage itself. Learned counsel clarified that in both cases basic claims under relevant insurance policies have already been settled in favour of the respondents/complainants. Consumer complaints were filed because the OP repudiated the claim for accident benefit under the same policies. The revision petitions are therefore, limited to challenging the award of DAB (Double Accident Benefit) by the fora below.

4. The LIC had rejected the DAB claim of the complainants on the ground that it was a case of natural and not accidental death. In this behalf, the letter of LIC dated 4.12.2009 said—

“The Competent Authority has rejected the DAB Claim under Pol. No.382918686 as per medical certificate issued by Ramkrishna Care Hospital, Raipur cause of death is cardio respiratory arrest, sepsis, LRTI, Thrombocytopenia, Hypertension, cronic renal failure and dislocation of featured operated neck femur and manner of deathis natural.”

5. Before the District Forum, the complaint was contested by the LIC on the ground that it was not a case of any deficiency of service as the basic claim had already been paid. On denial of the DAB benefit the plea of LIC was—

“In reply to para 19 the averment of non applicant is that to prove that cause of death is accident, following documents are required- FIR/MERG INTIMATION REPORT/NAKSHA PANCHAYAT NAMA/PMR/POLICE FINAL REPORT/. No such documents was made available to the non applicant. The complainant in para 16 of his affidavit has clearly mentioned that cause of death of Lt. Smt. Meena Devi is normal home accident. Hence, it is proved that in absence of cogent and admissible evidence cause of death cannot be deemed to be an accidental in nature. By this deed the complainant has acted in a fraudulent and deceiving manner and tried to obtain the claim amount illegally.”

6. The District Forum did not accept that absence of the above documents would permit an inference that the cause of death was not the accidental fall. It held that the fractured hip itself was evidenc