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PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Mr. Justice Paramjeet Singh Dhaliwal, President and Mr. Harcharan Singh Guram, Member
LIFE INSURANCE CORPORATION OF INDIA - Appellant
Versus
SMT. HARJIT KAUR - Respondent
First Appeal No. 488 of 2016
Decided on : 02-06-2017
Sh. Piyush Sharma, Advocate, for the Appellants; Sh. G.S. Sirphikhi, Advocate, for the Respondent
Insurance contracts should provide timely indemnification without cumbersome formalities, and claimants should be entitled to benefits under the policies in case of proven accidental death.
Headnote:
Consumer Protection Act - Insurance Claims - 12 of the Consumer Protection Act, 1986 - 174 Cr.P.C., 1973 - Indian Contract Act 1872
Fact of the Case:
The widow of a deceased army personnel filed a complaint seeking insurance claims under four policies after her husband's accidental death due to drowning. The opposite parties repudiated the claims, alleging non-disclosure of health information and lack of accidental death proof.
Finding of the Court:
The court found that the deceased had regularly paid premiums, and his death due to drowning was proven. The court observed that the insurance contract should provide timely indemnification without cumbersome formalities and upheld the complainant's entitlement to the benefits under the policies.
Issues: Dispute over insurance claims, non-disclosure of health information, and proof of accidental death.
Ratio Decidendi: The court emphasized the need for insurance contracts to provide timely indemnification without cumbersome formalities and upheld the complainant's entitlement to the benefits under the policies.
Final Decision: The appeal was dismissed, and the impugned order was upheld. The appellants were directed to remit the awarded amounts to the District Forum for release to the complainant.
ORDER
Paramjeet Singh Dhaliwal, President - The instant appeal has been filed by the appellants/opposite parties against the order dated 21.04.2016 passed by District Consumer Disputes Redressal Forum, Gurdaspur (in short, "the District Forum"), whereby the complaint filed by the respondent/complainant, under section 12 of the Consumer Protection Act, 1986, was allowed and the respondents/opposite parties were directed to pay the insurance claims pertaining to the related 4 nos. of policies, in question, with full accruals along with the double benefits as applicable in case of 'accidental-deaths' etc., if any; to pay Rs. 5,000/- as compensation for the harassment suffered by her; and to pay Rs. 3,000/- as cost of litigation; within 30 days of receipt of the copy of the order, otherwise the entire awarded amount would attract interest @ 9% per annum form the date of filing of the complaint till actually paid.
2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.
Facts of the Complaint
3. Brief facts, as averred in the complaint, are that the complainant is the widow of late Sh. Charanjit Singh; who was employed in Army under Sikh Regiment. He died due to drowning in an accident on 08.08.2011 in the area of District Gurdaspur. The postmortem on his dead body was duly conducted. Report under Section 174 Cr.P.C., 1973 was duly registered. During his lifetime, the husband of the complainant obtained the following four policies in his name from the opposite parties:
i) Policy No. 473071547 having sum assured of Rs. 2 lacs;
ii) Policy No. 472949781 having sum assured of Rs. 5 lacs;
iii) Policy No. 472820687 having sum assured Rs. 1,05,000/-; and
iv) Policy No. 472820686 having sum assured Rs. 1,00,000/-.
The complainant was appointed as nominee in the said policies. As per terms and conditions of those policies, in case of accidental death, the insured was entitled to double the amount of sum assured. It was further pleaded that during the subsistence of those policies, her husband died in an accident due to drowning and, as such, she is entitled for the claims under those policies i.e. the double of the sum assured. After the death of her husband, the complainant lodged the claim with the opposite parties and completed the requisite formalities, but they wrongly repudiated the genuine claim in all the policies, on the ground that the insured gave wrong answers regarding his health at the time of filing the proposal form. In fact, no material fact was ever concealed by her husband at the time of obtaining the said policies. The complainant sent representation to the opposite parties, who vide letter dated 19.02.2013 intimated her that they had admitted the death claim on Ex-gratia basis in full and final settlement.
However, the complainant never accepted the alleged amount, as she is entitled to double of the sum assured under the policies. The act and conduct of the opposite parties amounted to deficiency in service. Accordingly, the complainant approached the District Forum, seeking the following directions to them:
i) to pay the double amount of the sum assured as per terms and conditions of the policies, in question, along with interest @ 12% per annum; and
ii) to pay compensation, in the interest of justice.
Defence of the Opposite Parties
4. Upon notice, the opposite parties appeared before the District Forum and filed written reply, taking the preliminary objections that the complaint is not maintainable as Sh. Charanjit Singh, deceased life assured (DLA), allegedly died due to drowning in a canal, which cannot be termed as accidental death in the absence of any proof of the said accident. As such, the case of DLA is not covered under the Double Accident Benefit Clause, contained in the policy bonds. The complainant is estopped from filing the complaint by her own act and conduct, as she filed appeal to the Claims Disputes Redressal Committee in respe
