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2023 Supreme(Online)(Del) 18333
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
N/A, N/A
Life Insurance Corporation of India v. Banwari Lal Gupta
Revision Petition (RP) No. N/A | First Appeal (FA) No. 61 of 2019 | Consumer Complaint (CC) no. 231 of 2017
For the Appellants/Petitioners: N/A
For the Respondents: N/A
The Court affirmed that ambiguity in insurance policies should favor the insured, confirming coverage for accidental death despite arguments of suicide.
Headnote:The Court analyzed the provisions under Section 21(b) of the Consumer Protection Act, 1986, regarding the appeal from the order of the State Commission, which set aside the District Forum's dismissal of a complaint for accidental death claims. The Court found the Respondent’s claim for compensation of Rs. 10,00,000 based on the death of an insured individual due to poisoning adequately supported by evidence, refuting arguments of suicide and time bar. The Central question was the nature of death (accidental vs. suicidal) and whether the insurer was liable under the policy. The Court concluded that the death was accidental and upheld the State Commission's decision to direct payment under the policy, dismissing the revision petition accordingly.
| Table of Content |
|---|
| 1. commencement of proceedings under consumer protection. (Para 1 , 2) |
| 2. facts surrounding the death and claims for compensation. (Para 3 , 4) |
| 3. arguments presented by both parties regarding the nature of death. (Para 5 , 6) |
| 4. court's examination of evidence relating to the nature of death. (Para 7 , 8) |
| 5. final decision affirming state commission's ruling. (Para 9 , 10) |
1. The present Revision Petition (RP) has been filed by the Petitioner(s) against Respondent as detailed above, under S.21(b) of Consumer Protection Act 1986 , against the order dated 2.8.2019 of the State Consumer Disputes Redressal Commission, Rajasthan, Jaipur, (hereinafter referred to as the ˜State Commission'), in First Appeal (FA) No. 61 of 2019 in which order dated 7.1.2019 of District Consumer Disputes Redressal Commission, Sawai Madhopur, Rajasthan (hereinafter referred to as District Forum) in Consumer Complaint (CC) no. 231 of 2017 was challenged, inter alia praying to set aside the order of State Commission in FA / 61/2019 dated 2.8.2019.
2. While the Revision Petitioner(s) (hereinafter also referred to as OPs) were Respondents and the Respondent (hereinafter also referred to as Complainant) was Appellant in the said FA / 61/2019 before the State Commission, the Revision Petitioner(s) were OPs and Respondent was complainant before the District Commission in the CC no. 231 of 2017. Notice was issued to the Respondent on 28.11.2019. Parties filed Written Arguments / Synopsis on 9.1.2023 (Petitioner / OP) and 11.1.2023 (Respondents / Complainant) respectively.
3. Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Commission and other case records are that:
On 10.7.2010, the insured individual was a passenger aboard the Jan Shatabdi train when he allegedly became a victim of an attempted robbery, wherein he was administered a poisonous substance. Initially, he was admitted to the Railway Hospital in Gangapur city under the care of his father. However, due to the severity of his condition, he was subsequently transferred to SMS Hospital in Jaipur, where he tragically passed away on 11.7.2010. All requisite legal procedures, including the filing of an FIR, the conduct of a Panchnama, and the performance of a postmortem examination, were diligently undertaken. The Complainant, seeking rightful compensation, pressed for an amount of Rs. 10,00,000 along with accrued bonuses and other relevant benefits from the OP. Formal notification of the demise of the insured individual was dispatched on 10.8.2010. However, on 27.6.2011, OP declined to disburse the claimed sum. In response, the Complainant initiated the initial complaint, numbered 94/2011, which subsequently met dismissal owing to a deficiency in the required documentation. Subsequent to this, a court directive dated 30.4.2014 instructed the Complainant to submit an application along with the requisite documents to the local office of OP. The claim met rejection through a correspondence dated 11.7.2014. Consequently, a second complaint, identified as no. 2/2015, was presented before the District Forum, Karauli. However, this complaint was dismissed on the grounds of jurisdictional insufficiency. The Complainant filed a third complaint, numbered 231/2017, before the District Forum in Sawai Madhopur on the date of 12.5.2017. This complaint asserted instances of gross negligence, disinterest, unfair trade practices, and service deficiency on the part of the OPs.
4. Vide Order dated 7.1.2019, in the CC no. 231 of 2017 the District Forum has dismissed the complaint. Aggrieved by the said Order dated 7.1.2019 of District Forum, Respondent / Complainant appealed in State Commission and the State Commission order dated 2.8.2019 in FA No. 61 of 2019 has set aside District Forum's Decision and allowed the appeal. Directed OPs to grant Rs.10,00,000 to the complainant and other benefits of policy with 9% interest.
5. Petitioner(s) have challenged the said
