Tamil Nadu

StateCommission

CC/18/2008

Bharathi M Rathi - Complainant(s)

Versus

The Branch Manager, Life Insurance Corporation of India, City Branch-9 - Opp.Party(s)

V. Jayachandran & Asso.,

09 May 2018

ORDER

IN THE TAMILNADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION CHENNAI.

Present:   THIRU.K. BASKARAN                                     PRESIDING JUDICIAL MEMBER 

                  THIRU.S.M. MURUGESSHAN                         MEMBER          

 

C.C.No.18/2008

WEDNESDAY THE 09^th DAY OF MAY 2018

                                                                        Date of complaint filed:               24.04.2007

                                                                         Date of orders pronounced:        09.05.2018

 

Mrs. Bharathi M. Rathi

Wife of late. Mr.M.D. Rathi

Residing at No.AC-152

6^th Main Road Anna Nagar

Chennai – 600 040.                                                                                 Complainant 

                                                                     

                Vs

The Branch Manager

Life Insurance Corporation of India

City Branch-9.

Thyagaraya Road T. Nagar

Chennai – 600 017.                                                                               Opposite Party   

 

Counsel for the complainant         :   M/s.V. Jeyachandran Advocate.     

 

Counsel for the Opposite Party     :    M/s. M.B. Gopalan  Associates Advocates.

                  This complaint having come up for final hearing before us on 16.04.2018 and on hearing the arguments of both sides and upon perusing the material records this Commission made the following;-

                                                   ORDER 

 

THIRU.K. BASKARAN PRESIDING JUDICIAL MEMBER.

               This complaint has been filed by the complainant under section 17 (1) (a) (i) of the Consumer Protection Act 1986 praying this Commission to direct the opposite party to pay a sum of Rs.2100000/- together with interest at the rate of 18% per annum Rs.100000/- as compensation for mental agony and hardship Rs.10000/- towards cost of all correspondence and notice and also cost of the proceedings.     

1.         The complaint allegations in brief is as follows;-  That the husband of the complainant one Thiru.M.D. Rathi since deceased  had taken 34 Life Insurance Policies (with accidental death benefit (double benefits) with the opposite party as detailed below;

Serial No.	Policy No.	Sum Assured         Rs.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34	89762557 89762558 89762559 710124489 710126880 710126881 710126882 710126883 710130068 710130069 710134305 710134550 711690440 711694993 711698471 712144893 712643613 712644870 61735393 61752080 61752081 710124497 710127866 710127867 710127868 710127869 711013016 711013017 711013076 711013320 712643032 712647059 712647116 710992226	25000/- 25000/- 25000/- 100000/- 25000/- 25000/- 25000/- 25000/- 50000/- 50000/- 50000/- 50000/- 100000/- 100000/- 100000/- 50000/- 100000/- 300000/- 25000/- 25000/- 25000/- 100000/- 25000/- 25000/- 25000/- 25000/- 50000/- 50000/- 50000/- 50000/- 155000/- 200000/- 45000/- 50000/-

 

that the life assured had while those 34 policies were in force  met with a motor accident on 31.05.2005 and was immediately taken to a private hospital by name Apollo First Med Hospital Chennai where he died despite treatment on the same day; that the complainant being the nominee and the widow of the deceased/life assured had lodged her claims under those policies claiming double benefits but the opposite party insurance company had sanctioned only a single benefit and rejected the claim for the double benefit without any justification even though the life assured had died of injuries sustained in the said accident which would amount to deficiency in service and hence this complaint for a direction to the opposite party to pay a sum of Rs.2100000/- together with interest at the rate of 10% per annum as per the accidental death benefit accruing from those policies and a sum of Rs.100000/-as compensation for mental agony and hardship suffered by the complainant besides cost of Rs.10000/-.     

2.      The following is the defence of the opposite party;-  That it is true that the life assured took  34 policies as detailed in the complaint but all the 34 policies were not having double accident benefits and 12 policies mentioned in serial Numbers 1 2 3 5 16 to 21 and 31 and 33 as mentioned in the complaint were not relating to accidental death benefit and only the remaining 22 policies were eligible for accidental death benefit ; that in any event the nominee of the life assured would be eligible to claim accidental death benefits only in the event of the life assured dying due to the injury sustained in an accident which should be the sole and direct cause of death and in this case there was no proof to show that the death of the life assured was caused by any injury  sustained in the accident and on the other hand the medical documents relied on by the complainant herself would show that the death was due to natural cause and hence the complainant is not at all entitled to claim accidental death benefit under all those 34 policies;  that the opposite party had settled all the lawful claim to which the complainant was entitled under these 34 policies and as such there is no question of any deficiency in service on the part of the opposite party and payment of any amount as prayed for. 

 

3.        The points that arise for consideration are  

                    (1)    Whether there was any deficiency in service on the part of the  

                            opposite party?

                    (2)    If the answer to point No.1 is yes then what relief the complainant

                             is entitled to ?

4.         Point No.1;-   On the side of the complainant her power of attorney had filed a proof affidavit and marked documents  Ex A1 to A13 and one Mr. Rengarajan had filed his proof affidavit on behalf of the opposite party and marked documents  Exhibits B1 to B12.

5.         There is no dispute regarding the following facts.;-

            a)   That the complainants husband one Thiru.M.D. Rathi had taken 34 life insurance policies for various sums totalling Rs.2100000/- for various periods as listed in the complaint and that he had been promptly paying the premium for the above stated policies and that the complainant was the nominee of the life insured as well as his wife.

             b)   Further it is an admitted fact that the life assured died on 31.05.2005 after a motor accident while the car driven by the life assured himself met with an accident in front of Chennai Corporation Office (Rippon Building) on the fateful day of 31.05.2005 and that he was immediately rushed to Apollo First Med Hospital on the same day where the life assured died at 1.45 p.m. without responding to the treatment.

              c)    In respect of the accident a case in crime No.134/C3/2005 was registered under section 304(A) of IPC on the file of the Elephant Gate Traffic Police and investigation done vide A1 and the Apollo First Med Hospital gave death certificate regarding the death of the life assured under Exs A2 and Ex B12.  Copy of the inquest report death summary and the post-mortem report in respect of the life assured. 

6.         Let us first decide as to whether all the 34 policies taken by the life assured were with accidental death benefit or ordinary life insurance policies.  The defence of the opposite party in this regard is that 12 out of 34 policies as stated in the written version did not enjoy accidental death benefits.  A perusal of the document marked by the opposite party as Exhibits B1 to B11 would show that the life assured had not included accidental death benefit in respect of those 12 policies as stated by the opposite party and the same would be clear from the answer entered by the life assured in the column No.3 in the proposal form for the question “is accidental benefit required “– No.  Hence we hold that all the 12 policies specified by the opposite party in the written version did not carry accidental death benefit and as such there was nothing wrong on the part of the opposite party in repudiating the accidental death benefit under those 12 policies.  The next question is as to whether the complainant is entitled to accidental death benefit in respect of remaining policies.  

7.        The learned counsel for the complainant would contend that through medical documents the complainant had proved that the life assured had died on 31.05.2005 due to injuries sustained by him solely due to motor accident involving a car in which the life assured was on the wheels in front of the Rippon Building at about 12.40 hours and immediately thereafter he was admitted in a private hospital namely Apollo First Med Hospital  Chennai at about 1.05 p.m. and he succumbed to the injuries sustained in the  accident at about 1.45 p.m. on the same day in spite of treatment at the hospital.  He would further submit that this has been proved by the complainant through Exhibit A1 copy of the FIR.   Ex. A2 is the death certificate issued by the Private Hospital.  Ex A4 is the death report prepared by the concerned investigating officer and Ex A6 is the certificate of treatment recorded by the opposite party itself.

8.         Per contra the learned counsel for the opposite party would simply at the   same time strenuously contend that the opposite party is not disputing that the life assured died on 31.05.2005 after a road accident involving a car driven by life assured himself.  But at the same time the life assured did not die due to the injury sustained in the accident and on the other hand as per the medical certificate available in this case the life assured died of acute heart failure due to coronary heart disease and further that the complainant had not proved that the death was purely solely and directly  due to the injuries sustained in the accident.  He would further submit that the complainant had miserably failed to prove that her husband and the life assured died of solely and directly due to the injuries sustained by him in the said accident.     

9.         No eyewitness.  who could have witnessed the occurrence namely the accident was examined in this case.  But  it appears that it was only a passer-by who had set the criminal in law in motion by lodging a complaint with the concerned police and on the strength of the same a criminal case under section 304 (A) was registered in crime No.134/C3/2005 on the file of the Traffic Investigation Central Elephant Gate.  The contents of the FIR  are to the effect that at about 12.40 hours on 31.05.2005 when the complainant (in criminal case) was proceeding in his car on EVR Road near the Chennai Corporation Building he saw a car driven by an elderly person hit against a motor-cycle and stopped on the road itself and when the complaint (in criminal case)  rushed there he saw the driver of the accident involved car  blood was oozing from his mouth and there were some abrasions over his face and hence he took the injured to the said private hospital in his car and admitted him for treatment and the doctors who treated him declared him dead at 1.40 p.m. on the same day.     

10.          Ex A2 is the copy of death certificate issued by the hospital where the life assured breathed his last after admitted for treatment.  In Ex A2 it is stated as “Road Traffic Accident”   C?  MI  C?  Ventricular Febrillation - exact cause after post-mortem.  Hence this Ex A2 death certificate issued by the hospital where the First Aid treatment was given to the life assured would show that the life assured would appear to have died of Road Traffic Accident with suspected heart attack and with suspected Ventricular Febrillation. This opinion was given based on the clinical examination and the very same certificate would state that the exact cause of death could be ascertained only after the post-mortem.  It is pertinent to note  at this juncture even by clinical examination the said hospital had formed an opinion that the life assured might have died due to Road Traffic Accident associated with suspected heart attack and suspected Ventricular Febrillation.  Hence Ex A2 Death Certificate issued by the Hospital had relegated forming of opinion regarding the cause of death to the Post-Mortem Report which the complainant had omitted to bring on record but the same was filed by the opposite party as Ex B12.     

11.        A perusal of Ex B12 which is a post-mortem report in respect of the life assured would show that the deceased (life assured Shri.M.D. Rathi)  died due to acute heart failure due to coronary artery disease (natural).  Hence we are of the view that this opinion of the post-mortem doctor would resolve the conflicting views regarding the cause of death of the life assured.  Had it been a case of the life assured suffering a sudden impact of the steering wheel due to the accident then the post-mortem doctor would have opined that the deceased might have died of heart attack due to shock. But the post-mortem doctor had in  clear categorical unequivocal and unambiguous words opined that the death was due to acute heart failure due to coronary artillery disease (natural). There is no external injury over the chest region. Only 4 Abrasions  2 x 1 cm 4 x 0.5 cm 2 x 2 cm and 1 x 1 cm were noticed on the face and no other external injury was found on the dead body of the life assured. 

12.       From the materials available on record we can fairly visualise the probable cause of death.  One being that the life insured while driving the car in front of the Rippon Building on E.V.R. Road might have hit against a motorcycle and the central median and in that process he might have been caught between his seat and the steering wheel in which his chest could have been compressed due to the impact of the car.  Secondly that while the life assured was driving the car he might have suffered acute myocardial infarction and because of that he might have lost his control over the car and hit against the motor-cycle and the centre median and on being admitted in a hospital might have died of heart attack.  If the heart attack had preceded the accident then it is not a case of accidental death and if the accident had preceded the heart attack and the heart attack was due to sudden compression of the chest or due to some shock then it is a case of death solely due to injury sustained in the accident.

13.      But unfortunately the medical evidence available in this case only points to the situation that the life assured might have first suffered heart attack then hit against the motor-cycle.  Equally the complainant had failed to establish before this Commission through the opinion of some medical experts that the accident could have happened first causing sudden impact on his chest which might have resulted in acute myocardial infarction resulting in death.  But that has not been done by the complainant and the medical evidence such as Exhibits A2 and B12 would only support the hypothesis that the life assured suffered heart attack first which was the reason for the accident.  Hence we are unable to affix our seal of approval to the other theory namely that because of the accident the insured suffered heart attack in addition to small abrasion on his face and died of the same and hence it was a case of accidental death.

14.        Regarding the question as to whether all the 34 polices were eligible for double accident benefit or only 22 polices were eligible for Accidental Death Benefit;   A perusal of the documents filed by the opposite party would show that in the proposal forms submitted by the insured regarding the 12 polices which according to the opposite party were not eligible for accidental death benefit the life assured had not asked for accidental death benefit. Hence we are of the view that all the 34 policies were not eligible for Accident Death Benefits.   It is not in dispute that the sums assured under all the policies were paid to the complainant and the only dispute is with reference to the claim of accidental death benefit under all the policies and repudiation of the same by the opposite parties on the ground that the death was not due to any accident and death was due to natural cause.  In the above paragraphs we have held that the life assured did not die of any injury sustained in any accident and that he had died of natural cause namely heart attack.  It is not in dispute that the opposite party had settled all the sums other than the accidental death benefits under these policies to the complainant and as such there is no question of any deficiency in service or adoption of unfair trade practice on the part of opposite party. 

15.         In the light of the discussion held above we hold that there was no deficiency in service on the part of the opposite party and the point is answered in the negative.  

16.           Point No.2:-   While answering the point No.1 we have held that there was no deficiency in service or adoption of unfair trade practice on the part of the opposite party and hence it follows that the complainant is not entitled to get any relief as sought for in the complaint and this point is also  answered in the negative. 

17.           In the result the complaint is dismissed.  No order as to costs.         

 

 

S.M.MURUGESSHAN                                                    K. BASKARAN                                                                     

         MEMBER.                                                     PRESIDING JUDICIAL MEMBER. 

 

ANNEXURE

 

List of documents marked on the side of the complainant

 

Ex  A1   31.05.2005    First Information Report

Ex  A2                       Death Certificate issued by Hospital Authority

Ex  A3   08.06.2005    Death Certificate issued by Corporation of Chennai

Ex  A4                        Report of Death

Ex  A5                        Certificate of Cremation

Ex  A6   31.05.2005     Certificate of Hospital Treatment

Ex  A7   23.08.2005     Letter from Opposite party

Ex  A8      30.08.2005     Letters from Complainant

                01.09.2005                                  

Ex  A9       15.09.2005    Letter from Opposite party

                 28.09.2005   

Ex  A10      09.05.2006   Letter from complainant

Ex  A11      24.02.2007   Lawyer Notice

Ex  A12      27.02.2007   Acknowledgement card

Ex  A13      26.04.2004   Haematology Report of  Mr. M.D. Rathi.

List of documents marked on the side of the opposite party

 

Ex   B1       ..............      Copy of policy proposal Review slip for Policy No.712644870

Ex   B2       ..............      Copy of policy proposal Review slip for Policy No.712647116  

Ex   B3       ..............      Copy of policy proposal Review slip for Policy No.89762558

Ex   B4       ..............      Copy of policy proposal Review slip for Policy No.61752080

Ex   B5       ..............      Copy of policy proposal Review slip for Policy No.89762557

Ex   B6       ..............      Copy of policy proposal Review slip for Policy No.712643613

Ex   B7       ..............      Copy of policy proposal Review slip for Policy No.712643032

Ex   B8       ..............      Copy of policy proposal Review slip for Policy No.61735393

Ex   B9        ..............     Copy of policy proposal Review slip for Policy No.712144893

Ex  B10      ..............      Copy of policy proposal Review slip for Policy No.89762559

Ex  B11       ..............     Copy of policy proposal Review slip for Policy No.61752081

Ex  B12   30.08.2005       Letter of complainant enclosing Inquest Report Death

                                     Summary and Post-Mortem Report    

 

 

 

 

S.M.MURUGESSHAN                                                    K. BASKARAN                                                                     

         MEMBER.                                                     PRESIDING JUDICIAL MEMBER.