DHUKHILAL JAISWAL vs BRANCH MANAGER, LIFE INSURANCE CORPORATION OF INDIA

PURSUANT to the notice issued to the Counsel for the complainant by order dated 18.9.96, the Counsel appears for the complainant. The Counsel for the Life Insurance Corporation of India (L.I.C.) also appears. Though the case was not posted for hearing, at the request of the learned Counsel for both parties, it was taken up for hearing as it is a very old one.

THE complainant in this case has prayed for an award to the extent of Rs. 5,05,000/-, the break-up of which has been given in Para 11 of the complaint petition from the L.I.C. saying that he is entitled to the aforesaid amount by virtue of two policies in the name of his son who died on 5.3.91. THE admitted facts are that the complainant is the nominee in respect of two policies in the name of his son Sri Sundar Kumar jaiswal. Policy No. E-580325502 was for a sum of Rs. 1,00,000/- which commenced on 15.2.91 with double accident benefit and Policy No. E-580325152 was for of Rs. 25,000/- without any accidental benefit. THE commencement of the latter policy was 28.10.90. During the continuance of the said policies, the policy-holder having died, the complainant made a claim to be entitled to the benefits of both the policies. In his claim application he alleged that the policy holder (his son) was murdered and he is entitled to the benefit of the policy. An FIR was lodged and police investigation was also made in respect of the death of his son. His claim having not been settled, he filed the aforesaid case before this Commission on 13.9.93. The LIC impleaded as opposite party in this case filed their show cause denying their liability. The essential defence taken in their show cause is that the death of the policy holder was not on account of murder as alleged by the complainant, but it was a suicidal death in respect of which the complainant was informed by a communication dated 31.3.94. In the show cause, however, it was stated basing on the police report that since in the post-mortem report and in the police report the cause of death has been described as heavy drinking and falling down on a rocky river bed, the possibility of death due to murder should be completely ruled out. It has been further stated that the circumstances surrounding the death of the policy holder clearly points out that the life assured has attempted to put an end to his life by heavy drinks at a lonely place so that nobody can save him and finally he succeeded in his attempt.

The learned Counsel appearing for the complainant strenuously urged that the police report and the post-mortem report and all other documents available nowhere indicate that the death was a suicidal death and therefore, the repudiation of the claim on that ground is untenable. The learned Counsel appearing for the LIC analysed the circumstances to say that he verified that the complainant was found dead at a lonely place indicates his attempt to commit suicide unnoticed by anybody. He referred to Clause 10(b) of the Policy (Conditions and Privileges available to a policy holder) and contended that according to the terms of the said clause, the Corporation shall not be liable to pay the additional sum referred to in Clauses (a) and (b) if the disability or the death of the life assured shall 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 etc. His contention is that the police report clearly indicts that liquor bottles were found and seized near about the place where the deceased was lying and some amount of liquor was also found inside his stomach as per the report of the police. He, therefore, contends that Clause 10(b) aforesaid applies in full force and therefore, the repudiation of the claim was justified.

THE police report was not in the record. A certified copy thereof was produced before us by the learned Counsel appearing for the LIC which was also perused by the learned Counsel appearing for the complainant. THE authenticity of the said document is not challenged. We find from the said report that the deceased sustained the following injuries on his body. (1) Bruise over occipital region 4" x 1" x 1". (2) Congestion of left chest (sic) wall. (3) Dark blood found in peromal space. (4) Larynx and trachea congested. (5) Left lungs lacerated into two pieces. (6) Stomach congested and small alcohol found. From the inspection of the spot and examining the post-mortem report and the injuries that were sustained by the deceased, it was concluded that in all probabilities the deceased which in an intoxicated condition lost his balance and fell down from a height of 20'' hitting the water surface with his back in a supine position which resulted in rupture of lungs associated with other injuries in occipital rigion. This in our opinion appears to be nearer the truth. In the aforesaid circumstances, the plea of suicidal death taken by the present opposite parties cannot be accepted. But even then the matter may fall within the scope of Clause 10(b) of the policy inasmuch as the death was in a state of intoxication. But the consequence is that if death is due to any of the reasons enumerated in Clause 10(b), the benefits under the policy will not comprise the double accident benefit which would have been otherwise available under the policy. THErefore, whether the death was due to suicide or due to accidental fall during a state of intoxication becomes immaterial for the purposes of this case. In the conclusion, the complainant would be entitled to the sum assured under the aforesaid policies and not the accidental benefit because of the reason aforesaid. An intimation having been given to the Insurance Company soon after the death of the policy-holder it required certain documents to be produced in support of the claim made by the complainant by the communication dated 10.6.91. In pursuance to the said communication, the complainant submitted all the papers which reached the LIC on 23.5.92. In such circumstances the claim could not have been settled before the date of submission of the documents. After submission of the documents, a reasonable time is required for the LIC for investigation and settlement of the claim. In the aforesaid circumstances, a period of three months after 23.5.92 was enough. To put in round figures, the claim should have been settled by the end of October, 1992. That having not been done, the complainant would be entitled to interest on the assured sum under the two policies at the rate of 12% per annum. As already stated, the case was filed on 13.9.93. It is an accepted principle that neither party should suffer for the delay in disposal of a case pending in a Court. Keeping in view the aforesaid principle, we would direct that during the pendency of the litigation before this Commission, the interest would be calculated at the rate of 9% per annum. Thus the complainant would be entitled to interest at the rate of 12% per annum from 1.11.92 till 13.9.93 and thereafter at the rate of 9% per annum from 13.9.93 till date. THE amount payable to the complainant be calculated and paid by the LIC to the complainant within a month from the date of receipt of this order, failing which the awarded amount shall carry interest at the rate of 12% per annum from the date of default till the date of payment. This complaint/petition is accordingly allowed in part. Complaint partly allowed.