L.I.C. Of India vs BHOLA CHOUDHARY

APPELLANT Insurance Company insures people against life. The respondent''s wife had insured for life for Rs. 50,000/- on 28.9.2000 for period of 20 years. While issuing the policy the appellant undertook to make payment of Rs. 50,000/- with accrued bonuses on insured''s death. However, the assured, who was wife of the respondent died on 21.8.2001 on account of vomiting, diarrhoea and high fever before she could be taken to hospital. Death certificate was obtained by the respondent and the appellant was informed accordingly with the requisite documents. The respondent was asked to give a "Heart Declaration" executed by some responsible person other than the deceased''s husband and repudiated the claim. Feeling aggrieved the respondent filed the instant complaint which was allowed vide order dated 23.1.2002 directing the appellant to pay the insured amount of Rs. 50,000/- with interest @ 12%.

THE instant appeal has been preferred assailing the impugned order on the premise that wherever a death takes place due to sudden heart failure, drowning at sea while accidentally falling overboard from a ship, burns, air crash, suicide, murder of at the hands of justice, additional requirement of filing a certified copy of the inquest report in case of suicide, murder or burns and other eventuality as referred above and whenever a death due to sudden heart failure without any medical treatment and where no inquest is held a certificate by an efficient person well acquainted with the deceased who was present at the time of death or saw the dead body is required to be filed. Similarly where it is represented by a claimant that the deceased policy holder was not attended by any doctor during his last illness, a declaration set out in form No. 3790 containing a statement inter alia as to the circumstances in which the deceased died without any medical aid may be obtained. THE aforesaid stipulation is contained in Rule 4.4. in the Manual of Policy Servicing Department which when reproduced is as under: "4.4. Alternative proof of death: A death can take place due to sudden heart failure, drowning at sea while accidentally falling overboard from a ship, burns, air crash, suicide, murder or at the hands of justice. In such cases, in lieu of a certificate from the last attending physician which generally will not be forthcoming, additional requirements as mentioned hereinafter are to be called. A certified copy of the Police Inquest Report or a Panchnama or a report of the Coroner''s Court with statements made by the witnesses to the police authorities, should be called for in the case of suicide, murder of burns. Letter from Jail Authorities when death takes place there. When death is due to an air crash a letter from the Airlines company confirming that the assured was a passenger on the ill-fated plane and did not survive the disaster and a certified extract from the ship''s log book when death takes place at sea as a result of falling overboard, are necessary. When death is due to sudden heart failure without any medical treatment having been given to the policy holder or where no inquest is held, in lieu of the attending physician''s certificate a declaration made on stamped paper of the appropriate value before a Magistrate, by a disinterested person well acquainted with the deceased who was present at the time of death or saw the dead body (Form No. 3790) may be called for. In case where it is represented by a claimant that the deceased policy holder was not attended on by any doctor during his last illness, a declaration set out in Form No. 3790, which will contain a statement inter alia as to the circumstances in which the deceased died without any medical aid, may be obtained. THE declaration may normally be attested by a Magistrate or a Justice of the Peace or a Commissioner of Oaths or Notary."

It is pertinent to mention here that no such stipulation or condition formed part of the insurance policy or insurance cover. These are the rules framed by the LIC in the form of a Manual for Policy Servicing Department. Whenever a person is insured for life and his death takes place in other than natural circumstances only then the police report or the inquest report may be necessary. In the instant case the death took place before the patient was taken to the hospital due to high fever, vomiting and diarrhoea. Merely because the death took place within two years of the insurance policy and that too at the young age of 26 years is not a ground to entertain suspicion or doubt regarding the death of the deceased. Information by way of filing of an affidavit by the husband of the deceased along with Death Certificate was sufficient requirement to become entitled to the assured amount.

It may not be out of place to mention here that at the time of giving the insurance policy every young person or every assured person is medically examined by the Insurance Company and it is after a medical certificate is given by the doctor appointed by the Insurance Company that a policy is issued. On the one hand the Insurance Company issues policy after enquiring about the sound health of a person and on the other hand it has no mechanism at all nor can it be allowed to have any such mechanism which falls in domain of legal and law enforcement athorities like police or investigating officer or the inquest authority and in that eventuality there was no other option left with the Insurance Company but to accept the claim of the respondent. The only requirement in such a case was proof of death of a person in circumstances other than which require the inquest report or the report of the police or the record of medical treatment.

IN view of the foregoing reasons, we do not find any merit in the appeal and dismiss the same. A copy of this order, as per the statutory requirements, be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to record room. Appeal dismissed.