Life Insurance Corporation of India vs Sudha Jain

THIS is an appeal against the order dated 18.12.2002 passed by the District Forum, Udham Singh Nagar wherein the complaint of the complainant for recovery of accidental benefits of both the policies of the complainant was allowed along with interest @ 9% and cost of Rs. 1,000/- (Rupees one thousand).

ADMITTEDLY Smt. Sudha Jain is the widow of Sh. Suresh Chandra Jain who had got two double benefit policies including insurance and accident. Sh. Suresh Chandra Jain met with an accident on 2.10.1993 and admittedly he died on 8.2.1994. After the death the Insurance Company paid the amount of the policy but did not pay accident benefit, therefore, the complaint was filed. ADMITTEDLY the claim was rejected on the ground that the victim died after 120 days of the accident. After taking the evidence of the parties and hearing them, the learned Forum held that the complainant was entitled to the amount, the victim remained in coma for 130 days. The Forum held that the terms were against Section 28(b) of the Indian Contract Act. Being aggrieved by the above order, the present appeal has been filed.

We have heard the learned Counsel for the parties and gone through the records. The facts of the case are admitted from both the sides. The Insurance Company produced the policy of the deceased wherein there is specific provision under Clause 10(b) that "the Insurance Company will pay an additional sum equal to the sum assured under the policy, if the life assured sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury causes death of the insured within 90 days of the occurrence". It is said by the Insurance Company that since the deceased died after 90 days, therefore, additional sum under this clause shall not be paid.

THERE is no dispute that the victim died solely and directly from the accident caused by the scooter accident but the claim has been denied on the ground that he died beyond the prescribed period. The learned Forum has held that the clause is hit by Section 28(b) of the Indian Contract Act. The learned Counsel for the Insurance Company Sh. T.S. Bindra referred the ruling reported in (1993) 8 Supreme Court Cases 357, Saushish Diamonds Ltd. v. National Insurance Co. Ltd., in which it has been held that if different interpretation is given to the policy, the matter can be decided by the Civil Court and not by the District Forum. In this case, no different interpretation has been given, it is only said that the clause is hit by Section 28(b) of the Indian Contract Act.

IN our view, the clause may be hit by Section 28(b) of the INdian Contract Act or not but the INsurance Company itself has waived this clause of policy. IN the clause 90 days have been given but in the written statement, it is alleged in para 16 that the period of 90 days has been extended to 120 days and this benefit has been given to all the policy holders after 15.9.1989. Thus what was the contract between the parties was the terms of the policy, any outside direction was not a term of the policy and according to the own admissions of the INsurance Company, this term of policy has been waived and has been extended to 120 days. IN our view if by separate notification or direction, the period of 90 days can be extended to 120 days, it can be extended to 130 days also because the complainant cannot be blamed if the victim died within 120 days. The accident was there, the victim went into coma and if it is his mistake that he died within 130 days, the complainant cannot be blamed for that. IN suitable cases this period of remaining into coma can be excluded from 130 days and it is admitted fact that the victim went into coma immediately and remained in coma till his death. IN the ruling reported in 101 (2002) DLT 25=I (2003) ACC 178=AIR 2002 Delhi 485, Smt. Sipra Chatterjee v. Union of INdia & Others, the insured met with an accident and immediately went into coma. Permanent disability incurred till his death. Premium could not be paid. IN this case there is no dispute of premium but in this ruling the accident took place on 1.3.1997, the victim died on 18.12.1997 still the claim was allowed by the Hon''ble High Court. The ruling given by the Hon''ble High Court is binding on all the Forums and State Commission. IN this ruling in para 8 also the provisions of Section 28(b) of the INdian Contract Act were made applicable. IN our view the learned Forum did not commit any mistake in allowing the claim and the judgment of the learned Forum is further fortified by the finding that this plea of 90 days has itself been waived by the appellant. This appeal has got no force and is to be dismissed. ORDER The appeal is hereby dismissed. Cost of the appeal shall be easy. Appeal dismissed.