The National Consumer Disputes Redressal Commission has held that in a case of unnatural death, where a DD entry is duly made, an Inquest is duly carried out, a Post Mortem is duly conducted, a private agency providing “medico legal services” does not wholly substitute for and replace investigation by police.
The Court said this while allowing a plea filed challenging the order of State Commission by a widow and a son of the deceased who had died more than a decade ago when he was run over by a train. The State Commission had denied the claim based upon insurance policy while relying on a report of a private agency which had termed the said incident was suicide and not accidental. Due to an exclusion clause of the policy, that it was not a case of accidental death, the insurance claim over the policy was denied to the family of deceased.
The NCDRC overruled the said order of the State Commission and has noted that as per the facts there were three more policies were taken by the deceased from the same insurance company/Tata AIG Life Insurance Corporation Ltd and the objection was raised by insurance company in respect of the fourth policy only. It was also the claim of the insurance company that the deceased didn’t inform the insurance company about his three policies. But the said issue was already settled by the State Commission and the State Commission had said “in the instant case of non-disclosure of the previous policies by the life assured is not fatal to the claim,” which was also endorsed by the NCDRC.
The NCDRC dealt in depth with the findings of the State Commission which had relied on the medico legal opinion dated 19/01/2011 from one Adroit Consultancy Medico Legal Services and had held that death of the deceased was due to suicide and not accidental.
NCDRC’s Presiding Member Dinesh Singh said, “There is no evidence on record that the life assured was under pecuniary difficulty debts etc., or was having family problems etc., or was having psychological disorders etc.”
He said, “there is no evidence on record that the Insurance Co. made a police complaint or filed a complaint before the competent judicial magistrate that a false case of accidental death has been made out for wrongful gain when the death was by suicide, or that any remedial action in case of the other three policies settled earlier was subsequently undertaken, or any disciplinary action against its functionaries responsible for settling the earlier three policies was taken.”
“In a case of unnatural death, where a DD entry is duly made, an Inquest is duly carried out, a Post Mortem is duly conducted, a private agency providing “medico-legal services” does not wholly substitute for and replace Investigation by the Police. And, in the instant case, there is nothing out of the ordinary or palpably erroneous in the Investigation conducted by the Police as may cause to place principal reliance on a private agency’s report,” the Court has held.
“Weighing the evidence in its totality, the eventuality of the death being accidental cannot be ruled out. In the facts of the given case, the benefit of preponderance of probability goes to the Complainants,” it added.
Further it stated that the State Commission erred in placing reliance principally on the report of a private agency engaged by the Insurance Co. and ignoring the complete spectrum of evidence in the matter, especially the DD entry, Inquest, Post Mortem Report and Police Inquiry Report.
“This Commission does not agree with the appraisal and reasoning of the State Commission on this issue and does not endorse the State Commission’s findings that in the instant case the death was due to suicide and not accidental,” the Court said.
Furthermore, it held that the Insurance Co. has wrongly withheld the claim in respect of the subject policy. It is also clear that there has been inconsistency and arbitrariness in decision-making by the Insurance Co., in identical facts and same points of law a different decision has been taken in respect of the first three policies and a different decision has been taken in respect of the fourth subject policy.
The NCDRC has directed the Insurance Co. through its chief executive to settle the claim of the subject policy with interest at the rate of 9% per annum from the date of filing of the Complaint before the State Commission till realization within a period of four weeks from today, failing which the State Commission shall undertake execution against the Insurance Co. through its chief executive (by name and by designation) as per the law.
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“For the undue harassment and the loss and injury caused to the Complainants and for the inconsistency and arbitrariness in decision making, a cost of Rs 1 lakh is imposed on the Insurance Co. through its chief executive, of which Rs 50,000 shall be paid to the Complainants and Rs 50,000 shall be deposited in the Consumer Legal Aid Account of the State Commission within a period of four weeks from today, failing which the State Commission shall undertake execution against the Insurance Co. through its chief executive (by name and by designation) as per the law. The Insurance Co. through its chief executive (by designation) is also advised to inculcate and imbibe systemic improvements for future, in that there is no inconsistency or arbitrariness in decision-making in identical facts and same points of law,” it added.
The matter was filed and argued by Adv Praveen Kumar Aggarwal.