The Jammu and Kashmir and Ladakh High Court in an appeal filed by the Life Insurance Corporation of India against the order passed by the Jammu and Kashmir State Consumer Grievance Redressal Commission held that the registration of an FIR is not a sin qua non for processing the case under the policy of life insurance in case of accidental fall death.

The Court upheld the order of the State Commission that awarded a sum of Rs. 6 lakhs along with 9% interest in favor of the respondents.

The Bench of Justice Sanjeev Kumar and Justice Moksha Khajuria Kazmi adjudged –

"Since the accident was not attributable to any act or omission of any person as such the respondents in their wisdom did not lodge an FIR in the matter. As a matter of fact, in the accidents of the nature that claimed the life of the father of the respondents, there is hardly any necessity to lodge an FIR. This is so because for such accident like a person falling from veranda and sustaining fatal injuries, nobody can be held responsible. It is in this backdrop, the Commission correctly held that in the case of such nature where the death of the insured has occurred due to injuries suffered from a fall, the registration of FIR may not be required. We are entirely in agreement with the Commission that in the case of this nature, the registration of FIR is not a sin qua non for processing the case under the policy of life insurance. Moreso, when there is other evidence in abundance to demonstrate that the deceased insured had died in an accident."

The Bench further stated that the plea of the counsel for LIC that the insured had not correctly disclosed his age and submitted a false date of birth certificate at the time of insurance cannot be accepted at the appellate stage.

Advocate Shabaz Sikander appeared on behalf of the appellants while Advocate Tufail Qadri appeared for the respondents.

In this matter, the father of the respondents had obtained Life Insurance Policy with Rs. 3 lakhs as a sum assured. The policy was issued by LIC in favour of the father of the respondents. It contained a clause of "Double Accident Benefit" cover, which provided that in case the life insured would die due to an accident during the currency of the policy, the insurer (LIC) would be liable to pay double the sum assured. During the validity of the insurance policy, the insured i.e., the father of the respondents accidentally fell from the veranda of his house and sustained fatal head injuries. He was taken to the nearest hospital where he succumbed to injuries on his way.

The respondents informed LIC about the accidental death of their father and provided them with the medical certificate issued by the Medical Officer, a copy of the death certificate issued by the Police Station, and one issued by the Patwari concerned. The claim put forth by the respondents for payment of double the sum assured i.e., Rs. 6 lakhs under the policy of insurance were repudiated by LIC on the ground that the claim submitted by the respondents was without a copy of the FIR, if any, registered in the matter. The respondents, therefore, filed a complaint before the State Commission. The Commission rejected the stand of LIC and allowed the complaint. Hence, the LIC approached the High Court.

The High Court after hearing the contentions of both parties noted, "… we are of the opinion that the view taken by the Commission is unexceptionable and in complete conformity with the legal position. It is not in dispute that on the date the father of the respondents met accidental death he was covered by an insurance policy issued by the LIC. It is true that the sum assured in the policy was Rs. 3 lacs but the insured was entitled to double the sum assured in case he would die due to accident."

The Court further held that the medical record as also the copy of the death certificate issued by the authorities clearly demonstrates that the insured had died due to injuries suffered in an accident.

The Court concluded and held, "There is no whisper in the objections filed by LIC before the Commission to this extent nor any effort was made by LIC to submit supplementary pleadings to raise the issue of forged certificate of date of birth provided by the insured at the time of insurance. Otherwise also the date of birth certificate produced by the insured at the time of insurance can not be unilaterally declared by insurance company as fake and forged unless the person who has submitted such certificate or his legal heirs in the case of his death are given an opportunity of being heard."

Accordingly, the Court found no substance in the appeal and dismissed the same.

Cause Title - Life Insurance Corporation of India & Anr. v. Hamida Bano & Anr.

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