Case Title: Life Insurance Corporation Of India & Anr Vs Hamida Bano & Anr.
Citation: 2022 LiveLaw (JKL) 264
Summary
The Jammu and Kashmir and Ladakh High Court has affirmed a Consumer Commission judgment that filing a First Information Report (FIR) may not always be necessary to process a life insurance claim when the insured’s death was caused by injuries sustained in a fall. The ruling was made on an appeal from the Life Insurance Corporation (LIC) of India against the ruling of the J&K State Consumer Grievance Redressal Commission, Srinagar. The Commission had accepted the complaint and granted the next of kin of a man who died after falling off the veranda of his home, a sum of Rs. 6 lacs plus 9% interest. However, the LIC denied the claim, stating that the lack of a FIR record prevented it from being processed and paid.
About the case
Recently, the Jammu and Kashmir and Ladakh High Court affirmed a Consumer Commission judgment that stated that filing a FIR may not always be necessary in order to process a life insurance claim when the insured’s death was caused by injuries sustained in a fall.
Judges Sanjeev Kumar and Moksha Khajuria Kazmi made these observations in their ruling on an appeal from the Life Insurance Corporation (LIC) of India against the ruling of the J&K State Consumer Grievance Redressal Commission, Srinagar. The Commission had accepted the complaint and granted the next of kin of a man who had died after falling off the veranda of his home, a sum of Rs. 6 lacs plus 9% interest.
The father of the respondents got a life insurance policy with a “Double Accident Benefit” clause. This clause stated that LIC would be responsible for paying twice the sum assured if the life insured passed away as a result of an accident that occurred within the policy’s term. The bench learned from the case pleadings that the insured fell from his home’s veranda unintentionally while the insurance policy was in effect, resulting in fatal head injuries. After being transported to the closest hospital, he passed away from his wounds en route.
His children then notified the LIC of the unintentional death and gave them the medical certificate from the attending physician, a copy of the death certificate from Police Station Kupwara, and a certificate from the patwari of the Patwar Halqa in question. However, the LIC denied the claim, stating that the lack of a FIR record on the insured person’s accidental death prevented it from being processed and paid.
The next of kin filed a complaint with the Commission in Srinagar as a result of LIC’s decision to reject the claim. The Commission investigated the case and determined that filing a First Information Report (FIR) in relation to an accidental death of an individual is not always a requirement in order to file a claim. LIC challenged the order at the High Court. The division bench stated that the Commission’s position is “unexceptionable” and fully compliant with the law.
Further elaborating, the court said that the respondents wisely chose not to file a formal complaint (FIR) in this case because the accident could not be directly attributed to any individual’s conduct or omission. Regarding the argument put forth by Adv. Shahbaz Sikander Mir on behalf of the appellant, which was that the insured had not accurately disclosed his age and had submitted a false date of birth certificate at the time of insurance, the bench stated that the birth certificate that the insured had provided at the time of insurance could not be unilaterally declared as fraudulent or forged by the insurance company unless an opportunity to be heard was granted to the individual who submitted the certificate or, in the event of his death, his legal heirs.
