‘Dishonest motive’

• The commission observed that the evidence given by the insurance company clearly proved that the “gunshot was self-inflicted/suicidal” and the deceased had shot himself intentionally and not accidentally.
• It said “no prudent person” would hold a revolver so close to his temporal bone that it would be hazardous to his life.
• The commission said the argument that the insured was rotating the revolver in a “filmy style and he accidentally shot himself” was not convincing, as he not only placed the revolver on the “temporal of his face” but also took it from his friend’s custody and proceeded to attend nature’s call.
• It noted that such situations did not happen daily, and it only seemed that the intention of the insured was to kill himself or cause self-inflicted injury.
• According to the commission, the fact that the incident took place on the same day on which the policy commenced has led to a detrimental conclusion that there was a dishonest motive behind “taking the policy and thereafter dying on the same day.”
• The commission held that the insurance company, with “cogent and convincing evidence,” has justified its stand of rejecting the claim of the wife, as the same did not fall under “personal accidental death” coverage.
• Therefore, the 2022 order of the district commission awarding Rs 10 lakh, with interest of 9 per cent per annum, was set aside by the state commission, and the complaint was dismissed.
• It was also directed that the amount of Rs 6.82 lakh, deposited by the insurance company at the time of filing for the appeal, be returned to the firm, along with the applicable interest.

‘Filmy style’

• Jagmohan Singh bought an individual personal accidental policy from the insurance company, it was noted.
• The policy was valid from May 16, 2016, to May 15, 2017, for the sum assured of Rs 10 lakh against a premium of Rs 1,119.
• On the same day that the policy was bought, he went to the deputy commissioner’s office in Bathinda along with one Bhupinder Singh and one Dharamvir Singh in order to obtain an arms license for Dharamvir.
• While the three were returning from Bathinda, they stopped the vehicle at about 12.30 pm to relieve themselves. Jagmohan allegedly took Dharamvir’s and went to urinate.
• He then started moving the revolver in a “filmy style” and suddenly a shot was fired from the revolver, which hit Jagmohan in the head and he died on the spot.
• The incident was reported to the police by Jagmohan’s son, and a report was lodged at Dayalpura police station in Bathinda district on May 16, 2016.
• The wife of the deceased, being his nominee, filed a claim with the insurance company submitting all the required documents.
• She also sent a legal notice to the insurance company, requesting it to pay the claim amount of Rs 10 lakh.
• In response to the said notice, the insurance company sent a letter asking for some documents that were not received by it for finalising the claim.
• By a letter dated October 6, 2016, the wife informed the insurance company that she had already submitted all the documents along with the claim.
• After the insurance company failed to settle the claim, the wife filed a consumer complaint before the district commission.
• The district commission, on March 28, 2018, directed the insurance company to decide the claim as per the documents submitted by the wife.
• The insurance company, by a letter dated May 25, 2018, rejected the claim by applying the exclusion clause mentioned in the policy terms and conditions.
• The wife again approached the district commission and alleged that the service was deficient on the part of the insurance company.
• She prayed for direction to the insurance company to pay for the accidental death claim of Rs 10 lakh, along with interest at 18 per cent per annum, and to further pay Rs 2 lakh as compensation, along with Rs 1 lakh as the cost of litigation.
• The district commission on January 31, 2022, ordered the insurance company to pay the insurance claim of Rs 10 lakh with interest of 9 per cent per annum, besides Rs 5,000 as costs and compensation.
• Against the said judgment, the insurance company filed an appeal seeking to set aside the order, and the wife moved another appeal for enhancing the compensation, litigation amount, and interest from the date of the accident.

‘Suicide or self-inflicted’

Advocates Hritik Sharma and Vishak Bharadwaj, appearing for the insurance company, argued that the district commission overlooked the fact that the company took a specific plea that it was a case of suicide, where the deceased had bought an insurance policy on May 16, 2016, and killed himself on the same day.

It was submitted that the incident was investigated by an independent investigator, and according to his report, the deceased was upset over the problems being faced by her daughter in her marital home.

The counsel urged that the district commission did not take notice of the fact that the insurance company had appointed a forensic analyst, who had given a clear report that it was not a case of accidental firing but one of suicide.

It was further argued that even if it was presumed that it was not a case of suicide, even then, it is definitely a case of self-inflicted injury, and hence, no claim was payable under the said policy

‘Accidental death’

Advocate Nitish Grag, representing the wife, contended that the district commission had rightly observed that the insurance company had appointed an investigating agency, which investigated the matter and submitted its report on June 22, 2017.

It was further submitted that the insurance company had appointed another investigator, who had not joined any eyewitness, and the matter was also brought to the notice of the police. After the investigation, it was found that it was an accidental death.