Orissa

Kendujhar

CC/38/2015

Smt. Krishna Pradhan - Complainant(s)

Versus

1. The Zonal Manager, L.I.C. of India - Opp.Party(s)

Sri G.N. Jena & H.S. Mohanty

10 Feb 2016

ORDER

IN THE COURT OF THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KENDUJHAR

CONSUMER COMPLAINT CASE NO. 38 OF 2015

    Smt. Krishna Pradhan, aged about 41 years,

    W/o- Late Tapan Pradhan,

    Soket Ali Complex, Station Road,

    Near O.M.C. Chowk, Barbil,

    P.O/P.S- Barbil, Dist- Keonjhar                    ….………………Complainant

                        Vrs

1. The Zonal Manager, L.I.C. of India,

    East Central Zonal Office,

    Jeevan Deep Building, 6^th Floor,

    Exhibition Road, PATNA-800001

2. L.I.C. of India, Cuttack Divisional Office,

   “Jeevan Prakash”, P.B. No. 36, Nuapatna,

    Mangalabag, Cuttack-753001

3. Branch Manager, L.I.C. of India,

    Barbil Branch Office, Cuttack Division,

    At/P.O - Barbil, Dist- Keonjhar                   ………………….Op. Parties

 

PRESENT: - Shri A.K. Purohit, President

                    Mrs B. Giri, MEMBER (W)

                    Sri S.C. Sahoo, MEMBER

Advocate for the complainant - Sri G.N. Jena & H.S. Mohanty

Advocate for the O.Ps - Sri T.K Mohapatra and P.K. Jena

__________________________________________________________________________________ 

Date of Hearing - 20.01.2016                                Date of Order- 10.02.2016

Sri S.C. Sahoo, Member:

1. The brief facts of the case is in nutshell that the complainant is the legal heirs as well as the real nominee of the deceased consumer Late Tapan Pradhan has filed this case U/s 2(1)(b) of Sub-section ‘V’ that the deceased Tapan Pradhan was a Policy holder before the Op-3 having New Bima Gold Policy bearing No. 598559258, on dt.12.12.12 with sum assured of Rs.1.00 (Lac) and another Policy of Endowment assurance Policy bearing No. 598556163, dt.28.5.12 with sum assured of Rs.5.00 (Lac) and the date of risk of Endowment Policy was 11.6.12 and date of maturity is 28.5.2028 with an yearly payment of Rs.33,862/- as premium and the other Policy i.e. New Bima Gold was an early payment of Rs.6882/- as premium by the deceased Policy holder and accordingly went on paying premiums of both the Policy. The deceased Policy holder was died on 3.3.2013 at 8.10 pm at Sanjukta Curatives, B.K. Canal Road, Cuttack-1 bearing Regd. No. 315/2004, suffering from fever and pneumonia sepsis and prior to death the deceased Policy holder was admitted SCB Medical College & Hospital wherein Dr. U.C. Patra MD. DM (Gastro) Professor and Head of Department had treated the deceased Policy holder and diagnosed pneumonia. After the death of the Policy holder Tapan Pradhan the nominee Smt. Krishna Pradhan deceased wife lodged claim before the Ops for early settlement of the claim of the deceased Policy holder. But the Op-2 had repudiated the claim of the deceased Policy holder on 31.3.2015 on the ground of suffering from Polysystic liver disease which was existed since birth which is arbitral, unethical and unjust action of the O.Ps causes mental agony of the nominee as well as financial loss to the complainant/ nomine. Hence this case:               

2. After service of notice to Ops the Ops appeared and filed their Joint Version stating that the complaint petition is not maintainable in law or in facts and not maintainable for mis-joinder of parties like Op-1 who neither resides nor works for gain at the place do not fall within the purview of Section- 11(2)(a) of C.P. Act- 1986 and committed no deficiency of service and there is no cause of action to file the present case against these Ops and not engaged unfair trade practice and the claimant had not submitted the past treatment records of the deceased intentionally and basing upon the available medical reports like Dr. U.C. Patra and DMR (Divisional Medical Referee) who is a Physician in the rank of Professor of Medicine of SCB Medical College, Cuttack and as such the claim of the nominee was rightly repudiated.     

3. Heard both the parties, before going into the merits of the case. The learned advocate for the Ops raised preliminary objection regarding maintainability of the case and submitted that Op-1 was un-necessary party who neither resides nor works for gain at the place impleaded as Op-1 and the medical prescription written by Dr. U.C. Patra Prof. H.O.D. shown the deceased was suffering from Polysystic liver disease, pneumonia sepsis, Type-2 Diabetic and the deceased was habituated of taking Gutkha and Smoking and was also suffering with Jaundice at the time of admission in SCB Medical College & Hospital which was existing since from birth. On the other hand the learned advocate for the complainant/ nominee of the deceased submitted that all the past treatment particulars of SCB Medical College as it was a sudden illness for which she failed to produce past treatment reports and intimated to Op-2 in writing and despite providing all the documents to Ops who repudiated the claim of the complainant on 31.3.15 stating that the deceased Policy holder had already been suffering from Polysystic liver disease which was existed since from birth caused death further the learned counsel submitted that the disease which was not detected at the time of taking Policies from the Op-3, where Insurance Policy was issued after examination of insured by doctor of Insurer then repudiation of claim on the ground of suppression of vital facts amounts to deficiency in service by the Ops.               

4. Perused the materials available on record and perused both the Policy of the deceased made on 28.5.2012 & 12.12.2012 reveals that the death benefit is payable in case of death of life assured during the Policy term provided the life cover is in force for the full time assured.

5. With these material available on record it is proved that there is deficiency of service on the part of the Ops repudiating the claim of the complainant/ nominee of the deceased after executing Policy proposals which is a Insurance contract and as such Ops are jointly and severely liable for deficiency of service on repudiating the claim of the complainant/ nominee of the deceased.   

ORDER

  Hence, the Ops are directed to pay the assured amount of both the Policy of the deceased Policy holder amounting Rs.5.00 (Lac) + Rs.1.00 (Lac) making a total amount of Rs.6.00 (Lac) to the complainant/ nominee of the deceased along with Rs.5000/- towards cost & compensation for harassment & financial loss within 30 days of receipt of this order failing which the entire amount will carry an interest @ 10% p.a till realization.  

Accordingly the Case is disposed of.

 

                                                                                                I agree                                                                      I agree                                                                                     

     (Sri S.C. Sahoo)                                                       (Smt. B. Giri)                                                       (Sri A.K. Purohit)                 

           Member                                                               Member (W)                                                             President                               

 D.C.D.R.F Keonjhar                                                D.C.D.R.F Keonjhar                                               D.C.D.R.F Keonjhar

                                                                                                                      Dictated & Corrected by me

                                                                                  (Sri S.C. Sahoo)                                                                        

  Member, D.C.D.R.F Keonjhar