DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 21st day of May, 2018
Present:-
1. Shri Raghunath Kar, President
2. Shri Basanta Kumar Mallick, Member
3. Afsara Begum, Member
C.D Case No. 77 of 2017
Sanjukta Sarangi
W/o Late Akshaya Kumar Sarangi
At: Mirzapur
Po/Ps: Dhamnagar
Dist: Bhadrak
……………………. Complainant
(Versus)
1. The Branch Manager
LIC of India
Bhadrak Branch
At/Po/Ps/Dist: Bhadrak
2. Chief Manager
LIC of India, Cuttack
Po/Ps: Mangalabag
Dist: Cuttack
…………………………..Opp. Parties
Advocate for Complainant: Mr. B. Mohanty & Associates
Advocate for O.Ps: Sri Ddebendra Nath Panda
Date of hearing: 11.04.2018
Date of order: 21.05.2018
SRI BASANTA KUMAR MALLICK, MEMBER
The dispute arises out of a complaint filed by the complainant alleging deficiency of service.
The brief facts of the case are to the effect that the complainant is the widow and nominee of the insured namely Late Akshaya Kumar Sarangi who died in a road accident on 25.06.2014 and as the nominee, the complainant raised/staked claim with LIC of India, Bhadrak for death and accidental benefit @ Rs 1,00000/- each together with admissible bonus total of which comes to Rs 2,00000/- plus. In considering the claim proposal, the O.Ps settled the claim for Rs 1,00000/- under the provision of “death claim of premature policy” leaving aside the accidental death claim which forms a part of the claim has been settled. Complainant, once again, submitted an application to the OP No. 1 requesting rest half of the total claim on dt. 08.12.2015 enclosing death certificate etc. which was received by office on the said date on proper acknowledgement. O.Ps did not feel it necessary to respond the application of the complainant, rather preferred to overlook the grievance. The complainant as a legally entitled claimant ran to the office of OP No. 2, time and again, for settlement of accidental benefit claim but the O.Ps did not pay any heed to the grievance of the complainant which compelled her to file this dispute in the Forum, as she did not find any alternative, paying for a direction to the O.Ps to settle the accidental death claim together with cost and compensation.
O.Ps resisted the claim of the complainant and contests the case in engaging there legal retainer to conduct the case. In the written version so submitted, the counsel for O.Ps have raised that the complaint is not maintainable in facts, on the ground of suppression of truth, the complainant has not come to the Forum with clean hands and therefore the complaint is liable to be dismissed. The O.Ps have admitted the fact that the complainant’s deceased husband had taken up an insurance policy bearing No- 599450087 for a sum assured of Rs 1,00000/- commencing from 28.07.2013 with yearly premium @ Rs 6951/-. The life assured died in an accident on 25.06.2014 and the death claim of Rs 1,00000/- was settled for Rs 1,00000/- which was credited to the SB account No- 50211838350 of the complainant maintained with Allahabad Bank, Bhadrak. As the accidental benefit was not included in the said policy No- 599450087 the accidental benefits as claimed by the complainant is never due under the policy. Further it is also added by the O.Ps that while proposing for taking up the policy, the occupation of the life assured was ‘Truck Driver’ and therefore he had proposed for the accidental death benefits in the proposal form which was not allowed by the insurer. In such cases the accidental benefits is excluded due to occupation hazard and extra premium is not accepted. Hence payment of accident benefit at the request of the complainant is next to impossible. Moreover the O.Ps have also submitted that the policy under dispute was not covered under consideration for accident benefits and the extra premium @ Rs 1/- per thousand was not paid by the insured covering the sum assured. As the O.Ps have accepted the premium at ordinary rate that is why the accident benefit was not allowed to the complainant which is very much genuine. Hence under above circumstances the claim of the complainant is not genuine and liable to be rejected and dismissed with exemplary cost.
We have gone through the complaint, written versions and perused materials on record and observed as narrated here under.
Admittedly the husband of the complainant was an insured under O.Ps for a sum assured of Rs 1,00000/- bearing policy No- 599450087 which commenced from 28.07.2013 with yearly premium of Rs 6951/-. The insured died in an accident on 25.06.2014 and the death claim has already been settled and credited to the SB account of the complainant maintained with Allahabad Bank, Bhadrak. Leaving aside the above facts other allegation narrated in the complaint are disputed.
1. The complainant claims that her husband died in a road accident and she being the nominee of the policy, staked claim with the OP No. 1 for settlement. In consideration of the claim proposal, O.Ps settled the death claim for Rs 1,00000/- equivalent to sum assured and credited the amount to the SB account of the complainant maintained with Allahabad Bank, Bhadrak Branch. When the complainant found she has been deprived of her entitlement of accident benefit, she submitted a letter on dt. 08.12.2015 to OP No. 1 requesting release of accident benefit but the O.Ps turned a deaf year to the grievance petition and even did not prefer to make correspondence with the claimant who is rendering a life not less than a destitute. On the other hand O.Ps have taken the plea that the policy bearing No- 599450087 does not include the accident benefit as O.Ps have not collected any extra premium @ Rs 1/- per thousand of the total sum assured. In the said premises complainant is not entitled to get the same. Further the complainant has submitted a copy of the original proposal form in obtaining from OP No. 1 under the provisions of Right to Information Act where in it is clearly opted by the insured for accidental benefit. The O.Ps have taken the plea that the required extra premium was not collected for extra benefit and hence the policy so issued under Table Term 179/2016 which is an ordinary policy and the benefits as claimed by the complainant is not admissible under such policy.
2. It is nothing but the only truth that the insured opted for accident benefit which is at column 5 of clause 3 of the proposal form under broad head “it is in the interest of proposal to avail the facility of nomination” and it is also evident that the agent bearing agency code 03744503 has filled up the form and has also signed the original proposal form as an witness. Hence it is made clear that the insured has opted for accident benefits. Secondly as per the submission of O.Ps if such benefit would not be allowed to policy holder/insured who is a professional driver, the agent could have denied and clarified the doubt of the insured instantly and also mentioned “No” in column 5 of clause 3 of the proposal form but the agent has mentioned in his own handwriting as “Yes” under subhead “is accident benefit required”. Further the proposer of the policy is not having sound knowledge about the table term and premium. The insured has paid the premium amount as calculated by the agent Sri Promod Kumar Upadhaya who is the official authorized agent of O.Ps to motivate the people for business for the O.Ps as the “Master” and the agent working on behalf of O.Ps as “servant”. It is the settled position of law that the master is responsible for the fault of the servant. Hence the gross misstate of the agent must be treated as mistake of the O.Ps and for the mistake of the O.Ps, the innocent widow of the deceased insured should not suffer. Hence the actions of O.Ps in not responding the prayer of complainant and in not releasing the accident benefit are considered as deficiency of service and this Forum holds the O.Ps are liable for payment of accident benefit as claimed by the complainant. Hence it is ordered;
ORDER
In the result the complaint be and same is allowed in part against the O.Ps on contest. O.Ps are directed to release the accident benefit of Rs 1,00000/- in favour of the complainant along with Rs 2,000/- as cost of litigation and credit the amount to the SB account of the complainant maintained with Allahabad bank within 30 days from the date of receipt of this order. Any deviation in complying this order within the stipulated time shall attract imposition of interest @ 9% P.A on the benefit amount with effect from the date of order.
This order is pronounced in the open Forum on this day of 21st May, 2018 under my hand and seal of the Forum.
