Complaint Case No. CC/39/2014 |
| | 1. Mithila Karali | vill-Satakama, via/ps-Kuchinda, Dist-Sambalpur |
| ...........Complainant(s) | |
Versus | 1. Branch Manager, L.I.C. India. | Panposh Branch, Dist-Sundargarh Duly represented though Sr. Divisional Manager, LIC, Sambalpur Division, Budharaja, Dist-Sambalpur. | 2. Commandant, (In-charge) | 6th Indian Reserve Battalion, Khordha, Odisha. | Khordha | ODISHA |
| ............Opp.Party(s) |
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ORDER | SHRI A.P. MUND, PRESIDENT:- Complainant Mithila Karali has filed this case against the O.Ps alleging deficiency in service. Complainant is the nominee and legal heir of Late Rohit Karali, who died on 16.3.2013 out of burn injuries at V.S.S.Medical College & Hospital, Burla at about 2.15 P.M. Late Rohit Karalai was working as a constable under the O.P.No.2. During his service at 6th India Reserved Battalion, Baraipali, he obtained two L.I.C policies from the Panposh Branch of the O.P.No.1 on 19.9.2011 vide Policy No.592267208 with sum assured of Rs.90,000/- with monthly premium of Rs.523/- and another Policy No.592267207 with sum assured of Rs.1,75,000/- with monthly premium of Rs.1,003/-. Both the policies are under triple cover endowment plan with maturity date on 19.9.2027. Both the policies are under Salary Savings Scheme. 2. Monthly premiums were being paid by the O.P.No.2 to O.P.No.1 by deducting from the monthly salary of the deceased policy holder Late Rohit Karali deposited the 1st premium amounting to Rs.2,006/- for policy No.592267207 vide Money Receipt No.0160530 and an amount of Rs.1,046/- was paid for Policy No.592267208 for the month of September and October,2011 in shape of Cash vide M.R.No.0160531 dt.19.9.2011.Complainant alleges that the O.P.No.2 collected premium amounting to Rs.9,156/- for both the policies for the period from August,2012 to November,2012 under Salary Savings Scheme by deducting from the salary of the deceased policy holder. 3. Complainant further avers that O.P.No.2 himself has honoured the claim of the nominee-mother, but O.P.No.1 illegally repudiated the claim by assigning reason that both the policies were in lapsed condition. O.P.No.2 intimated the same to the complainant on 24.5.2014. O.P.No.2 had knowledge regarding the disease suffered by Late Rohit Karalai and it is duty bound to collect the premium amount from his salary as the policies were obtained under Salary Savings Scheme.O.P.No.2 also never gave any intimation to the deceased policy holder regarding payment of premium which is clear violation of the regulations. On the basis of the above, complainant has filed this case and prayed to direct the O.Ps to pay her Rs.2,75,000/- in Policy No.592267208, Rs.5,25,000/- in Policy No.592267207 along with Rs.50,000/- for mental pain and agony, totaling to Rs.8,45,000/- with interest @ 16% per annum. 4. In order to support her case complainant has filed a list of documents along with copies thereof which are Xerox copies of: (1) Appointment letter of Rohit Karali issued by Commandant,OSAP 5th Battalion, Baripada (2) Report regarding death of Rohit Karali (3) Death claim Policy No.592267207 & 592267208of Late Rohit Karali dt.24.5.2014, 24.3.2014 and 18.1.2014 (4) Legal heir certificate issued by Tahasildar, Kuchinda of Late Rohit Karali (5) Proforma for T.V. certificate for settlement of claim in Policy No.592267207 & 592267208 (6) S.S.S.collection receipt in Policy No.592267207 & Policy No.592267208 (7) Forst premium Receipt in Policy No.592267208 & Policy No.592267208 (8) Jeevan Mitra (Triple Cover) 18 & 35 (9) SOPD Bed Tiocket, Emergency Deptt. V.S.S.Medical College Hospital, Burla (10) Death certificate of Rohit Karali issued by Registrar of Birth & Death, NAC, Burla (11) Autopsy over the dead body of deceased Rohit Karali (12) Inquest Report P.M.No.206/13/16.3.13 (13) Post Mortem Report 206/13 (14) Claimant statement of Policy No.592267207 & 59226720-8 of Rohit Karali (15) Certificte of hospital treatment on Policy No.592267207 & 592267208 (16) Certificate of Idemnity & burial or cremation of Rohit Karali on Policy No.592267207 (17) Medical Attendants certificate of Rohit Karali on Policy No.592267207 & Policy No.592267208. 5. O.P.No.1 appeared through their Advocate and filed its show cause acknowledging about the scheme that the policies were under Government Salary Savings Scheme (OGSSS) of L.I.C. of India, which can be availed by a regular Government employee. O.P.No.1 also admitted regarding the death of the deceased policy holder, who had taken two policies bearing No.592267207 & 592267208 commencing from 19.9.2011. According to the O.P.No.1, the policies were obtained at Panposh branch of L.I.C. of India and subsequently transferred to Baripada branch. 6. O.P.No.1 further avers that deceased life assured was working under Commandant 6th India Reserve Battalion, Khurda and the policies were attached to OGSS department of Cuttack Divisional Office of L.I.C. of India. According to this O.P., the claim under the policy Nos.592267207 & 592267208 were not in force and both the policies were in lapsed condition on the date of death of the deceased policy holder. The case of the O.P.No.1 is that L.I.C. did not receive premiums for both the policies within due period as per policy of contract. Therefore, the O.P.No.1 did not settle the claims as it is a pre-condition that policy should be in force as on the date of death of the policy holder. 7. The premiums for the above two policies were not received from December, 2012. As the policies were under monthly mode of remittance, only 15 days grace period was admissible and as premiums for the policies were not received for long period, the same were lapsed by the time of the death of the policy holder. O.P.No.1 has cited two clauses of the Government policy i.e. payment of premium and non-forfeiture regulations. 8. O.P.No.1 further avers that the deceased policyholder took up the responsibility to pay premium directly to the L.I.C. in case of non-receipt of salary for proceeding on leave without pay to prevent the policy from lapsing. The Commandant, O.P.No.2 was the paying authority and authorised by the deceased policy holder for remittance of premium and in the event of non-remittance of premium by the employer, duty is caste upon the policy holder to pay premium within due date. 9. O.P.No.1 further avers that the deceased policy holder was suffering from renal failure resulting in transplantation of kidney which was not within the knowledge of this O.P. and this is a suppression of fact. According to L.I.C., the prayer for relief sort for by the complainant is out of terms and conditions of the policy contract as the policies were in lapsed condition on the date of death of the policy holder. Therefore, repudiation of the claims by this O.P. is proper and justified and the O.P. has not committed any deficiency in service for non-settling of the death claims. Therefore the submission for reliefs claimed for is not maintainable and prays for dismissal of the complaint with costs. 10. O.P.No.2 appeared and filed its written version acknowledging that present petitioner is the mother and legal heir of deceased in the alleged two LIC policies issued in favour of the Late Rohit Karali. O.P./No.2 further admits that monthly premiums of Rs.523/- and Rs.1,003/- for the respective two policies were being deducted from the monthly salary of the deceased policy holder regularly from December,2011 to July,2012 in accordance with the authorization letter received from O.P.No.1. O.P.No.2 filed a chart showing the deducted premium amounts with date for the alleged two policies. 11. O.P.No.2 further submits that deceased policy holder was working as a Constable, who sustained disease during his training and was returned back to Ir Bn. Headquarters on 17.4.2012. The deceased was granted 20 days E.L. on medical ground with effect from 17.4.2012 to 7.5.2012. He was diagnosed with kidney disease and was treated in the S.C.B. Medical College & Hospital, Cuttack from 15.5.2012. 12. O.P. No.2 further avers that the deceased was newly recruited and served only for 1 year and 11 months till August, 2012. As no sufficient leave was due to his credit, so his pay was held up from August, 2012. So, it is no way concerned with the loss and sufferings of the complainant. 13. Heard the arguments from the parties. Complainant filed his written argument. Perused the complaint petition, written argument, versions filed by the O.Ps and documents filed by the complainant and placed on record. Advocate for complainant cited and filed two decisions in order to support the case of the petitioner which are as under: (1) 1997(II) OLR (CSR)-50 (Smt. Laxmi Patnaik Vrs. Divisional Manager, L.I.C. , Sambalpur Division & 2 Others) (Odisha State Commission) (2) Supreme Court of India (Delhi Electric Supply Vrs. Basanti Devi and Another) 28 September, 1999 14. Learned counsel for complainant argued that O.Ps are duty bound to intimate the policy holder regarding non-payment of premium amount from August, 2012. But in this none of O.Ps have ever intimated the deceased policy holder regarding non-payment of premium amount and lapsed condition of the two policies for non-payment of premium till the date of his death on 16.3.2013. 15. We carefully have gone through the decisions filed by the complainant. The Judgement of our own State Commission reported in 1997 OLR (CSR)-50 is a guiding factor to the present case. Facts of the reported case are quite similar to the facts of the present case. In para-5 of the judgement, the Hon’ble State Commission has held: ……………….This indicates that a duty is cast on the L.I.C. under the terms of the scheme itself that the policy-holder will not be required to remit the premium monthly to the L.I.C. but the same shall be deducted from his pay by his employer for the purpose of remitting the premium against his policy to the L.I.C………………………. In the same para it has further been held : ……………….In the aforesaid circumstances, it was also the duty of the L.I.C. to ascertain from the employer as to why the monthly premiums have not been remitted against the policy of the complainant’s husband and as to whether his leave was with or without pay……………….. 16. Considering the facts of the reported case, Hon’ble State Commission in para-9 of the judgement held as under: …………………In the aforesaid view of the matter, our conclusion is that the complainant would be entitled to the benefits of the policy from the L.I.C. and the L.I.C. if so advised may seek its remedy against the employer of the policy holder or anybody who is responsible for non-payment of the premium as alleged in their show cause. The aforesaid payment should be made within two months from the date of receipt of this order. We however, direct the L.I.C. may deduct the unpaid premium from out of the money to be paid to the complainant………………………… 17. In the present case, as stated by the O.P.No.2 premiums were remained unpaid from August, 2012 and the policy holder died on 16.3.13. During this period none of the O.Ps have ever intimated the policy holder regarding non-payment of premium amounts and lapsed condition of the policies. In case the policy holder or his family members were aware about non-payment of premiums, they would have directly deposited the same with the L.I.C. But O.Ps failed to do so, which in our opinion is against the interest of the policy holder/beneficiary under the policy. 18. After careful consideration of the facts and circumstances of the present case, we hold that the principles enunciated by the Hon’ble Odisha State Commission in the reported case is squarely applicable to this case. Accordingly, we allow the case of the complainant against the L.I.C.(O.P.No.1) on contest and hold that the complainant would be entitled to the benefits of the policies from the L.I.C. and the L.I.C. if so advised may seek remedy against the employer of the policy holder or anybody who is responsible for non-payment of the premium. The aforesaid payment should be made within two months from the date of order. However, L.I.C. may deduct the unpaid premiums from out of the money to be paid to the complainant. | |