Jharkhand

Bokaro

CC/17/53

Sri Sundar Tudu - Complainant(s)

Versus

Branch Manager, LIC India - Opp.Party(s)

Parikshit Mahto

05 Jan 2022

ORDER

1. Complainant has filed this case with prayer for direction to O.Ps. to pay insurance claim of Rs. 3,00,000/- with 12% interest P. A. since 28/12/2014 and for payment of Rs. 1,00,000/- and Rs. 20,000/- as compensation and litigation cost respectively to the complainant.
2. Complainant’s case in brief is that while complainant was in    service of Bokaro Steel Ltd.  he purchased LIC policy on 21.06.1997 having policy No. 541232675, policy dated 26.03.2003 No. 543033835 both for Rs. 50,000/- each having maturity date 21.06.2017 and 24.04.2017 respectively. He also purchased double accidental benefit policy No. 542010139 of Rs. 1,00,000/- having maturity date on 28.02.2017.  Further case is that unfortunately on 08.06.2013 at about 07:30 P.M. due to fall from high roof complainant sustained grievous head and spine injury causing 75% disablement and due to it he became paralytic. Due to permanent disablement complainant obtained voluntary retirement from his service who filed insurance claim on 28.12.2014 before the O.Ps. but it has not been settled for long period in spite of repeated request. Lastly on 18.03.2016 Legal Notice was served on O.Ps. having no impact hence this case has been filed with above noted prayer.
3.       O.Ps. appeared and they have filed W.S. mentioning therein that there is no cause of action. W.S. further discloses that except para 10 of the complaint petition there is no specific denial of the facts mentioned in the complaint petition.  As per W.S. there is no denial regarding opening and issuance of alleged three insurance policies and its maturity dates. It has been mentioned in the W.S. that till date claim of the complainant has not been repudiated rather it is in process of the consideration. Hence there is no cause of action and complaint is liable to be rejected.
4.     Issuance of all three LIC policies is not in dispute. The date regarding issuance of policies and its maturity date are also not in dispute. Value and nature of the policies are also not in dispute. It is also apparent that both parties are admitting the fact that no payment has been made by the O.Ps. to the complainant in respect to those LIC policies.
5.   Photo copy of all the three policies have been filed by the complainant for perusal of the Commission. Acknowledgement slips dt. 03.03.2015 and 04.03.2015 are showing that claim form, policy papers, Bond etc have already been submitted before the O.Ps. for settlement with due acknowledgment by the O.Ps.
6.     During course of argument, it has been submitted on behalf of the O.Ps. that the complainant himself has disclosed that he became disable on 17.01.2014 hence information to the O.Ps. regarding disablement has been furnished after the statutory period of 180 days from the date of disablement, hence complainant is not entitled to get any claim. But it appears that this fact has not been alleged in the W.S.
7.    On perusal of terms and conditions of policy bond as indicated in para 11 it is apparent that “ information regarding disability is required to be given immediately after the happening, of the disability, full particulars thereof must be given in writing to the office of the corporation where this policy is serviced together with the then address and where about of the life assured and within 180 days after the happening of the disability there must be given to the servicing branch office of the corporation in the manner required by it proof of disability satisfactory to the corporation “.
8.   On perusal of photo copy of pay slips of the complainant it is being disclosed that after the accident also monthly premium of the LIC Policies has been paid to the O.Ps. Claim for disability benefit form shows that complainant has declared himself disabled from 17.01.2014 and has also declared that said disability is due to fall from height causing head injury with paralysis due to falling on 08.06.2013.  On perusal of terms and conditions of the policy bond it is apparent  that the information regarding disablement is required to be given within 180 days immediately after the happening of the disability. It is common prudent that everyone will be hopeful that he may recover from the injury and may perform all normal activities but when medical experts say that such injury is irrecoverable rather it is permanent disability then he feels that now he become disable. Therefore, when that person comes to know about disablement then it is required to give information to the corporation within 180 days of the disablement and it cannot be interpreted that said 180 days will be counted from the date of accident. However, there is no such averment in the W.S. of the O.Ps.
9.    Another aspect is to be considered by the Commission is that Form 5280 has been filled up by the expert Doctor on 17.11.2014 in which at serial No. V and VI detail information regarding disablement, its percentage, etc were required to be furnished by that very doctor but said doctor has not disclosed his opinion, rather he has mentioned that “As per Medical Board”. This aspect cannot be ignored by the Commission that when Medical Expert is not in a position to say about the disablement then it cannot be expected from a common/lay man to disclose  it in a manner better than the medical expert. Photo Copy of the disability certificate No. 227 Bokaro  dated 19-02-2015 shows permanent disability of 75% and it has been issued by a medical board of the State of Jharkhand. In this way complainant has well established the fact that he became disabled due to accident and suffering with permanent disability.
10.  Another aspect is to be considered by this commission is that all the policies have became matured on 21-06-2017, 26-04-2017 and 28-02-2017 respectively hence complainant is entailed get maturity benefit also.
11. In light of above discussion we are of the opinion that there is deficiency of service by the O.Ps. and complainant is entitled to get relief as prayed. Accordingly prayer is allowed in the manner indicated below:-

O.Ps. are directed to pay within 45 days from today Rs. 3,00,000/- (50,000 +50,000+2,00,000)with 6% P.A. interest since 18-12-2014 to the complainant failing which they shall pay the interest @ 12% from 18-12-2014.

O.Ps. are further directed to pay within 45 days from today the compensation of Rs. 50,000 to the complainant (A permanent disabled paralysed person) for the harassment (Mental and Physical) caused to him since long period.

O.Ps. are further directed to pay Ra 20,000/- as litigation coastwithin 45 days from today.

Let a copy of this order be given to the parties free of cost.