Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs : Raj Kumar Mondal
Date of filing of the case :04.01.2022
Date of Disposal of the case :22.02.2024
Final Order / Judgment dtd.22.02.2024
The basic fact of the case of the complainant in a nutshell is that the Bijay Das son of the complainant Bipad Das during his lifetime purchased an insurance policy of LICI (OP) vide plan no. 179 terms
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and conditions 16 years vide policy no. 426123812, sum assured Rs.50,000/- accidental benefit rider sum assured Rs.50,000/- , through agent of LICI. The said policy holder Bijay Das died on 22.03.2014 in an accident against which a police case vide Kotwali P.S case no.UD150/2014 dated 23.03.2014. After the death of the policy holder the complainant as nominee informed the matter to the agent of LICI and submitted all relevant documents to him. Thereafter, the complainant several times met with the agent of the LICI to settle the claim but to no effect. Subsequently, on 18.07.2018 the complainant submitted an application along with death certificate , P.M report, etc. to the OP No.1 Branch Manager LICI. On 13.04.2021 the complainant submitted original policy bond along with death certificate inquest report, on police final report, PM report, cremation certificate, Voter Identity Card etc. Thereafter, the Branch office of LICI sent a letter to the complainant on 29.04.2021 along with some forms. Complainant filled up the said form along with relevant documents. Subsequently, OP No.1 investigated the matter and verified all the documents. Despite fulfilling all the conditions the OP No.1 did not settle the claim. They lastly informed that they had submitted report to the Divisional Manager being OP No.3 Salt Lake City LICI, Kolkata. But till date they have not settled the claim. So, the OPs have violated the rules of IRDA. So, the complainant files this case. The cause of action arose on 13.04.2021 and on subsequent dates. The complainant therefore, prayed for an award for Rs.50,000/- towards the insurance claim, Rs.50,000/- towards DAB along with interest @12% p.a Rs.2,00,000/- for harassment ,mental pain and agony and cost of the case.
The OP contested the case by filing W/V wherein they have denied the major allegation. The positive defence case of OP No.1&2 in brief is that they have admitted the content of para 15 and 16 of the complaint and further stated that after receiving the letter dated 13.04.2021 along with documents the OP wrote a letter on 29.04.2021 and sent to the complainant stating inter-alia that the claim is barred by limitation since no claim has been lodged with the corporation by submitting necessary proof of death of the life assured and other requirements within three months from the date of death. However, the claim forms were issued without prejudice to the above stand only to consider whether any ex-gratia payment may be made and satisfactory reason for delay intimation for lodging in time. He was further asked to submit all the forms duly executed by the claimants at an early date to settle the claim with a request to submit the certified copy of final police report. The OPs further admitted the contents of para 20 after receiving all the documents and processed the claim. At the time of death of the life assured the said policy was in extended claim concession and the
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said policy was not in running condition and it was not in force. At the time of death of the life assured as per terms and conditions of the policy DAB is not payable and after scrutiny and verification of all the documents to be settled basic death claimed on 05.10.2021 through NEFT. The OP rightly and legally settled the claim of the complainant and paid basic death claim but DAB is not payable as per terms and conditions of the policy. There is no negligence or any sort of deficiency in service . The OP claim that the case is liable to be dismissed with cost.
The OP No.3 filed W/V wherein they stated that the W/V filed by the OP NO.3 will be same as OP NO.1 and they rely upon it.
After perusing the pleadings of the both the parties the Commission considers that the following points are required to be decided for proper adjudication of the case.
Points for Determination
Point No.1.
Whether the case is maintainable in its present form and prayer.
Point No.2.
Whether the complainant is entitled to get the relief prayed for.
Point No.3.
To what other relief if any the complainant is entitled to get.
Decision with Reasons
Point No.1.
OPs have challenged the case as not maintainable on the ground that it is barred by law of limitation.
The complainant categorically stated in the complaint that the cause of action arose on 13.04.2021 and thereafter, everyday till the filing of this case.
Ld. Defence Counsel in course of argument submitted that the claim is barred by limitation. So, there is a difference between the limitation regarding the claim and the limitation regarding filing of this case. While deciding the maintainability of this case we have to first consider as to whether the case itself is barred by limitation.
After perusing all the documents is transpires that after the death the son of the complainant Late Bijay Das on 22.03.2014 due to accident, Kotwali P.S case no.150/14 dated 23.03.2014 was
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started. So, the unnatural death case was immediately started. This specific averment of the complainant that he made with the agent of LICI and requested to settle the claim but despite repeated request he did not take any positive steps. As regards all the statements in para 7 to 13, relates to explanation regarding the delay in taking steps. But the OP did not deny it or did not say that these statements are false. So, as per the provisions of law of pleadings facts not specifically denied shall be deemed to have been admitted. However, the OP has tried to make an evasive denial of the statement by stating only that agent of LICI is not in any way involved with the settlement of claim or LICI did not authorise any agent to settle the claim or to receive any documents for LICI.
Ld. Advocate for the complainant argued that in common parlance usually the agents act for registering LICI policy and other activities on maturity. The argument has reasonable force. In respect of the denial that in the disputed policy there was no agent, the Commission holds that the explanation given by the complainant is duly acceptable.
After the said submission of letter on 17.07.2018 the OP asked to submit the original bond and other documents to the complainant. The complainant again submitted a letter to the OP on 13.04.2021 along with the documents.
So, it is crystal clear that the cause of action actually arose on and from 13.04.2021 and continued till the filing of this case. The present case is filed on 07.01.2022. So, it is well within the time limit as per the provisions of C.P Act.
In the light of the aforesaid observation the Commission is of the view that the present case is not barred by limitation .
Both the parties reside within the territorial jurisdiction of this Commission. The relief claimed also falls within the pecuniary jurisdiction of this Commission. So, having considered all these aspects, it is held that the instant case is not barred by any provisions of law.
Accordingly, point no.1 is answered in favour of the complainant.
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Point No.2&3.
Both the points are very closely interlinked with each other, so these are taken up together for brevity and convenience of discussion.
The complainant in order to substantiate the case proved the following documents:-
Annexure-1 is the LICI policy certificate of the insured Bijay Das vide policy no.426123812.
Annexure-2 is the death certificate of the policy holder Late Bijay Das dated 09.04.2014.
Annexure-3 is the Cremation Certificate of Late Bijay Das dated 10.04.2014.
Annexure-4 is the inquest report vide UD case no.150/14.
Annexure-5 is the final report of UD case.
Annexure-6 is the PM report.
Annexure-7 is the police morgue document.
Annexure-8 is the copy of letter dated 17.07.2018 to the Branch Manager LICI.
Annexure-9 is another letter to Branch Manager dated 13.04.2021.
Annexure-10 is the copy of receipt issued by LICI, Krishnagar dated 13.04.2021.
Annexure-11 is the letter issued by LICI dated 29.04.2021.
Annexure-12 is the letter to the LICI by the complainant dated 14.06.2021.
Annexure-13 is the copy of claim form no.3783.
Annexure-14 is the another copy of claim form no.3801.
Annexure-15 is the another scheme form no.3785.
Annexure-16 is the Xerox copy of NEFT receipt of policy payment.
Annexure-17 is the Xerox copy of bank account.
Annexure-18 is the Voter I.D card of the complainant.
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The opposite parties did not question the genuinety of all those documents proved by the complainant.
After perusing the said documents it transpires that the complainant also stated in every letter that after the death of his son he submitted all the documents to his agent but did not get the benefit.
The OPs could not disprove the said documents or the contents of that documents where from it is the revealed that the facts of pleading and the documents are genuine and correct.
There is nothing within the four corners of the case record that the OP denying the contents of the said documents by any letter of replied to the complainant.
That apart Ld. Advocate for the OP argued that after arising cause of action they have made payment.
It is the admitted position that the OP has made basic payment but did not make any payment towards double action benefit or DAB.
Ld. Advocate for the complainant argued that sinc4e OP made payment only basic pay , so the claim of the complainant is genuine and the OP cannot evade their liability towards payment of DAB.
Ld. Advocate for the complainant drew the attention of this Commission by filing a document being LIC’s new Bima Gold Table no.179. Under the heading Auto Cover Facility it is reflected that if at least two full years premium have been paid in respect of this policy any subsequent premium be not duly paid, full death cover shall continue from the date of first unpaid premium or till the end of policy term whichever is earlier.
The OP could not show any ground that the deceased does not come within the provisions and terms and conditions of the said policy.
Ld. Defence Counsel repeatedly hammered in course of argument that an agent has no authority to settle the claim expeditiously .
It is fact that the claim is approved by the LICI but liaison between the policy holder and the LICI is done by the agent and illiterate man like the complainant is fully dependent upon the agent.
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That apart in view of the observation made hereinabove about the specific steps by the complainant through his agent which could not be properly discarded the Commission hold that the submission made by the complainant in the pleadings and the evidence are considered as fair and proper.
The case record further reveals that the OP condoned the delay and Ld. Senior Advocate for the OP also argued that the limitation was condoned and form was supplied to the complainant for filling up and submission.
So, the complainant seems to have taken all the reasonable steps and fulfilled the procedures for getting the DAB.
Ld. Senior Defence Counsel further argued that the OPs are sufficiently considered towards the complainant and as such they had made payment by taking him from the ICU. So, there is no scope for further payment . Premium was taken for payment of only the basic pay. So, there is no negligence by the OP.
The argument is not sufficient to discard the claim of the complainant in as much as the complainant submitted the claim form on the basis of the direction of the OP and the basic payment was made due to satisfactory explanation given by the complainant and on fulfilment of the conditions for getting the benefit . Regard being also had to the Auto Cover Facility under the new Bima Gold table no.179 policy which insures the Auto Cover facility of the policy holder. So, in the event of the death of the original policy holder in the instant case, he cannot be deprived of the DAB as claimed by the complainant.
The discussion made hereinabove and the observation undergone therein lead to hold this Commission that the complainant successfully proved the case against the complainant upto the hilt.
Consequently, points no.2&3 are answered in affirmative.
In the result the complaint case succeeds on contest with cost.
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Hence,
It is
Ordered
that the complaint case no.CC/06/2022 be and the same is allowed on contest against all the OPs with cost of Rs.5,000/- (Rupees five thousand). The complainant do get an award for a sum of Rs.50,000/- (Rupees fifty thousand) plus bonus plus DAB for Rs.50,000/- (Rupees fifty thousand) together with interest @ 8% p.a from the date of claim till the date of payment, Rs.10,000/- (Rupees ten thousand) towards mental pain and agony, harassment and damages, and Rs.5,000/- (Rupees five thousand) towards litigation cost . The OPs are directed to pay Rs.1,15,000/- (Rupees one lakh fifteen thousand) plus bonus plus DAB within 30 days from the date of final order till the date of its realisation. Any sum already paid by the OPs to the complainant over that policy shall be excluded from the award money.
All Interim Applications (I.A) stand disposed of accordingly.
D.A to note in the trial register.
The case is accordingly disposed of.
Let a copy of this final order be supplied to both the parties at free of costs.
Dictated & corrected by me
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PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,) ................ ..........................................
PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,)
I concur,
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MEMBER
(NIROD BARAN ROY CHOWDHURY)
