Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs : Raj Kumar Mondal
Date of filing of the case :20.01.2022
Date of Disposal of the case :28.05.2024
Final Order / Judgment dtd.28.05.2024
The concise fact of the case of the complainant is that the wife of the complainant Chandrani Ghosh during her lifetime purchased two insurance policies of Ops LIC of India, policy no.42339275 sum assured of Rs.55,000/- and policy no.423392490 sum assured of Rs.52,000/-. The said Chandrani Ghosh had a sound health at the time
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of purchasing the said policy. The said Chandrani Ghosh died on 11.08.2019 in an accident for which Kaliganj P.S case G.D No.367 dated 12.08.2019 and Entali P.S U.D case no.872 dated 12.08.2019 was started. After the death of the policy holder the complainant Samiran Ghosh nominee and husband of the policy holder informed the matter to the LICI Branch office at Krishnagar Branch-II along with all relevant documents. On 09.12.2019 the said LICI Branch deposited the policy money nominee to the bank of the complainant in an account no.11792058989 of SBI Debagram Branch for Rs.97,812/- and Rs.1,03,455/- against the two policies respectively as sum assured plus bonus. Thereafter, the complainant requested to settle the claim amount of DAB part. The OPs assured that it would be settled immediately. The complainant requested to the OPs several times but the OPs did not settle the DAB till date and thus violated the IRDA norms. The OPs has thereby caused deficiency in service for which the complainant filed the present case. The cause of action arose on 12.01.2022 and thereafter, everyday till the filing of this case. The complainant ,therefore, prayed for Rs.1,07,000/- towards accidental benefit, together with interest @12% p.a from the death of the policy holder , Rs.1,00,000/- towards harassment and mental agony and damages and litigation cost.
The OPs contested the case by filing Written Version wherein they denied each and every allegation of the complainant. The OPs LIC of India challenged the case as not maintainable on the ground that the case is bad for defect of parties, barred by law of limitation. The positive defence case of the OPs in brief is that Chandrani Ghosh submitted two filled up proposal form to the OPs. OP No.1, Krishnagar Branch-II LIC issued the said two policies. It is fact that the said Chandrani Ghosh died on 11.08.2019 and the nominee being the complainant submitted two claim forms for the death benefit along with original policy bond, death certificate and P.M report of the decease policy holder. After receiving the claim of the complainant the OPs requested the claimant to submit copy of FIR/GD, Surathal report, copy of final report through their letter dated 09.10.2019. The complainant sent a letter dated 23.10.2019 to the OP No.1 to settle the basic sum assured because he was not able to collect the Surathal report and final report. The complainant also stated that he would submit the same letter. On the basis of the death certificate, PM report , cremation certificate the OPs processed the claim and considering the terms and conditions of the policy, the OP No.1 settled the claim for Rs.1,03,355/- against the policy no.423392750 and Rs. 97,812/- against policy no.423392490. Subsequently, OP No.1 asked the claimant to submit his bank particulars. After getting the said documents the OP No.1 paid the basic death claim on
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07.12.2019, through NEFT to the complainant. The DAB includes accidental death of the life assured . In case of getting DAB the claimant must prove that life assured died out of an accident . The claimant did not file any DAB claim and required documents until now. The claimant requested to the OPs to settle the claim only on the basis of basic sum assured which has already been settled. So, there is no cause of action. The OPs claimed that the case is liable to be dismissed with cost.
The OP No.2 has not filed any separate W/V. As per order no.6 dated 07.07.2022 the W/V of OP No.1 be treated as W/V of OP No.2.
Accordingly, the W/V OP No.1 is taken into consideration and it is treated as W/V of OP No.2.
The conflicting pleadings of the parties led this Commission to ascertain the following points for proper adjudication of this 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 as prayed for.
Point No.3.
To what other relief if any the complainant is entitled to get.
Decision with Reasons
Point No.1.
Complainant challenged the case as not maintainable on the ground that it is barred by limitation.
Ld. Defence Counsel for OPs argued that a case for realisation of insurance claim should be filed within two years from the cause of action. If he fails to raise the claim within two years then he is not entitled to get the relief.
Ld. Advocate for the complainant counter argued that the complainant raised his claim within reasonable time. Since the OPs
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refused to allow the claim of the complainant , so he sent a letter of advocate towards his insurance claim. So, the case is not barred by limitation .
Ld. Advocate for the complainant further argued that the OPs demanded the documents and since then correspondence is going on between the parties, so it is a continuing cause of action.
The argument is reasonable and acceptable. The cause of action is not a particular act but it is a bundle of facts. After perusing the pleadings of the parties it transpires that the complainant categorically stated that the policy holder Chandrani Ghosh died on 11.08.2019 in an accident. Thereafter, the complainant raised the grievance . Subsequently, the OPs company deposited the sum assured for Rs.1,03,455/- and Rs.97,812/-. But they did not pay the DAB part of the claim. The complainant further stated that on 14.01.2020 the complainant went to the office of OP No.1 and subsequently, on several times he went to the office of the OP No.1. But OP No.1 did not settle the DAB part of the said policies.
It is further appeared that during cross-examination the complainant was asked by the OPs in question no.5 inter-alia that “have you filed any document to show that you have supplied the above mentioned documents to the OP No.1 for settlement of DAB claim.” Against the said question the complainant answered “yes”.
So, answer in cross-examination has a special force. Since the complainant categorically stated that he had filed the document for settlement of DAB claim , so the cause of action was continuing.
Ld. Advocate for the complainant repeatedly argued that it takes much time to get the PM report, so the delay has caused for filing the documents.
The argument has reasonable force in as much as getting PM report is a time consuming matter.
The complainant categorically stated that the OPs processed the claim on the basis of the death certificate and PM report and cremation certificate . After perusing the PM report it transpires that it is categorically mentioned in the PM report that “death was due to the effects of injuries as noted ante-mortem in nature.”
Ld. Advocate for the complainant further argued that death due to injury means that the complainant died due to the accident. It is not a normal death.
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The said argument is acceptable because the OPs could not establish that the complainant died in any reason other than the said accident.
So, the OPs could have settled the claim on the basis of the documents file by the complainant. Due to not settling the claim the complainant had to wait for a long time and thereafter he sent the legal notice through his advocate which gave the rise to the present cause of action. Accordingly, in the light of the discussion made hereinabove case is not barred by limitation or under any provisions of law.
Accordingly, point no.1 is answered in affirmative and decided on behalf of the complainant.
Point No.2&3.
These points relate to the ascertainment as to whether the complainant is entitled to get the relief or not.
The complainant in order to substantiate the case put the following documents in addition to the affidavit in chief in support of his case.
Annexure-1 is the insurance policy.
Annexure-2 is the another insurance policy in the name of Chandrani Ghosh which are not disputed .
Annexure-3 is the certificate of death of Chandrani Ghosh who died on NRS College and Hospital.
Annexure-4 is the formal death certificate issued by NRS Hospital.
Annexure-5 is the burial certificate issued by Entali I.C sent for cremation.
Annexure-6 is the U.D certificate.
Annexure-7 is the FIR of U.D case for death of Chandrani Ghosh.
Annexure-8 is the P M report which shows that death was due to the effect of injuries.
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Annexure-9 is the letter of Advocate dated 12.01.2022 to the Branch Manager, LIC, Krishnagar, Branch-II along with some documents namely premium receipt , death certificate, final report and PM report.
Annexure-10 is the account statement showing deposit of money transferred by SBI to the account of Samiran Ghosh of the complainant.
Annexure-11 is the Aadhar card of the complainant .
Annexure-12 is the PAN card of the complainant.
It is the admitted fact that the wife of the complainant that is insured Chandrani Ghosh died in a road accident on 11.08.2019 and the nominee of the said policy Samiran Ghosh who is the present complaint submit two claims along with policy bond , death certificate and PM report of the deceased.
After perusing the PM report it is crystal clear that death of the insured was due to effect of injuries ante-mortem in nature.
All the documents proved by the complainant suggest that the insured died due to road accident.
The OPs defended the case on the ground that the DAB includes accidental death of the life assured and in case of DAB as per terms and conditions of the policy claimant must prove that life assured died arising out of an accident.
From the documents filed by the complainant it is evident that the life assured died arising out of an accident .
The complainant explained as to how the delay caused.
There is nothing to show that the DAB has been paid or that the claim of the complainant has been repudiated .
The OPs during answer to cross-examination against question no.5 categorically stated that they did not repudiate the said DAB claim of the said two policies. Therefore, since OPs did not repudiate DAB amount claim of the complainant , so the complainant is entitled to get the DAB claim. Ld. Defence Counsel repeatedly argued that cause of action cannot be created after serving a notice of advocate.
Previously, it has been discussed under point no.1 that there is a chain of circumstances of the complainant duly explained under
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what circumstance the claim was not granted and after waiting for a long time they issued notice of advocate.
Ld. Defence Counsel further argued that since the documents were not supplied by the complainant, so the OPs were not in a position to repudiate the claim.
Ld. Advocate for the complainant argued that the OPs paid basic sum assured money after getting the letter dated 23.10.2019. So until and unless the said letter was given the OPs had no good intention to pay the death benefit .
The argument has reasonable force in as much as it appears that after receiving claim of the claimant the OPs did not pay the insurance money immediately and when the complainant again sent a letter dated 23.10.2019 then only the basic sum assured money was not paid . It is also the admitted fact that the complainant was not able to collect the Surathal report and police final investigation report but he requested that he submitted the same later on. Even after submission of all these documents the OPs deposited basic death claim benefit on 07.12.2019 that is after 4 months of death of the complainant and 2 months after receiving the letter for settlement.
This demeanour on the part of the OPs by not settling the claim tantamount to deficiency in service.
Ld. Senior Defence Counsel also argued that the complainant could have submitted the documents before this Commission. Then it would have been easier for the OPs to settle the claim.
Ld. Advocate for the complainant argued that the nobody comes to the court at his sweet will until and unless all doors for getting the relief are closed. Getting relief from the court is very expensive and matter of great trouble and harassment. Since the OPs did not settle the claim , so the complainant had no alternative but to file the present case.
The crux of the said point of argument by both the parties leads to infer that the complainant even after death of his wife just to get the insured money under policy lodged this case.
The oral and documentary evidence duly proved by the complainant and the argument advanced by both the parties suggest
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this commission that the complainant duly proved the case against the OPs to get the relief prayed for .
Thus having assessed the entire factual metrics and the evidence led by both the parties the Commission is of the firm of view that the complainant successfully proved the case upto the hilt.
Accordingly, point no.2& 3 are answered in positive on behalf of the complainant.
Consequently, the complaint case succeeds on contest with cost.
Hence,
It is
Ordered
that the complaint case no.CC/08/2022 be and the same is allowed on contest against both the parties with cost of Rs.5,000/- (Rupees five thousand). The complainant do get an award for a sum of Rs.1,07,000/- (Rupees one lakh seven thousand) towards accidental benefit rider sum assured together with interest @12% p.a from the date of death of the insured till the date of payment, Rs.20,000/- (Rupees twenty thousand) towards deficiency in service , harassment and mental agony. The OPs are directed to pay Rs.1,32,000/- (Rupees one lakh thirty two thousand) to the complainant within 30 days from the date of passing the final order failing which the entire award money shall carry an interest @ 8% p.a from the date of final order till the date of its realisation.
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
............................................
PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,) ................ ..........................................
PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,) ........................................
MEMBER
(SHRI NIROD BARAN ROY CHOWDHURY)
