Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs : Raj Kumar Mandal
Date of filing of the case :31.07.2023
Date of Disposal of the case :23.07.2024
Final Order / Judgment dtd.23.07.2024
A refusal to pay the insurance claim dragged the complainant to file the present case. The basic fact of the case of the complainant is that the complainant Sanchita Dutta is the wife of Prabir Dutta alias Ashok Dutta. The said Prabir Dutta alias Ashok Dutta during his lifetime purchased one insurance policy of OP LICI Plan 75 term 20 years vide policy number 423998960 sum assured Rs.50,000/- at a premium of Rs.911/- quarterly. It was purchased through agent of LICI. Suddenly, the policy holder Prabir Dutta died on 19.05.2022 at Gandhi Memorial Hospital, Kalyani, Nadia while the policy was active. After the death of the policy holder the complainant as nominee wife informed the matter to the LICI, Krishnagar, Nadia along with all documents on 15.07.2022. The complainant requested the OP to settle the claim but it was not so settled. The complainant again filed an application on 27.04.2023 to the OP to settle the claim. But the OP informed to the complainant that the name of her husband was differing on the ground that in the policy the name is Ashok Dutta and in the death certificate name is Prabir Dutta . The OP also requested the complainant to submit affidavit to that effect. Accordingly, the complainant submitted an affidavit sworn before Judicial Magistrate along with Municipality Certificate to the LICI, Krishnagar Branch –II. The OP further informed that the name of the father of deceased was also differing since in the policy father’s name is Nilmoni Dutta but in the death certificate father’s name is Dhirendra Dutta . The complainant informed to the OP that the name of the father of her husband is Dhirendra Dutta and his nick name is Nilmoni Dutta . She also submitted an affidavit of Judicial Magistrate to the OP. Thereafter, the complainant sent one legal notice by Registered Post which the OP received on 12.05.2023. The OP stated that the identity of DLA and the DLS father name could not be established but the said claim was not repudiated . The OP violated the IRDA norms. So, the present case is filed. The cause of action arose on 19.05.2022 and thereafter each day. The complainant prayed for an award of Rs.50,000/- plus Bonus of sum assured together with interest @ 12% p.a , Rs. 40,000/- towards loss damages and harassment and mental agony and litigation cost.
The OP contested the case by filing W/V wherein they denied the major allegation. The OP challenged the case as not maintainable on the ground that it is barred by limitation and bad for defect of parties. The positive defence case is that the husband of the complainant Prabir Dutta purchased LICI policy bearing no. 423998960 sum assured Rs.50,000/-. Complainant is the nominee of the said policy. After the death of policy holder Prabir Dutta the complainant informed it to the OP and filed claim petition. The OP requested the complainant to produce the relevant documents regarding death policy. The complainant submitted some documents. After proper identification of the policy holder various discrepancy were found . Thereafter, the OP stated by letter dated 05.08.2023 that DLA and DLS father name could not be established and requested the complainant to satisfy the OP. The present claim is premature . The OP claimed that the case is liable to be dismissed with cost.
The dispute involved in the present case demands for adjudication on the following points.
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.
The OP challenged the case as not maintainable on the ground that it is bad for defect of parties and barred by law of limitation.
In course of argument the Ld. Advocate for the OP did not press these two points. However, having perused the pleadings of the parties and the evidence in the case record it transpires that the present case is filed against the LICI/ OP. The parties are residing within the territorial jurisdiction of this Commission. The relief claimed falls within the pecuniary jurisdiction of this Commission. Having considered all aspects the Commission finds that there is no legal impediment to hold that the present case is barred under any provisions of law.
Accordingly, point no.1 is decided in favour of the complainant.
Point No.2&3.
Both the points have very close nexus to each other and as such these are taken up together for brevity and convenience of discussion.
It is the admitted fact that the complainant is the nominee of the deceased Prabir Dutta who purchased LIC Policy bearing no. 423998960 sum assured Rs.50,000/-. The said policy holder Prabir Dutta died while the policy was active.
The OP further admitted that complainant submitted some documents to the OP for settlement of the claim.
The OP challenged the case on the ground that the claim could not be allowed due to discrepancy in the name of the deceased policy holder and the name of the father of the deceased policy holder.
From the case record and different documents it is found that in the LIC policy the name of the deceased policy holder is recorded as Ashok Dutta but in the death certificate the name of the deceased is recorded as Prabir Dutta. So, the reasonable discrepancy may arise. But in order to remove the said discrepancy the complainant was asked to submit affidavit. Accordingly, the complainant submitted an affidavit sworn before the Judicial Magistrate of 1st Class. The said affidavit dated 13.06.2022 discloses that the Prabir Dutta and Ashok Dutta is the same an identical person as per the affidavit of the nominee Sanchita Dutta.
As per annexure-8 the certificate issued by Councillor also discloses that the said Prabir Dutta and Ashok Dutta is same and identical person.
As regards the refusal of the claim the OP further took the plea that the name of the father of the deceased policy holder also differed. In the insurance policy the name of the said Ashok Dutta was registered under the (C/O. Nilmoni Dutta). In the death certificate the father’s name of the deceased is recorded as Dhirendra Dutta in the Ration Card the father’s name has been recorded as Dhirendra Dutta.
In order to satisfy the OP the complainant also sworn another affidavit before the 1st Class Judicial Magistrate on 14.07.2022 wherein it is stated that the Nilmoni Dutta and Dhirendra Dutta is same and identical person.
The complainant also filed another affidavit dated 10.08.2006 before the Notary, Krishnagar wherein the said Nilmoni Dutta stated that Nilmoni Dutta and Dhirendra Dutta is same an identical person.
The complainant also proved the letter issued by the complainant Sanchita Dutta to the Branch Manager of LICI as an annexure-6 dated 27.04.2023 wherein she claimed the insurance death claim from the OP.
It is the argument of the Ld. Advocate for the complainant that the OP did not repudiate the claim of the complainant.
Ld. Advocate for the OP argued that the OP repeatedly demanded the documents from the complainant but she failed to produce the documents. Until and unless the relevant documents are produced the benefits cannot be given. It is the OP who has been harassed. Other than the affidavit the complainant has no other documents to establish the case. Without sufficient documents LIC cannot grant the said claim. The fact stated in affidavit must be proved by cogent and supported evidence. Affidavit can sworn as per his own wish.
It is fact that the name of both the deceased policy holder and his fathers are different. But the complainant removed the said anomalies by swearing affidavit before 1st Class Magistrate. If any person swears false affidavit is liable to be prosecuted and it can be challenged before the court of law. The OP could not prove anything that the said affidavits are false.
It is found from the cross examination that the OP No.1 cross-examined the complainant as to whose name LIC policy was purchased. The complainant answered as Ashok Dutta . Previously , we have found that the complainant categorically stated by affidavit that Ashok Dutta and Prabir Dutta is same an identical person. Said evidence could not be discarded. Moreover, in answer to question no.3 the complainant stated that the death certificate in the name of Prabir Dutta is already submitted and Ashok Duttta and Prabir Dutta is one and same person.
The OP could not prove any document to establish that apart from the documents submitted by the complainant what other documents were required to satisfy that the complainant is entitled to get the claim.
As per annexure-13 the OP demanded some documents and in the last para of the said letter identity of DLA and DLS were demanded. It is further written in that document that father name could not be established.
After analysis of all the documents it is found that the complainant removed the discrepancy through documents.
The OP could not prove any document to show that after analysis of those documents the OP company or their higher authority decided to repudiate the claim.
So the refusal to allow the claim by the OP has caused harassment and mental pain and agony.
The aforesaid misdeeds on the part of the OP tantamount to deficiency in service which should be compensated in terms of money.
In the backdrop of the aforesaid discussion and having assessed the entire evidence in the case record vis-a-vis the observation made hereinabove the Commission comes to the finding that the complainant duly proved the case against the OP.
Accordingly, point no.2&3 are answered in affirmative in favour of the complainant.
Consequently the complaint case succeeds on contest with cost against opposite parties.
Hence,
It is
Ordered
that the complaint case no.CC/83/2023 be and the same is allowed on contest against both 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) towards insurance claim plus Bonus sum assured by the OPs together with interest @12% p.a , Rs.10,000/- (Rupees ten thousand) towards harassment , deficiency in service and mental pain and agony and Rs.5,000/- (Rupees five thousand) towards litigation cost. The opposite parties are directed to pay Rs.65,000/- (Rupees sixty five thousand ) to the complainant together with interest as above 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 passing the 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
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PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,) ................ ..........................................
PRESIDENT
(Shri HARADHAN MUKHOPADHYAY,)
I concur,
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MEMBER
(SHRI NIROD BARAN ROY CHOWDHURY)
