MRS RAJASHREE AGARWALLA , MEMBER (W)-
This is a dispute which has been filed by the petitioner due to non settlement of insurance claim.
The facts as stated by the petitioner in the complaint petition shortly are that Arpita Sarangi the wife of the petitioner had availed a Insurance policy for her life from L.I.C situated at Divisional Office Kolkata on 28.12.2013 bearing policy No.458905803 to be matured on 28.12.2028 having the yearly premium Rs.4804/- as against the sum assured Rs.1,00,000/- wherein the petitioner was not only the nominee but also the only legal heir of the policy holder. That after obtaining the policy insured was paying the premium regularly and the last premium was paid in the year 2015. In the mean time the assured Arpita Sarangi met with her premature death on 02.06.2015 due to Cardiac arrest. Accordingly the petitioner being the nominee and legal heir of the deceased applied for Insurance claim to the O.P.no.1 on 24.11.2016 and as per advice of O.P.no.1 met the O.p.no.2 who advice the petitioner to deposit all relevant documents in the office of O.P.no.3 ( the agent of L.I.C) .Thereafter the petitioner deposited all relevant documents along with original Bond on 24.11.2016 in the office of O.p.no.3. After expiry long period the petitioner though wanted to know about the settlement of Insurance claim from O.P.no.3 and made several telephonic call but no result. Finding no other way the petitioner sent a legal notice on 11.01.2018 to O.p.no.2 by R.P but no result. Owing to above situation the petitioner has filed the present dispute for redressal his grievance with the prayer to direct the O.P. No.1 and 2 to pay the assured value with 18% interest per annum from 24.11.2016 as well as award Rs.50,000/- as compensation for mental agony and litigation expenses.
After appearance the O.p.no.1 and 2 filed the written version denying the allegation of the petitioner as well as has taken the stand that the wife of the petitioner Arpita Sarangi had taken LIC policy bearing No.458905803 for a sum assured Rs.1,00,000/- having the payment of yearly premium Rs.4804/- . The life assured died on 02.06.15 as per report of the petitioner and 1st unpaid payment on Dec-2015 and duration of policy was one year five months where-in the Petitioner is the nominee of the life assured but after the death of life assured the claim form –B and B-1 executed by Dr. Basudev Sahoo MBBS of Bilahar disclosed the case of death as cardiac failure and the said from also reflects the deceased life assured was suffering from shortness of breadth for last one year prior to her death and she had also severe . A anaemia one month prior to her death. On the basis of past medical history reflected in the claim form B and B-1 the O.ps told the petitioner for submission of treatment papers relating to elements of the deceased of life assured from which she was suffering from last one year along with death certificate issued by Dr. Basudev Sahoo. Inspite of several letters issued to the petitioner on 02.09.2016 ,05.01.2017, 01.04.2017, 30.11.2017, 1.01.2018,01.06.2018 and 01.09.2018 the petitioner paid a deaf ear. The petitioner has neither produced the documents before the O.ps nor replied at any time. It is further submitted that without production of documents like death certificate, treatment papers the O.Ps are not in a position to proceed with the claim of the petitioner. Accordingly the present dispute is liable to be dismissed against the Ops.
In view of the above assertion and counter assertion it is Cristal clear that the O.ps have not settled the Insurance claim of the petitioner due to non receipt of the relevant documents. In this contest the petitioner has stated in the complaint petition that as per advice of O.p.no.2 the petitioner has deposited the relevant papers along with original bond in the office of O.p.no.3 on 24.11.2016 who is the agent of LIC .In addition to it we have also come across with the observation of Hon’ble National Commission reported in 2012(1) CPR-391( N.C) LIC India Vrs Smt Sudesh) wherein it is held that-
“Insurance company must investigate health issue before issuing insurance policy. Moreover regarding submission of relevant documents by the petitioner we are in the opinion that since as per complaint petition the petitioner has deposited the relevant documents along with original bond in the office of Op. No.3 the agent of LIC, the insurer is advice to settle the Insurance claim of the petitioner after receipt of the same from O.P No.3 as well as the Petitioner also advised to approach Op.No-3 for submission of the documents .
The O.p.no.2 also advice to settle the claim within one month after receipt of the relevant documents ,failing which the petitioner is at liberty to file 2nd complaint within the period of limitation.
The dispute is disposed of with the above observations.
This order is pronounced in the open Commission on this the 16th day of April ,2021. Under my hand and seal of the Commission.
