SRI NAYANANANDA DASH,MEMBER:-
The case relates to alleged deficiency of service on the part of Life Insurance Corporation of India, the Ops in not settling the death claim of the policy No. 598077463 in the name of Late Surendra Das, husband of the complainant.
Brief facts of the case is that Sri Surendra das,S/o:- Late Hadibandhu Das,At:-Balipatna,Po:-Kusiapal,Dist:-Kendrapara, who were serviing as Grade-A Employee in CESU,Kendrapara under Junior Manager(Elec.) had opened two LIC Policies bearing No.580095304 and 598077463. On dt.28.03.11,Sri Surendra Das fell ill and was admitted to SCB Medical College Hospital for treatment but during his treatment, he passed away oan dt.01.09.2011. The complainant had submitted all relevant documents to the LIC for the death claim of two LIC Policies, bearing No. 580098304 and 598077463. The LIC released the payment for the Policy No. 580095304 for Rs.75,456.00 on dt.24.01.12. But regarding the Policy No.598077463, the claim has not been settled and the LIC has written to the complainant to produce treatment records for treatment of Fistula in Feb.,2011 and till-date has neither released the death claim nor repudiated the same. On the otherhand the complainant had intimated to LIC regarding absence of knowledge for the treatment of fistula of her late husband. Thus, the complainant filed this C.C.Case for release of death claim of Policy No.598077463.
The complainant further submitted that she had submitted all the documents for settlement of death claim to the LIC basing upon which the LIC released the payment for one of the policies bearing No.580095304 but for the other Policy bearing No.598077463, they are taking the plea for submission of treatment particular for treatment of Fistula. The complainant has clearly written to the LIC about her ignorance of treatment of Fistula and hence her inability to submit the same to LIC. After which LIC is sitting over the death claim neither granting nor rejecting.
On the otherhand the Ops have stated that the said Policy No.598077463 for a sum assured of Rs.1,87,500/- was taken by the husband of the complainant Sri Surendra Das on dt.28.08.10. The Policy holder died on dt.01.09.11 i.e. within two years from the date of opening of the Policy. As per Ops, there is an agreement between the Life assured and the insurer to disclose all material facts i.e. disease and other facts before the insurer at the time of opening of the policy. The OP further states that the policy holder was undergoing treatment for fistula in Ano during the month of Feb.,2011 and the treatment papers were called for from the complainant on dt.23.01.13 and also B.H.T. and discharge summary of said treatment was also called for from SCB Medical,Cuttack and the OP is yet to submit the same to OP for which the claim remains pending.
Taking into consideration the views of both the complainant and the Ops it is an admitted fact that Sri Surendra Das had purchased LIC Policies bearing No.580095304 and 598077463 the policy holder Sri Surendra Das passed away on dt.01.09.11. After the death of Sri Surendra Das, Smt. Renubala Das, wife of the policy holder and the nominee of those two policies, lodged the death claim with the LIC and submitted the relevant documents required for the purpose. The OP-Insurance Corpn. Released the death claim amount in respect of the Policy No.580095304 in Cheque
for Rs.75,456/- on dt.24.01.12., but has withheld the death claim payment for the Policy No.598077463 although three and half years has passed since then. It is unfortunate that the largest Life Insurance Company has taken such a long time to take a decision on the death claim of a policy while releasing payment of another policy. Further, the LIC has called for reports and history of treatment from the complainant regarding treatment of Mr. Surendra Das with Fistula in Feb.2011 which the complainant has denied. If the LIC has definite knowledge and documentary evidence to that effect, they should have taken appropriate decision based upon such facts. But instead of doing that not taking any decision( either approval or repudiation) and sitting over a death claim for nearly four years approximately totally unjustified and amounts to deficiency in service. The case in hand is peculiar in nature where the Ops for the same reason of death award in the insured value and whereas in case of other policy and for its settlement wait for a long period to investigate the cause of death which is not only unjustified, but a disgusting affair. Ld. Counsel for Ops during course of argument raised that the complainant has no ‘cause of action’ to file the proceeding as the claim of complainant-claimant is pending for its disposal. Ina this regard, we are of the view that ‘cause of action’ is wider in part as it includes ‘bundle of facts’ which gives relief to the plaintiff/complainant. In this case cause of action arose when the policy holder dies and his nominee files claim application wait for 2 ½ years expecting a settlement of her claim. Hence, this plea of Ops do not create any impressions on this Forum.
O R D E R
That, the complaint is allowed in part with cost. Therefore, we hereby ordered that LIC,the Ops should release the death claim for the Policy No.598077463 for the sum assured amount of Rs.1,87,500/- to the complainant within a period of one month from the date of this order, failing which 9 per cent interest will be payable by LIC for the period of delay beyond one month. Further towards mental harassment and cost Rs.1,000/- shall be payable.
Pronounced in the open Court, this the 22nd day of September,2015.
