Orissa

Jajapur

CC/32/2014

Anjali Samal - Complainant(s)

Versus

Chief Manager L.I.C of India - Opp.Party(s)

Madhusudan Mahunta

31 Mar 2015

ORDER

                                      IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JAJPUR.

                                                                     Present:  1.Shri Biraja Prasad Kar, President.

                                                                                     2.Sri Pitabas Mohanty, Member,

                                                                                     3. Miss Smita Ray, Lady Member. 

Dated the 31st day of March,2015.

C.C.Case No.32 of 2014

Anjali Samal, W/O late Ajit Samal

Vill/P.O.Jari ,P.S. Binjharpur ,

Via. Singhpur, Dist. Jajpur.

At present:Suanla (Nilapada)

P.O.Managobindapur,Via.Danagadi

P.S.Jajpur Road, Dist.Jajpur.                                    ……………..Complainant .                                                                                              

                        (Versus)

1.Chief Manager,L.I.C of India,Jajpur Branch Office,At/P.O/Dist.Jajpur.

2.Manager,( Claims) L.I.C of India, Cuttack Divisional Office, Nuapatana,

  Cuttack.         …………………………Opp.Parties.                             

   For the Complainant:                  Sri J.P. Pati, Advocate.

For the Opp.Parties     :             Sri M.S.Mahunta, Sri R.K.Jena, Advocates.

                                                                               Date of order: 31.03. 2015

MISS SMITA RAY, LADY MEMBER.

                        The complainant being the nominee of late Ajit Samal, the policy holder, has filed this dispute alleging deficiency of service on the part of the O.Ps. in not settling the Double Accident benefit of her husband who died in an accident on 02.08.12 . It is alleged by the complainant that her deceased husband had done one L.I.C policy bearing policy No.598587312 on 05.12.11 under the O.Ps. for Rs.50,000/- with Double Accident Benefit . The complainant’s  husband paid two premiums for the said policy. The complainant’s husband died on 02.08.12 at Manapur Railway plot due to accident coming in contact with railway electric line. The O.Ps. have settled and paid Rs.50,000/- to the complainant but refused to settle the D.A.B to the complainant . Alleging deficiency in service the complainant has filed this dispute with the prayer to direct the O.Ps. to settle the claim of complainant for Rs.50,000/- towards the D.A.B. The complainant also prayed to award Rs.30,000/- towards mental agony and litigation expenses.

                        On being noticed the O.Ps. Have appeared through their advocate and filed their written version denying the allegations made in the complaint petition. It is pleaded in the written version that  Ajit Samal had taken an Insurance policy on his own life bearing No.598587312 for a sum assured of Rs.50,000/- and date of commencement of 05.12.2011 with table / term as 179/16 , maturity date as 05.12.2027 and installment of premium @ Rs.824/- per quarter. Anjali Samal W/O Late Ajit Samal is the nominee in the policy. It is worthwhile to mention here  that DAB was not allowed under the policy and the premium thereto was not charged. Late Ajit Samal died on 02.08.2012 and the Death claim of Rs.50,000/- paid on 24.04.2013 vide cheque No.77587 in favour of the nominee. The policy conditions are binding to both the parties. As per the special provisions contained in the policy bond regarding accident benefit rider- if the option is exercised and the premium is paid: condition number-11 will apply for an amount equal to the Accident Benefit Rider Sum Assured . As per policy conditions Accident benefit is available under the policy, as an optional benefit with payment of additional premium of @  Rs.1.00 per year per thousand sum assured. The life assured is to exercise the option as well as pay the premium thereon to avail the accident benefit cover.

                        In the policy under consideration, bearing No.598587312, the extra premium as mentioned in the foregoing paragraph is not paid by the deceased life assured, to which he had never mentioned during his life time. Thus the benefits for which the life assured had not paid the premium during his life time, the nominee is not entitled for, after his death.

                        It is also pleaded that in the proposal form DAB was opted by the deceased policy holder, but L.I.C has not given Double Accident Benefit  as Double Accident Benefit premium not charged. Manager (Claims) vide their letter CD/claims/40 dt.24110 returned the docket with comment Double Accident Benefit  is not payable in the said policy as not opted by the policy holder.  As there is no deficiency in service on the part of the O.Ps. and  the C.C. Case is liable to be dismissed.

                        On the date of hearing none appeared on behalf of the complainant and O.Ps. We have perused the pleadings of the respective parties and documents available on record.

                        As per the pleadings of the complainant the complainant’s husband in his proposal form opted for Double Accident Benefit  but the O.Ps did not settle the Double Accident Benefit  in her favour which amounts to deficiency in service.

                        As against the above pleadings the O.ps. have pleaded that in the proposal form of the DAB was opted by the deceased policy holder but the L.I.C has not given D.A.B and D.AB premium was not charged.

                        We have verified the photo copies of proposal form of the deceased  filed by the O.Ps. where in the deceased Ajit Samal had specifically opted for D.A.B . But the O.Ps. have not accepted it. The O.Ps. have unilaterally did not accept the D.A.B opted by  the deceased,

without giving any notice to the deceased, which is arbitrary ,illegal and is  not sustainable in law. The O.Ps. have not also given any intimation to the deceased the reason for the non acceptance of D.A.B, which amounts to violation of Natural Justice . Had the DAB was accepted by the O.Ps. the deceased could have paid the premium charged under the policy . Hence, on the aforesaid analysis, facts and circumstances of the case we hold that there is deficiency in service on the part of O.Ps. in not accepting the D.A.B opted by the deceased. The O.Ps. are liable to pay D.A.B of Rs.50,000/- minus the additional premium of D.A.B  to the complainant.

                                                                   O R D E R

                        Resultantly, the  C.C. Case is allowed on contest  against the O.Ps.  The O.Ps. are directed to pay DAB amount to the complainant after deducting  the additional premiums of @ 1.00 per year per thousand sum assured  under DAB scheme . The above amount is to be paid within two months of receipt of the order ,failing which the O.Ps. are liable to pay interest @ 9% per annum from the date of filing of the Case i.e 09.04.14 till realization . No order for costs.                     

                        This order is pronounced in the open Forum on this the 31st  day of March ,2015. under my hand and seal of the Forum.

 

               

                                                                                                                      (Miss Smita Ray )

                                                                                                                       Lady Member.

(Shri Biraja Prasad Kar)                                                           Typed to my dictation & corrected by me                                              

         President.                                                                       

 

 

                                                                                                             (Miss Smita  Ray)

(Shri Pitabas Mohanty )                                                                                  Lady Member.

      Member.