DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C.NO.20 OF 2017
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member .
Sri Purna Chandra Tripathy - Member .
Mamata Rani Nayak, aged – 38 years
W/O: Late Sribanta Kumar Mahananda
C/O: Udayanath Nayak AT: Kendupadar, (Front of Telephone coony)
PO: Contractorpada PS: Town Phulbani Dist: Kandhamal ……………………….. Complainant.
Versus.
1. The Chief Manager
LIC of India, Phulbani Branch
AT/PO/PS: Town Phulbani Dist: Kandhamal.
2. Manager (claims) (DM)
Claims Department”Jeevan Prakash” Khodasing
Berhampur- 760010
E.Mail: Claims. Berhampur@licindia. Com …………………………….. OPP. Parties.
For the Complainant: Sri K.B Satpathy, Advocate, Phulbani and his associates
For the OPP. Parties: Sri Bijay Kumar Mohanty, Advocate, Phulbani .
Date of Order: 26-12-2017
O R D E R
The case of the Complainant in brief is that she is the legal married wife of the deceased Sribanta Kumar Mahananda who died on 22-08-2011 in the MKCG Medical College Berhampur in Malaria fever and jaundice. The deceased husband was a policy holder under the O.Ps for policy No 572247311 dtd. 17-03-2009 in Kamal Jeevan” plan, policy No 573405058 dtd. 01-01-2011 in the Jeevan Sathi plan and the policy No 5734052994 dtd. 15-01-2011 and he deposited the premium regularly till his death. Being the nominee of the deceased the Complainant intimated to the O.Ps regarding the death of her husband and requested the O.ps for
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payment towards the claim of the assured amount of the said policies. She had filed the claim application along with all relevant documents before the O.Ps, on 08-05-2012. Subsequently on 19-05- 2013 she had filed other documents as per requirements of the O.Ps. On 02-02-2017 she gave a pleader notice to the O.Ps but the O.Ps remain silent after giving an reply on 13-02-2017. She applied for some relevant documents in connection with these policies on 30-01-2017 through R.T.I Act but the P.I.O of the L.I.C authorities has intentionally avoided to supply the same .She is a widow of S.C Community and she has a small school going daughter .She spent a lot of money by running to the office of the O.Ps time and again but she has not received any claim from the O.P which amounts gross negligence and deficiency in service on the part of the O.Ps .The sum assured Rs. 2, 10,000/- towards the policy No. 573405294, Rs.2, 10,000/- towards the policy bearing No. 573405058 and Rs. 1, 00,000/- towards the policy No. 572247311. So, she has filed this complaint and claimed total assured sum of Rs. 5, 20,000/- from the O.Ps along with compensation of Rs. 50,000/- including appropriate interest from the O.ps.
The case of the O.Ps as per their joint version is that it is not proved that the deceased policy holder died due to malaria fever and jaundice. But deceased died due to suffer from sickle cell. . The petitioner has to produce the medical report from the M.K.C.G Medical College, Berhampur where the deceased was under treatment before his death. The cause of death has been suppressed by the Complainant .All the above policies are within 3 years from the date of commencement of the policies. The policy No. 573405058 and 573405294 were issued within 7 months of the death of the policy holder. As per the enquiry conducted by the O.Ps, the policy holder had suppressed the suffering from Sickle Cell at the time of signing proposal. The Complainant had filed her claim application on 19-05-2013. The O.P No.1 called for treratment papers on 16-12-2013 and 24-02-2014 for considering the claim but the Complainant did not respond and remained silent. On 01-08-2016 the O.ps applied through the R.T.I application to the M.K.C.G Medical College Berhampur to provide the treatment papers of the deceased but on 12-08-2016 they denied to furnish the same as the L.I.C is not a party to the case. As per their suggestion the O.P requested the Complainant on 22-08-2016 to obtain the treatment papers for settlement the claim but she did not respond. On 20-02-2017 the C.P.I.O cum- Manager Sri Ghasiram Singh has supplied required information to the Complainant by registry post. In the said letter he has also requested to provide the treatment particulars but the Complainant did not comply the same. So, the allegation of the Complainant are false and denied by the O.Ps , as such they have not committed any negligence, deficiency in service and monopoly trade practice as alleged by the Complainant. The deceased was suffering from Sickle Cell which is a blood disorder disease inherited from parents and the same was suppressed by the deceased at the time of proposal and the Complainant intentionally not producing the treatment papers of the deceased. After getting the treatment papers they shall consider the admissibility of the claim of the policy. Due to non cooperation of the Complainant, the settlement of the claim can not be completed, so they are not liable to pay compensation as prayed by the Complainant.
We have heard the Complainant and the learned counsel appearing on behalf of both the parties. We have gone through the complaint petition, the joint version filed by the
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Opp.parties and the copies of the documents filed by the Complainant in support of her case. It is admitted fact that the deceased was the policy holder of three policies bearing No.572247311, 573405058 and 573405294 which were in force till his death. It is also admitted that the policy holder died on 22-08-2011 at MKCG Medical college Hospital, Berhampur. In the meantime more than 6 years has already been passed but the nominee is waiting to get the death benefit of her late husband. It transpires from the complaint petition, Death claim intimation, certificate of identity and Burial or cremation, claimant’s statement and the pleader notice dated 02-02-2017 that the policy holder died in malaria fever and jaundice. It is for the first time the Opp. Parties pointed out in their version that the policy holder died due to suffer from sickle cell. They have not produced any documents in support of their stand. So onus lies on the Opp. Parties to prove that the policy holder died due to sickle cell. The OP can not stand on the leg of the Complainant. It is not proved by the Opp. Parties that the deceased policy holder had concealed the material fact regarding his illness at the time of filing up of the proposal form or prior to the filling-up of the proposal form. The Opp. Parties have also not filed the proposal form of the deceased policy holder in this regard.
It is settled principle of law is that nonpayment of Insurance claim within reasonable time amounts to deficiency in service. The contract of insurance is founded on good faith. No enquiry report regarding the illness of the deceased is produced by the Opp. Parties. As there is no clear evidence in order to support the plea of the Opp. Parties, the Complainant -nominee is entitled to get the death benefit of her deceased husband from the Opp. Parties. Accordingly the complaint is allowed on contest against the opp. Parties in connection with policies bearing No. 573405058 and 573405294 as the Complainant is the nominee of both the policies. The Complainant is not entitled to get any benefit out of other policy bearing No.572247311 at present as the same policy is in the name of the minor daughter of the deceased and the date of maturity of the said policy is 17-03-2033.
Hence, the Opp. Parties are directed to release the death benefit of the deceased policy holder in respect of the above two policies bearing No- 573405058 and 573405294 in favour of the Complainant- nominee within 30 days from the date of receipt of this order. In case of failure the Complainant shall be entitled to get 9% annual interest on the entire awarded amount from the date of this Final order till the date of realization.
The C .C is disposed of. Supply free copy of this order to both the parties at an early date.
MEMBER MEMBER PRESIDENT
