Present         (1)      Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                               President

(2)     Sri Sheo Shankar Prasad Singh,

                              Member

Date of Order : 17.07.2015

                    Sri Sheo Shankar Prasad Singh

1. In the instant case the Complainant has sought for following reliefs against the Opposite party:-

1. To pay full assured amount of Rs. 1,00,000/- ( Rs. One Lac only ) after deduction of paid amount from the date of accidental death with bonus which is more than 2 Lac with interest @ 18% per annum under policy no. 511527950.
2. To pay full assured amount of Rs. 50,000/- ( Rs. Fifty Thousand only ) after deduction of paid amount from the date of accidental death with bonus which is more than 1 Lac with interest @ 18% per annum under policy no. 513080210.
3. To stop the E.M.I. and interest from the date of accidental Death and refund the excessive paid amount.
4. To pay Rs. 50,000/- ( Rs. Fifty Thousand only ) as compensation.
5. To pay Rs. 5,000/- ( Rs. Five Thousand only ) as litigation cost.

2. Brief facts of the case which led to the filing of complaint are as follows:-

1. The present complaint is filed against the opposite party no. 1 & 2 for the payment of full and final insurance amount against the policies of the insured Late Sashi Bhushan Kumar Sinha, who died on 11.12.2005 – 2007 as Accidental death and also filed against the opposite party no. 3 for stop the E.M.I. and interest after death of the insured because the housing loan was issued to the deceased against the policies of the opposite party no. 1 & 2 and opposite party no. 1 & 2 paid the amount of the said policies, which was not full assured amount, to the opposite party no. 3, without considering the death of the insured as accidental.
2. Unfortunately on 11.12.2005 – 2007 at night the husband of the complainant died due to the cyclone, admitted in the P.M.C.H., Patna where Doctor declared that her husband died, Daily news paper published the news and Govt. of Bihar issued his death certificate on 15.05.2007. ( Vide Annexure 1, 1A, 1B and 1C respectively )
3. After the death of the husband, the complainant got knowledge regarding the insurance policies of her husband and also received information in respect of his housing loan, then complainant filed the accidental claim before opposite party no. 1 & 2 against her husband policies along with all necessary documents and also informed the opposite party no. 3 to stop the E.M.I. and interest after death of her husband and made request that housing loan be adjusted with her husband policies, which are pending before opposite party no. 1 & 2.
4. The husband of the complainant had taken two Life Insurance Policies from opposite party no. 1 & 2 i.e.

1. First :- Plan no 108, policy no. 511527950 for 25 years, w.e.f. 13.03.2000, sum assured amount of Rs. 1,00,000/- ( Rs. One Lac only ) quarterly premium is Rs. 2,444/- ( Rs. Two Thousand Four Hundred Forty Four only ) in which the complainant was entitled to receive more than Rs. 2 Lac in all respect as per terms of the policy, but she receive directly in her account only Rs. 26,200/- ( Rs. Twenty Six Thousand Two Hundred only ).
2. Second :- Plan no. 106, Policy No. 513080210 for 15 years, w.e.f. 20.12.2002, sum assured amount of Rs. 50,000/- ( Rs. Fifty Thousand only ) yearly premium is Rs. 5,845/- ( Rs. Five thousand Eight Hundred Forty Five only ) in which the complainant was entitled to receive more than Rs. 1 Lac in all respect as per terms of the policy, but she received directly in the housing loan account of the deceased only Rs. 53,410/- ( Rs. Fifty Three Thousand Four Hundred ten only ).

5. Neither opposite party no. 1 & 2 nor opposite party no. 3 considered her request to accept the death of her husband as accidental, although the complainant paid the E.M.I. of housing loan till January 2009, which was excessive payment, as the complainant being house wife, she has no full knowledge in respect of insurance policy, lastly she filed the instant case. The payment of housing loan E.M.I. may be observed by the letter of the L.I.C. Housing Finance Limited dated 04.01.2010, 06.02.2010 and 08.03.2010. ( Vide Annexure 3, 3A and 3B )

3. The Opposite Party No. 1 and 2 in their written statement cum objection petition has admitted the following facts in opposition to the submission of the complainant :-

1. The present complaint case filed by the complainant is not maintainable either on facts or in law.
2. There is no cause of action against this opposite party Life Insurance Corporation of India.
3. There is no deficiency on the part of the opposite party Life Insurance Corporation, Patna.
4. The complainant has filed present complaint case against the opposite party claiming for the payment of full assured amount of two policy taken by her husband Late Shashi Bhushan Kumar Sinha from the opposite parties no. 1 & 2 who died due to accidental death.
5. The opposite parties no. 1 & 2 provide details of the policy taken by deceased for his life for kind consideration and appraisal of this Court which are as under :

1. Policy no. 511527950, Sum Assured 1,00,000/- ( Rs. One Lac only ) plan & term 108/25/18 ( policy term 25 years and premium paying term 18 years ) D.O.C. 13.03.2000, first unpaid premium 06/2004 SB due 03/2004 was paid on 29.04.2004 Rs. 24,240/- ( Rs. Twenty Four Thousand two Hundred fourty only ). As per record of these answering opposite parties. The policy was lying under lapsed condition at the time of death of the Life Assured ( Deceased ) only paid up value is payable.
2. Policy no. 513080210, plan/term/P term : 106/15/12 ( policy Term 15 years, premium paying term 12 years, sum assured 50,000/- ( Rs. Fifty Thousand only ) date of commencement 2012.2002 mode yearly.

Installment Premium - 5,845/- ( Rs. Five Thousand Eight hundred Fourty Five only )

First unpaid Premium – 12/2006

Last accounting date – 11.12.2006

Nomination / Assignment policy was assigned absolutely to L.I.C. HFL, Patna. SB payment details SB due 12/2006 paid on 26.12.2006 vide cheque no. 873432 Rs. 15,000/- ( Rs. Fifteen thousand only ).

6. The statements in the complaint are purely on imaginary basis and the answering opposite parties placing full details of the policy and its calculation of the payment made in policy no. 511527950 as under:
7. The policy was lying under lapsed condition and only paid up value was payable the premium paid for 4 years 3 months only.

Paid up value after S.B.

Due 03/2004 paidRs. 2,500/-

Bonus for the periodRs. 31,025/-

Total paid up valueRs. 33,525/-

Less : policy loan principal Rs. Rs. 7,000/-

Policy loan interest Rs. 325/- Rs. 7,325/-

Balance Amount payableRs. 26,200/-

The amount has been paid vide cheque no. 581341 dated 10.03.2008 in the names of the nominee Prabha Sinha complainant in her SBI Gulzarbagh A/c No. 10796243421, and that the above payment was made as per rules of the corporation.

8. To another Policy No. 513080210, it is submitted that since the policy was assigned to LIC HFL by the deceased Life Assured, the sole owner of the policy was LIC HFL, after receipt of discharge voucher and policy bond and early claim was settled in favour of LIC HFL, as under the policy was received on 11.12.2006 on the basis of DGH, the claim comes under early claim. The policy was in lapsed condition for non payment of premium due on 20.12.2006. as per the rules of the LIC the death occurred with 6 month, the full sum assured was paid deducting the premium overdue.

The settlement of accidental benefit is being processed separately and requirement regarding proof of accident are being called for in this context the LIC wrote to the complaint nominee vide letter dated 12.08.2008 ( Regt. No. 743 & 744 dated 29.08.2008 & 08.10.2010. the LIC requesting therein to send the copy of first information report, Police Final report and Post Mortem Report which is still un - complied. It will not out of place to mention that without requirement mentioned above, the accidental claim cannot be processed.

Perused the documents available in the record are heard the parties at length.

About the claim of the complainant regarding payment of dues amount of policy in the question opposite parties in their written statement have submitted details about the amount which was paid to the complainant in respect of Policy No. 511527950 and to the LIC Housing Finance in respect of Policy No. 513080210 which was assigned by the deceased complainant to the LIC Housing Finance Limited and we are of the opinion that payments has been made as per rule.

So far accident claim is concerned the opposite parties have themselves admitted that the same is under process for which complainant has been requested to provide some documents thus it means that matter is still pending with the opposite party.

Under the aforesaid circumstances we direct the opposite party no. 1 & 2 jointly and severally to decide the accidental claim of the complainant as per law within two months from the date of receipt of this order if the complainant has already submitted all the relevant documents asked by the opposite parties. Incase the complainant has not submitted the relevant documents till date then he is directed to submit the same within a fortnight from today so that accidental claim is decided within the stipulated period of two months.

Even after submission of the documents by the complainant the claim is not decided between the stipulated period of two months then in that case the opposite party no. 1 & 2 jointly and severally are directed to pay the amount of accidental claim with interest thereon @ 9% per annum and the interest will be paid till final payment is made.

Aforesaid opposite parties are further directed to pay to the complainant Rs. 10,000/- ( Rs. Ten Thousand only ) as litigation costs.

Accordingly, this case stands disposed off.

                                                                       Member                                                                 President