MR BIBEKANANDA DAS, MEMBER:-
The C.C.Case No. 167/2023 has been filed U/s-35 of C.P.Act, 2019 seeking the following relief;
“ The Op may kindly be directed to settle the Insurance claim and pay Rs. 3 Lakhs to the Complainant along with interest and compensation to the tune of Rs. 50,000/- for mental agony and harassment and so also pay the litigation expenses which the Hon’ble Commission deem just and proper”.
The case of the Complainant is that, the Complainant is the daughter and only legal heir of her mother Late Kumudini Parida, W/o- Bhikari Parida who died on dt. 18.10.2017. The Complainant’s mother Late Kumudini Parida had a L.I.C. policy vide No. 847544460 and premium of Rs. 6,948/- has been paid for the said policy. The policy was valid from dt. 28.07.2017 to dt. 28.07.2042 and the sum assured value is Rs. 3,00,000/- (Three Lakhs only). That after Complainant mother’s death the complainant claimed insured amount with all required documents of her deceased mother on dt. 17.09.2020 after knowing the LIC Bond was valid at the time of her mother’s death to which one letter has been issue by the Op on dt. 03.07.2020 vide claim No. 1585/945. It is further the case of the Complainant is that the Op after receiving all the required documents in respect of the above said claim is now playing hide and seek game with the Complainant by taking advantage of her illiteracy, ignorance of law and not settling the claim amount of the Complainant for which complainant compelled to take shelter before this Hon’ble Commission.
The Op on the other hand submitted in their written version that, the averments made in the complaint petition are all false, baseless and concocted one.
It is further submitted by the Op that as per the proposal papers the life assured of late Kumudini Parida for taking insurance policy No. 847544460 had referred the date of birth as dt. 15.05.1969 to her previous Policy No. 586175163, which is not within the knowledge of the Complainant and nor the Op has submitted any document in this respect. The Op further stated on its written version regarding the different date of birth of the life assured Late Kumudini Parida in Death Certificate, Aadhar Card and Voter ID Card which are not authentic document as per the decision of the Hon’ble Apex Court.It is further submitted by the Op in the written version that, the maximum age at entry under the Plan No. 817 is 55 years. Hence as per provisions U/s-45 Insurance Act, 1938 the L.I.C. of India had already refunded an amount of Rs. 6948/- to Kabita Rout, the nomine / petitioner on dt. 18.12.2020. So, the complaint petition is devoid of any merit and liable to be dismissed.
Heard, the Ld. Counsel for both the parties and after a careful scrutiny of the entire record and documents available on record, it is our considered view that, the Op has committed deficiency in service in not providing service to the Complainant and due to gross negligence of the op, the Complainant has been deprived from getting her legitimate claim amount of her deceased mother Kumudini Parida. Being aggrieved by such deficiency in service of the Op the Complainant filed present C.C.Case before this Commission for mental agony undergone for denial of claim by the op and so also for other expenses. The Op is at fault because they accepted the premium as per the contract of Insurance. The insurer has not followed the principle where they could have examined the date of birth of the insured. The insured had no opportunity/knowledge prior to sign the Insurance contract and the insured has not suppressed any material facts in the proposal form. In order to substantiate the present case, the Op has not filed any relevant document nor adduced any evidence relating to the exact date of birth of the deceased Kumudini Parida and so also not filed any related documents as they have stated in their written version. The Complainant on the contrary filed status of two Policies bearing No. 849667664 and 847544460 (Xerox copy annexed) wherein the date of birth of deceased Kumudini Parida has been mentioned as dt. 15.05.1969. Out of the above said two policies the husband of deceased Kumudini Parida, Sri Bhikari Parida (the nominee) has already received an amount of Rs. 2,07,360/- from the Op on dt. 18.12.2020 in respect of Policy No. 849667664. But the reason best known to the Op why they are not disbursing the claim amount in respect of Policy No. 847544460 to the Complainant. It was held by the Hon’ble national Commission in Metlife Insurance Co Ltd. vrs. Urbashi Goel and another 2018(2) CPR, 450(NC) wherein it was held that Insurance Company can’t refuse to settle the death claim after retaining premium amount for a long period. In another case decided by the Hon’ble Apex Court in Smt. Meenakshi Popat Kambhoje & others Vrs. LIC of India & another, it was held that reliance has been placed on Sec-50 of Insurance Act, 1938 in which it has been mentioned that a notice shall be given to the policy holder informing of the options available before the expiry of three years of the date on which the premium in respect of the policy of Life assured was payable.
It is further reveals from the record and contention raised by the op that in Plan No. 817 the deceased life assured was not eligible as because she had already crossed the upper age limit, for which the Op refunded the premium amount of Rs. 6948/- to the Complainant on dt. 18.12.2020.
It is a quite interesting that the Complainant is not having any such policy under Plan No. 817 and the Policy number has not been mentioned in respect of Plan No. 817 and no document has been filed in this respect by the Op in its written version. That apart the deceased mother of the Complainant had two policies bearing No. 849667664 & 847544460 and whose Plan/Term/PPT No. 814/16/16 and Plan/Term/PPT No. 814/25/25 respectively (Xerox copy annexed). Moreover no documents have been filed by the Op party with regard to the refund of premium amount and Policy number under Plan No. 817. So, the contention of the Op Party is not acceptable to this Commission and in our considered view the said contentions of the Op are devoid of merit and not tenable in the eye of law.
The insurer once accepted the premium under an Insurance, it is presumed that the insurer made appropriate inquiry about the insured. In our considered view the Op party is liable to pay the sum assured of Rs. 3,00,000/-(Three Lakhs) with other consequential relief from the date of claim i.e from dt. 17.09.2020, till its realization. Further the Op is liable to pay other additional amount as per order below.
O R D E R
Taking into the all the facts and circumstances, it is hereby directed by this Commission that he Op Party shall pay Rs. 3,00,000/- (Three Lakhs) alognwith @6% p.a. from the date of claim i.e from dt. 17.09.2020 till its realization to the Complainant. Further the Op shall pay Rs. 20,000/- towards mental agony and harassment and Rs. 5,000/- for cost of litigation to the Complainant within a period of 45 days from the date of receipt of this order, failing which the Complainant is at liberty to take appropriate step under the Provision of C.P.Act, 2019.
With the aforesaid direction and observation the C.C.Case No. 167/2023 is allowed & accordingly disposed off.
Issue extract of the order to the parties for compliance.
Pronounced in the open Commission, on this the 4th day of November, 2024.
I, agree,
SD/- SD/-
PRESIDENT(I/C) MEMBER
