Orissa

Cuttak

CC/134/2022

Pratikshya Panda - Complainant(s)

Versus

LIC of India - Opp.Party(s)

10 Jul 2023

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL COMMISSION,CUTTACK.

                                                      C.C.no.134/2022

Pratikshya Panda,

D/O:LatePravat Kumar Panda,

C/o: Fakir Mohan Panda,

At: Siva Automobiles, N.H-5,

Link Road,Madhupatna,Cuttack-10.                                     ... Complainant.

 

                                   Vrs.

1.        Divisional Manager,

LIC of India,At:Nuapaptana,

                P.O/P.S-Mangalabag,Cuttack

 

2.        Chief Manager,

LIC of India, DBO Link Road,

                  Cuttack.                                                                          ...Opp. Parties

 

 

Present:                Sri Debasish Nayak,President.

                   Sri SibanandaMohanty,Member.

 

Date of filing:      05.07.2022

Date of Order:    10.07.2023

 

For the complainant:          Mr. M.K.Dash,Adv. & Associates.

For the O.Ps               :         Mr. R.K.Pattnaik,Adv. & Associates.

 

Sri Sibananda Mohanty, Member.              

             The case of the complainant in short is that her father during his life time had obtained a policy bearing No.585036331 from the O. Ps for a sum assured of Rs.2,00,000/-.  The policy commenced from 28.3.2003 to 28.3.2019 and mode of payment of premium was yearly.  It is stated by the complainant that the nominee of the said policy was her mother,Pragyan Paramita Choudhury @ Panda who is dead.  It is stated by the complainant that while the policy was in force, her father died on 29.12.2003 due to C.V.A (hypertension) in low condition.  It is alleged by the complainant that her mother was an illiterate lady as well as she wasan Arthritis patient and was bedridden in most of the time.  At the relevant date of death of her father she was aged only about five months.  It is stated by the complainant that the legal heirs of her father are her mother, her grand-mother and herself.  It is further stated by the complainant that after death of her father, her mother became mentally weak as well as due to chronic Arthritis disease,she could not intimate about the policy of his deceased father to her grandmother.  However, her mother died on 9.2.2011.  The grandmother of the complainant also died on 1.1.2019.  The complainant’s date of birth is 8.11.2003 and she became major only in the year,2021 only.  After death of her grandmother, shebecame a destitute and resided with her uncle.  It is stated by the complainant that while searching locker of the almirah of her grandmother, she found the policy of her deceased father alongwith other documents.  It reveals from the said documents that the claim amount of the policy of her deceased father has not been settled by the O.Ps.  Hence, she submitted an application for settlement of the claim before the O.Ps on 31.12.2021.  It is the further case of the complainant that at the time of death of her father she was a minor and after attaining the majority, she applied to the O.P for settlement of the claim of her father as the O.Ps had not settled the claim amount.  But the O.Ps did not take any steps.  Hence, alleging the deficiency of service on the part of the O.Ps, she has filed the present case with a prayer for a direction to the O.Ps to pay the claim amount of Rs.2,00,000/- with bonus amount alongwith interest thereon @ 12% per annum from the date of death of her father as well as cost of her litigation.  So also she has claimed compensation for her mental agony.

             In order to prove her case, the complainant has filed copies of some documents alongwith her complaint petition.

2.         The O.Ps have contested this case and have filed their written version jointly.  It is stated by the O.Ps that the present case is barred by time.  It is stated by them that as the life assured died on 29.12.2003 and the mother of the complainant being the nominee in respect of the policy had lodged claim on 7.2.2006, but the claim was repudiated by them on 16.9.2008 due to suppression of material facts as regards to health conditions of life assured.  As such, it is stated by them that the cause of action for filing the case arose only on 29.12.2003, when the life assured died and thereafter on 7.2.2006, when the nominee lodged the claim and on 16.9.2008, when the O.Ps had repudiated her claim, but case has been filedin the year,2022 which is barred by time.  It is stated by the O.Ps that legal heir certificate issued by the Tahsildar is not a valid document, for settlement of claim amount as the succession certificate is required for settlement of claim.  The O.Ps admit about the issuance of policy, so also admitted about the death of life assured.  It is stated by them that the nominee,who was the mother of the complainant had lodged the claim before them.  The O.Ps alleged that after the enquiry,they came to know that the life assured had suppressed the material facts pertaining to his previous illness for which they had already repudiated the claim on 16.9.2008.  It is stated by them that as the policy had already ben repudiated since 2008 and the matter has been closed since long, the present dispute is not maintainable before this Commission.

             The O.Ps have also filed some documents in order to support their stand.

3.         Keeping in mind the averments as made in the complaint petition and the contents of the written versions of the O.Ps no.1 & 2, this Commission thinks it proper to settle the following issues in order to arrive at a definite conclusion here in this case.

                      i.              Whether the case of the complainant is barred by limitation?

                      ii.             Whether the case of the complainant is maintainable?

iii.            Whether there was any deficiency in service on the part of the O.Ps  and if they have practised any unfair  trade ?

iv.            Whether the complainant is entitled to the reliefs as claimed by her?

Issues no.i.

             It is admitted by the O.Ps that father of the complainant was issued a policy bearing No. 585036331.  It is also admitted by them that the life assured had died on 29.12.2003.  Though the O.Pshave alleged to have repudiated the claim vide their letter dt.16.9.2008  on the ground that the policy holder had suppressed the material facts as regards to his health but such letter dt.16.9.2008 has not been produced before this Commission.  During course of the hearing, this Commission had directed the O.Ps to produce that letter but the O.Ps could not produce the same inspite of taking several adjournments to produce the same.  Hence, it is presumed that no such letter has ever been issued to the nominee or any of the legal heirs of the deceased policy holder.  Hence, the plea of the O.Ps that as they had already repudiated the claim vide their letter dt.16.9.2008 and thereby filing the present case in the year 2022 is barred by time is not sustainable.   The O.Ps admitted to have received the claim form from the nominee of the deceased policy holder alongwith all documents but till date they have not settled the claim.  The complainant was only of 5 months old at the time of death of her father.  It is not disputed by the O.Ps that the mother of the complainant being the nominee of the policy holder had appliedthem for settlement of the claim amount, who died on 9.2.2011.  It is alleged by the complainant that after death of her father, her mother was bed ridden due to her illness, so also her mother had not intimated about the policy of her deceased father to her grandmother.  The O.Ps have not denied such allegations of the complainant specifically.  Hence, it is presumed that the mother of the complainant was bed ridden and she had not intimated about the policy of her father to her grandmother.  The grandmother of the complainant also died on 1.1.2019 but the O.Pstill that date had not settled the claim.The complainant attained hermajority only in November,2021.  She represented on 31.12.2021 to the O.Ps to settle the claim amount. But the O.Ps did not take any action.Thereafter, she has filed the present case on 5.7.2022.  Be that as it may, the complainant being the legal heir of the deceased as well as of the nominee could not file the case earlier due to her legal disability as she was a minor.  As such, Section-6 of the Limitation Act is applicable in the present case and the complainant is entitled to get the relief under that provision.  Thus, as per the said provision, limitation for filing the present case would run from the date when the complainant attained her majority.  She attained the majority only in the year 2021 and the present case has been filed in the year,2022 which is within the period of limitation.  Hence, the case has been filed within the limitation period.  This issue is answered in favour of the complainant. 

Issue no.iii.

             This issue being a pertinent issue is taken up before issue (ii) for consideration here in this case.

             It is admitted by the O.Ps that the father of the complainant had obtained a policy bearing No. 585036331 from them.  The O.Ps alleged that as the policy holder had withheld the material informations about his previous health condition, they had repudiated the claim in the year,2008.  The said allegation is far from truth.  The policy was valid at the time of death of the policy holder i.e. on 29.12.2003.  It is also admitted by the O.Ps that the mother of the complainant being the nominee had applied to the O.Ps for settlement of her claim.  It reveals from the record that the said nominee had filled up the form supplied by the O.Ps, wherein the treating doctor of S.C.B Medical College & Hospital, Cuttack of the life assured had given the opinion and certified on 7.2.2006 about the death of the policy assured vide Annexure-6 series, as filed by the complainant.  The O.Ps without any evidence simply saying that the policy assured had suppressed material facts and thereby repudiated the claim.  The treating doctor was of the opinion that the life assured died of CVA(hypertension) in low condition.  That doctor has never stated anywhere while filing up form issued by the O.Ps that the life assured had ever suppressed the material fact about his health condition.  The said doctor had stated that past history of disease of the life assured was “hypertension” which was only detected before one day of admission in the hospital.  Hence, it cannot be concluded that the life assured had suppressed the material fact pertaining to his previous illness.  The O.Psalso have not produced any evidence as to the suppression of material facts pertaining to the health condition by the deceased policy holder as well as evidence to the effect that cause of death of the policy holder was related to the pre-existing disease.  As such, the ground taken by the O.Ps in repudiating the claim is not sustainable.  The policy holder had not suppressed any material fact pertaining to his previous illness.  In view of the discussions made above and in view of the discussions and observation made while answering the issue no.i,  it is held that the O.Ps have not taken any decision on the claim application of the deceased life assured.  In order to coverup their lacuna, the O.Ps are taking false plea that they have already repudiated the claim in the year,2008.  It reveals from the case record that the nominee of the life assured who was the mother of the complainant had submitted all the documents to the O.Ps by February,2006 but till date the O.Ps have not taken any decision on the claim application of thesaid nominee.The complainant also had approached to the O.Ps for settlement of her claim but the O.Ps did not take any action. Hence, it is held that the O.Ps have not settled the genuine claim of the complainant although 16 years have elapsed in the meantime, calculated from the year,2006, when the mother of the complainant submitted all the documents to the O.Ps for settlement of her claim amount.  Thus, it is a clear case of deficiency of service by the O.Psand so also they have also practised unfair trade in not releasing the claim amount.  This issue is answered in favour of the complainant.

Issues no.ii& iv.

             In view of the discussions as made above, the case of the complainant is maintainable and she is entitled to the reliefs.  The O. Ps have not settled the genuine claim in respect of the policy in question although 16 years have elapsed in the meantime.  The ailing wife of the policy holder, who was the nominee as well as old mother of the policy holder had died in the meantime.  Thus, it is held that the complainant, her mother and her grandmother must have suffered a lot as the claim amount was not settled by the O.Ps.  Hence, it is so ordered;

                                                                             ORDER

             The case is allowed on contest against both the O.Ps, who are jointly and severally liable here in this case.  Thus, the O.Ps are directed to pay the complainant’s claim amount of Rs.2,00,000/- and bonus alongwith interest thereon @ 12% per annum from 7.2.2006, when the mother of the complainant had submitted all the documents with the O.Ps till the final payment is made.  The O.Ps are further directed to pay compensation amount of Rs.10,00,000/- to the complainant towards the mental agony and harassment as well as a sum of Rs.20,000/- towards her litigation expenses.

Order pronounced in the open court on the 10^th day of July,2023 under the seal and signature of this Commission.          

                                                                                                                                           Sri Sibananda Mohanty

                                                                                                           Member

                                            

                                                                                                Sri Debasish Nayak

                                                                                                            President