DISTRICT CONSUMER DISPUTES REDRESSAL FORUM Civil Station, Palakkad – 678001, Kerala
Dated this the 20th day of August, 2010
Present: Smt.Seena.H, President Smt.Preetha.G.Nair, Member Smt.Bhanumathi.A.K, Member
CC.No.20/2010 1. Mini Pius Kurian W/o.Late Pius Kurian, Moolekudiyil House, Pottassery.P.O, Mannarkkad – 678 598
2. Nissy Pius Kurian D/o.Late Pius Kurian, Moolekudiyil House, Pottassery.P.O Mannarkkad – 678 598
3. Minor Mincy Pius Kurian D/o.Late Pius Kurian, Moolekudiyil House, Pottassery.P.O Mannarkkad – 678 598 Rep by her next friend and guardian Mother Mini Pius Kurian - Complainants (By Adv.G.Jayachandran for all complainants)
Vs Life Insurance Corporation of India Ottapalam Branch, P.B.No.7, Sundara Aiyer Road, Ottapalam – 679101 Rep by its Branch Manager - Opposite party (By Adv.Rajivijay Sankar)
O R D E R
By Smt.Seena.H, President
In short the case of the complainant is as follows:
The complainants are the legal heirs of one Pius Kurian who was a policy holder under the opposite party as per policy number 773096562 dt.20/10/1998 for Rs.2,00,000/-, 770944249 dt.22/06/1992 for Rs.1,00,000/- and 772524452
dt.3/11/1994 for Rs.1,00,000/-. All the three policies were having accident benefit cover to the insured. The insured was working abroad at Cook County, Illinois. During the period of coverage of the policy on 3/07/2002 he was shot dead by another person. The insured suffered multiple gun shot injuries as a result of which he died on 9/07/2002. The complainants preferred claim petitions along with all the necessary documents in order to get claims including accident benefit cover in all the three policies. The opposite parties paid the insurance amount excluding the accident benefits. Opposite parties has demanded production of policies, investigation report, final police report and court verdict for processing the claim. According to the complainants, all necessary documents for proving accident is already handed over to opposite party. Even then complainant again produced a certificate dt.1/05/2007 issued from the State Attorney, Cook County, USA stating that her husband was shot to death without any provocation in the Cook County on 9/07/2002 and the accused has be charged with double murder since there was another victim also in the incident. Complainants submit that so far opposite party has not settled the claim. Hence the complaint.
Opposite party entered appearance and filed version contending the following.
The main contention raised by opposite party is regarding limitation. It is submitted that the basic claim amount, bonus etc. were settled under the policies in 2002 itself. These amount were received in full and final satisfaction of all claims
under the policies. Thereafter, no further claim is maintainable. The complaint filed after nearly 7 years from the date of settlement of claim is barred by limitation.
It is admitted by the opposite party that the said policies cover accident benefits equivalent to the basic sum assured subject to policy conditions. But this benefit is payable if and only if the cause of death is accident and also if the accident is proved to the satisfaction of the corporation and also if the nature of accident is not excluded under the policy. It is submitted that the complainants failed to produce the requisite documents and hence opposite party could not make proper adjudication of the claim. It is also further submitted that the necessity of documents to be produced is to be decided by the corporation and not by the complainants. It is also contented that no certificate dt.1/05/2007 as alleged by the complainants has been received by opposite party. Opposite party submits that there is no deficiency in service on the part of opposite parties and complaint is liable to be dismissed.
Both parties adduced evidence in the form of proof affidavit. Exts.A1 to A13 were marked on the side of the complainant. No documentary evidence on the part of opposite party.
The issues that arises for our consideration are; Whether the complaint is barred by limitation?
Whether there is any deficiency in service on the part of opposite party? If so, what is the reliefs and cost complainants are entitled to?
Issue No.1: The main contention raised by the opposite party is regarding the limitation aspect. It is submitted on behalf of opposite party that the alleged happened on 3/07/2002 and the death occurred on 9/7/2002. Immediately on receipt of the claim form dt.1/11/2002 the basic sum assured and bonus etc were settled on 31/12/2002 itself. In the argument notes filed by the opposite party, it is stated that even after the letter dt.25/04/2007 issued by complainant no further action was taken by the complainant for settling her grievance. Opposite party produced two citations for substantiating this case that the complaint is barred by limitation. The dictum laid down in both the decision rendered by Hon'ble National Commission is that 'no amount of correspondence or meetings can extend the period of limitation'.
It is settled position that cause of action is said to arise only when the opposite party repudiates the insurance claim. Here it can be seen that the claim is not repudiated by the opposite party, instead they are requesting for further proof regarding the accident. It is seen that correspondences are going on between the complainants and opposite party during the period. Hence there is no question of limitation in this case. So the 1st issue is answered in favour of the complainants.
Issue No.2: The existence of accident benefit cover for the policies availed by the insured
is admitted by opposite party. So the short question to be answered is whether the opposite party is justified in not processing the claim petition on the ground of non-production of police investigation report, charge and court verdict.
Complainant has submitted that the death of the insured was due to multiple gun shot injuries. Opposite parties has no case that it is a suicide. So it is admitted that the incident is an accident. Ext.A4 which is the copy of the death record clearly reveals the fact that the insured was succumbed due to multiple gun shots. Ext.A5 which is the letter issued from the office of State Attorney also substantiate the case of the complainant. Opposite party has contented that they have not received any letter dt.1/05/2007. At the juncture it is pertinent to note that opposite party has not adduced any documentary evidence. When making a specific denial of non receipt of certain documents it is proper on the part of opposite party to produce the claim petition along with the documents whatever is produced by the complainant. We are of the view that opposite party is denying payment of insurance amount for a flimsy reason.
In view of the above discussions we are of the view that the inordinate delay in processing the claim petition of the complainants amount to gross deficiency in service on their part.
Issue No.3: Complainants has claimed Rs.2,04,200 with respect to policy NO.773096562,
Rs.1,07,000/- with respect to policy No.770944249 and Rs.1,04,900/- with respect to No.772524452 together with interest and also compensation and cost of the proceedings. Opposite party has admitted that as per the accident benefit the amount payable is equal to the basis sum assured. Opposite party has not raised any objection in the version or affidavit regarding the calculation of the amount. Hence the complainants are entitled for the said amount along with cost.
In the result, complaint allowed. Opposite party is directed to pay complainants an amount of Rs.4,16,100/- [2,04,200 + 1,07,000 + 1,04,900] (Rupees Four Lakhs sixteen thousand and one hundred only) with 12% interest from 1/11/2002 to the date of order. Order to be complied within one month from the date of order failing which the whole amount shall carry interest @ 9% p.a from the date of order till realisation.
Pronounced in the open court on this the 20th day of August, 2010 Sd/- Seena.H, President Sd/- Preetha.G.Nair, Member Sd/- Bhanumathi.A.K, Member Appendix Date of filing: 19/02/2010 Witnesses examined on the side of complainant Nil Witnesses examined on the side of opposite parties Nil
Exhibits marked on the side of complainant Ext.A1 – Photocopy of policy No.773096562 dt.28/10/1998 for Rs.2,00,000/- Ext.A2 – Photocopy of policy No.770944249 dt.22/06/1992 for Rs.1,00,000/- Ext.A3 – Photocopy of policy No.772524452 dt.03/11/1994 for Rs.1,00,000/- Ext.A4 – Photocopy of certificate of death Ext.A5 – Certificate issued by State's Attorney dt.31/08/2006 Ext.A6 – Photocopy of statement issued by Hursen Funeral Home, Illinois Ext.A7 – Easement of burial Ext.A8 – Photocopy of Certificate issued by State's Attorney dt.01/05/2007 Ext.A9 – Copy of letter dt.25/04/2007 sent by complainant to opposite party Ext.A10 – Letter sent by opposite party to complainant Ext.A11 (Series)- Copy of lawyer notice sent by complainant to opposite party, postal receipt, acknowledgement card etc. Ext.A12- Reply dt.22/1/2010 sent by opposite party to complainant Ext.A13 – Letter dt.27/01/2010 sent by opposite party to complainant Exhibits marked on the side of opposite parties Nil Cost (Not allowed)
| | [HONORABLE Smt.Bhanumathi.A.K] Member[HONORABLE Smt.Seena.H] PRESIDENT[HONORABLE Smt.Preetha.G.Nair] Member | | 
