DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C.NO.34 OF 2016
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member.
Sri Purna Chandra Tripathy - Member.
SMT. Mamata Mallick, aged- 35 years
W/O- Late Upendra Mallick Vill/ PO: Rasimendi
PS: Phulbani Sadar Dist: Kandhamal, PIN-762029 ……………………….. Complainant.
Versus.
Reliance General Insurance Co. Ltd
4-1-327 to 337, 4th Floor Sagar Plaza, Abids Road
Hyderabad- 5000001, Andhra Pradesh. …………………………….. OPP. Parties.
For the Complainant: Sri Kishore Chandra Patnaik, Advocate, Phulbani and his associates.
For the OPP. Parties: Sri V.V Ramadas Advocate,Phulbani .
Date of Order: 30-06-2017
O R D E R
The case of the Complainant in brief is that her husband Upendra Mallick had an Insurance Policy under the O.P namely SBI Personal Banking Business Unit bearing No. 1111342914000034 which was valid from 04-01-2014to 03-01-2015. On 09-10-2014 her husband died in a road accident at Village Adabadi of Kandhamal District. So, the Complainant submitted some relevant documents relating the death of her husband before the O.P on 13-11-2014 and 31-03-2015 through post. As the O.P did not respond the Complainant again filed the claim application with all required documents on 13-10-2015 before the O.P. On 29-10-2015 the Complainant had received a repudiation letter from the O.P due to delay of 370 days from the date of loss of Insured Late Upendra mallick. The Complainant was suffering from both mental and physical disorders after the sudden death of her husband and was on treatment. Hence, this complaint was filed by her for settlement of the claim to the tune of Rs. 3,00000/- with interest along with compensation of Rs. 50,000/- for her suffering and mental agony.
The case of the O.P as per his version is that the death intimation of Upendra Mallick ought to have been reached to the Insurance company within 90 days and documents within 180 days of the death of the person but the claim intimation was received by the O.P on 13-10-2015 .
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So the terms and conditions of the Insurance policy were violated by the Complainant. The further case of the O.P is that there is no cause of action to file this complaint and the O.P has not committed any deficiency in service, for which the complaint may be dismissed with cost.
During course of hearing the Complainant has filed an affidavit with one witness in support of her evidence .The Complainant and one witness Anaka kata was examined and cross examined as witness No. 1 and 2 on behalf of the Complainant. Exit-1 to Exit8 were marked upon the documents on behalf of the Complainant. One witness was also examined on behalf of the O.P and he has filed an affidavit in support of him. He was also cross examined in this case and Exit-A and Exit-B were marked for the O.P.
We have heard the learned counsel of the parties. We have gone through the complaint petition, the version filed by the O.P, the deposition of the witnesses and the copy of the documents marked Exits on behalf of both the parties. During course of argument it is submitted by the learned counsel of the Complainant that the Complainant intimated regarding the fact on 13-11-2014 and 31-03-2015 and thereafter on 13-10-2015 but the learned counsel for the O.P submitted that the O.P had received the intimation on 13-10-2015 only .On perusal of Exit -8 the certificate given by the Branch Manager State Bank of India Damanjodi Branch of District, Koraput, It is seen that the accidental death of Sri Upendara mallick was held on 09-10-2014 and he had expired on the same day. He was a holder of salary package account bearing No. 11070227847 for Rs. 3,00000/-. So it is an admitted fact that the deceased husband of the Complainant expired on 09-10-2014. This fact is corroborated by Exit -1, the first information report vide UDGR NO40/2014 and Exit-5 , the death certificate of the deceased. So, the main question of consideration is that whether Exit -7, the repudiation letter given by the O.P on 29-10-2015 is justified and whether the Insurance claim of the Complainant can be settled in favor of the Complainant?
It is seen from Exit-7 the repudiation letter dated 29-10-2015 that the O.P received the claim intimation on 13-10-2015 after 370 days from the date of loss as per the O.P. The Complainant failed to intimate within 90 days and also failed to submit documents within 180 days of the death of her husband. As per complaint the Complainant intimated the fact to the O.P on 13-11-2014 and on 31-03-2015 and thereafter on 13-10-2015. So, the case of the Complainant has continuous cause of action. It is pleaded by the Complainant that she was suffering from mental and physical disorders after sudden death of her husband and she was under treatment till the date of filing of this case on 16-09-2016. The Complainant is an illiterate lady who is a member of S.T community. He could not file the claim application within 90 days and also failed to file the documents within 180 days if it is believed that the O.P has not received her intimation on 13-11-2014 and 31-03-2015. So, in the above circumstances the claim of the complainant can not be rejected on this ground. There is no dispute regarding the Insurance policy of the husband of the Complainant and the nature of policy was paramilitary salary package as reveals from Exit-8 and Exit-B, the certificate
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of State Bank of India Damanjodi Branch. There is no dispute that the O.P has not received the premium of the Insurance policy from the Insured through his authority. In this connection we relied on the decision given by the Hon’ble National Commission ,New Delhi in the case of Bajaj Allianze General Life Insurance Company Ltd Vs. Krishna Devi .(2016NCJ)162(NC).
The Complainant is the widow of the deceased as per legal hair certificate vide Exit-2 issued by the Tahasildar, Phulbani. From the legal hair certificate Exit-2 it reveals that the deceased had 2 sons namely Rusikesh Mallick and Pankaj Kumar Mallick who are also the legal hairs of the Complainant. All the legal hairs of the deceased are entitled to get the benefit of the death claim. So, the complaint filed by the Complainant is allowed against the Opp. Party on contest.
In the above circumstances the Opp. Party is directed to pay the claim amount under personal accident Insurance of the deceased to the tune of Rs. 300,000/- along with other benefit applicable as per provision to the Complainant and her two minor sons namely Rishikesh Mallick and Pankaj Kumar Mallick. Out of this amount a sum of Rs. 200,000/- shall be paid to both the sons of the deceased in equal share and the same shall be deposited in any Nationalized bank by the Complainant at least for 5 years in any fixed deposit scheme.
The above order be complied by the O.P within 30 days from the date of the receipt of this order. In case of failure the O.P shall also be liable to pay interest @ 9% p.a till realization.
The C.C is disposed -of. Supply free copies of this order to both the parties at an early date.
MEMBER MEMBER PRESIDENT
