DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 30th day of October, 2017
C.D.Case No.19 of 2015
Sri Dibakar Mohanty
S/o: Late Dayanidhi Mohanty
Vill: Gopalbindha
Po: Aharpada
Ps: Bhadrak (R)
Dist: Bhadrak
……………………. Complainant
(Versus)
S.B.I General Insurance Co. Ltd., Health Claims Team
Through AVP Claims Health
101,201,301, Natraj
Junction of Western Express Highway & Andheri Kural Road
Andheri East, Mumbai- 400069
…………………………..Opp. Parties
For the Complainant: Sri P. Diwedee & Others
For the OP: Sri P. Kanongo
Date of hearing : 22.09.2016
Date of order : 30.10.2017
SRI RAGHUNATH KAR, PRESIDENT
The complainant has filed this complaint against the OP with regard to the deficiency of service caused by the later are to the effect that Sibaram Mohanty & he has made an insurance policy vide No. 68100-0000-00 the complainant is the nominee of the said policy. The insured Sibaram met an untimely death due to shock & hemorrhage in a road accident on 25.11.2013. A few days after the death of Sibaram the complainant made an application on 15.02.2014 to the OP for disbursement of the insurance amount. On 08.02.2014 the OP asked the complainant to submit the following documents such as-
1. Original certificate of insurance.
2. Copy of death certificate attested by issuing authorities.
3. Copy of final police report attested by issuing authorities.
4. Copy of FIR/MLC Copy/Spot Panchnama/Inquest Panchnama attested by issuing authorities.
5. Affidavit from the legal heirs of the deceased (in case nomination has not been filed by the deceased).
6. Copy of Post Mortem Report attested by issuing authorities.
The complainant submitted the following documents before the OP.
1. The Original certificate of insurance.
2. Attested copy of death certificate.
3. Certified copy of final police report, FIR, Panchnama, and Post Mortem Report obtained from the District Judge, Bhadrak.
4. Copy of the voter ID.
5. And canceled cheque.
In spite of such compliance, similar letters were also sent to the complainant on 21.03.2014 & 04.04.2014. After all the receiving documents the OP sent a letter on 07.05.2014 asking the complainant to submit the above documents along with chemical analysis report instead of disbursing the complainant. As the insured met a road accident & there is no question of chemical analysis report. On 14.07.2014 the complainant informed the OP through a letter by Reg. post that his son died in a road accident. The post mortem report shows the cause of death as shock & hemorrhage, there is no question of any viscera report or chemical analysis report. The complainant made request to gate his amount disbursed in early date. After receiving the letter dt. 25.09.2014 the complainant has thoroughly disheartened & made contact with his advocate for proper advice in this matter. So on 14.11.2014 the complainant’s advocate sent a legal notice to the OP by the Reg. post with AD. The above narration of the events clearly suggested that the OP is bent upon avoiding payment the legitimate dues of the complainant. The cause of action arose within the territorial jurisdiction of this Forum upon the death of the insured.
Hence the complainant sought for the reliefs of Rs 4,000,00/- as insured amount, Rs 40,000/- for mental agony, Rs 50,000/- compensation for delay payment. Total claim Rs 4,90,000/- the complainant has filed the following documents such as-
1. Insurance cover note- Anx-1 (Xerox copy).
2. Post mortem report- Anx- 2(Xerox copy).
3- (i) Original Certificate of Insurance Anx-3.
3- (ii) Copy of death certificate attested by issuing authorities Anx-3.
3- (iii) Copy of final police report attested by issuing authorities Anx-3.
3- (iv) Copy of FIR/MLC Copy/Spot Panchamnama/Inquest panchamnama attested by issuing authorities Anx-3.
3- (v) Affidavit from the legal hairs of the deceased (in case nomination has not been filed by the deceased) Anx-3.
3- (vi) Copy of post mortem report attested by issuing authorities Anx-3.
4. The Xerox copy of the letter sent by the OP to the complainant on 21.03.2014- Anx- 4.
5. The Xerox copy of the letter sent by the OP to the complainant on 04.04.2014- Anx- 5.
6. The Xerox copy of the letter sent by the OP to the complainant on 24.05.2014- Anx- 6.
7. The Xerox copy of the letter sent by the OP to the complainant on 13.06.2014- Anx- 7.
8. The letter issued by the complainant to the OP on Dt. 14.07.2014- Anx- 8.
9. The addressee has received the said letter of the superintendent of post offices, Bhadrk Dt. 13.10.2014- Anx- 9.
10. The letter sent from the OP to the complainant on Dt. 14.07.2014- Anx- 10.
11. The letter sent from the OP to the complainant on Dt. 11.08.2014- Anx- 11.
12. The letter sent from the OP to the complainant on Dt. 25.08.2014- Anx- 12.
13. The letter sent from the OP to the complainant on Dt. 10.09.2014- Anx- 13.
14. Legal notice issued by the concerned advocate of the complainant to the OP on Dt. 14.11.2014- Anx- 14.
15. The letter issued by the OP to the complainant or the reply of the legal notice on Dt. 21.11.2014- Anx- 15.
On the other hand the OP has filed his written version appearing in the Forum through his concerned Advocate describing the following facts to support his stands. The OP has challenged the cause of action, the maintainability & the limitation of this proceeding. The OP has also challenged the maintainability of the proceeding with regard to the non-joinder & mis-joinder of necessary parties, as well as he has challenged the territorial jurisdiction this proceeding. The OP has also denied the averments in the complaint. He admitted the facts paragraph No. 3 but he has denied the facts made in the paragraph No. 2 of the complaint. The OP has denied the facts describing the paragraph No. 4, 5 & 6. The allegation made in the paragraph No. 7, 8 & 9 of the complaint relating to the facts that the OP is delaying to the matter only to avoid the payment to the complainant & after receipt of all the documents instead of disbursing the money the OP has asked for submission chemical analysis report are not admitted to be true & correct. The OP has also described in his written version that he has not caused any deficiency in service towards in the complainant the compensation claimed by the complainant is high & exaggerated. In fact the being the insurer has to abided all the guidelines as laid down by IRDA for processing & settlement of the claim & accordingly this OP has asked for the compliance of the required documents. As per the proposal submitted by the insured, the insurance policy bearing No. 22378413 covering the period from 05.12.2014 to 04.12.2013 is issued by this OP subject to its terms & under Group Personal Accident Insurance Policy in Sibaram Mohanty. Just after that on receipt of claim intimation in the matter the OP has issued the claim from to be submitted by the complainant duly filled in along with relevant documents in support of his claim, which was submitted on 27.01.2014 by the complainant to the OP.
After scrutinizing the claim file the OP asked the complainant vide letter dt. 20.02.2014, 08.03.2014, 21.03.2014 & 04.04.2014 with a request for the compliance of further relevant documents for processing of the claim according to the norms of the policy for an early settlement of claim. The complainant complied a part document as required, again he was asked vide letter dt. 15.04.2014 for submission of chemical analysis report, which the complainant is not complied for which the complainant again & again reminded compliance of the chemical analysis report for further processing of pending claim. In spite of required document the complainant issued a legal notice through his concerned advocate for payment of the claim amount. After observing the post mortem report it is found by the OP that the viscera was preserved of chemical analysis to be confirmed about the real cause of death. At last the OP has stated that he has not harassed the complainant he has not caused any deficiency of service rather the OP has disturbed in the official works. Rather the complainant should comply the premium. The O.P has refused to take no decision regarding payment to the complainant, rather he has prayed for the dismissal of the complaint.
The OP has filed a bunch of documents (Xerox copies) to support his stand points such as follows.
1. Claim letter submitted from the complainant before the OP.
2. The letter issued by the complainant to the OP on dt. 08.03.2014.
3. The OP sent reminder to the complainant on 21.03.2014.
4. The OP sent reminder to the complainant on 04.04.2014.
5. OP is a letter to the complainant on 15.04.2014.
6. The same letter to the complainant on 28.04.2014.
7. The same letter to the complainant on 27.05.2014.
8. The same letter issued on 13.06.2014.
9. The same letter issued on 28.06.2014.
10. The same letter issued on 11.08.2014, 25.08.2014, 30.09.2014 (3 sheets).
11. Objection made by the O.Ps against the complainant (3 sheets).
12. Xerox copy of FIR vide Gr case No. 2284/13 lodged by Badrinarayan Padhi (3 sheets).
OBSERVATION
We have already perused the averments of the complaint & the written version as well as we have already gone through the documents of both the parties. We have heard the submission of the concerned advocate of the complainant only. The OP was found absent in the Forum & did not participate on the hearing.
The complainant is a permanent inhabitant of the address mentioned in the above cause title situated within the territorial jurisdiction of this Forum. Sibaram Mohanty was the son of the complainant and he had initiated an insurance policy with the aforesaid OP vide policy No. 68100000000 & the complainant is the nominee of his deceased son. Sibaram met an unfortunate death due to sock & hemorrhage in a road accident on 25.11.2013. The post mortem report has been attached here with as Anx- 2 & the insurance cover note is attached here with as Anx- 1. Few days after the death of his son the complainant made representation to the O.P for the disbursement of insurance amount on 15.02.2014. On 08.03.2014 the O.P asked for the complainant to submit the following document in Anx- 3 described there, on 07.05.2014 the O.P asked the complainant to submit the documents along with Chemical Analysis Report. There is no existence of such report. On 24.05.2014 & 13.06.2014 the O.P issued letter once after another to the complainant to submit the Chemical Analysis Report before the O.P. On 24.05.2014 the complainant informed to the O.P by writing that his son died out of accident by meeting an accident at Bhandaripokhari situated at District Bhadrak. Those letters are attached here as Anx- 6 & 7. In this manner the OP continue to write letters which are attached here with Anx- 10 to 13 instead of disbursing the assured money in which the life of the son was insured. At last on 14.11.2014 the complainant sent a legal notice to the O.P to disburse the insured money of his deceased son which is attached here as Anx- 14. The O.P sent reply to the complainant which was the so cause of the legal notice which is made as Anx- 15.
Although the complainant has raised his legitimate claim but without making attention towards the appeal of the complainant the O.P continuously asked for compliance of some documents with regard to the insurance claim of the complainant. At last the O.P asked for the viscera report to the O.P. We have held that this is nothing but the false plea of the O.P for avoiding the insurance claim of the complainant. It is primafacie that there is no question of preservation of viscera & the investigating agency had already preserved the same. After compliance of all the documents the O.P had asked for further documents which is a clear evidence of harassment, persecution & torture to the complainant made by the O.P. The collection of all such documents is not the primary duty of the complainant rather it is the duty of the O.P because he is the service provider. The negligence of the O.P can never shifted to the complainant & it is tantamount to the deficiency in service.
The complainant’s son met an accident and died within the jurisdiction of the police station of Bhandaripokhari situated at District Bhadrak. The U.D case has been registered by the police of Bhandripokhari P.S. The dead body complainant’s son was sent to District Hospital at Bhadrak where the post mortem was conducted by a group of doctors & health workers the said hospital. The post mortem report also has been prepared by the medical officer of Bhadrak Hospital. In spite of all such procedures has been complied but still the O.Ps avoiding to make payment to the complainant which is his legitimate claim. If the occurrence of the took place within the jurisdiction of Bhadrak District, the U.D case has been registered by Bhandaripokhari police, the autopsy has been conducted by the medical office of Bhadrak District Hospital & the native place of the deceased is within the jurisdiction of Bhadrak (R) police station, where the question arises this present CD Case with regard to the same occurrence has been initiated within a wrong jurisdiction? So the challenge made by the O.P in his written version with regard to the jurisdiction of the case is completely vague & groundless. The complainant has properly instituted this case in the proper territorial jurisdiction. The challenges of the O.Ps described in their written version such as non-joinder & mis-joinder of necessary parties & limitation are also vague.
The cause of action arose on 25.11.2013 when the deceased sustained shock & hemorrhage in a road accident & the complainant the father of the deceased initiated the CD Case on 21.02.2015. The complainant has made a little delay of one month & 26 days of delay for filing of this CD case because the continues correspondences of letters between the complainant & the O.P were going on, sending legal notice & receiving show cause by the complainant made a little bit delay to file the complaint. When the matter was corresponding & negotiating between the parties for solution of the problem such little delay is condonable by the Forum. Hence the present CD Case is free from discrepancies. This is a feet case for awarding the reliefs to the complainant because he has come to this Forum with clean hands. Hence ordered;
ORDER
The complaint is & the same be allowed. Directing the O.P to pay Rs 4,000,00/- to the complainant as some assured or his insured amount, he is also directed to pay Rs 10,000/- for mental agony & Rs 20,000/- for cost of the litigation & interest within 30 days on receipt of this order failing the O.P is liable to pay Rs 100/- interest cost per day to the complainant till the date of final payment of the complainant.
This order is pronounced in the open Forum on this day of 30th October, 2017 under my hand and seal of the Forum.
(Sri Raghunath Kar)
President
(Sri Basanta Kumar Mallick)
Member
Typed to my dictation & corrected by me
(Sri Raghunath Kar)
(Apsara Begam) President
Member
