West Bengal

Paschim Midnapore

CC/49/2014

Rina De. - Complainant(s)

Versus

Senior Branch Manager, L.I.C. - Opp.Party(s)

17 Feb 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

 

 Complaint case No.49/2014                                                                                                Date of disposal:  17 /02/2015                               

 BEFORE : THE HON’BLE PRESIDENT :  Mr. Sujit Kumar Das.

                                             MEMBER :  Mrs. Debi Sengupta.

                                             MEMBER :  Mr. Kapot Chattopadhyay.

  

 For the Complainant/Petitioner/Plaintiff : Mr. S. Chakraborty, Advocate.

 For the Defendant/O.P.S.                       : Mr. D. Ghosh, Advocate.                                   

          

 Rina De, W/o Late Uday Hari De, minor Anupama De, D/o Late Uday Hari De, Vill. & P.O.  

 Ekarukhi, P.S. Belda, Dist- Paschim Medinipur…………..Complainant

                                                           Vs.

1)Sr. Branch Manager, Life Insurance Corporation of India, Medinipur Branch, P.O. & P.S. Medinipur, PIN-721101.

2)Manager, Claims, Life Insurance Corporation of Indfia, Claims Department, Kharagpur  Divisional Office; Near Lal Banglow, Nimpura, Kharagpur, P.S. Kharagpur, Dist- Paschim Medinipur, PIN-721304..……………Ops.

         The case of the complainants, in short, is that deceased Uday Hari De, husband/father had purchased two policies being its’ Nos.-499329089 & 499333106 for Rs.6,25,000/- & 3,50,000/- respectively with the date of its’ commencement from 28/03/2011.  During validity of the said policies Uday Hari De died on 8/05/2011 of Acute Cardio Respiratory Failure.  The complainants accordingly reported the matter to the Op/L.I.C.I. Medinipur Branch and submitted claim forms with all relevant documents in their office on 25/04/2012 & 26/04/2012  for insurance-benefit of Rs. 9,75,000/- in their favour. It is alleged, that even till date the complainants have not received any benefit in terms and conditions of the policies.  Ultimately, Advocate’s notice demanding the claim has been served upon the Opposite Parties.  But no steps has been taken by them.  On the contrary, the OP asked for submitting treatment papers of the deceased policy holders.  Whereas the deceased had, in fact, no ailments during his life time and as such there was no requirement for medical treatment for him.  Stating the case, complainants made allegation of deficiency in service and unfair trade practice against the OP.  In order to prove the allegation, some documents namely Policy Certificates, Letter dated 4/09/2013, 28/08/2013 & Death Certificate of the deceased Uday Hari De are filed before us.  

Contd…………….P/2

 

- ( 2 ) –

 

         The Op contested the case by filling written objection challenging that the case is not maintainable for want of cause of action and the same is barred by limitation.  The complainant submitted claim forms on 25/04/2012 & 26/04/2012 are all denied by the OP and the case is totally baseless and imaginary.  In this connection, it is submitted by the OP that the complainant Rina Dey is working for the OP/L.I.C.I.  At the time of purchasing policies, the proposal form was furnished with false informations and also upon suppression of material facts relating to the particulars of     the deceased policy- holder, particularly, in respect of the matter of his ailments including the ailment, namely, Cancer that he suffered from.  The OP claimed that the deceased policy holder received medical treatment from several hospitals and various doctors.  Further stated that he was treated in CMC hospital at Vellore, South Inida and also in the Appollo Gleneagles, Kolkata.  He was also treated by Dr. D.P. Dolai, Dr. S.A. Advani an Oncologist.  The nature of treatment indicates that the deceased had been suffering from Cancer for long days.  Upon suppression of the dreadful disease for a long time, the insurance – policies were managed to have collected by the complainant.  Thus, the complainant has induced the OP/L.I.C.I. to issue the policy under mistake and by fraudulent means.  During inquiry, it was revealed to the Op that the complainant suppressed the material particulars and thereupon the OP declared that without necessary particulars, the claim cannot be proceeded with.  Disclosing the conduct of the complainant, the OP demands that there is no ground for the allegation of deficiency of service against the OP and thereby the case should be dismissed.  In this connection, a bunch of documents as per firisty is filed from the end of OP Insurance Company.  Those are treatment paper of Appollo  Gleneagles, report dated 02/08/2013 of Allollo Gleneagles Hospitals, OPD – ticket dated 01/02/2011 of CMC Hospitals, doctors advice dated 2/05/2011, letter dated 17/03/2014 sent by the Op, reminder-letter dated 28/04/2014 with letter dated 23/05/2014 & 17/03/2014 together with some L.I.C documents bearing  information on personal history of the deceased policy holder and a letter dated 16/07/2014 requesting the complainant to submit treatment particulars for speedy disposal of the claim case.  The OP claims that since the matter is under process there is no cause of action for filing this case and the same should be dismissed.

         Upon the case of both parties the following issues are framed.

Issues:

1)Whether the case is maintainable in its present from?

2)Whether the complainants have any cause of action for presentation of this petition of complaint?

3)Whether the case is barred by jurisdiction?

4)Whether the complainants are entitled for getting relief as prayed for.?

Contd…………..P/3

 

 

- ( 3 ) -

 

Decision with reasons

Issue Nos.1 to 4:

              All the issues are taken up together for discussion as those are interlinked each other for the purpose of arriving at a correct decision in the dispute.

              Ld. Advocate for the complainant made his argument that there is no dispute as regard to the question of validity of the policies and the fact of death of the deceased policy holder Uday Hari De.  Now it is long days passed, no insurance benefit has been given to the complainant despite necessary claim form together with relevant documents was submitted immediately after the death of the policy holder.  So, this is a fit case of deficiency of service against the OP and thereby the prayers for payment of death benefit should be allowed in favour of the complainants.

               Ld. Advocate for the Op raised strong objection referring to the serious point of suppression of necessary particulars relating to the actual ailment and its nature the deceased Udey Hari De had been suffering from.  The complainant Rina De herself is an experienced agent, working under the OP/L.I.C.I., motivatedly made the meaningful policies in the name of her deceased husband anticipating his death may possibly take place within a very short time.  In order to bolsters his logic, it is pointed out very categorically by the Ld. Advocate that the entry against the items of personal history in the proposal form discloses negative entry denoting that the policy holder had no ailments in any form at the time of opening insurance policy on his own life. Beside, the Op Insurance Company, as submitted by the Ld. Advocate, has not taken any final decision repudiating the claim or played dilatory process or harassing steps towards the interest  of the complainants, rather the Op remains waiting for further steps upon requesting  them for filing the relevant documents as asked for by  letter dated 16/07/2014.  But till date no cooperation despite such request is found to have extended by the complainants.  So, the OP is now unable to proceed further towards settlement of the claim.  Referring to this aspect based on available evidence, Ld. Advocate tried to attract our notice as to how much justification for deciding the question of deficiency in service as alleged is available in this petition of complaint.

              Upon due hearing the parties we have carefully considered the case on material evidence available on record.  It appears that two policies were opened on 28/03/2011 in the name of deceased Uday Hari De aged 52 years for sum assured for Rs.2,96,725/- of which death benefit & accidental benefit Rs.6,25,000/- each and sum assured of another policy was Rs.3,50,000/-  on yearly premium of Rs.29,400/- & 34,449/- respectively.  It also appears from the death certificate No.010891 dated 18/11/2011 produced by the complainants that the policy holder Udey Hari De

Contd……….P/4

 

                                                                                               - ( 4 ) –

 

 aged 52 years died on 8/05/2011.  For the purpose of processing the claim, OP Insurance Company on 28/08/2013 made a request to the complainants for submitting necessary documents.  In this context, it is evident that the complainants made a reply on 4/09/2013 disclosing that the matter of medical treatment was beyond the knowledge of the complainants on the ground that the deceased was quite fit for last three years prior to 15/03/2011and there was no scope for treatment prior to his sudden death on 8/05/2011.  It is also evident that on reply of the complainants, the OP made a request to the complainant for giving details treatment particulars of the deceased in Apollo Gleneagles Hospital, Kolkata and CMC, Vellore enabling the OP to further proceed for settlement of the claim.  Upon careful scrutiny of the total evidence so far available from the complainants as on record, there appears no iota of evidence at least towards the compliance of the request made by the OP by means of their letter dated 16/07/2014, Ref: D/Claim/MBO-2012-177,189.

               Under the facts and circumstances of the case as discussed here in above, we do not find any case of deficiency in service since the matter of claim, placed by the complainant, is under active process awaiting reply with necessary particulars, if any, from the end of the complainants in terms of the existing request made by the OP as in their letter dated 16/07/2014.  So, the present case filed on 24/04/2014 suffers from want of cause of action and as such the case is not maintainable at this stage.  So, it may be equitable for the contending parties to avail of the process towards the final settlement of the claim by virtue of necessary documents if any which may be produced in compliance with the request as in the letter dated 16/07/2014  and as such the issues 1 & 2 should be held and decided against the complainants.

              Under the facts and circumstances and decision on issues 1 & 2, the rest issues need no further discussion.  As a result, all the issues are decided and disposed of accordingly.

              Following the result of the issues the case should be dismissed with giving liberty for presentation of fresh complaint on valid cause of action.      

               Hence,

                           It is Ordered,    

                                                   that the case be and the same is dismissed on contest  without cost with giving liberty to the complainant for presentation of fresh petition of complaint on valid cause of action, if any.

                   The complainants in the meantime, may take necessary steps to comply with the request appearing in the letter dated 16/07/2014 issued by the Op/Insurance Company.  The Op is accordingly directed to make final settlement of the claim and decision therewith in terms and

Contd………..P/5

 

 

- ( 5 ) –

 

conditions of the policies in question within 60 days from the date of taking immediate steps towards the said request under letter dated 16/07/2014 by the complaints in the light of observation made in the judgement. 

Dictated & Corrected by me

              

         President                          Member                                   Member                             President

                                                                                                                                      District Forum

                                                                                                                                    Paschim Medinipur.