West Bengal

Paschim Midnapore

CC/73/2015

Rina De - Complainant(s)

Versus

Senior Branch Manager, Life Insurance Corporation of India - Opp.Party(s)

30 Nov 2015

ORDER

                                                              DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President

And

 Mrs. Debi Sengupta, Member.

   

Complaint Case No.73/2015

                                                       

                                        Rina De & Anupama De…………..….……Complainants.

Versus

 

1)Senior Branch Manager, L.I.C.I.,

 2)   Manager (Claims), L.I.C.I...………...........…..Opp. Parties.

 

              For the Complainant: Mr.  Subal Chakrabarty, Advocate.

              For the O.P.               : Mr. Diptendu Ghosh, Advocate.

 

Decided on: - 30/11/2015

                               

ORDER

                          Bibekananda Pramanik, President – This is an application under section 11,12,13 & 14 of the Consumer Protection Act, filed by Smt Rina De and Minor Anupama De against the Senior Branch Manager, Life Insurance Corporation of India and another.                                               

                        Complainant’s case, in brief, is that Uday Hari De, since deceased, the husband of the complainant during his life time purchased two L.I.C.I policies being nos.499329089 &  499333106  for  Rs.6,25,000/- and Rs.3,50,000/- respectively and the date of it’s commencement was on 28/03/2011.  After purchase of those policies, Uday Hari De paid premium and thereafter all on a sudden he died on 08/05/2011 due to acute cardio respiratory failure in his residence.  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 and 26/04/2012 claiming insurance benefit in their favour.  Thereafter, the complainant filed a complaint case being no.49/2014 before this Forum and in the said case, this  Forum was pleased to dismiss the case with liberty to

Contd…………….P/2

 

 

 

( 2 )

the complainant for presentation of a fresh petition of complaint.  After that the complainant sent a notice dated 07/03/2015 to the opposite party for death claim benefit as per policy conditions and the said letter was duly received by the opposite parties.  In spite of that, the opposite party No.2 did not response.  It is submitted that the opposite parties have adopted an unfair trade practice and such act of the opposite parties amounts to deficiency in service.  Hence the complaint praying for directing the opposite parties to make payment of the death benefit of those two policies total amounting to Rs.9,75,000/- with interest, compensation of Rs.2,00,000/-, cost and other reliefs.   

                  The opposite parties have contested this case by filling a joint written statement. Denying and disputing the allegation of the complainant, it is the specific case of the opposite parties that after a contested hearing of that complaint case no.49/2014, this Ld. Forum  vide it’s order dated 17/02/2015 was pleased to dismiss the said complain case on contest with a direction to the complainants to take necessary steps to comply with the  request in the letter dated 16/07/2017 issued by the opposite parties and these opposite parties have been directed by the Ld. Forum in that case to make final settlement of the claim and decision therewith as per terms and conditions of the policies in question within 60 days from the date of taking immediate steps towards the said request under the letter dated 16/07/2014 by the complainants.  After passing of that order, the complainant no.1 sent one letter dated 06/03/2015 to the opposite party no.2 with false, mala fide, baseless, irrelevant, misleading, frivolous and defamatory allegations but the said letter did not disclose the compliance of the request letter dated 16/07/2014 sent by the opposite parties as per order dated 17/02/2015 passed by this Ld. Forum in CC no.49/2014, thereby the complainant did not comply and abide by the order dated 17/02/2015 and so no valid cause of action has been accrued for filing the present case.  In spite of that, the opposite party no.2 replied the letter dated 16/03/2015 of the complainants by sending a letter dated 25/03/2015 by speed post to the complainants.  In spite of receipt of that letter, the complainants took no step and the staid fact has been suppressed in the present petition of complaint.  It is submitted by the opposite parties that unless and until the complainants do not comply the request of letter dated 16/07/2014, it would not be possible for the opposite parties to settle the claim in accordance with the terms and conditions of the policies.  Complainant Rina De replied falsely to L.I.C.I that she does not know about the illness of her husband. Op-L.I.C.I. asked the complainant Rina De by their said letter to deposit medical treatment papers of Uday Hari De for consideration of her claim but she denied.  Opposite parties advised the complainants Rina De to move before the Zonal office of L.I.C.I. ombudsman etc. if she is not satisfied with the decision of the opposite parties but

Contd…………….P/3

 

 

 

( 3 )

she filed cases one after another before this Ld. Forum with oblique motive.  It is claimed by the opposite parties that there is no cause of action to file this case and there is no deficiency in service on their part.   

Point for decision

                      Is the complainant entitled to get the reliefs, as sought for ?    

                    

Decision with reasons

In this case, neither the complainants nor the opposite parties have adduced any evidence, either oral or documentary but they have relied upon some documents, so filed by them in this case.  We have gone through the earlier petition of complaint case no.49/2014, the written objection filed thereof and the judgement dated 17/02/2015 passed by this Forum and the pleadings and documents of this complain case.  It appears from that judgement dated 17/02/2015 that after a contested hearing, this Forum passed the said judgement with the findings that there is no 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 opposite parties in their letter dated 16/07/2014.  This Forum was also of opinion in that case that the petition of complaint filed on 24/04/2014 in that complaint case no.49/2014 suffers from want of cause of action and as such the case is not maintainable and the case was, therefore, dismissed on contest with liberty to the complainant for presentation of a fresh petition of complaint on valid cause of action if any and the complainants were given liberty to take necessary steps to comply with request appearing in the letter dated 16/07/2014 issued by the opposite parties-Insurance Company and the opposite parties were directed to make final settlement of the claim and decision therewith in terms and 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 complainant in the light of observation made in the judgement.  We find from the said letter dated 16/07/2014 that by sending that letter dated 16/07/201, the opposite parties informed the complainant Smt Rina De that they are unable to proceed further for settling the claim without the treatment particulars of her deceased husband Uday Hari De of Appollo Gleneagles Hospital, Kolkata and CMC and the complainant was therefore requested to submit the same, at the earliest for speedy disposal of the claim.  After passing of that order and judgement of case C.C. no.49/2014, the complainant, as  it appears from her letter dated 16/03/2015, that she informed the Ops that she has already made replied by sending a letter dated 05/06/2014 and in spite of that by sending a letter dated 16/07/2014 the opposite parties have again claimed the treatment paper which is most illegal

Contd…………….P/4

 

 

 

 

( 4 )

and against the interest of the claim.  From the said letter dated 05/06/2014, we find that the complainant informed the opposite parties that she has no knowledge about the treatment of her husband at CMC, Vellore and by Dr. S.H. Advani of Apollo Gleneagles Hospital. By that letter she further intimated the opposite parties that her husband was quite healthy and able bodied prior to his death on 08/05/2015.  But from the documents and treatment sheets, filed by the opposite parties, we find that on 24/05/2014, Uday Hari De, the husband of the complainant, was treated at Apollo Gleneagles Hospital and he was also treated as outpatient in Paschim Medinipur College and Hospital and by Dr. D.P. Dolai on 02/05/2011 of  Medical College and Hospital Medinipur.  In spite of that, by sending the  said letter dated 16/03/2015, the complainant did not submit any such medical papers as required  by the opposite parties by their letter dated 16/07/2014 and as directed by this Ld. Forum vide it’s order dated 17/02/2015 passed in C.C. No.49/2014.  In spite of that, it appears from the letter dated 25/03/2015 that in reply to the said letter dated 06/03/2015, the opposite parties sent a letter requesting the complainant to comply with the requirements as asked for by their letter dated 16/07/2014 and which is also ordered by this Ld. Forum vide order dated 17/02/2015 and it was also intimated to her that in absence of those documents  it would not be possible by the opposite parties to settle the claim in accordance with the terms and conditions of the policies.  It appears that the complainant did not submit those medical papers, as required by the opposite parties and as  directed  by this Ld. Forum.  Opposite parties are quite justified in stating that in absence of those documents it is not possible for them to settle the claim in accordance with the terms and conditions of the polices. 

                  In the above facts and circumstances of the case and in view of our discussions, as above, we are constrained to hold that the complainant has no cause of action to file this case and there is no deficiency in service on the part of the opposite parties.  The complainants are therefore not entitled to the reliefs, as prayed for.

                                                  Hence, it is,

                                                     Ordered,

                                                       that the complaint case no.73/2015  is hereby dismissed on contest but in the circumstances without cost.

                 Dictated & Corrected by me

                                Sd/-                                            Sd/-                                        Sd/-

                            President                                    Member                                  President

                                                                                                                          District Forum

                                                                                                                       Paschim Medinipur