DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KANDHAMAL, PHULBANI
C.C NO. 23 OF 2015
Present: Sri Rabindranath Mishra - President.
Miss Sudhiralaxmi Pattanaik - Member.
Sri Purna Chandra Tripathy - Member.
Basant Manjari Mohanty, aged about 56 years
W/O: Jasananda Mohanty At: Phulbani Sahi
Po: Contractor Pada PS: Phulbani Dist: Kandhamal …………………….. Complainant.
Versus.
1 . SR. Divisional Manager, LIC, INDIA
Divisional Office, Jeevan Prakash, Khodasing
Post Box No- 18, Berhampur, Dist: Ganjam
2. The Zonal Manager, LIC of INDIA
East Central Zonal Office Jeevan Deep Building, 6th Floor
Exhibition Road PATANA- 800001 …………………………Opp. Parties.
For the Complainant: Sri B.K Pattnayak, Advocate and his Associates
For the OPP. Parties: Sri B.K. Mohanty Advocate.
Date of Order: 29-06-2016
O R D E R
The case of the Complainant in brief is that she is the mother of the deceased Amit Kumar Mohanty. During his life time Amit Kumar Mohanty had insured his life on 28-03-2012 vide policy No. 5734323469 under LIC of India but on 06-05-2012 he died out of a road accident. The said policy covers accidental benefit for a sum of Rs. 3, 20,000/- under the table No. 14-25 which was assured by the L.I.C of India that the insured amount shall be doubled in case of death out of road
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accident of the policy holder. Hence the Complainant is entitled to get Rs. 6,40,000/- from the O.Ps after his accidental death .
The further case of the Complainant is that the policy holder had paid Rs. 12,174/- towards the first premium. As such the said policy was in-force for one year from the date of commencement of the policy. After accident the deceased was shifted to DHH, Phulbani and the doctor declared him dead. Subsequently the inquest of the dead body was conducted by DHH, Phulbani where it is mentioned that the reason of death is out of accident. The post mortem of the dead body was also conducted by doctors and they have opined that the cause of death was “Ante mortem in nature and due to hemorrhagic shock “. Being a nominee the complainant has received Rs. 3, 20,000/- from O.P No.1 but the rest amount of Rs. 3, 20,000/- was not paid to her by the O.P for which he raised protest before O.P No.1. On failure the Complainant put forth her grievances before the O.P No.1 but on 28-03-2014 the O.P No.1 repudiated the DAB liability with a plea that the deceased was driving the vehicle under the influence of alcohol. Then the Complainant submitted his representation before O.P No.2 on 30-07-2014 by registered post.
The complainant has filed an application before the District Legal service Authority but the O.P did not agree to make any payment, accordingly the LAC case No. 460/2014 was droped on 31-01-2015 with advice to take shelter before appropriate Forum. Hence this complaint is filed by the Complainant against the O.Ps to get the rest amount of Rs. 3, 20,000/- with 12 % annual interest and she claimed Rs. 50,000/- as compensation and litigation charge for her mental agony.
The case of the O.Ps as per their joint version is that it is clearly mentioned in para 10 (2)(B)(1) of the policy bond that the Corporation shall not liable to pay the additional sum assured amount referred in (a) or (b)in case of disability or the death of policy holder if it is caused by intentional self injury, attempted suicide, insanity or immorality or under the influence of intoxicating liquor, drug or narcotic .
It is further case of the O.Ps that during investigation the police found that the policy holder had consumed liquor while driving the motor cycle. Due to intoxication the bike dashed near piaber Sahi culvert and the driver of the motor cycle could not able to control himself and sleeped to the nala. As a result of which the driver as well as two pillion riders namely Prabhat Kumar Bhoi and Tutu Pradhan were injured. The policy holder was shifted to DHH, Phulbani where he died and two pillion riders were admitted in the K.Nuagaon Medical. Though the sitting capacity of motor cycle is two but three persons were driving in the said motor cycle for which the policy holder violated the conditions of the policy knowingly for which the Complainant is not entitled to get double accident benefit. The deceased died after 38 days of the commencement of policy and a single premium of Rs.12, 174/-was paid by him. It reveals from the final report in G.R case No. 123/12 of the file of S.D.J.M, Baliguda that the policy holder was under intoxication at the time of driving of the vehicle .As the Complainant has already received Rs. 3,20,000/- towards the policy of the
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deceased, she is not entitled to get further amount of Rs. 3,20,000/- with interest and also compensation .So the complaint be dismissed.
During the course of hearing two witnesses were examined on behalf of the Complainant and non for the O.Ps. Exits -1 to Exit -7 were marked on behalf of the Complainant and Exit-A, Exit –B and Exit –C were marked on behalf of the O.Ps.
We have heard the learned counsels appearing for the complaint and the O.Ps .We have gone through the complaint petition, the joint version of the O.Ps , the affidavits and depositions given by the witnesses for the complainant ,all exhibits, other documents available in the record and the written argument submitted by both the parties carefully .
It is admitted by both the parties that the policy holder was died on 06-05-2012 out of the road accident. It is also admitted that the Complainant had received Rs. 3,20,000/- from the O.P o.1 after the accident of her deceased son being nominee. So, the sole point for consideration in this case is that whether the Complainant being nominee is entitled to get the total accidental benefit amounting Rs. 6,40,000/- from the O.Ps after the accidental death of her son .
On perusal of the documents of both the parties it is seen that the policy of the deceased was in-force at the time of accident. The learned counsel of the O.P submitted that the corporation shall not be liable to pay additional sum to the nominee of the deceased as per Para 10-2(b) of the conditions of the policy as the deceased was driving the vehicle under intoxication. He relied on the charge-sheet submitted by the O.I.C Baliguda In G.R Case No. 123/2012 of the file of the S.D.J.M, Baliguda. The learned counsel of the Complainant pointed out that there is nothing in the post mortem report and inquest report of the deceased to support the comments of the I.O that the deceased was driving the vehicle under influence of liquor. The O.Ps have no any other allegations against the deceased except the allegations that the deceased was driving the vehicle under the influence of alcohol. This objection based on the charge sheet of the I.O. In our considered opinion the statement of I.O in the charge sheet without any corroborative evidence cannot be conclusive evidence in the eye of law especially when the post mortem report is silent regarding the allegation. The I.O is not the expert to examine the deceased and to give any opinion regarding the consumption of alcohol at the time of accident. The O.Ps have not adduced any evidence to support their allegations in this case. Neither the I.O nor the concerned doctor was examined by the O.P to prove that the deceased was under alcohol while he was driving his motor cycle at the time of accident.
So, the reason of repudiation of the claim amount as per the policy of the deceased is not justified. The provision of facilities in connection with the insurance is an agreement between two persons, the insurer and the assured. Insurance is a contract. When the insurer failed to abide by the undertaking given by it in pursuance of a contract or otherwise, there is deficiency in relation to service. So it is the duty of the corporation to make payment to the nominee appointed under section 39 of the Insurance Act.
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It is admitted by the Complainant that she had received Rs. 3, 20,000/- the assured sum of the policy. So she is entitled to get the additional sum equal to the sum assured under this policy. Hence, the O.P No.1 is directed to Pay Rs. 3, 20,000/- to the Complainant, the nominee of the deceased within 30 days from the receipt of this order along with Rs. 2,000/- as cost of litigation. In the above circumstances no compensation is awarded in favor of the Complainant.
The C.C is disposed -of accordingly. Supply free copies of this order to both the parties at an early date.
MEMBER MEMBER PRESIDENT
