28-04-2015 - The reasons for delay in disposal of this appeal can be seen from the order sheet.
1. Inspite of fixing this case for exparte order nobody appears for the respondents. It appears that respondent has not been appearing in this case after 5.11.2012.
2. Heard Mr. Sachin Kumar, learned counsel appearing for the O.Ps-appellants- (LIC for short) on the prayer for condoning the delay of about 95 days in filing this appeal.
3. On being satisfied with the grounds, the delay is condoned.
4. On merits, he submitted as follows. Even as per the complaint petition, the present complaint case was filed after the decision of Ombudsman passed on 29th July 2008. The complainant appeared before the Ombudsman and after hearing the parties his complaint was dismissed. The learned District Consumer Forum is not the appellate authority of the Ombudsman. If the complainant was aggrieved by the order of the Ombudsman, he could have taken recourse to appropriate proceeding.
According to the insured he applied for inclusion of accidental benefit in the policy on 14.5.2003 but if the LIC did not do anything, he could move before appropriate forum/ court after waiting for reasonable time, but he continued to pay the premium as per the policy issued, for about 4/5 years i.e. upto his death on 23.7.2007. In the written statement LIC did not admit that it received any such application from the insured and the complainant was put to strict proof thereof, which he did not prove.
He lastly submitted that a false claim has been made, after the insured died due to accidental death. He relied on certain orders passed by the Hon’ble National Commission.
5. After hearing Mr. Sachin Kumar and going through the materials available on record, we find that in view of the judgment of Ombudsman, the learned District forum should not have entertained the complaint petition. Further, in the complaint it was said that an application for inclusion of accidental benefit in the policy was made on 14.5.2003, whereas in paragraph 6 of his evidence Sujit Kumar, own brother of the insured/ deceased - Ajit Kumar Singh stated that the insured made an application on 25.10.2002 but the Complainant could not prove that actually such application was made. Moreover, if it was made by the insured and the LIC did not do anything, the insured could move appropriate court/ forum after waiting for a reasonable time, but he continued to pay premium for about 4/5 years before his death. Thus, the complainant could not prove that any such application was made.
6. In the facts and circumstances of this case, we are satisfied with the impugned judgement cannot be upheld. Accordingly it is set aside, the appeal is allowed and the complaint is dismissed.
Issue free copy of this order to all concerned for information and needful.
Ranchi,
Dated:- 28-04-2015
