DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 31st day of July, 2019
C.D Case No. 20 of 2017
Present 1. Shri Raghunath Kar, President
2. Shri Basanta Kumar Mallick, Member
3. Afsara Begum, Member
Sri Gobinda Chandra Patra
S/o: Late Umakanta Patra,
At: Kuansh (National Saw Mill),
Po/Ps/Dist: Bhadrak
……………………. Complainant
(Versus)
1. The Branch Manager, Life Insurance Corporation, Bhadrak Branch
At: Bonth Chhak,
Po/Ps/Dist: Bhadrak
2. The Senior Divisional Manager, Life Insurance Corporation Cuttack Divisional Office,
Jeevan Prakash, Post Box No- 36, Cuttack- 753001
…………………………..Opp. Parties
Counsel For Complainant: Sri R. K. Nayak & Others, Adv
Counsel For the O.Ps: D. Panda, Adv
Date of hearing: 15.01.2019
Date of order: 31.07.2019
BASANTA KUMAR MALLICK, MEMBER
This dispute arose out of a complaint filed by the complainant alleging deficiency of service against O.Ps.
The facts of the complaint are to the effect that the deceased father of the complainant was insured under the O.Ps on dt. 28.07.2011 for a sum insured of Rs 1,00,000/- and received the policy paper vide policy No- 598663842 which was operative from 28.07.2011 to 07.07.2031. The policy holder was liable to pay premium of Rs 6,936/- P.A. and accordingly the insured paid a sum of Rs 6,936/- as first premium at the time of opening of the policy. The deceased father of the complainant also went on paying the premiums up to 28.07.2013 but unfortunately died due to heart stroke while going to Bhadrak Kacheri Bazar by cycle. Due to severe heart stroke the insured fell down from the cycle on the railway over bridge at Randia, (Madhab Nagar) Bhadrak who was carried to Bhadrak D.H. Hospital by the local people for necessary treatment where the father of the complainant breathed his last on 20.10.2013 after sincere treatment of Doctors for more than five hours. After the sad demise of insured, his son intimated the insurer (O.Ps) on the next day of death and obtained the claim form from the office of the OP No. 1 and submitted the claim proposal together with all required documents on 31.10.2015 being physically present in office of OP No. 1. Awaiting for a period of nearly six months, the complainant met the competent authority in the office of OP No. 1 and requested him to settle the claim who assured to settle the claim within a week or two but no tangible result came out of the assurance of OP No. 1. The complainant also met OP No. 2 for an early settlement of claim who also assured to get it done very shortly. In this manner the complainant ran from pillar to post but did not yield any positive result from the O.Ps. But to his misfortune, like a bold from the blue, the complainant received a letter from the insured O.Ps on 19.12.2016 wherein the O.Ps repudiated the claim of the complainant which was absolutely genuine and correct. Being extremely disappointed by the action of O.Ps, the complainant, finding no other way, took shelter in this Forum and filed a dispute seeking justice from the respected Forum and prayed to issue a direction to the O.Ps to settle the claim earliest as possible with cost and compensation.
The O.Ps objected the allegations of the complaint and contested the case. In submitting the written version, O.Ps have raised the question of maintainability on the ground of barred by limitation and suppression of facts. It is also stated by the O.Ps that the complainant is bound to prove with proper evidence as to the death of insured was caused due to heart attack as the O.Ps are very much inclined to suspect the cause of death. In addition to above facts the O.Ps raised the point of non-submission of valid documents required for settlement of claim such as Voter Identity card to prove the age of the insured while taking up policy. Therefore the complainant has not come to this Forum with clean hands. In disclosing suppressed facts the O.Ps have stated that the actual age of the complainant as on the date of submission of proposal was more than 78 years which contravenes the settled position of IRDA Rules. Therefore the relief prayed by the complainant is not justified and also not tenable in the eye of law. It is also stated by the O.Ps in demanding that the parties to a contract are supposed to disclose material facts, as a part of their moral responsibility, to conclude the contract and in order to avoid future legal complication as well as dispute between the parties. But in the instant case the complainant has suppressed the material facts which were essential for a valid contract and under such situation the O.Ps were constrained to repudiate the claim. Hence the complaint filed by the complainant is devoid of merit and liable to be dismissed with cost.
Gone through the complaint, written version of O.Ps, materials on record, heard the parties to this case and observed as detailed here under.
Evidently the deceased father of the complainant was the insured under the insurer O.Ps and has paid three annual installment premiums before breathing his last. It is also a fact that the present complainant is the son and legal survivor of the deceased policy holder and in such capacity he has intimated the fact of death to the insurers and also staked the claim after collection of all required documents from the different competent Govt. authorities. Despite submission of all required documents the O.Ps have disputed all other allegations of the complaint.
1. At the outset O.Ps raised the question of maintainability of the present case as the death of the insured was occurred on 20.10.2013 and as such this dispute falls under barred by limitation as the dispute has been filed after three years from the date of death. In objecting the contentions of O.Ps, the complainant stated that he was not sitting idle and not ignored to stake it claim soon after death was occurred. It is nothing but the only truth is that the complainant remained engaged for collection of relevant documents and soon after having the documents, he staked the claim within the limitation period and waited for a prolonged period to get his claim settled. It is also a fact that the complainant has never left a single stone unturned for the settlement of this claim and has also ran from pillar to post because of neglecting attitude and irresponsiveness of the O.Ps. Hence it is clear and evident that the O.Ps have raised objection for the sake of objection only and trying their best how to avoid the claim.
Perused the material on record and observed that the complainant has staked the claim within the limitation period and as such the dispute does not come under barred by limitation.
2. The written version submitted by the O.Ps discloses that the O.Ps have left on the complainant to prove the death was caused due to heart stroke. On the contrary the complainant stated that the materials such as the medicine prescriptions, Bed Ticket and Medical Attendant’s Certificate completely discloses that the death of the insured caused due to heart stroke while he was on a bi-cycle on his way to Bhadrak for his own work. The documents are sufficient to provide a clear understanding about the cause of death.
On examination of documents pertaining to the treatment of the deceased insured and other material evidences this Forum does not have any doubt to say that the death has occurred due to heart stroke.
3. The O.Ps have objected that despite of correspondence made on 31.10.2015 addressing to the complainant requesting him to furnish the Voter Identity card of the insured or any school leaving certificate and VI card of the nominee for early settlement of the claim. But the complainant did not turn up to comply the requirements as a result of which the O.Ps, finding no other alternative, repudiated the claim as those materials were barely necessary for age proof of the insured as well as nominee. The complainant vehemently opposed the objection of O.Ps in stating that the Voter Identity card of the deceased insured was submitted at the time of submitting policy proposal for insurance and also the VI card of the nominee. The plea taken by the O.Ps for repudiation of claim due to non-submission of Voter Identity card is not a valid reason for repudiation of a death claim. The complainant has also arrested the attention of the Forum in course of hearing that if the complainant has not submitted the Voter Identity card of the deceased insured then how could the O.Ps get the said Voter Identity card which is submitted by them together with the written version. This clearly proves that the O.Ps have intentionally and deliberately made correspondence with complainant seeking submission of Voter Identity card of the deceased insured with an intention to reject the claim on the ground of over age. It is pertinent and very important to mention that when the Voter Identity card was with the O.Ps from the date of submission of proposal which reveals that the age of the insured was 78 as on 2009 and the O.Ps could have rejected the proposal instantly before issuance of policy bond. But the insurer have issued the policy for their own interest knowing everything that the age of the proposer of policy is beyond permissible limit with an intention to get the premiums till the death of the insured and the claim can easily be repudiated on this particular ground of over age. Secondly the Medical Attendant’s Certificate shows that the age of the applicant age on the date of the death was 53 years which does not deprive the complainant of his death claim. Finally it is worth mentioning that the claim has been repudiated because of over age at the time of opening of policy and in order to substantiate the objections raised, the O.Ps have submitted a policy bond, policy opening proposal form, Voter Identity card and voter list of the deceased those belongs to another person named as Umakant Rout, a different person but not the insured. This clearly proves the irresponsibility of the insurer O.Ps and how they have deprived a genuine person/claimant of getting his legitimate claim. It cannot be disbelieved that the O.Ps intentionally with an ulterior motive have repudiated the claim of the complainant for no just and proper reason for which an innocent claimant failed to get his benefits in time.
In view of the above analysis, taking the facts of the forgoing paragraphs into consideration and reference of the material evidence available on record, this Forum reached at the conclusion that the O.Ps have grossly neglected in performing their duties and responsibilities with due diligence as a result of which the complainant suffered mentally, physically and financially for no valid reasons and therefore O.Ps are liable to pay the claim amount along with compensation and cost.
- ORDER
The complaint be and the same is allowed against the O.Ps on contest. The O.Ps are directed to pay the sum insured of Rs 1,00,000/- along with bonus on the paid up amount and interest @ 7% P.A from the date of filing case. Further the O.Ps have to pay an amount of Rs 5,000/- as compensation and Rs 3,000/- towards cost of litigation to the complainant. This order must be complied within a period of 30 days from the date of receipt of order failing which an additional interest @ 8% on the awarded amount shall be charged from the date of order till the date of payment.
This order is pronounced in the open Forum on this day of 31st July, 2019 under my hand and seal of the Forum.
