West Bengal

Paschim Midnapore

CC/200/2016

Smt. Namita Maity - Complainant(s)

Versus

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

30 Mar 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President,

and

 Kapot Chattopadhyay, Member.

   

Complaint Case No.200/2016

 

             Smt. Namita Maity, W/o Late Anadi Maity, Village Madhabpur, P.O. Debra Bazar,

             P.S. Debra, District - Paschim Medinipur, PIN-721126..………..……Complainant.

                                                                              Vs.

1)The Branch Manager (L.I.C.I.), Medinipur Branch, Barpathar cantonment, Medinipur, Dist- Paschim Medinipur, PIN-721101,

2)The Divisional Manager (L.I.C.I.), Jeevan Prakash Building, Jeevan Bima Sarani, Malancha, Kharagpur, P.O. Nimpura, Dist- Paschim Medinipur, PIN-721304

                                                                                       ……………..….….Opp. Parties.

                                                    

              For the Complainant: Mr.  Subrata Das, Advocate.

              For the O.P.               : Mr. Dipankar Pati, Advocate.

 

Decided on: -30 /03/2017

                               

ORDER

                          Bibekananda Pramanik, President – Facts of the case, in brief, is that Anadi Maity,  since deceased, the husband of the complainant Smt Namita Maity,  obtained a Life Insurance Policy named New Janarakksha Policy with profits cum accidental benefit on 28/11/2004 vide policy no.436605454 having sum assured Rs.30,000/- and the date of maturity was on 28/11/2020.  The complainant was the nominee of the said policy of her husband.  After taking the said policy, the husband of the complainant regularly paid all the premiums till his death on 28/12/2015.  As per terms of the policy, if the policy holder dies during the period of continuation of the policy due to accident, then the same amount of sum assured will be given by the O.P.-Insurance Company.  Unfortunately on 14/06/2016 at about 3 p.m., the husband of the complainant

Contd……………..P/2

 

 

( 2 )

died in a road traffic accident near Panigeria Bazar on N.H. 6 by unknown vehicle.  Over such accident, police of Debra P.S. started U.D. case being no.63/2016 dated 14/06/2016 and inquest report was prepared by the policy authority and post mortem was held over the death body of the husband of the complainant.   Autopsy surgeon, who hold Post- Mortem opined that the death was due to anti-mortem in nature.  Thereafter the complainant being the nominee of the said policy submitted claim form along with all original papers and copy of policy papers  claimed sum assured amount along with accidental benefit on 24/09/2016 but the O.P.-Insurance Company only paid the sum assured amount including the bonous of Rs.45,300/- but they refused to pay the accidental benefit without any reason.  It is stated that as the husband of the complainant died due to road traffic accident, so as per terms of the policy the complainant is entitled to get Rs.30,000/- as accidental benefit  but the O.P.-Insurance company most illegally refused to pay the same thereby causing deficiency in service on the part of the O.P.  Hence the complaint,  with a prayer for directing the O.P.-Insurance Company to pay Rs.30,000/- to the complainant as accidental benefit and further to direct the O.P.-Insurance company to pay Rs.10,000/- as compensation and Rs.5000/- as litigation cost.   

                  The opposite party-Insurance company has contested this case by filling a joint written objection.

                   Denying and disputing the case of the complainant, it is the specific case of the opposite party-Insurance Company that after getting the information of death of Anadi Maity, they immediately paid the assured amount of Rs.30,000/- plus vested bonus of Rs.15,300/- to the complainant as nominee of the policy but since the complainant did not provide them with copy of charge sheet or F.R.T., so they are not in a position to make payment of the accidental benefit to the complainant.  According to the O.P., for want of such document, they are unable to settle as to whether the death was caused due to road traffic accident or not.  It is stated by the O.Ps that they never neglected or refused to pay the accidental benefit to the complainant and they have not yet repudiated the claim of accidental benefit but they are awaiting for the  police papers basing upon which the benefit of accidental death can be substantiate.  O.P.-Insurance Company therefore claimes dismissal of the complaint with cost.

                 To prove her case, the complainant Smt Namita  Maity  has examined herself  as PW-1 by tendering a written examination-in-chief, duly supported by affidavit and during her evidence, two documents have been marked as Exhibit 1 & 2 respectively.  On the other hand, O.Ps adduced no evidence.

                                                              

Contd……………..P/3

 

(3 )

 

Points for decision

1)Is the case maintainable in it’s present form and prayer?

2)Is there any deficiency in service on the part of the opposite parties?

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

                   

Decision with reasons

For the sake of convenience and brevity, all the above points are taken up together         

                for consideration.

    Admittedly Anadi Maity, the husband of the complainant Smt. Namity Maity, obtained a Life Insurance Policy named  New Janarakksha Policy  vide policy no.436605454 for a sum assured of Rs.30,000/-.  Admittedly,  the complainant,  being the wife, is the nominee of the said policy of Anadi Maity.  Fact remains undisputed that on 14/06/2016, the husband of the complainant died in a road traffic accident and after the death of the husband, the complainant submitted claim of insurance before the O.P.-Insurance Company and after receiving the same,  O.P.-Insurance Company paid Rs.45,300/- towards the sum assured plus bonus  to the complainant.  Grievance of the complainant is that although the O.P.-Insurance Company paid her the amount of sum assured plus bonus but she has not been given the amount of accidental benefit of Rs.30,000/- as per terns and condition of the policy.  As against this, it is the case of the O.Ps. that since the complainant did not provide them with the charge sheet or F.R.T of the said U.D. case, so they are unable to ascertain as to whether the death of Anadi Maity occurred due to road traffic accident or not.  At the time of argument,  Ld. Lawyer for the complainant submitted that since the I.O. of that case has not yet submitted final report so the complainant could not supply copy of F.R.T to the O.P.-Insurance Company but the complainant duly sent the investigation report under Section 174 of Cr.P.C and Post Mortem report in connection with that case wherefrom it would be evident that the death of Anadi Maity was caused due to road traffic accident and the O.P.-Insurance Company did not settle her claim relying upon those documents.  In reply,  Ld. Lawyer for the O.P.-Insurance Company submitted at the time of hearing of argument that those documents are not sufficient to arrive at a decision that the death of Anadi Maity was caused due to road traffic accident.  Said copies investigation report under Section 174 of Cr.P.C. and P.M. report have been marked as Exhibit 1 & 1/1 respectively in this case and from those two documents we find that after enquiry, the investigating officer of that U.D. case came to know that the cause of death of Anadi Maity was due to road traffic accident and the

 

Contd……………..P/4

 

(4 )

 

Autopsy Surgeon also opined that the death of Anadi Maity was due to the effect of injuries which were Anti -mortem in nature.  From those two documents it clearly appears that the death of Anadi Maity was accidental in nature and relying upon those two documents, the O.P.-Insurance Company could very well settle the claim of accidental benefit under the said policy.  Since the O.P.- Insurance Company did not settle the said claim relying upon those two documents, so we are of the view that the O.P.-Insurance company has caused deficiency in service in settling the claim of Insurance.  The complainant is therefore entitled to get accidental benefit of Rs.30,000/- from the O.P. as per terms and conditions of the policy in question.

                       All the points are accordingly decided in favour of the complainant.

                        In the result, the complaint case succeeds.

                                                    Hence, it is,

                                                                         Ordered,                                                                                                    

 

                                                                               that the complaint case no.200/2016  is allowed on contest with cost against the 0.P.-Insurance Company.  O.P.-Insurance company is directed to pay Rs.30,000/- to the complainant towards accidental benefit of the policy in question being no.436605454  within a month from this date of order and they are also further directed to pay Rs.1000/- as compensation and Rs.500/- as litigation cost to the complainant. 

                All such payments should be made within a month from this date of order.  

               Let plain copy of this order be given to the parties free of cost.

 

 

                 Dictated & corrected by me

                    

                            President                                 Member                                    President 

                                                                                                                         District Forum

                                                                                                                     Paschim Medinipur