Order No. 9 Dtd. 15.09.2016

As 13.09.2016 was declared holiday, record is put up today for delivery of judgement.

Smt. Bandana Roy, President

Brief fact of the complainant’s case is that the complainant’s husband Sri Somnath Maiti, S/o late Nagendra Nath Maiti took a Life Insurance Policy from the OP being no. 4594544433 on 28.08.2013 whose policy value was for Rs.100000/-. The complainant was the nominee of the said policy. But unfortunately, complainant’s husband died on 01.04.2014 in the midnight by stroke (heart attack) without giving any chance of treatment at the age of 49 years.

The complainant being the nominee of the said policy claimed the value of the insurance policy, filed all the original documents to the OP on 17.11.2014. But till date the OP neither settled the claim nor repudiate the claim which is beyond law and for which the complainant has been suffering from mental agony due to deficiency in service on the part of the OP. Hence, this case.

The OP contested the case by filing written version wherein they alleged that the nominee of the deceased Somnath Maiti, i.e. the complainant, neither claimed the policy amount by filing all original documents to the OP on 17.11.2014 nor the OP, LICI, denied or repudiate the said claim. The OP also denied any deficiency in service on their part. The OP stated that claim for the policy no. 499275860 is Non-Early in nature and LICI paid the entire claim of Rs.136760/- to the nominee on 05.04.2014 through NEFT. The other claim being no. 459454433 is early in nature. The OP stated that just to settle the claims early in nature, the LICI called for claim form A,B,B1,C previous treatment particulars and original Policy Bond from every claimant as per rule to judge admissibility of the claim. The OP alleged that they called for the same documents from the complainant on 18.11.2014 but the complainant did not submit any paper.

The OP then sent reminder again to the complainant on 03.12.2014 and 21.12.2014 for submission of the documents but the same have not yet been received by them. They stated that the complainant although claim to have submitted papers but was unable to provide any proof. The OP also requested the complainant to provide copy of the documents, if any with the complainant, for the OP’s decision making purpose regarding the admissibility of the claim.

That the OP had no intention to delay in settlement of any claim. The non early claim of the same complainant had already been admitted without any delay.

Point for consideration:

Whether the complainant is entitled to get relief, as prayed for?

Decision with reason

Complainant filed Xerox copies of Premium Receipt of Policy No. 459454433, copy of Death Certificate, copy of Claimants Statement, copy of Certificate of Indemnify and burial of cremation, copy of certificate of treatment of hospital and copy of Medical Attendance certificates. We have perused the complaint and W/V and documents filed by the parties. We have also heard the submissions of the ld. Lawyers of both sides. It is very crucial to mention that the W/V is not supported by any affidavit. Admittedly, the deceased took the policy in question on 28.08.2013 and admittedly he died on 01.04.2014. It is also admitted that the deceased took two policies being no. 499275860 and 459454433. It is also not disputed that the claim for the policy no. 499275860 has been paid by the OP LICI on 05.04.2014. According to the OP, the policy in question is early in nature. According to the OP that they called for some documents from the complainant but the complainant has not submitted the same in spite of OP’s reminder. From this version of the OP, it is clear that the OP is willing to pay the policy amount but the complainant has not submitted the relevant documents. On the other hand, complainant stated that the documents have already been supplied to the OP. So, for ends of justice, we are of the view that OP should pay the insured value within one month after complainant submitted the relevant documents.

Hence, we are of the view that the complainant is entitled to get relief but the complainant has also to comply the terms of contract according to the law. We do not think that the complainant is entitled to any compensation from the OP.

Hence, it is,

ORDERED

That the complaint case being no. CC/54/2016 be and the same is allowed on contest against the OP. Complainant is directed to submit relevant documents to the OP for settlement of the claim as early as possible. Op is directed to settle the claim and to pay the insured value to the complainant within one month from the date of this order. OP is also directed to pay Rs.5000/- as litigation cost to the complainant within one month from the date of this order, failing which OP will be liable to pay Rs.100/- daily as punitive charges which will be payable to the Consumer Welfare Fund.

Let the copies of the judgement be supplied to all the parties free of cost.