IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,PURI

CONSUMER COMPLAINT NO. 10/2016

Present: Sri D.Moharana,President I/c

Ms. S.K.Rath,Member(W)

Smt.Sarojini Pradhan, D/o.Late Janaki Pradhan,

At/PO- Olla, via-Bhalipur, PS- Chandanpur,Algum, Dist-Puri-752014 ..Complainant

Vrs.

1- The Branch Manager,

L.I.C. Of India Ltd.,Puri Branch,

At-Penthakata,PO-Shree Vihar,PS-Sea Beach,

Dist- Puri-752003 …Opp.Party

For the Complainant-Sri Pradipta Kishore Mohapatra, Advocate.

For the Opp.Party- Sri M.R.N.Sahoo & Anjana Sahoo, Advocates

DATE OF FILING- 08.01.2016

DATE OF DISPOSAL-30.06.2020

O R D E R

Sri D.Moharana, President I/C

The gist of the case of the complainant is that complainant is the daughter of one Janaki Pradhan W/o. Ekadasi Pradhan. Janaki Pradhan during her life time had assured her life with the Opposite Party- L.I.C of India, Puri Branch, Puri vide Policy bearing No.574513754. The date of commencement of the policy was 28.8.2012 under the term and table of 091/16 for the assured sum of Rs.75,000/-. The mode of payment was yearly. The maturity of the policy was 28.2.2028. The present complainant viz. Smt. Sarojini Pradhan was kept nominee in the said policy by the life assured. But, unfortunately, while the policy was in force, the life assured Janaki Pradhan died on 4.10.2012 in the D. H. Hospital, Puri while under treatment. Subsequently, the complainant being the nominee and natural daughter of the deceased in the said policy, applied with all required application forms and documents as desired by the Opposite Party for payment of insured amount. The Opposite Party repudiated the claim of the complinant on 29.10.2015 intimating the complainant that she is not entitled to get the insurance claim lying in the name of Janaki Pradhan as it deviates the terms and conditions of the policy. Being aggrieved to the decision of the O.P., the complainant files the present complaint alleging deficiency in service on the part of the O.P in repudiating the genuine claim and prayed for release of the insured amount with interest and compensation for the mental agony and harassment caused to her. Hence, this case.

2- The Opposite Party has appeared through its learned counsel and filed written version denying all the allegations of the complainant . It is stated that one Janaki Pradhan made a policy bearing No.574513754 whose date of commencement was 28.8.2012 and date of risk was 6.9.,2012. It is further submitted that the life assured committed suicide by consuming poison within duration of 28 days from the date of commencement of the policy as per the medical attendant's certificate completed by Dist. Head quarters Hospital, Puri by Dr. Nandita Gupta, Asst. Surgeon. It is also stated that the final report submitted by the I. I. C, Chandnpur reveals that the deceased was suffering from disease since long, could not be cured and in order to avoid suffering, she took poison. Taking into account all these aspects, the policy was repudiated and informed to the complainant accordingly. Thus, it is contended that the complainant is not entitled to get any claim against the policy in question and the complaint of the complainant has no merit for which it is liable to be dismissed.

3- We have gone through the case in details, perused the documents filed by both the parties in support of their respective grounds and heard the learned counsels appearing for both the parties at a length. We have crefully gone through the copy of Final Report of a case of unnatural or sudden death sent to Magistrate under Section 174 Cr.PC by Chandapur Police Stationas submitted before us. It is not disputed that the complainant is the nominee of a policy bearing No.574513754 insured by late Janaki Pradhan for the sum of Rs.75,000/-. It is also not disputed that the life assured died while the policy was in force. However, the Opposite Party repudiated the claim of the complainant on the ground that the deceased life assured committed suicide by consuming poison within a period of 28 days from the date of commencement of the policy. It is also argued by O.Ps corroborating to the Medical Attendant's Certificate completed by District Head Quarters Hospital, Puri and the Bed Head Ticket of the said hospital that the said life assured took some danadar due to some domestic quarrel and cause of death is oregano phosphorous poisining. On the other hand, the learned counsel for the complainant gave emphasis to the Post mortem report and argued that the Opp.Parties has comiitted wrong in repudiating the claim of the complainant without applying the mind on the factual aspects and documents submitted to them and argued that the complainant is entitled to get all the benefits with respect to the policy under dispute.

4- We have carefully gone through the certified copy of final report being perpared by the Chandanpur P.S under Section 174 CrPC while conducting enquiry regarding the cause of death of Janaki Pradhan. It is found from the report that the deceased Janaki Pradhan was died due to Asphyxia relating to adult respiratory distress syndrome(ARDS). So far as concerned with Inquest Report, it does not reveal any inmportant information relating to deceased Janaki Pradhan but on the the other hand in witness column one of the sister whose name has not been mentioned stated that the deceased has taken poison. Therefore, the statement given by her sister can not be taken into consideration being no evidential value at all. Coming to the post mortem report, it discloses that the cause of death of the deceased due to Asphyxia relating to Adult Respiratory Distress Syndreome(ARDS). The doctor who examined the dead body of the deceased Janaki Pradhan did not make it sure that the deceased had taken poison but kept for chemical analysis of Viscera Report. None of the parties filed the visera report before conclusion of hearing even though the deceased died on 4.10.2012. So the post mortem report is the vital piece of evidence and more relevant to the present case for proper adjudication. Undoubtedly, the deceased died on Asphyxia due to Adult Respiratory Disease Syndrome(ARDS) as revealed in the post mortem report . More detailing the word 'Asphyxia' means the state or process of being deprived of oxygen which can result in unconsciousness or death, suffocation. The word A.R.D. S means acute./ adult respiratory distress syndrome is a life-threatening lungs conditions that presents enough oxygen from getting to the lungs and into the blood. Infant can also have respiratory distress syndrome. But it is strange to see as to how the O.P Insurance company repudiated the claim of Janaki Pradhan under Policy No.574513754 on the ground of taking Danadar(poison) due to some domestic quarrel. No evidence is found in any report that the deceased had taken Danadar(Poison) due to untolerable attitude of the family members. .

5- Moreover, in the post mortem report, no where it is pointed out that the concerned person Janaki Pradhan has taken any poison specifically which has caused death to her. However, the death of Janaki Pradhan has been caused due to respiratory problem for her acute diseases. On this admitted documentary evidence available on record, we are not in a position to accept the contentions of the O.P that the complainant has committed suicide by taking poison and ,therefore, the repudiation of death claim made by the O.P on this ground is quite illegal and unjustified.

6- Thus, on the facts as described above, we are satisfied that the repudiation of claim made by the Opposite Party in respect of the policy of Janaki Pradhan is not justified for which the nominee of the life assured is entitled to get the insurance claim of Rs.75,000/- together with interest thereof at the rate of 9% per annum from the date of filing of this case i.e. 08. 01.2016 till the date actual payment . Hence, it is ordered that:-

O R D E R

The case of the complainant is allowed on contest against the Opposite Party. The Opposite Party is directed to pay the insured amount of Rs. 75,000/- against the policy No.574513754 to the complainant together with interest thereof at the rate of 9 % per annum from the date of filing of the case i.e. 08.01.2016 till the date of actual payment. The Opp.Party is also directed to pay compensation of Rs.3,000/- for the harassment and mental agony caused and Rs.500/- towards cost of litigation to the complainant. The order shall be complied within 30 days from the date of receipt of this order.

Dictated and corrected by me on this 30th day of June, 2020

Sd/-S.K.Rath Sd/-D.Moharana

I AGREE(MEMBER) PRESIDENT I/C