DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KALAHANDI AT BHAWANIPATNA.

C.C. 06 OF 2017

Date of order 19^th January,2018

PRESENT:-

Sri Aswini Kumar Sahoo, M.A, LL.B    OSPS(I) Sr. Retd.                    President.

Sri Ashok Kumar Patra, Retd. O.I.S  ( I)                                                     Member.

Smt.Bhawani Pattnaik,M.A,LL.B,PGDCLP,                                           Member

          Nikunja Choudhury, S/o Sitaram Choudhury, Resident of Chikili, Dist.    Kalahandi, Odisha.                                                                                                                                                                          ………Complainant                                                               Versus

1. Branch Manager, SBI  Ladugaon, Kalahandi.
2. Branch Manager, SBI Life Insurance Company Limited Service Branch, Bhubaneswear PC,2^nd Floor,Stock Exchange Bhawan, Jayadev Vihar, Chandrasekharpur, Bhubaneswar, Dist.Khorda.
3. Regional Director, SBI Life Insurance Company limited service Branch Bhubanenswear,2^nd Floor, Stock Exchange Bhawan, Jayadev Vihar, Chandrasekharpur, Bhubaneswar, Dist.Khorda.                                                                                                           ………Opp.Parties
4.  

For the Complainant:Sri SudhirRanjan Das & Associate Advocate, Bhawanipatna.

For the Opp.Party No.1:Exparte.

For theOpp.Party 2 & 3 :Mr.Navin Kumar Pradhan,Advocate, Bhawanipatna.

                                         JUDGEMENT

The facts of the complaint in brief is that the complainant has obtained an insurance policy  Smart Humsafar of SBI  Life through the Opp.Party No.1 in the name of his wife Sarita Choudhury with annual premium of Rs.25,012/- for fifteen years which is to be paid every year on or before 31^st August of every year. The first premium amount was deducted  from the account of the complainant on 19^th August,2015 and the policy  commenced from 31^st August,2015 and the  policy bond was issued  in the name of Sarita Choudhury where the present complainant is the nominee.  On 3.09.2015  the wife of the complainant  died at Manipal Hospital at Visakhapatnam. After death of his wife the complainant claimed insured amount  and other benefit as per the terms and conditions of the policy before the Opp.Party No.1 and also at SBI Life Insurance office at Bhawanipatna but  the OP No.1 as well the insurance office at Bhawanipatna  did not  heed to the claim of the complainant. Hence prayed to  direct the Opposite Party to  release the assured amount of aRs.3,30,000/-  and other benefits  of the policy to the complainant and award Rs.10,000/-  towards mental agony and cost of litigation. Hence, this complaint.         

Being noticed the Opp.Party No.1 neither appeared nor filed written version as such the Opp.Party No.1 was set exparte. The Opp.Parties 2 & 3   appeared through advocate Sri Navin Kumar Pradhan and filed written version inter alia denying the petition allegations  on all its material particulars. It is submitted by the Opp.Party No.2 & 3  that the complainant and Smt.Sarita Choudhury   had applied for insurance  cover   under SBI Life Smart Humsafar  vide proposals No.1WQP656006 dt.19.08.2015 and accordingly Policy bearing No.1W000427901 with date of commencement as 31.08.2015  with sum assured of Rs.3,30,000/- and accidental death benefit of Rs.3,00,000/- was issued. The Ops came to know about the death of DLA only on receipt of notice of the Hon’ble Forum and in the process of checking the admissibility  of the claim, the Ops requires the following documents from the complainant i.e. Death Certificate of Deceased Life Assured, Claim Form, Original Policy Document, Photo ID proof of claimant, Medical Attendant Certificate, Hospital Treatment Certificate, Proof of Bank Details of Claimant, Cause of Death Certificate and all past treatment paper, If accidental Death, All policy report, i.e. FIR,PMR, Panchanama Report/Inquest Report. The Ops will be able to decide the admissibility  of the claim only after receipt of the  above documents. As per the policy, the Policy holder, nominee or the legal heir should intimate the death of the life assured in writing stating the policy number, cause of death and date of death. There is no cause of action for the complainant to file this present complaint because the onus of proving the cause of death and other details lies squarely on the complainants/nominee. Hence, prayed to dismiss the complaint with a directive to the complainant to submit the requirements to the Ops to verify the admissibility  of the claim.

                                                   F I N D I N G

                   It is admission case of both the parties that the complainant has obtained an   insurance policy  of SBI, Life Insurance Co. Ltd. for fifteen years  in the name of his wife Sarita Choudhury bearing Policy No.No.1W000427901  with date of commencement 31.08.2015 . It is alleged by the  complainant  that his wife was died while she was under treatment at Manipal Hospital, Visakhapatnam on 3.09.2015 and the complainant claimed for his insured amount to the Opp.Party No.1 and in the office of SBI Life Insurance at Bhawanipatna but the Opp.Party No.1 and the Insurance Office did not pay any heed to his grievance. The Opp.Party No.2 & 3 submitted that they  came to know about the death of DLA only on receipt of notice of the Hon’ble Forum and in the process of checking the admissibility  of the claim, the Ops requires the some documents from the complainant i.e. Death Certificate of Deceased Life Assured, Claim Form, Original Policy Document, Photo ID proof of claimant, Medical Attendant Certificate, Hospital Treatment Certificate, Proof of Bank Details of Claimant, Cause of Death Certificate and all past treatment paper, If accidental Death, All policy report, i.e. FIR,PMR, Panchanama Report/Inquest Report  and then the Ops will be able to decide the admissibility  of the . As per the policy term,  the Policy holder, nominee or the legal heir should intimate the death of the life assured in writing stating the policy number, cause of death and date of death.

                   The complainant alleged that he went to the OP 1 and Office of SBI Life Insurance at Bhawanipatna  but he has not made the SBI, Life Insurance, Bhawanipatna Branch as necessary party and also not filed any document to which we can believe that he approached the Bhawanipatna Branch because the Opp.Party No.2 & 3 countered the allegations of the complainant and contended that for the first time they knew about the claim of the complainant after receipt of notice of this Forum and also not denied the payment of insurance amount and prayed to direct the complainant to submit the required documents  to verify the admissibility of the claim. We also perused the  policy bond and found that the policy obtained in the month of August,2015 and the wife of the complainant was died in the month of September,2015 i.e. within one month of obtaining policy. It is genuine and we are not disagree with the argument advanced by  the Opp.Parties. In view of the above discussion, we  feel it necessary to dispose of the matter with the following directions.

                   Since the Opp.Parties are not denying the claim of the complainant, we directed the complainant to submit the required documents to the Opp.Parties No.2 & 3 within fifteen days of receipt of this order and the Opp.Parties are directed to verify the documents and settle the claim amount as per term and conditions of the policy and pay the insured amount to the complainant within 45 days of receipt of this order. There shall be no order as to costs and compensation.

                   Pronounced in open forum today on this 19^th  day of  January,2018 under the seal and signature of this forum.

Member                       Member                                     President

Documents relied upon:

By the complainant:

1. Copy of  Term & Condition of the Policy
2. Insurance Bond
3. Detail payment of the bill to Manipal Hospital.
4. Copy of  Death Certificate

By the OP:                                                                                                                                                                       President