C.F. CASE No. : CC/11/93
COMPLAINANT : Sumati Das,
W/o Lt. Dhiren Das,
Vill. Jugpur, Dhaka Colony,
P.O. Jugpur Bazar,
P.S. Nakashipara
Dist. Nadia, Pin – 741126
OPPOSITE PARTIES/OPs: 1) The Divisional Manager,
LIC of India
Kolkata Suburban Divisional Office,
Jeevan Prabha, DD-5, Sector – 1,
Salt Lake City, Kolkata – 700064
- Branch Manager,
LIC of India,
Krishnagar Branch – 1,
5/1A D.L. Roy Road,
P.O. Krishnagar, P.S. Kotwali,
Dist. Nadia, Pin – 741101
PRESENT : SHRI KANAILAL CHAKRABORTY PRESIDENT
: SHRI SHYAMLAL SUKUL MEMBER
: SMT JHUMKI SAHA MEMBER
DATE OF DELIVERY
OF JUDGMENT : 28th May, 2012
: J U D G M E N T :
In brief, the case of the complainant is that her husband late Dhiren Das purchased one insurance policy of LIC of India, Table No. 165 with sum assured of Rs. 62,500/- and the date of commencement was 16.08.10. Before the purchase of the policy, Dhiren Das was hail and hearty. First premium amounting to Rs. 3,002/- was received by the OP LIC on 26.07.10 and the next date of premium was 8/11. It is her further case that on 04.11.10 her husband said Dhiren Das expired in a road accident on NH 34 in Dhubulia P.S. Accordingly, on the basis of a written complaint Dhubulia P.S. started a case No. 428 of 2010 dtd. 04.11.10 under Section 279 / 304 I.P.C. PM examination of the dead body of deceased was held at Nadia District Hospital. After the death of her husband she being the nominee of the policy intimated the LIC Office at Krishnagar Branch about this incident of death and accordingly submitted a claim application. On the basis of a letter dtd. 18.03.10 sent by the OP No. 2 she submitted further documents to the OP. Thereafter, she met the OP No. 1 several times, but the OP did not settle her claim. On 23.09.11 she sent an application through currier service to the OP requesting to pay the claim amount. On 11.10.11 the OP No. 2 sent a letter asking her to submit prescriptions, medical reports regarding the previous ailment and treatment of the deceased for the last 3 years. On 22.10.11 she sent a reply to LIC intimating him that she had no such document in her custody. In spite of that the OPs did not settle her claim nor repudiated the same. So having no other alternative, she has filed this case praying for the reliefs as stated in the petition of complaint.
The OP No. 1 has filed a written version, inter alia, stating that the case is not maintainable in its present form and nature. It is his submission that late Dhiren Das purchased one LIC policy from him on 16.08.10 with a sum assured of Rs. 62,500/- and the name of the complainant is recorded as nominee wife of the said policy. It is his further submission that the complainant intimated him about the death of her husband on 04.11.10 due to road accident and submitted a claim form along with the relevant documents. But from the post mortem report it is revealed that the death of the life assured occurred due to carcinogenic shock which is a pre-existing case of fatty enlarged heart with left ventricular hypertension which is ante mortem in nature. In the post mortem report it is also stated that death is to be determined by circumstantial evidence and the body of the deceased had no external injury. So from this post-mortem report it is clear that the cause of death was not actually from accident. Therefore, this OP took a claim review process and before completing that this case was filed. So the complainant has no cause of action to file this case as claim is yet repudiated by him. Hence, the case is liable to be dismissed.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
Both the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint and the written version filed by the OP No. 1 along with the annexed documents filed by the complainant and also the oral evidence laid down by the OP and after hearing the arguments on both sides it is available on record that the husband of the complainant, late Dhiren Das purchased one LIC policy from the OP on 16.08.10 and the assured amount is Rs. 62,500/-. ‘Annexure – 1’ is the copy of the policy document which also supports this. From the ‘Annexure – 3, 4, 5, 6 & 7’ it is available that said Dhiren Das expired on 04.11.10 on NH 34, Bahadurpur, P.S. Dhubilia when he was crossing the road. It also available that at that time the offending vehicle dashed him due to which he fell down on the road and lost sense. Thereafter, he was taken to Sadar Hospital, Krishnagar where the attending doctor declared him dead. PM examination over his dead body was held by the Sadar Hospital and from this it is available that nature of death is due to carcinogenic shock resulting in a pre-existing case of fatty enlarged heart with left ventricular hypertension which is ante mortem in nature and nature of death is to be determined by circumstantial evidence. ‘Annexure – 6’ is the inquest report of the dead body from which it is available that investigating officer found that at the time of crossing the road the victim was dashed by the offending vehicle and received injury which is the cause of his death. Admittedly there is no external injury as per PM report. In this case police submitted final report against the driver of the offending vehicle under Section 279 and 304 I.P.C. who has already stated in his report that the victim was previously injured due to accident and was admitted at Sadar Hospital where he succumbed to his injury.
So considering all the annexed documents specially the PM report, F.I.R., inquest report and final report it is available to us that this victim Dhiren Das was dashed by offending vehicle at the time of crossing the road due to which he sustained injury though not physically which is the ultimate cause of his death. Undoubtedly, this death was caused due to this accident which is clear from the above stated documents. Regarding previous ailment the complainant categorically intimated the OP that she had no document to that extent. She already filed the claim application before the OP and met him so many dates, but to no effect. From the written version it is available also that the OP neither settled her claim nor repudiated it. Rather he killed time by saying to review her claim. From the order sheet it is also available that the OP took time to settle the claim, but ultimately no settlement was done due to which the case is fixed for hearing argument.
In view of the above discussions and on a careful perusal of the facts of this case along with the annexed documents our considered view is that the death of the life insured was caused due to the accident met by him on 04.11.10. We do also hold that the complainant has become able to prove her case and so she is entitled to get a decree as prayed for. In result the case succeeds.
Hence,
Ordered,
That the case, CC/11/93 be and the same is decreed on contest against the OPs. The complainant is entitled to get the sum assured amounting to Rs. 1,25,000/- plus Rs. 5,000/- as compensation towards mental harassment caused to her along with Rs. 5,000/- as litigation cost, i.e., in total Rs. 1,35,000/-. The OP No. 1 & 2 are jointly and severally liable to pay the decretal amount of Rs. 1,35,000/- to the complainant within a period of one month since this date of passing this judgment, in default, the decretal amount will carry interest @10% per annum since this date till the date of realization of the full amount.
Let a copy of this judgment be delivered to the parties free of cost.
