Tripura

West Tripura

CC/20/2016

Sri Nitai Chandra Saha. - Complainant(s)

Versus

The Divisional Manager, Life Insurance Corporation of India & 1 another. - Opp.Party(s)

Mr.N.Chaudhuri, B.Chakraborty, M.Chaudhury.

04 Jul 2016

ORDER

DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM
WEST TRIPURA  :  AGARTALA

CASE   NO:   CC- 20 of 2016

Sri Nitai Chandra Saha,
S/O- Late Brajabashi Saha,
Shibnanagar, Masjid Road,
P.O. Agartala College,
P.S. East Agartala, 
West Tripura.                    ...….…...Complainant.
  

VERSUS

1. The Life Insurance Corporation of India,
    Represented by its Divisional Manager,
    Divisional Office at Meherpur,
    Silchar-15, Assam.

2. The Branch Manager,
    Life Insurance Corporation of India,
    Branch Office at Thakur Palli Road,
    Krishnanagar(TRTC), Agartala, 
    Agartala, West Tripura.            ..............Opposite parties.

      __________PRESENT__________

 SRI A. PAL,
PRESIDENT,
  DISTRICT CONSUMER  
DISPUTES REDRESSAL FORUM,
      WEST TRIPURA, AGARTALA. 

SMT. Dr. G. DEBNATH
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.

C O U N S E L

For the Complainant        : Smt. Baisakhi Chakraborty,
                      Smt. Manisha Choudhury,
                      Advocates.

For the O.Ps                 : Sri Prahlad Kr. Debnath,
                      Advocate.                    

        JUDGMENT  DELIVERED  ON:    04.07.16
J U D G M E N T

        This case was filed by one Nitai Chandra Saha U/S 12 of the Consumer Protection Act. Fact of the case in short is that the complainant purchased a policy from the O.P., Life Insurance Corporation of India(in short LICI) under 'Jeevan Anand Scheme'. Complainant was a driver who met an accident and suffered serious injury on 30.12.2008. He was treated in different places and on 05.05.10 State Disability Board certified that he was 70% disabled after amputation of right leg. The relatives of the complainant went to the office of LICI at Agartala but could not collect the documents to give information. On 29.12.14 he submitted the application for getting accidental benefit under the policy. But the claim was not settled and it was repudiated. Petitioner therefore, filed this petition for redress. 

2.        O.P. LICI appeared, filed W.S denying the claim. It is stated that as per terms and conditions disability should occur within 6 months from the date of accident. And the fact  disablement should be informed to the LICI within 4 months. Disablement was certified on 04.05.10. Disablement was up to 70%.  it was certified after 11 months 12 days it is not 180 days. Matter was also not informed within 120 days but after whole year. So, the claim was rightly repudiated as per terms and conditions of the policy. 

3.        On the basis of contention raised by the parties following points cropped up for determination.
        (I) Whether the claim is rightly repudiated by the Insurance company or not?
        (II) Whether the petitioner is entitled to get the compensation for the deficiency of service of the Insurance company?
    
4.        Complainant produced Insurance Policy, Premium Receipts, Discharge Certificate, Police Report, Permanent Disablement Certificate, Application in prescribed Form, letter dated 31.03.16. Petitioner also produced the statement on affidavit of Nitai Chandra Saha, complainant of this case. 

5.        O.P. on the other hand produced the Insurance Policy certificate, letters marked as Exhibit- A Series. O.P. examined one witness, Nabarun Ghosh, Branch Manager of LICI. 
        
6.        After going through the evidence adduced by both the parties we  shall now determine the above points.

            FINDINGS  AND  DECISION:
7.        We have gone through the policy certificate as per Clause 10. (A) of the policy condition immediately after happening of the disability full particulars thereof must be given in writing to the office of the corporation where this policy issued together with the address of the life assured and within 180 days after happening of the disablement. It is also written that the disability above referred must be disability which is the result of accident. It must be total and permanent. It is also written that after disablement the life assured was not doing any work or profession and within 180 days from the happening of such accident result in the irrecoverable loss of both hands, both feet above ankle or one foot above the ankle. From this, it is clear that if one foot above the ankle is amputated then it is full disablement. We have gone through the certificate for handicapped person issued by the 'District Disability Board'. The extent of disablement is written 70%. Nothing written to support that amputation done above ankle. 

8.        There is no denial that the petitioner was the policy holder under LICI accidental benefit. The policy covers the period from 2008. Petitioner was under treatment up to 2010. It is stated that thereafter his relatives visited the office of the Insurance company but there is no evidence to support it. Petitioner produced the claim petition form. From the perusal of that form it appears that claim petition form was actually submitted in prescribed format on 29.12.14. By the letter dated 23.02.15 Manager, Claims of LICI asked the petitioner to produce FIR, Driving License and other particulars. Then those were submitted on  08.04.15. Reminder sent on 10.09.15. On 31.03.16 finally the LICI informed that the claim is repudiated. 

9.        From the evidence produced before us it is clear that immediately after the happening of the disablement whole particulars was not submitted before the LICI within 180 days. It is also clear that disablement was not 100% and no evidence produced to support that disablement caused or resulted amputation of feet above ankle. There is no evidence before us to support that it is total disablement though it was permanent. 
    
10.        Learned advocate for the O.P., LICI submitted a decision of National Consumer Disputes Redresssal Commission in connection with Revision Petition No. 613/2009. In that case National Commission repudiated the claim of the petitioner on the ground that complainant did not suffer permanent disablement as he was capable of earning wages. It was also held that in case of amputation of one hand no award admissible as it did not fall within the purview of Clause-10.(A) of the policy. Learned advocate also referred the decision of the National Forum in connection with the Revision Petition 483/ 2013. Order dated 30th March, 2015. In that case National Commission held that immediately after happening of the disablement full particulars of the claim thereof must be given to the LICI within 180 days. It is also held that the Insurance benefit in case of 100% permanent disablement on account of accident will be available. In this case petitioner was a driver. His one leg was amputated. It might have rendered him  incapable of earning wages of livelihood. But petitioner is to give evidence on this point. But petitioner failed to do so.  Accident occurred in the year 2008 and after recovery in the year 2010 he failed to inform the Insurance company and informed the company after long time in the year 2014. Finally the claim made in the 2015 in prescribed format. Terms and conditions of the LICI Policy was violated. Disablement was not total & claim is time barred. The condition is to be strictly followed as there was a contract between the Insurance company and the petitioner. Petitioner failed to follow the contractual liability. So he is not entitled to get any benefit. Points are decided accordingly.

11.        In view of above findings over the points it is held that the claim of the petitioner for accidental benefit was rightly repudiated by the company LICI. There was no deficiency of service by the LICI. Petitioner therefore is not entitled to get any relief and his case is dismissed. Parties are to bear their own cost.   
                  
    
                          Announced.

SRI A. PAL
PRESIDENT,
DISTRICT CONSUMER  DISPUTES 
REDRESSAL FORUM,
WEST TRIPURA,  AGARTALA.

 

 

SMT. DR. G. DEBNATH,
MEMBER,
 DISTRICT CONSUMER DISPUTES 
REDRESSAL FORUM, 
WEST TRIPURA, AGARTALA    SRI U. DAS
MEMBER,
  DISTRICT CONSUMER 
DISPUTES REDRESSAL FORUM, 
  WEST TRIPURA,  AGARTALA.