Orissa

Cuttak

CC/29/2017

Gitanjali Malla - Complainant(s)

Versus

The Divisional Manager,LIC Of India - Opp.Party(s)

P K Kanungo

06 Dec 2017

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

C.C No.29/2017

Geetanjali Malla,

W/O:late Udayanath Malla,

Vill:Pandia,PO:Jhadeswarpur,

PS:Mahanga,Dist:Cuttack.                                                      … Complainant.

 

                                Vrs.

 

1. The Divisional Manager,LIC of India,

Cuttack Divisiion Office,Nuapatna,

PB No.36,Cuttack.

 

2. The Branch Manager,LIC of India,

Kendrapara Branch,

At/PO/PS/Dist: Kendrapara.                                           … Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Sri Bichitra Nanda Tripathy, Member.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:   06.03.2017

Date of Order: 06.12.2017.

 

For the complainant:               Sri P.K.Kanungo,Adv. & Associates.

For the O.Ps :                            Sri N.N.Mohapatra,Advocate & Associates.

 

 

Sri Bichitra Nanda Tripathy,Member.

                The complaint is against the O.Ps for deficiency in service.

1. Shortly the complaint is that Udaynath Malla, the husband of the complainant was having LIC policy No.599391217 for Rs.1,00,000/- with Branch Office,Kendrapada.  The husband of the complainant had paid 1^st installment of premium amounting to Rs.3401.00 only and expired on 20.01.2014 due to diarrhoea.  The complainant was the nominee in the said LIC policy i.e Jeevan Anand Policy.  After the death of her husband the complainant applied for settlement of the claim relating to the policy and submitted the papers as required for the purpose.  Vide letter dt.29.06.2016 the O.P intimated the complainant to submit the medical treatment papers of the deceased.  Since Late Udaynath Malla had expired without undergoing any treatment, the complainant could not produce the same.  Late Udaynath Malla, had one more policy with LIC of India vide policy No.585113551 dt.28.07.2003 and the said policy was settled without production of  medicaltreatment papers whereas the O.Ps are insisting for medical treatment papers for the policy made during 2014.  For such an act of the O.Ps the complainant, her two children and her old mother are suffering a lot.  A legal notice was served on the O.Ps on 19.12.2016.  The O.Ps replied that vide their letter dt.16.02.2015,05.08.2015,26.09.2015 and 02.11.2015 the complainant was requested to submit required  medical report which the complainant has not submitted.  Since the policy period was less than 3 years, such medical report was required as per Section-45 of the Insurance Act.

Finding no other way, the complainant has taken shelter of this Hon’ble Forum.  She has prayed to direct the O.Ps to settle the claim amount of policy No. 599391217 dt.28.08.2013 along with interest @ 14% per annum from the date of claim till final payment along with a sum of Rs.1,00,000/- as compensation towards mental agony.

2. Vide written version dt.16.09.2017 the O.Ps have submitted that the delay in considering the claim of the complainant was due to non-submission of treatment particulars as required under the statute.  In spite of repeated requests vide letter dt.16.02.2015, 05.08.2015, 02.11.2015 and lastly on 29.06.2016 the complainant has not complied with the requirements i.e. complainant has not submitted Forum-A and treatment particulars of the Deceased Life Assured(DLA).  A pleader’s notice was also served by the complainant on 14.12.2016 and was replied on 19.12.2016 wherein the complainant was requested for submission of required medical records for consideration of the claim.  Since the death of the Life Assured was occurred within 3 years from the date of commencement of the policy, the medical treatment papers are mandatory requirement under the law to ascertain the genuineness of the claim and also to ascertain the correctness of the information given by the DLA relating to his health condition while effecting the policy.  Regarding the other policy No.585113551 of the same DLA which was settled without asking for any medical papers, the O.Ps have submitted that the said policy was made on 28.07.2003 and the date of death of the life assured was on 20.01.2014 as such the duration of the said policy was more than 3 years for which no medical papers were required under law for consideration of death claim.  As such the O.ps are not deficient in service.
3. We have gone through the case records in details and heard the learned advocates from both sides.  Uday Nath Malla,husband of the complainant had made one Jeevan Anand LIC policy on 29.08.2013 for Rs.1,00,000/- vide policy no.599391217.  Nominee for the said policy was his wife Smt. Geetanjali Malla.  Udaynath Malla died on 20.1.2014.  Vide letter dt.16.02.2015, 05.08.2015, 02.11.2015, 29.06.2016 and 19.12.2016 the O.Ps have requested the complainant to submit all previous treatment papers for processing of the claim.  The complainant did not submit such treatment papers since Udaynath Malla expired on the way to hospital and no treatment was provided to him for the purpose.  Section-45 of Insurance Act,1938 says that

Policy not be called in question on ground of mis-statement after three years.

 (1) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of policy i.e, from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later.

(2) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud;

(3) Notwithstanding anything continued in sub-section (2), no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement of suppression of a material fact was true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of a material fact are within the knowledge of the insurer:

(4) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date f revival of the policy or the date of the rider to the policy, whichever is later on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued:

 

4. All the policies issued by LIC are subject to the provisions of Section-45 of the Insurance Act,1938 and generally printed as a condition in the back side of each Bond issued for the purpose.  In the present case, the policy No.599391217 was made on 29.08.2013.  The payment of premium was half yearly.  The life insured expired on 20.01.2014, within six months of making the policy.  The O.ps asked for medical papers/details of treatment made to process the said claim as per Sec-45 of Insurance Act since the death was occurred within 3 years of making the policy.  In the other case the policy No.585113551 was made on 28.07.2003 and the death of insurer was occurred during January,2014 i.e. after 10 years of making such policy.  Since the claim was settled after 3 years, the modalities relating to Sec-45 were not applicable for this policy.  But the policy which was made on 29.08.2013 vide Policy no.599391217, the death of the life assured was occurred on 20.01.2014 and was occurred within 3 years of making the policy, the modalities of Sec-45 were very much applicable as per Insurance Act,1938.  Hence the O.Ps are not at fault.

ORDER

From the facts and circumstances as stated above, the complainant failed to prove deficiency in service on the part of O.Ps.  Hence the case is dismissed.

Typed to dictation, corrected and pronounced by the Hon’ble Member in the Open Court on this the 6^th day of December,2017 under the seal and signature of this Forum.

 

   (Sri B.N.Tripathy )

                                                                                                     Member.

                                                                                      

                                                                                              (  Sri D.C.Barik )

                                                                                                   President.

 

                                                                                          (Smt. Sarmistha Nath) 

                                                                                      Member(W).