This case has been filed U/s.12 of the Consumer Protection Act, 1986 by the complainant, Sahida Bibi praying for double accidental benefits of Rs. 30,000/- along with the interest upto this date and compensation of Rs. 30,000/- irreparable loss and mental sufferings and agony of Rs. 30,000/- and litigation Cost of Rs. 10,000/- including Rs. 1,00,000/- along with the interest upto this date.

The complainant states that husband of the complainant made a LIC Policy through the opposite party branch under the plan of “New Jana Rakhaya” vide policy no. 436232608 dt. 28.3.2008 covered under table no. 091 and term no. 16 for proposed sum of Rs. 30,000/- and the said policy was covered under the benefit of Double Accidental Facility and the complainant is the nominee of the said policy no. 436232608 and her husband died on 25.2.2016 while met with a fatal accident by electrocution in his own house and as a result of which one U.D. Case was started being Case no. 10/2016 dt. 25.2.2016 at Dadpur P.S. and accordingly P.M. was done.

The complainant also states that as her husband died with an accident by electrocution the electricity department of W.B.S.E.D.C.L. enquired the said accident matter and after completion of their inquiry and perusing all the relevant documents of deceased as per rules of electricity passed an order on 3.10.2016 vide order no. 81 and gave compensation award of Rs. 2,50,000/- towards the legal heirs of her husband with a view “this compensation is being paid due to fatal accident met by Late Amir Hossain” and the said policy was covered with the benefit of double accidental facility the complainant being the wife of deceased as well as nominee of said policy claimed before LIC office at Chinsurah for getting the benefit along with accidental coverage in support of all the proper documents and it is very surprising that the LIC Policy vide no. 436232608 was also under the risk coverage of double accidental benefit but in spite of that facility on 30.1.2016, the opposite party disbursed only the amount of sum assured Rs.30,000/- along with interest but did not pay the double accidental amount of Rs. 30,000/- of proposed policy.

The complainant also states that the impression of immediate cause of death in P.M. report is “the death is due to the effect of electric shock” and the investigation report of police in the column of cause of death, is “Bidyut Pristho” and in the report submitted by investigation officer it is clearly reflected “the deceased Amir Hossain’s death is due to by electrocution of his own house” and in spite of all relevant papers regarding the cause of death which is nothing but an accidental death but op intentionally and deliberately did not disburse the said amount, keeping the money in their hand.

The complainant also states that at last on any occasion went to the opposite party office but did not get any relief and she met with her Ld. Advocate and Ld. Advocate of the complainant sent a legal notice to opposite party on 21.3.2017 but in spite of receiving the notice opposite party did not disbursed the accidental benefited amount of Rs. 30,000/- to her and the cause of action arose on 30.5.2016 when the opposite party pay only sum assured of LIC along with interest and lastly on 21.3.2017 when in spite of receiving legal notice opposite party did not disburse any amount to her which is still continuing and it has been arisen under P.S. Chinsurah and Dadpur.

Complainant filed the complaint petition praying directions upon the opposite party to pay the accidental benefit of Rs. 30,000/- along with interest upto this date to the petitioner and to pay Rs. 30,000/- as compensation in favour of the petitioner and to pay Rs. 30,000/- to be paid in favour of the petitioner by the opposite party for mental agony and suffering and to pay Rs. 10,000/- in favour of the petitioner as litigation cost and any other relief or reliefs as per law and equity.

The opposite party contested the case by filing written version denying inter-alia all the material allegations as leveled against him.  This opposite party submits that one Amir Hossain was the policy holder in respect of policy no. 436232608 and the said policy was commenced on 28.3.2005 under the head “New Janaraksha Policy” and one intimation was given to the LICI about the date of the original policy holder and accordingly answering opposite party had already paid of Rs. 44,040/- dt. 28.5.2016 unto the registered nominee and the complainant although claimed for the double benefit due to accident but as yet failed to supply the final police report wherein it can be ascertained that “No foul play could he detected” along with the copy of the F.I.R. and the discharged voucher as required under the law to settle such policy and in spite of several assurance the complainant failed to supply the relevant documents as required by the answering opposite party and the opposite party is guided by the rules and as such the opposite party is ready and willing to pay the additional amount is entitled by the complainant subject to the supply of relevant documents as required under the law for final settlement in respect of the said policy and as such the act of the answering opposite party is quite bona fide and lawful and the alleged claim of the complainant with regard to the alleged deficiency of service as alleged in the original complaint application is baseless, harassing, mala fide and motivated and the said false plea was taken by the complainant only to cause harassment to the opposite party and to grape amount from the opposite party and the answering defendant being a public institution shall very much for such false plea as alleged by the complainant. Moreover it is the complainant who will be solely liable to proof the fetal accident as alleged in the complaint application and the opposite party has got no knowledge about the same. So, the instant complaint case has been lodged on the basis of some false and frivolous fact and as such the complainant is not entitled to get any relief from the Ld. Forum and the instant complaint case may be dismissed with exemplary cost.

The complainant filed evidence on affidavit which is the replica of complaint petition.

The opposite party filed evidence on affidavit which is nothing but replica of his written version.

Both sides filed written notes of argument which are taken into consideration for passing final order.

 Argument as advanced by the agent of the complainant and the opposite party heard in full.

From the discussion herein above, we find the following Issues/Points for consideration.

ISSUES/POINTS   FOR   CONSIDERATION

1. Whether the Complainant   Sahida Biwi ‘Consumer’ of the opposite party?

2. Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?

3. Whether the O.Ps carried on unfair trade practice/rendered any deficiency in service   towards the Complainant?

4. Whether the complainant proved her case against the opposite party, as alleged and whether the opposite party is liable for compensation to her?

DECISION WITH REASONS

               In the light of discussions here in above we find that the issues/points should be decided based on the above perspectives.

(1). Whether the Complainant Sahida Biwi is a ‘Consumer’ of the opposite party?

               From the materials on record it is transparent that the Complainant is a “Consumer” as provided by the spirit of section 2(1)(d)(ii) of the Consumer Protection Act,1986. The complainant herein being the nominee as well as beneficiary of deceased customer of the opposite party insurance company, so being a consumer she is entitled to get service from the opposite party insurance company being the service provider.

(2).Whether this Forum has territorial/pecuniary jurisdiction to entertain and try the case?

               Both the complainant and opposite party are residents/carrying on business within the district of Hooghly. The complainant prayed for a direction upon the opposite party a death claim amounting to Rs.100,000/- against the policy being no.436232608, for mental pain, agony and harassment, for litigation cost and other reliefs as this Forum deems fit and proper ad valorem which is within Rs.20,00,000/- limit of this Forum. So, this Forum has territorial/pecuniary jurisdiction to entertain and try the case.

(3).Whether the opposite party carried on Unfair Trade Practice/rendered any deficiency in service towards the Complainant?

                  The opposite party being the largest Insurance Company of the Nation associated with the insurance of a lot of people of throughout the whole nation since a long back with self generated assets i.e. goodwill of the business. So, the credibility of the opposite party Insurance Company is unquestionable and that is why the husband of the complainant insured his life before the said company without any doubt.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     It is well settled proposition of law that a contract of insurance is based on the principles of utmost good faith-uberrimae fidei applicable to both the parties. The rule of nondisclosure of material facts vitiating a policy still holds the field. The bargaining position of the parties in a contract of insurance is unequal. The insured knows all the facts, the insurer is unaware of anything which may be material to the risk. Very often, it is the insured who is the sole person who has this knowledge. The insurer may not even have the means to find out facts which would materially affect the risk. The law, therefore, enjoins on the insured an absolute duty to disclose correctly all material facts which is within his/her personal knowledge or which he ought to have known had he made reasonable inquiries. A contract of insurance, therefore, can be repudiated for non disclosure of material facts.

The case of the  complainant is that husband of the complainant made a LIC Policy through the opposite party branch under the plan of “New Jana Rakhaya” vide policy no. 436232608 dt. 28.3.2008 covered under table no. 091 and term no.16 for proposed sum of Rs.30,000/- and the said policy was covered under the benefit of Double Accidental Facility and the complainant is the nominee of the said policy no.436232608 and her husband died on 25.2.2016  with a fatal accident by electrocution in his own house and as a result of which one U.D. Case was started being Case no.10/2016 dt. 25.2.2016 at Dadpur P.S. and accordingly P.M. was done.

The complainant further stated that the electricity department of W.B.S.E.D.C.L. enquired the said accident matter and after completion of their inquiry gave compensation award of Rs.2,50,000/- towards the legal heirs of her husband with a view “this compensation is being paid due to fatal accident met by Late Amir Hossain”. As the said policy was covered with the benefit of double accidental facility the complainant being the wife of deceased as well as nominee of said policy claimed before LIC office at Chinsurah for getting the benefit along with accidental coverage in support of all the proper documents and it is very surprising that the LIC Policy vide no. 436232608 was also under the risk coverage of double accidental benefit but in spite of that facility on 30.1.2016, the opposite party disbursed only the amount of sum assured Rs.30,000/- along with interest but did not pay the double accidental amount of Rs.30,000/- of proposed policy.

The complainant also states that the impression of immediate cause of death in P.M. report is “the death is due to the effect of electric shock” and the investigation report of police in the column of cause of death, is “Bidyut Pristho” and in the report submitted by investigation officer it is clearly reflected “the deceased Amir Hossain’s death is due to by electrocution of his own house” and in spite of all relevant papers regarding the cause of death which is nothing but an accidental death but opposite party intentionally and deliberately did not disburse the said amount, keeping the money in their hand.  So the complainant served legal notice but the opposite party did not pit no bid for which the complainant being aggrieved preferred the recourse of law before this Forum praying directions as incorporated in the prayer portion of the complaint petition.

Opposite party in his argument assailed that one Amir Hossain was the policy holder in respect of policy no. 436232608 and the said policy was commenced on 28.3.2005 under the head ‘New Janaraksha policy’. One intimation was given to the LICI about the death of the original policy holder and accordingly the answering opposite party paid a sum of Rs. 44,040/- dt. 28.5.2016 to the registered nominee. The complainant although claimed for the double benefit due to accident but as yet failed to supply the final police report wherein it can be ascertained the no foul play could be detected along with the copy of the FIR and the discharge voucher as required under the law to settle such policy and in spite of several assurances the complainant fail to supply the relevant documents as required by the answering opposite party. LICI authority is ready and willing to pay the additional amount is entitled by the complainant subject to the supply of relevant document as required for the final settlement. So, the opposite party is not deficient in providing service to the complainant and prays to reject the complaint petition. The answering opposite party further assailed that the complainant filed the instant complaint case on the basis of some false and frivolous fact as such the complainant is not entitled to get any relief from this Forum. Moreover, the complainant failed to produce the relevant papers and documents about the accidental death of the original policy holder neither before the LICI authority nor before the Ld. Forum. So, there is no question of deficiency of service and harassment and mental agony by the LICI Authority.

It appears from status report of policy no. 436232608 dt. 23.9.2019 filed by the opposite party, the name of the nominee is Sahida Bibi, wife of late Amir Hossain and the plan/trm/ptrm is 91/16/16, sum assured-Rs.30,000/-, date of commencement 28.3.2005, maturity date 3/2021 and in the lower portion it is stated the Claim/ surrender history record. It is transparent that the opposite party paid a sum of Rs.44040/- on 30.5.2016 and a sum of Rs.30000/- on 21.9.2019. So the opposite party paid the due amount of Rs.30,000/- during the pendency of the complaint petition i.e. chiefly during hearing of argument. The Ld. Advocate of the complainant argued that the complainant received the double benefit from the opposite party after filing the complainant case. So the complainant prays for compensation and litigation cost from the opposite party.

After hearing the arguments advanced by the Ld. Advocates of both sides and perusing the case record and documents it appears that the complainant being the legal heir of deceased Amir Hossain filed the claim Form before the opposite party in respect of her deceased husband. The policy was of NEW JANRAKSHA PLAN WITH PROFITS (WITH ACCIDENT BENEFIT). The case of the complainant is that she is deprived of accident benefit by the opposite party for which she served notice dated-NIL for getting the same inspite of getting the notice the opposite party did not take any measure for which the complainant getting no alternative preferred the recourse of law before this Forum. It is evident from the post mortem report that the deceased life assured insured before the opposite party in the plan in which there is a provision of accident benefit. As the deceased life assured died due to the effect of electric shock which is a case of accident so the complainant being the beneficiary as well as legal heir of deceased life assured rightly claimed the accident benefit before the opposite party insurance company. By not settling the claim the opposite party insurance company destructed the myth of goodwill of the business and compelled this complainant to prefer the recourse of law under Consumer Protection Act,1986.  It is transparent from the case record that the opposite party paid the accident benefit in the month of September, 2019 during the pendency of the complaint petition. It is utmost question why a consumer/beneficiary have to approach the recourse of consumer Forum to get her `valid demand from a reputed company like LICI. So the act or omission on the part of the opposite party tantamount to deficiency of service coupled with unfair trade practice. The complainant being a poor rustic lady compelled to approach the Consumer Forum to ensure her right.

So we are in a considered opinion to allow the complaint in respect of compensation for mental pain, agony and harassment and litigation cost as the opposite party already paid the sum assured including interest and accident benefit.

4. Whether the complainant proved her case against the opposite party, as alleged and whether the opposite party is liable for compensation to her?  

            The discussion made herein before, we have no hesitation to come in a conclusion that the Complainant is abled to prove her case and the Opposite Party is liable to pay compensation as ascertained by this Forum.

ORDER

             Hence, it is ordered that the complaint be and the same is allowed in part on contest against the opposite party with a litigation cost of Rs.8,000/-.

The whole gamut of the facts and circumstances leans in favour of the complainant. We, therefore, allow the complaint in part and opposite party is directed to pay a sum of Rs.10,000/-as compensation for mental pain, agony and harassment to this complainant within 45 days from the date of order.

The opposite party is directed to pay a sum of Rs.10,000/- for unfair trade practice in the account of Consumer Legal Aid Account.

 At the event of failure to comply with the order  the Opposite Party shall pay cost @ Rs.100/- for each day’s delay, if caused, on expiry of the aforesaid 45 days by depositing the accrued amount, if any, in the  ‘Consumer Legal Aid Account’.

Let a plain copy of this Order be supplied free of cost to the parties/their Ld. Advocates/Agents on record by hand under proper acknowledgement/ sent by ordinary Post for information & necessary action.