Orissa

Cuttak

CC/6/2015

Baidhar Jena - Complainant(s)

Versus

The Manager,Claims Department,LIC - Opp.Party(s)

H B Sutar

29 Dec 2016

ORDER

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

C.C No.06/2015

        Sri Baidhar Jena,

        Vill:Ganja,Po/P.S:Rajkanaika,

        Dist:Kendrapara..                                                                                 … Complainant.

 

Vrs.

1.       The Manager,

                     Claims Department,L.I.C,

                       Cuttack Divisional Office,Nuapatna,

                      P.B No.36,Cuttack.

 

2.      The Branch  Manager,L.I.C,Pattamundai Branch,

     At/PO/PS:Pattamundai,Kendrapara.                                                       … Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,President.

Sri Bichitrananda Tripathy, Member.

Smt. Sarmistha Nath, Member.

 

Date of filing:    18.01.2015

Date of Order:  29.12.2016

 

For the complainant:      Mr. H.B.Sutar,Advocate & Associates..

For the O.Ps               :     Sri Umakanta Mishra,Advocate.

 

Mr. Bichitra Nanda Tripathy, Member.

The complaint is against deficiency in service on the part of O.Ps.

1. In nutshell the complaint is as follows:-

i)  The complainant is the father of the deceased policy holder Late Prasanta Kumar Jena under the Policy No.588329285 on his life with the LIC of India.

ii) That Late Prasanta Kumar Jena was working as Senior Engineer under Mott Macdonald, Singapore PTE Limited, Singapore.  On 16.12.2012 while he was on duty the untoward incident/accident took place and he was dead due to causes consistent with drowning at Singapore River at the age of 36 years.

iii) That the complainant as nominee of the LIC policy filed the required documents for settlement of claim.  The O.P paid only the death benefits amounting to Rs.4,53,051/- to the complainant on 09.02.2013, but did not pay the accidental benefit without any cause for which the complainant filed another application claiming the accidental benefits on 18.03.2014.

iv) The O.P No.1 issued a letter to the complainant and asked to submit other documents like all police reports/court certified all police reports such as FIR, PIR, PMR & PFR for confirmation of rest amount of claim.  The complainant replied to such letter on 02.04.2014 but the O.P kept quite.  The complainant sent an Advocate’s notice on 25.06.2014 and the O.P replied that they are not in a position to settle the accidental benefits in absence of police report.

v) Since the death of the policy holder was due to an accident and the O.Ps did not pay the accidental benefits as payable for the purpose, finding no other way, the complainant took shelter of this Hon’ble Forum.  He has prayed to direct the O.Ps to pay the accidental benefits amounting to Rs.4,68,000/- and Rs.1,10,000/- towards mental agony and as cost of litigation amounting to a sum of Rs.8000/-.

2.            Vide their written brief dt.3.7.15 the O.Ps have intimated as follows:

i) That the complainant’s son Late Prasanta Kumar Jena had made a life insurance policy on his own life bearing No.588329285 for a sum  assured of Rs.4,00,000/-.  The date of commencement of the policy was 23.10.2009 and the life assured died on 16.12.2012 at Singapore.  After receiving the death certificate and other relevant documents the claim was settled and the sum assured along with Bonus was paid to the nominee on 09.02.2013.  Since the complainant has not submitted the relevant police report such as FIR, PIR and PFR, the Double Accident Benefit ( DAB in short) has not been paid.

ii) It was further stated that the complainant has not submitted any document called for (FIR, PIR & PFR) to ascertain whether it is an accident, normal, suicidal or Homicidal death.

iii) They have also intimated that from the postmortem report of Late Prasanta Kumar Jena submitted by the complainant it is learnt that there were some external injuries found in the body and also stomach contained 1100 ml. of light brown fluid with an alcoholic beverages like odour.

iv) The police report as to the exact cause of death in a requirement for settlement of DAB as per the provision of claim manual chapter-5 sub-section-1.2(b) para-3. It is the claimant to produce proof to the satisfaction of the corporation that there was an accident as defined in the policy condition.  Hence the complainant needs to submit the certified copies of police report such as FIR, PIR, PMR & PFR for payment of DAB to him.

v) As mentioned in policy conditions 10(b) the corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or death of the life assured shall:-

a) Be caused by intentional self injury, attempted suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic.

vi) The PMR submitted by the petitioner reveals that “Stomach contained 1100 ml. of light brown fluid with an alcoholic beverage like odour”.  In fact the documents submitted by the complainant do not show whether the death was accidental, suicidal or homicidal, rather the aforesaid observations contained on PMR is in conformity with the policy conditions as above.

Vii) Since the complainant has failed to produce the certified copies of police report such as FIR,PIR & PMR to ascertain the exact cause of death, the O.Ps are not able to decide the admissibility of the DAB claim.

3. We have gone through the case in details.  We have heard the learned counsels from both the sides.  We have also perused the documents/papers/version as filed by the complainant and as well by the O.ps and have observed that 

1. Late Prasanta Kumar Jena had made a life insurance policy with LIC vide No.588329285 for a sum assured of Rs.4,00,000/-.  The life assured died on 16.12.2012 and LIC settled the claim amounting to Rs.4,00,000/- + bonus as applicable which was paid on 09.02.2015.
2. Ii) The complainant failed to prove that the death was due to accident, since the complainant failed to produce copy of police report such as FIR,PIR & PFR  etc. without just cause
3. As per the PMR as submitted by the O.Ps it is stated that “stomach contained 1100 ml. of light brown fluid.  The fluid had an alcoholic beverage like odour”.
4. As per policy conditions, the Corporation stall not be liable to pay the additional sum referred in (a) or (b) above if the disability or death of the life assured shall:-

1. be caused by intentional self injury, attempted suicide, insanity or immorality or whilst the life assured is under influence of intoxicating liquor, drug or narcotic.

       ORDER

Basing on the facts and circumstances as stated above and to meet the ends of justice, we observed that the complainant has failed to prove that the death of the life insured was due to an accident.  Hence the case is dismissed.

Typed to dictation, corrected and pronounced by the Hon’ble Member in the Open Court on this the 29^th day of December, 2016 under the seal and signature of this Forum.

 

   (Sri B.N.Tripathy )

                                                                                                                         Member.

                                                                                                                  (Sri D.C.Barik)

                                                                                                                         President.

                                                                                                               (Smt. Sarmistha Nath) 

                                                                                                          Member(W).