DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, JHARSUGUDA

CONSUMER COMPLAINT CASE NO. 42 OF 2016

1. Tarulata Pradhan,

W/O: Gobardhan Pradhan,

R/O: Debadihi, PO/PS: Jharsuguda,

Dist: Jharsuguda, Odisha.

2. Dalma Kisan,

W/O: Late Sundar Kisan,

R/O/PO: Bandharpada ( Kali Munda),

PO: Talmal, Dist: Jharsuguda, At Present

residing with her daughter At: Debadihi,

PO/PS: Jharsugudam Dist: Jharsuguda, Odisha……..……Complainants.     

Versus

1. The Branch Manager,

LIC of India, Jharsuguda Branch, Near Court, Jharsuguda,

PO/PS / Dist: Jharsuguda, Odisha.

2. The LIC of India, Divisional Office,

Ainthapali, Sambalpur,

Dist: Sambalpur, Odisha……..…………………………..….…...Opp. Parties.

Counsel for the Parties:-

For the Complainants                               Shri A.B.Sarangi, Adv. & Associates.

For the Opp. Parties                               Shri B.N.Dutta, Adv.  &  Associates.

Date of Order: 06.12.2016

Present

                                                  1. Shri S.L.Behera, President.

                                                  2. Shri S. K. Ojha, Member.

Shri S. K. Ojha, Member: - This is the case filed by the complainants being legal hires of their deceased husband and father, Sundar Kisan. The said deceased had taken two numbers of life Insurance policies with profits plus accidental benefits during his life time and after death of said deceased the LIC of India has given only sum assureds not accidental benefits.

In nutshell, facts of the complainant’s case is that, the Complainant No.1 is the daughter of her deceased father Sundar Kisan and Complainant No.2 is the wife of her deceased husband Sundar Kisan.  The said deceased Sundar Kisan,  during his life time had insured himself with the O.P.No.1 by taking two numbers of Life Insurance Policies having ‘Endowment Assurance Policy with profits plus Accident Benefits’ vide policy NO. 592802801 under plan 14/12 with sum assured of Rs.50,000/- only commencing from dtd. 27.11.2003 and policy No. 592806349 with sum assured of Rs.30,000/- only commencing from dtd. 28.01.2004. The said Sundar Kisan unfortunately died on dtd. 08.02.2006 due to fall down from bullock cart.  The complainants claimed for said insurance policies by submitting all the original documents before the O.Ps. where the O.Ps. given Rs.52,574/-only for the 1^st policy and Rs.32,312/- for the other one, without paying the double accident benefits as per policy terms and conditions.  The complainants approached several times to the O.Ps. but the O.Ps. kept silent.  The complainants being harassed asked through RTI on dtd. 04.03.2016 where the PIO of O.P.No.1 given wrong information, afterwards the complainant No.1 appealed before O.P.No.2 who given some informations but not replied on the said double accident benefits.  The complainants further requested several times but the O.Ps. did not turn up as such  finding no other way the complainants knocked the door of this Hon’ble Forum seeking proper relief by filing this case along with relied documents.

The O.Ps. were noticed through this Forum who appeared and filed written version through their counsel.  The O.Ps. submitted that the claims of complainants have been settled in favour of the nominee on dtd. 13.03.2007 as per the policy conditions and facts of the incidence of accident.  The case is not maintainable as after nine years of settlement of claim which exceed the limitation period, the complainants filed this case and on the above ground the O.Ps. prayed for dismissal of case.

Both the parties presented the case in elaborate manner.

Heard the matter in length and gone through the materials available. It is not disputed that the deceased namely Sundar Kisan had insured himself with the O.Ps. having two numbers of life insurance policies bearing policy Nos.  592802801 and 592806349.  Both the policies were  “Endowment Assurance Policy with profits plus Accident Benefits” having table and term 14-12(12).  The policy bearing No. 592802801 was having date of commencement 27.11.2003, sum assured Rs.50,000/- only, date of maturity 27.11.2015 so also the policy bearing No. 592806349 was having date of commencement 28.01.2004, sum assured Rs.30,000/- only, date of maturity 28.01.2016. During the period of validity of insurance i.e. on dt.08.02.2006 the said insured unfortunately expired due to “Injury scalp by fall from a height (Bullock Cart)” mentioned as per clause 4(a) of the “Certificate of Hospital Treatment”  issued by O.P.No.1 in favour of the deceased so also mentioned “condition was serious” in clause-09. 

The said “Certificate of Hospital Treatment” issued by O.P.No.1 in favour of the deceased, itself reveals that the deceased was very serious due to heavy injury   

scalp by fall from a height (Bullock Cart) and expired on dtd. 08.02.2006. The above mentioned cause of death cannot be treated as normal death rather treated nothing but as an accidental death.  The O.Ps. calculated and settled the insurance claim treating the cause of death as normal death and paid Rs. 52,574/- only against the  policy No. 592802801 and also paid Rs.32,312/- only against the policy No. 592806349. Both the policies were having sum assured of Rs.50,000/- only and Rs. 30,000/- only respectively. Instead of calculating on the basis of “Accidental death benefits” the O.Ps. calculated on the basis of ‘Normal death benefit’.

            So far as period of limitation is concerned, the complainants were regularly and continuously approaching the O.Ps. after receiving the mis-calculated claim settlement amounts but the O.Ps. did not take any heed towards the queries of complainants.  Being harassed the complainants asked through RTI Act, 2005 on dtd. 04.03.2016, from where also they did not get any satisfactory answer.

If we look into the provisions specifically mentioned on the rights of consumers as per Under Sec-6 of the Consumer Protection Act,1986 which relies as follows;

4. the right to be heard and to be assured that consumer's interests will receive due consideration at appropriate forums.

(e) the right to seek redressal against unfair trade practices or restrictive trade   practices or unscrupulous exploitation of consumers.

            However in the bare eyes, the limitation period looks to be barred by limitation as per the provisions of The Consumer Protection Act, 1986, but if we observe into the facts and circumstances of the matter of protesting for the legitimate insurance claim amounts from the O.Ps in regular manner, the matter is treated to be within limitation period as applied for necessary information under the RTI Act,2005 on dtd. 04.03.2016.

            The complainants filed several evidence in shape of affidavits along with an affidavit of one Guru Kissan, son of late Kutru Kissan stating that, he was knowing the deceased very well and he was present at the time of said accident which was occurred in front of him on dtd. 21.11.2005 at about 7.30PM while he was standing at the side of said bullock cart in question. The complainants also filed the required documents to prove their case and to brought forward the facts of the matter.

On the abovementioned observations and analysis and taking into consideration the principles of natural justice this Hon’ble Forum inclined to allow the complaint petition with following directions to the O.Ps.    

ORDER

1. The O.P.No.1 (LIC of India ,Jharsuguda Branch) is hereby directed to pay to the complainant No.1 a sum of Rs.50,000/- (Rupees fifty thousand) only in favour of policy No. 592802801 and Rs.30,000/- (Rupees thirty thousand) only in favour of policy No. 592806349 towards the remaining Sum Assured amounts of the above mentioned policies.

2. The O.P.No.1 is further directed to pay a sum of Rs.1,000/-( Rupees one thousand) only towards harassment including litigation costs.

3. All the above mentioned orders are to be carried out within 30 (thirty)  days from the date of receipt of this order, if fails, interest @ 09%  per annum will be charged on the aforementioned awarded amounts till realization.

Accordingly the case is disposed of.

Order pronounced in the open court today the 6^th   day of December’ 2016 and copy of this order shall be supplied to the parties as per rule.              

          I Agree.                                                                                               

         S.L.Behera,President                                                 S. K.Ojha,Member                 

                                                 Dictated and corrected by me,

            S. K.Ojha, Member.