SRI JIBAN KRUSHNA BEHERA, MEMBER (I/C)
The complainant has filed this complaint petition U/s 12 of the Consumer Protection Act, 1986, (here-in- after called as the “Act”) alleging deficiency in service against the Opp. Parties claiming compensation.
2. The factual matrix of this case is that the deceased father of the complainant namely Dambarudhara Panda was working as a Helper under Executive Engineer, OSEB, Electrical Division, Balasore, who had purchased policy from the OPs vide policy No.S-580178539 & S-581027676 and the premiums have been deducted from his salary. He died on 4.11.1993. At that time, the legal heirs of the deceased were minors. After the death of life assured, his son and daughter informed the death of the life assured and accordingly all the required documents including policy bonds were sent to the office of LIC, Balasore Branch. Thereafter, OP No.2 sent intimation to the Executive Engineer, OSEB, Balasore on 24.11.1995 regarding gap of premium. After compliance of all documents, the legal heirs were waiting for death claim of their deceased father, but the Ops have not taken any step for settlement of the claim. Therefore, the complainant served legal notice against the OP No.2 on 10.5.2005 for taking necessary action in the matter. On being receipt of the legal notice, OP No.2 sent some Forms and asked for required information towards settlement of the death claim in different dates which was also complied by him. But the Ops were silent over the matter. So, the complainant again sent legal notice on 23.1.2006 against the Ops which were also received by the Ops. Still then, the death claim in respect of their deceased father has not yet been settled. Hence, this case.
3. In the present case, both the OPs appeared and filed their joint written version challenging the maintainability of the case on the ground of limitation. They have stated, inter alia, that the life assured was absence in his office from 28.3.1989 to 4.11.1993 and on leave for 191 days on his health ground and during the above period there was non-deduction of premium from his salary and has not been remitted to LIC of India. The same has not yet been regularized. The legal heirs of life assured or the complainant had never intimated about the death of life assured on 24.11.1995 with the claim form to OP No.2. The complainant was asked to reply for non-deduction of premium money from the salary of the life assured for the above mentioned period from May, 1989 to October, 1993, but he remained silent. As the complainant had not complied with the formalities and had not submitted any documents with regard to claim before LIC for its settlement, so the matter could not be settled. That apart, on enquiry, it was learnt that the life assured was taking medicine for stomach problem for last six years prior to his death, but the complainant had suppressed this fact of illness. Further, Smt. Bilasini Panda, the wife of life assured, was the nominee under the policy, who expired on 17.09.1993 i.e. before the death of life assured, but the complainant intimated about the death of life assured after 10 years of his death. Hence, it is prayed to dismiss the case.
4. In view of the above averments of the parties, the points for determination in this case are as follows:-
(i) Whether this consumer case is maintainable?
(ii) Whether there is any deficiency in service on the part of the OPs?
(iii) Whether the complainant is entitled to get the relief, as sought for?
(iv) What other relief(s), the complainant is entitled to?
F I N D I N G S
5. Perused the documents filed on behalf of the complainant. The complainant has filed the photocopies of certain documents viz. Letter dated 24.11.1995 issued by OP No.2 in favour of the employer of deceased life assured, Legal notice issued against OP No.2, Reply of legal notice dated 6.6.2005 issued by OP No.1 to the Advocate of the complainant, Application in lieu of clarification made by the complainant to OP No.2, Letter dated 22.8.2005 issued by OP No.1 in favour of the complainant, Compliance made by the complainant vide letter dated 8.9.2005, Letter dated 23.9.2005 issued by OP No.2 in favour of the complainant seeking compliance, Letter dated 23.9.2005 issued by OP No.2 in favour of complainant for compliance, Letter dated 14.10.2005 issued by OP No.2 in favour of complainant for settlement of the claim, Application in lieu of reply dated 19.10.2005 made by the complainant before OP No.2, Legal notice dated 23.1.2006 against OP No.1, Reply dated 18.2.2006 made by OP No.1 to the Advocate of the complainant, Legal heir certificate, Death certificate of life assured, Death certificate of Bilasini Panda, the nominee under the policy.
6. On the other hand, the Ops have relied on a bunch of photocopies of documents viz. Claim form, Confidential report regarding financial status of surety, Policy bond vide No.S580178539, Legal heir certificate, Application dated 19.10.2005 made by the complainant, Letter dated 21.10.2005 made by OP No.2. Statement of one Dhabaleswar Mohapatra, Compliance of the complainant, Power of Attorney in lieu of Notarial Certificate executed by the legal heirs of deceased life assured in favour of the complainant, Reply to the legal notice dated 10.5.2005, Policy Bond vide No.S581027676, Compliance of complainant, Death certificate of Bilasini Panda, the nominee under the policy, Death certificate of life assured, Claim Form, Affidavit sworn by one Pradipta Kumar Mohapatra, Claimant’s statement, Certificate of hospital treatment, Medical attendant’s certificate, Certificate of hospital treatment, Certificate of identity and burial or cremation, Certificate by Employer with office order & Letter dated 23.9.2005 issued by OP No.2 in favour of the complainant.
7. On a bare reading of the documents filed by the complainant, it is made out that his deceased father Dambarudhara Panda (Life assured) had purchased the LIC bond bearing No.580178539 & 581027676 from the Ops. It is seen that Policy No. 580178539 was commenced on 28.3.1989 and its date of maturity was 28.3.2009 whereas Policy No. 581027676 was commenced on 28.3.1992 and its date of maturity was 28.3.2014. Admittedly, the life assured died on 4.11.1993. It is a fact that the life assured was an employee under the Executive Engineer, OSEB, Electrical Division, Balasore and the premiums of the policies had been deducted from his salary. It is claimed that after the death of the life assured, his son and daughters informed about his death and all the necessary documents including Bond had been sent to the office of LIC, Balasore Branch for which OP No.2 gave an intimation letter to the Executive Engineer, OSEB regarding gap of premium on 24.11.1995. In this regard, on perusal of the letter dated 24.11.1995 issued by the OP No.2, it is crystal clear that it has been issued to the Executive Engineer, OSEB, Balasore Division, Balasore with reference to their earlier letter dated 13.11.1995 seeking clarification as to the non-deduction of premium under the polices in question. Letter dated 6.6.2005 reflects that OP No.1 had issued the same to the Advocate of the complainant. Letter dated 22.8.2005 shows that OP No.2 had issued the same to the complainant for compliance. Letter dated 23.9.2005 shows that OP No.2 had issued the same to the complainant calling for some documents. Letter dated 6.10.2005 issued by OP No.2 shows that it has been sent to the complainant seeking compliance. Letter dated 14.10.2005 shows that it has been issued by OP No.2 to the complainant regarding approval of the surety. Letter dated 18.2.2006 shows that it has been issued by OP No.2 to the Advocate of the complainant. So, on a thorough scrutiny of the above letters issued by the Ops, absolutely it is seen that the Ops have acted upon in the matter from their side since 24.11.1995 till 18.2.2006 either on the information of the legal heirs of the life assured or otherwise. But the Ops have claimed that the legal heirs of the life assured have not intimated about the death of the policy holder at the earliest occasion to OP No.2. On the other hand, the complainant claimed that he along with his sisters have intimated the death of the policy holder and submitted all relevant documents in the office of OP No.2. In the above premises, a question crepts in the mind of the Commission as to whether the OP No.2 sent the letter dated 24.11.1995 to the Executive Engineer, OSEB, Electrical Division, Balasore out of his own volition or on the claim submitted by the legal heirs of the life assured. In this regard, the Ops have not stated a single word to the fact that they have issued the aforesaid letter of their own volition in the year 1995. Further, the Ops have not stated anything regarding issuance of the letter dated 24.11.1995. In the above facts and circumstances, it is held that the Ops have already started their processing in the matter since the year 1995 and even after filing of the present case. Therefore, the claim of the Ops that the case of the complainant is barred by limitation and not maintainable is held to be not substantiated in the eye of law.
8. Besides the above, in the present case, it is seen that the complainant has filed all the required documents before this Commission which ought to have been filed before the Ops for settlement of the death claim in respect of his deceased life assured father. Further, it is also found that the documents, which has been filed in this case, are sufficient for settlement of the claim. It is claimed by the Ops that on enquiry they came to know that the life assured was taking medicine for stomach problem for last six years prior to his death. Th Ops have submitted a statement of one Dhabaleswar Mohapatra of Village Gobardhanpur. It is reflected in the said statement that the life assured was his co-villager, he knew him since his childhood, his age was 45 years at the time of his death, good relation with him, life assured was treated for stomach pain and he took medicine and he died for the said disease and he was present at the time of cremation. On perusal of the said statement, it is noticed that it is a photocopy of the statement of one Dhabaleswar Mohapatra and who recorded his statement has not put his signature. Further, no certificate is appended to the effect that the statements given by Dhabaleswar Mohapatra was correctly recorded by him and the same has been read over and explained to the person concerned who after understanding the contents to be true put his signature. Therefore, the statement, as filed by the Ops, has no evidentiary value. From the documents like claimant’s statement, certificate of hospital treatment, medical attendant’s certificate, certificate of hospital treatment, certificate of identity & burial or cremation filed by the Ops, it is seen that the life assured was died in his house and prior to his death he has not admitted into any hospital. Therefore, calling for any medical papers from the complainant is nothing but a futile exercise committed by the Ops with a view to defer the claim settlement.
9. The Ops have further took the plea that the nominee Smt. Bilasini Panda under the policies expired on 17.9.1993, before the death of the life assured, but the legal heirs of the deceased did not intimate about the death of nominee. On perusal of the case record, interestingly, it is seen that the present case was filed by the complainant on 1.3.2006 when he was aged about 27 years. His life assured father died on 4.11.1993. So, on the date of death of his father, the age of the complainant was approximately 13 years that means he was then minor. Further, it is seen that his nominee mother was expired on 17.9.1993 i.e. two months prior to the death of his life assured father. Then also the complainant was a minor. Moreover, it is seen from the deed of general power of Attorney executed before the Notary Public, Balasore that the legal heirs of deceased life assured had alienated their consent in favour of the complainant to withdraw the money from any nationalized Bank, State Bank or from any Government Office deposited by their deceased father which was pending or subjudice for payment. Therefore, taking into consideration the above facts and circumstances, the complainant is the only person, who was perhaps aged about 13 years at the time of demise of his parent. After the sad demise of his parent, a boy, at this age, not only became helpless in the society but also might have lost his cognizance in respect of his future. In that situation, collection of all relevant documents, as demanded by the OPs-Insurance Company, is out of imagination. However, it is seen that the complainant has collected all the required documents and submitted the same before the OPs-Insurance Company and in the aforesaid background, the delay, as agitated by the OPs-Insurance Company sounds no good. In the above facts and circumstances, it cannot be said that the complainant is not entitled to get the death benefit of his deceased life assured father. But, as it is seen that the OPs-Insurance Company has withheld the claim of the complainant in flimsy grounds since 1993 till today, which should have been settled just after receiving all the documents and legal notice. Furthermore, from the documents filed on behalf of the Ops, it is seen that in the year i.e. on 3.12.1994, the Executive Engineer, Balasore Electrical Division, Balasore (NESCO) has intimated the Ops in complying the query sought for by the Ops with reference to their letter dated 24.11.1995 about the leave particulars of deceased life assured wherein it is found that the S.D.O., Electrical, Jaleswar was directed to prepare the bill and to submit the same to their office for quick disposal. The Ops are silent about the action taken on receipt of the above information from the employer of the life assured nor submitted any paper to show that they had ever taken any follow up action as to whether the S.D.O., Electrical, Jaleswar had prepared the salary bill of the deceased life assured for the aforestated period and as to whether the premium in respect of the above policies has been deducted or not. It is incumbent on the part of the DDO to prepare salary bill on receipt of the order from the Authority. In that event, it is presumed that the salary bill of the deceased life assured supposed to have been prepared and disbursed to the legal heirs of the deceased life assured after deduction of the LIC premium. Therefore, the question of deduction of premium in respect of the policy does not arise at all.
10. However, in the present case, it is seen that the complainant had already submitted all the relevant papers to the OP No.2 for settlement. Thus, the question of non-submission of required papers, as agitated by the OP No.1, sounds no good. Further, the complainant is not required to submit all relevant papers to both the Ops for settlement of the claim. Once the complainant had submitted the papers to OP No.2, the question of further submission of papers does not arise. As it is made out from the documents relied on by the parties, the Ops are trying to defer the matter intentionally in flimsy grounds by calling for unnecessary documents and clarifications from the complainant since 2005 and not acted upon promptly to resolve the issue in their hand. By their above acts, the complainant, without having father and mother, would certainly live in a very miserable condition and suffering from mental agony and sustaining of financial loss cannot be ruled out.
11. From the above discussions made in the foregoing paragraphs, this Commission is of the considered opinion that the complainant has cause of action to file the case and the case is maintainable. Further, the Ops are held to be deficient in rendering their service towards the complainant. Consequently, they are jointly and severally liable for the compensation.
Hence, it is ordered -
O R D E R
The case of the complainant be and the same is allowed on contest against the OPs. Both the O.Ps are hereby directed to -
- disburse the sum assured in respect of the policy No.580178539 and 581027676 along with death & other benefits, to the complainant with interest @ 9% per annum from 04.11.1993 till its actual disbursement,
- pay a sum of Rs.50,000/- to the complainant, towards compensation for mental agony, harassment & litigation cost.
All the aforesaid awarded amounts shall be paid by the O.Ps to the complainant within 45 days from the date of receipt of this order, failing which the complainant is at liberty to realize the same from the O.Ps through the process of law.
Pronounced in the open court of the Commission, this the 10th day of December, 2024 under the signature & seal of the Commission.
