Complaints filed on: 23-02-2021

                                                      Disposed on: 22-09-2021

BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL COMMISSION, TUMAKURU

CC.No.24/2021

DATED THIS THE 22^nd DAY OF SEPTEMBER, 2021

PRESENT

SRI.C.V.MARGOOR, B.Com, L.L.M, PRESIDENT

SRI.KUMARA.N, B.Sc., L.L.B, MEMBER

SMT.NIVEDITA RAVISH, B.A., L.L.B, LADY MEMBER

Complainant: -

                                                B.P.Prakash,

No.221, TUDA Layout,

Behind Apollo Pharmacy,

Sira gate, Tumakuru-06

(In person)

V/s

Opposite parties:-    

1. The Branch Manager,

LIC of India, Branch-1,

Gandhinagar,

Tumakuru-01

2. The Senior Divisional

Manager, LIC of India,

Divisional Office-1,

Jeevan Jyothi, JC Road,

Bengaluru-02

                                                (By Sri.G.S.Narayan, Advocate)

ORDER

SMT.NIVEDITA RAVISH, LADY MEMBER

This complaint is filed under section 35 of the Consumers Protection Act 2019 to direct the Opposite parties to pay balance of Rs.3,75,298-00 together with interest at 9% p.a. and Rs.5,000=00 towards the cost of litigation and Rs.20,000=00 as general damages towards deficiency in service, negligent attitude and mental agony suffered by the complainant.

2. The 1^st OP is LIC of India, Branch-I Gandhinagar, Tumkur and 2^nd OP is the Senior Divisional Manager, LIC of India, Divisional Office-I, Bangalore.       

3. It is the case of complainant that the Single Premium Life Insurance Policy (Jeevan Utkarsh) No.617850726 dated 6-9-2017 was issued by 1^st OP on the life of complainant son Dixit.B.P. Deceased B.P.Dixit life Assured (DLA) was died on 28-1-2018. Deceased was working as Software Engineer and aged 25 years. The single premium amount is Rs.43,812-00. The complainant being the nominee of the said policy submitted the death claim papers to the 1^st OP on 27-11-2018 for Rs.4,12,425-00. Despite so many follow up and numerous personal visits by complainant 1^st OP slept on claim papers, gave false assurance that the claim is under process with 2^nd OP. The 2^nd OP issued query letter on 10-12-2019 when the complainant has approached the 2^nd OP directly. Complainant submitted the police inquest report and police final “B” report as per the query letter of  the 2^nd OP on 17-12-2019. Thereafter so many letters and mail correspondence the complainant has made with Insurance Ombudsman (Karnataka), Bengaluru and same was registered as BNG-L-029-1920-0682 dated 6-3-2020. The complaint was partly allowed against the 1^st and 2^nd OP under award No.IO/BNG/A/LI/0027/2020-2021 dated 29-7-2020 as undue delay and negligence in settling the claim which clearly established and they stated that they are not the original fact finding authority and directed the complainant to approach any other forum/court. After passing the order by the Ombudsman the 1^st OP on 3-7-2020 credited to the complainant’s bank account a paltry sum of Rs.37,127-00 as against the full death claim of Rs.4,12,425-00. Further the complainant has sent email to OPs to credit difference amount of Rs.3,75,298-00 along with interest for delayed settlement. Further the complainant has got issued legal notice on 28-10-2020 but till date there is no response from the opponents hence, this complaint.

          4. After issuing notice by this Commission the 1^st and 2^nd OP appeared through their counsel and filed written version stating that the insurer i.e. OPs can investigate about the death of policy holder whose death claim was made within three years of policy term. After receiving the police inquest report, police final “B” report the OPs have made internal investigation. The OPs concluded the death of deceased as “Suicide” and refunded the 90% of premium amount to the nominee as per Section 2 suicide clause of part-F of the terms and conditions of the policy. Further OPs admitted the award passed by the Ombudsman. But OPs submitted that Ombudsman gave liberty to approach any forum/court means Appellate Authority to Ombudsman. The OPs raised the objections as complainant did not approach the Appellate Authority to Ombudsman hence, the order passed by the Ombudsman has reached the finality. On the above grounds the OPs asked to dismiss the complaint.

          5. The complainant filed his affidavit with documents which are marked as Exs.P1 to Ex.P25 and OPs have also filed affidavit evidence with two documents which are marked as Exs.R1 and R2.

          6. The complainant filed written arguments and OPs have submitted their oral arguments. After hearing arguments the points that would arise for determination are as under:

1. Whether the complainant proves the deficiency in service on the part of OPs?
2. Can complainant file the complaint before this Commission after the order passed by Ombudsman?
3. Whether the complainant is entitled for relief sought for?

7. Our findings on the aforesaid points are as follows:

Point No.1: In the affirmative

Point No.2: In the affirmative   

Point No.3: In the partly affirmative for the                  

below

REASONS

          8. Point No.1 to 3: The complainant submitted that the OPs have  not settled the claim amount of the policy of the deceased son Dixit.B.P which was made by him as Single Premium Life Insurance Policy (Jeevan Utkarsh) No.617850726 dated 6-9-2017 issued by 1^st OP. Policy made by the DLA is not disputed by OPs in their version. Further the complainant submits that the OPs have not responded about settling the claim despite close follow up and numerous personal visits by complainant.  The complainant produced the document Ex-P7 claim letter submitted by him to 1^st OP dated 27-11-2018, Ex-P8 query letter of 2^nd OP seeking police inquest and police “B” final report dated 10-12-2012. After submitting these Ex.P7 and Ex.P8 the OPs have took more than one year to respond to the complainant. Further Exs-P9, P10, P12, P13 and P14 clearly shows the approach made by complainant to OPs for settlement of claim amount.

          9. The learned counsel for OPs submitted that the OPs should investigate about the death of policy holder whose death claim falls within three years of issue of policy. After internal investigation the OPs concluded that the death as “Suicide” and they refunded the 90% of premium to nominee as per Section 2 suicide clause of part F of terms and conditions of the policy. The complainant has not challenged the police “B” final report. On perusal of the documents produced by the OPs, the OPs have not produced any documents to show the terms and conditions of the policy and Section 2 Suicide clause of part “F” of terms and conditions of the policy. AS against this, the complainant produced Ex-P1 LIC’s Single Premium Life Insurance Policy No.617850726 “Jeevan Utkarsh” in the name of B.P.Dixit.  Risk coverage starts from the date of payment of premium and premium was paid on 6-9-2017 and the deceased was died on 28-1-2018 hence, the policy was in force or active on the date of death.     

          10. The OPs have submitted that the death of DLA is suicide as per their internal investigation. On perusal of Ex-P2 police inquest report and Ex.P3 post mortem examination report-FSL/TS/605/2018 we have not found the reference of suicide in any above exhibits. On perusing Ex-P18 and Ex-P19 produced by complainant, the complaint was partly allowed by the Hon’ble Insurance Ombudsman under Award No.IO/BNG/A/LI/0027/2020-2021 dated 29-7-2020 and the Hon’ble Insurance Ombudsman gave liberty to the complainant to approach any other forum/court as he deems fit. On perusal of Ex-P19 the Hon’ble Ombudsman has not directed to approach the appellate authority. He has mentioned to approach any other forum/court as the complainant deems fit. As per Insurance Regulatory and Development Authority of India (IRDAI) guidelines under “Policy for protection of interest of policy holders, 2017 the OPs should have raised requirements within 15 days of complainant’s claim submission and communicated their decision within 120 days of complainant’s claim submission. But the OPs took 377 days to raise the claim requirements and took 583 days to take a decision on the claim.

          11. The complainant himself admitted that the 1^st OP credited to his bank account partly a sum of Rs.37,127-00 as against the full death claim for Rs.4,124-25 and difference is Rs.3,75,298-00.

          12. The OPs have not produced any documents to believe that the death of deceased is suicide. There is no basis for the opinion of OPs to believe that the death of deceased is suicide. On the contrary PM report is acceptable that the death of deceased is unnatural homicide. Therefore, the OPs shall liable to pay the policy amount to the complainant who is nominee of the deceased. The OP insurance company shall liable to pay difference amount of Rs.3,75,298-00 out of the sum assured amount for the single premium life insurance policy no.617850726 dated 6-9-2017 with interest at 8% p.a.. The complainant has approached personally as well as through letters and emails and also approached the Hon’ble Insurance Ombudsman and for that he suffered mentally. Therefore the OPs shall pay a sum of Rs.10,000-00 as compensation towards mental agony and Rs.5,000-00 towards litigation expenses. For the above reasons, we proceed to pass the following;

ORDER

The complaint is partly allowed directing the OP Nos.1 and 2 are jointly and severally liable to pay balance amount a sum of Rs.3,75,298-00 with interest @ 8% p.a. from 27-11-2018 till the date of payment.

It is further ordered that the OP Nos.1 and 2 shall pay Rs.10,000-00 as compensation and Rs.5,000-00 as litigation cost to the complainant within 45 days from the date of this order otherwise, it carries interest @ 8% p.a. from the date of filing the complaint till the date of payment. 

Furnish the copy of order to the complainant and opposite parties at free of cost.

(Dictated to the Stenographer, got it transcribed, corrected and then pronounced in the Open Commission on this the 22^nd day of September, 2021).

LADY MEMBER          MEMBER                   PRESIDENT