DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 14th day of July, 2020
C.D Case No. 19 of 2018
1. Shri Raghunath Kar, President
2. Shri Basanta Kumar Mallick, Member
3. Afsara Begum, Member
Sri Bishnu Mohan Malik
S/o Late Narahari Malik
At: Balibili,
Po: Ichhapur,
Dist: Bhadrak, Odisha
……………………. Complainant
(Versus)
1. The Chief Manager, L.I.C of India, Bhadrak
NH- 5, Bonth Chhak, Bhadrak, Pin- 756100
2. Senior Divisional Manager, L.I.C of India
Nuapatna, Po: Mangalabag, Dist: Cuttack- 753001
Dist: Bhadrak
3. Sri Manas Kumar Ojha, Insurance Agent
At/Po: Dolasahi,
Ps: Tihidi,
Dist: Bhadrak, Pin- 756127
……………………..Opp. Parties
Counsel For Complainant: In Person
Counsel For the OP No. 1 & 2: Sri P.K. Roul, Adv
Counsel For the OP No. 3: In Person
Date of hearing: 19.02.2019
Date of order: 14.07.2020
BASANTA KUMAR MALLICK, MEMBER
This dispute arises out of a complaint filed by the complainant alleging deficiency of service and unfair trade practice against the O.Ps.
The facts of the case as narrated in the complaint are to the effect that the complainant is the father of Late Niranjan Malik who had taken up a life insurance policy with OP No. 1 for sum assured of Rs 1,15,000/- vide policy No. 596996217. The deceased being a poor man had been to Tamilnadu for earning his livelihood and was working there as a laborer. During his stay in Tamilnadu, he suffered from viral fever and proceeded to a nearby Hospital on 24.04.2016 for preliminary treatment at Ramu Medical Foundation, Palladam and continued such treatment from 24.04.2016 to 28.04.2016. When his health condition was found not improving, he returned back to Odisha on 03.05.2016 with the help of some co-workers belong to his native place and reached at home. The complainant admitted his son in 4S Care Hospital on 04.05.2016 for batter medical treatment but to his ill luck the patient breathed his last on 05.05.2016 in the aforesaid hospital. After the demise of policy holder, the complainant immediately intimated the fact of death to OP No. 1 & 3 on 18.07.2016 and subsequently staked the claim with Chief Manager L.I.C of India, Bhadrak Branch (OP No. 1) along with required documents for settlement of claim. OP No. 1 conducted investigation by deputing his branch officials where all necessary documents consisting of 12 sheets were submitted and the officials assured to settle the claim within a short time. Waiting for the result from the O.Ps up to 12.09.2017, the complainant for a quick result met and requested OP No. 2 for settlement of the claim at an early date. OP No. 2, on 14.11.2017 made some queries about the cause of death which was complied on 21.11.2017. In this manner whenever and whatever information were required by the O.Ps, the complainant complied all the requirements but the O.Ps did not take any concrete step to settle the death claim and being desperate filed a case in the present Forum praying for relief.
The OP No. 1 & 2 resisted the claim of the complainant and contested the case. In the written version submitted by the counsel of O.Ps raised the question of maintainability as the O.Ps have never caused any deficiency of service nor there is any mention about the cause of action. Further the O.Ps have also raised that the O.Ps required some information vide letter dt. 21.04.2017 which is not complied by the complainant till the date of filing of this case and the O.Ps are in doubt about the death of the complainant is not due to viral fever and respiratory problem. The OP No. 1 & 2 also sought information about the employer and the address of the deceased policy holder while he was working in Tamilnadu which is not complied by the complainant so far. It is also stated that the complainant, in spite of several intimations, did not co-operate and submitted the documents which are barely required for settlement of claim. The documents sought for are mandatory to be submitted by the complainant for settlement of death claim as the death occurred within 3 years from the date of commencement of policy. Therefore the complainant is not entitled to any death claim and this petition is liable to be dismissed.
OP No. 3, the authorized agent of OP No. 1 & 2, in submitting written version has stated that there is no valid reason to disallow settlement of death claim as per prevailing policy. He has also admitted that the complainant has intimated about the death of the policy holder within a week and therefore the claim need to be settled.
Gone through the complaint of the complainant, written versions of O.Ps, heard the parties in course of hearing, perused the materials on record and observed that the following points are barely necessary to be discussed to arrive at the conclusion.
1. The complainant claimed that in spite of submission of all documents, the O.Ps did not settle the death claim on some irrelevant pleas about the address of the employer and the address of the deceased policy holder where he was staying during his stay in Tamilnadu and the prescription of preliminary treatment given by Ramu Medical Foundation, Palladum, Tamilnadu. The complainant has repeatedly intimated in writing to the appropriate authorities in reply to the correspondences made by O.Ps stating that the deceased was a daily laborer, not a permanent employee of the spinning mill, and his name was not in the pay roll of the establishment. During his stay the deceased was staying with some other laborers and co-workers belong to the native place of the deceased and the prescription of medical aid given by Medical Foundation is not available which is beyond the knowledge of the complainant. Had he been a permanent employee of the establishment where the deceased was working, it would have been easier to comply the requirements. In spite of frequent clarification issued by the complainant in response to all the correspondences made by the O.Ps the death claim of the complainant could not be settled because of ulterior motive of the O.Ps. This makes clear that the O.Ps are not in a mind to settle the death claim. On the contrary the O.Ps stated that unless the requirements are complied, the death claim cannot be settled. On perusal of records it is seen that the complainant has responded all the letters communicated to him stating that the address as required by the O.Ps cannot be complied. Hence it is believed that the O.Ps have caused inordinate delay in settlement of the claim which is absolutely unfair and violates the settled position of I.R.D.A Rules and therefore the objection raised by the O.Ps is not sustainable.
2. Secondly the O.Ps have argued that the death caused due to viral infection and severe respiratory problem is not believable. In reply to such objection the complainant argued that all the documents pertaining to medical treatment of deceased in 4S Care Hospital, Cuttack revels that the deceased policy holder was suffering from viral fever causing respiratory problems. When the doctors attending the patient issued genuine certificate which shows the cause of death, the objection of O.Ps is irrelevant and non settlement of claim is purely intentional and guided by ulterior motive. Hence the objections of O.Ps are not suitable to the present case and in the present context. On perusal of material evidence on record it is crystal clear that the patient has died due viral infection and respiratory problem.
Taking the above analysis into consideration, this Forum arrives at the conclusion that the deceased policy holder has died due to severe viral infection and respiratory issues and therefore the O.Ps No. 1 & 2 are liable to settle the death claim.
- ORDER
In the result, the complaint be and the same is allowed against the OP No. 1 & 2 with cost and compensation. OP No. 1 is directed to settle the death claim for Rs 1,15,000/- with compensation of Rs 7,000/- for mental agony and harassment and Rs 3,000/- towards cost of litigation. OP No. 1 & 2 are required to comply this order within 30 days from the date of receipt of order copy failing which interest @ 7% P.A on quarterly rest basis shall be charged from the date of staking claim till the date of payment.
This order is pronounced in the open Forum on this day of 14th July, 2020 under my hand and seal of the Forum.
