State Consumer Disputes Redressal Commission
Smt.Shilpa Koushik vs Zonal Manager , Life Insurance ... on 23 December, 2017
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
Complaint Case No.CC/2017/40
Instituted on : 27.05.2017
Smt. Shilpa Kaushik, W/o Late Harish Kumar Aharwal,
D/o Shri Ramvilas Kaushik,
R/o : Near Sharda Mandir, Raipur Road,
Parsada, Bilaspur, District Bilaspur (C.G.) ... Complainant
Vs.
1. Zonal Manager,
Life Insurance Corporation of India,
Central Zonal Office 60-B,
'Jeevan Shikha', Hoshangabad Road,
Arera Hills, P.B. No.28,
Bhopal (M.P.) 462011
2. Branch Manager, Branch Office - 2,
Life Insurance Corporation of India,
Shivdulare Complex, Vyapar Vihar,
Bilaspur (C.G.)
3. Manager (Claims),
Life Insurance Corporation of India,
L.I.C. Bhawan, Magarpara,
Bilaspur (C.G.) ... Opposite Parties
PRESENT: -
HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT
HON'BLE SHRI D.K. PODDAR, MEMBER
COUNSEL FOR THE PARTIES:
Shri Ghanshyam Patel, Advocate for the complainant.
Shri D. Dutta and Shri G.V.K. Rao, Advocates for the OPs.
ORDER
Dated : 23/December/2017 PER :- HON'BLE SHRI JUSTICE R.S. SHARMA, PRESIDENT. The complainant has filed this consumer complaint under Section 12 of the Consumer Protection Act, 1986 (but actually the complaint should have been filed under Section 17 of the Consumer Protection Act, 1986) against the OPs seeking following reliefs :-
// 2 // (1) To direct the OPs to pay the insured amount / maturity amount of Rs.80,00,000/- (Rupees Eighty Lakhs) along with interest @ 12% p.a. to the complainant. (2) To direct the OPs to pay a sum of Rs.2,00,000/- (Rupees Two Lakhs) towards compensation for mental agony.
(3) To direct the OPs. to pay cost of litigation to the
complainant and to grant other reliefs, as this
Commission deems fit in favour of the complainant.
2. Briefly stated the facts of the complaint of the complainant are that on 15.12.2015, the husband of the complainant Harish Kumar purchased insurance policy No.359084232 from the O.P. No.2. The sum assured was Rs.40,00,000/- (Rupees Forty Lakhs). The premium of the policy was paid by Harish Kumar. The O.P. No.2 issued insurance policy in the name of deceased Harish Kumar on 16.12.2015 in which the name of the complainant Smt. Shilpa Kaushik, who is wife of the deceased, was mentioned as his nominee. As per terms and condition of the insurance policy No.359084232 if the policy holder died in accident, then the double amount of the sum assured i.e. Rs.80,00,000/- (Rs.40,00,000 x 2) was payable. On 17.12.2015 Harish Kumar Aharwal died in road accident near Bypass Road, Ratanpur. The First Information Report was registered against the driver of Truck (Tanker) bearing No.C.G.-12-AL-1222 and after investigation charge sheet has been filed before Judicial Magistrate First Class, Kota, District Bilaspur (C.G.) on 09.02.2016. After accidental death of the policy holder Harish Kumar Aharwal, the complainant completed all // 3 // the formalities and submitted claim form along with relevant documents before the O.P. No.2 on 14.01.2016. The O.P. No.2 registered the claim of the complainant. After registering the claim of the complainant, the OPs informed the complainant vide email dated 30.03.2016 as per instruction of Zonal Office, Bhopal, the claim of the complainant will be decided after settlement of the pending case by the Court. The complainant got married with Harish Kumar Aharwal on 27.04.2008 and they have two children namely Vedant Kaushik and Kush Kaushik. The OPs are avoiding to pay the claim amount and are not settling the claim of the complainant. The Life Insurance Corporation has fixed a time for settlement of the claim, but inspite of lapse of period of 1 years and 4 months, the OPs have not settled the claim of the complainant, which comes in the category of deficiency in service. On 05.04.2017, the complainant sent legal notice through her counsel to the O.P. No.1 to 3 and requested to pay the claim amount, but even then the OPs did not settle her claim and did not pay the sum assured. Hence the complainant filed instant complaint and prayed for granting reliefs as mentioned in the relief clause of the complaint.
3. The OPs have filed their written statement and averred that the claim of the complainant has not been decided by the OPs, therefore, the complaint is pre-mature and is not maintainable, hence the complaint is liable to be dismissed. The complainant has not made other legal heirs of the deceased Harish Kumar Aharwal, who are necessary party and the O.P. No.1 & O.P. No.2 are not necessary party, therefore, for non-joinder of necessary party and mis-joinder of the party, the complaint is liable to be dismissed. The OPs further averred // 4 // that the deceased Harish Kumar Aharwal submitted proposal form on 03.12.2015 for New Jeevan Anand for sum assured Rs.40,00,000/- and Amulya Jeevan-2 for sum assured Rs.35,00,000/-. Due to non compliance of formalities , the policies could not be issued in time. After completion of necessary formalities, for New Jeevan Anand for sum assured Rs.40,00,000/- half yearly premium of Rs.64,904/- and for Amulya Jeevan - 2 sum assured Rs.35,00,000/- annual premium of Rs.14,385/- were fixed. After depositing the above premium amount and income tax return / information for income proof, the OPs bonafidely as per procedure on 15.12.2015 accepted the proposal of the policy holder for New Jeevan Anand and policy No.359084232 for sum assured Rs.40,00,000/- and policy document was issued on 17.12.2015. In the above policy, the complainant is mentioned as nominee but nominee is only a trustee of the insured. The policy was issued for covering accidental benefit also but the death of the Life Assured is dubious, therefore, the complainant is not entitled to get any benefit under the policy. The Life Assured had died within 2 days from the date of issuance of the insurance policy, therefore, inquiry was necessary. The complainant has not filed relevant documents and Final Police Report. The OPs demanded the relevant documents from the complainant vide letter dated 20.02.2016. The documents were provided by the complainant on 08.03.2016. Due to negligence and delayed tactics of the complainant, the claim could not be decided by the OPs. The Life Assured Harish Kumar Aharwal was posted as Development Officer in Branch Office - 2 Korba, Life insurance Corporation of India and he was terminated from service after // 5 // completion of inquiry and he has no permanent source of income. The Life Assured had obtained both the policies of Rs.40,00,000/- and Rs.35,00,000/- after suppressing material facts. The complaint is liable to be dismissed.
4. The complainant has filed documents. Documents are Proposal Form for policy No.359084232, Policy Bond for policy No.359084232, income tax return, copy of complaints made to the Police by the persons against the insured, Final Report, First Information Report, Merg Intimation, Notice under Section 175 Cr.P.C., Inquest prepared under Section 174 Cr.P.C., Post Mortem Examination Report of the deceased Harish Kumar Aharwal, Spot Map, Supurdginama of dead body, Seizure Memo, Arrest Memo and Bail Bond etc.
5. The OPs have filed documents. Documents are letter dated 10.08.2017 sent by Sr. Branch Manager, LIC of India, Branch 1, Bilaspur to the Sr. Divisional Manager, LIC of India, Bilaspur D.O. Bilaspur, copy of First Information Report, copy of news paper Nai Dunia dated 06.08.2017, copy of news paper Dainik Bhaskar dated 06.08.2017, copy of news paper Dainik Haribhumhi dated 06.08.2017, Rules (Section 45) of Insurance Act, 1938 Amended Act 2015, Terms and conditions of New Jeevan Anand and Amulya Jeevan -2, Prevailing rules of the LIC on the basis of which death claim is settled.
6. Shri Ghanshyam Patel, learned counsel appearing for the complainant has argued that deceased Life Assured Harish Kumar Aharwal purchased insurance policy No.359084232 from the O.P. No.2 for sum assured of Rs.40,00,000/-. The premium of the policy was paid // 6 // by the deceased Life Assured and he mentioned the present complainant, who is his wife, as nominee in the insurance policy. On 17.12.2015, Harish Kumar died in a road accident near Bypass Road, Ratanpur. The First Information Report was lodged against the driver of Truck bearing registration No.C.G.12-AL-1222 and after investigation, charge sheet has been filed. under Section 304A IPC against the driver of the offending vehicle before Judicial Magistrate First Class, Kota, District Bilaspur (C.G.). The complainant submitted claim form along with relevant documents before the O.P. No.2, but the O.P. No.2 did not settle the claim of the complainant holding that criminal case is pending before Criminal Court and after decision in the criminal case, the claim of the complainant will be decided. Even after lapse of about 1 year and 4 months from submitting the claim form, the claim of the complainant has not been settled by the OPs, which comes in the category of deficiency in service. The complainant suffered mental agony. The complainant is entitled to get compensation from the OPs, as mentioned in the relief clause of the complaint. The complaint may be allowed.
7. Shri D. Dutta and Shri G.V.K. Rao, learned counsels appearing for the OPs have argued according to the complainant, the deceased had left two sons namely Vedant Kaushik and Kush Kaushik, but the complainant did not make them as party in the complaint, whereas both the sons of the deceased, are necessary party and for want of necessary party, the complaint is liable to be dismissed. The relevant documents in respect of claim were provided by the complainant to the OPs at belated stage on 08.03.2016. The OPs sought documents // 7 // from the OPs so many times, but the complainant did not provide the documents to the OPs and ultimately, the documents were provided by the complainant on 08.03.2016. Due to negligence and delayed tactics of the complainant, the claim of the complainant could not be decided by the OPs. The complaint of the complainant is pre-mature, hence, it is liable to be dismissed. The Life assured died within 2 days of issuance of the insurance policy, therefore, the death of the deceased is doubtful. Probably, the deceased committed suicide, therefore, necessary investigation is required. The deceased Life Assured was posted as Development Officer in Branch Office - 2, Korba of the Life Insurance Corporation and he was terminated from service, therefore, the Life Assured had no source of income and he obtained policy after suppressing material facts, therefore, the complaint is liable to be dismissed. The complainant is not entitled to get any amount under the insurance policy from the OPs.
8. We have heard learned counsels appearing for both the parties and have also perused the documents filed by the parties in the complaint.
9. It is admitted fact that the deceased Life Assured Harish Kumar Aharwal had obtained insurance policy No.359084232 from the O.P. No.2 for sum assured Rs.40,00,000/-.
10. The complainant has filed Final Report, First Information Report, Merg Intimation, Notice under Section 175 Cr.P.C., Inquest prepared under Section 174 Cr.P.C., Post Mortem Examination Report of the deceased Harish Kumar Aharwal, Spot Map, Supurdginama of dead // 8 // body, Seizure Memo, Arrest Memo and Bail Bond. In the First Information Report and Merg Intimation, it is mentioned that Harish Kumar Aharwal met with an accident near Bypass Road, Ratanpur. In the Inquest, it is mentioned that deceased died due to accident and he sustained injuries on his head, hands, legs and other parts of the body. In the post mortem examination report, injuries sustained by the deceased Harish Kumar Aharwal, is mentioned. The Doctor, who conducted post mortem examination of the dead body, opined that the mode of death is Shock Haemorrhagic and cause of death is injury in vital organ (brain) and nature of death is accidental in nature. The Superintendent of Police, Bilaspur (C.G.) sent letter dated 29.08.2016 to Smt. Shilpa Kaushik (complainant), in which it is mentioned that deceased Harish Kumar Aharwal died due to accident and Merg Intimation No.98/2015 was registered and Offence No.304/2015 for offence under Section 304A IPC, was registered. The charge sheet was filed against the driver of offending vehicle in the Court of Judicial Magistrate First Class, Kota. The case has been registered as Criminal Case No.192/2016.
11. Looking to the above documents, it is established that the deceased Harish Kumar Aharwal, died due to road accident and his death is accidental in nature.
12. According to the complainant, she submitted all relevant documents along with claim form before the O.P. No.2, but the O.P. No.2 did not settle her claim. According to the OPs, the complainant // 9 // provided relevant documents belatedly on 08.03.2016 to the OPs and the complainant herself did not provide documents to the OPs in time.
13. In para 4 of their written statement, the OPs pleaded that on 08.03.2016, the complainant submitted documents before the OPs at a belated stage, therefore, her claim could not be settled in time. The complainant herself is responsible for delay in settling her claim. It appears that the claim of the complainant has not yet been settled or repudiated by the OPs, therefore, the complaint of the complainant is pre-mature. Hence, it is appropriate to direct the OPs to decide the claim of the complainant within two months from the date of this order. If the complainant will not satisfy with the decision of the OPs, then the complainant can again filed fresh complaint against the OPs for the same cause of action, before this Commission.
14. Therefore, the complaint filed by the complainant, is dismissed with a direction that the OPs will decide the claim of the complainant within two months from the date of this order. If the complainant will not satisfy with the decision of the OPs, then the complainant can again file fresh complaint against the OPs for same cause of action, before this Commission. The complainant is entitled to get benefit of limitation for the time spent by her in prosecuting this complaint. No order as to the cost of this complaint.
(Justice R.S. Sharma) (D.K. Poddar)
President Member
23 /12/2017 23/12/2017