Sri Shyamal Gupta, Member

This Appeal is directed against the Order dated 06-08-2015 passed by the Ld. District Forum, North 24 Parganas in C.C. No. 541/2014 whereof the complaint has been dismissed on contest.

Brief facts of the complaint case are that wife of the Complainant no. 1, Rimpa Paul, since deceased, and Complainant No. 1 opened a joint Savings Account in the OP No. 1 Bank and they were issued Visa International Debit Card with comprehensive personal accidental insurance coverage of Rs. 2,00,000/-.  Subsequently, wife of the Complainant No. 1 died in a road accident on 14-11-2013.  On 10-12-2013, Complainant No. 1 intimated the matter in black and white to the OP No. 1.  Thereafter, the Complainant, on numerous occasions, urged the authorities concerned to do the needful to settle his insurance claim, but in vain.  Finding no other alternative, the complaint was filed.

By submitting a WV, it is stated by the OP No. 1 that it did not render any service to the Complainant and the contract of insurance was between the OP No. 2 and the Complainant/his deceased wife.  It was only a facilitator/referral agent.  Further case of this OP is that free accidental death insurance, associated with ATM International Debit Card was provided to the deceased wife of the Complainant No. 1 without charging any consideration and the same being a bounty or gratitude associated with the said ATM International Debit Card, the dispute does not fall within the purview of the Consumer Protection Act. 

Counter case of the OP Nos. 2&3 is that, wife of the Complainant No. 1 was not an Insured under these OPs.  Admitting that these OPs associated with the OP No. 1 for the purpose of giving insurance coverage to the customers of the OP No. 1 under specific terms and conditions, they claimed that they did not get timely information regarding the accidental death of the wife of the Complainant No. 1 either from the OP No. 1 or from the Complainants.  It is further stated that they came to know of it after 261 days since happening of the accident.  Accordingly, the said claim was repudiated following governing terms and conditions of the policy.

Decision with reasons

Ld. Advocates for the parties are heard in the matter.  We have also gone through the record carefully.

Since the Respondents raised question about status of the Appellant No. 1 as ‘consumer’, let us first discuss this issue. 

It is a fact that the Appellant no. 1, or for that matter, his wife, since deceased, did not pay any money towards insurance premium for availing of accidental insurance coverage.  Having said that, we cannot overlook the fact that the definition of ‘consumer’ includes any beneficiary of such services other than the person who 'hires or avails of the services for consideration paid or promised, or partly paid and partly promised, or under any system of deferred payment.

In this case, the Respondent No. 1 hired the services of the Respondent nos. 2 and 3 against consideration for extending certain benefits to its customers.  Therefore, as a ‘beneficiary’ of such service, the deceased wife of the Appellant No. 1, as also the Appellant No. 1 were bona fide consumers under the Act. 

In this regard, we are inclined to discuss another important aspect regarding the claim of the Respondent No. 1 of offering bounty to debit card holders without any monetary consideration.  It is to be kept in mind that the bank realizes hefty sum of money from its customers as annual fees in respect of ATM Debit Cards.  Besides this, the bank also taxes its customers for usage of debit card beyond the prescribed limit.  As against this, the Insurance premium paid to the Insurer for extending insurance coverage is a pittance.  Naturally, it is not at all difficult for the bank to realize the premium amount from its customers indirectly.

It is clear from the above discussion that the objection regarding the status of the Appellant no. 1/his wife, since deceased, as consumers, is virtually a misnomer.

Now, coming to the merit of the case, undisputedly, Rimpa Paul, wife of the Appellant No. 1 was the holder of ATM-Debit Card of the Respondent No. 1 bank bearing no. 4902 2390 0800 7762.  It is also not in dispute that said Rimpa Paul died in a road accident.

The only plea of the Respondent Nos. 2&3 is that due intimation about such occurrence of death did not reach them in time, i.e., within 7 days of occurrence of such death.  In this regard, be it mentioned here that Insurance Regulator, IRDA, by issuing a Circular bearing no. IRDA/HLTH/MISC/CIR/216/09/2011 dated 20-09-2011 stated, “The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc.  However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances”.

In this case, we find that due intimation about such peril was communicated to the Respondent No. 1 by the Appellant No. 1 in writing on 10-12-2013.  Along with said intimation letter, the Appellant No. 1 also attached death certificate of Rimpa Paul.  Thereafter, by submitting another letter on 19-07-2014, the Appellant No. 1 asked the Respondent No. 1 to do the needful to facilitate due indemnification over said accidental death of his wife.  Appellant No. 1 also sent a letter to the Respondent no. 2 on 01-08-2014 explaining the delay therein. 

In view of this, we feel that, while the delay was duly explained by the Appellant No. 1 and relevant particulars were suffice to convince one the bona fide of such claim, the Respondent Insurer ought to settle the claim taking a leaf out of the afore-mentioned Regulatory directive. 

Since the Respondent Insurer intentionally avoided toeing the Regulatory directive, there can be no manner of doubt about their gross deficiency in service in the matter. 

This Appeal deserves favourable consideration and as such, we are inclined to allow the Appeal. 

Hence,

O R D E R E D

The Appeal stands allowed on contest against the Respondents.  The Respondent Nos. 2&3 are directed to pay Rs. 2,00,000/- to the Appellant No. 1 within 40 days hence along with simple interest @ 9% p.a. over the aforesaid amount with effect from 24-09-2014 till full payment is made and another sum of Rs. 10,000/- as litigation cost.  The impugned order is hereby set aside.