FINAL ORDER/JUDGEMENT
SMT. SUKLA SENGUPTA, PRESIDENT
This is a case U/s 12 reads with section with CP Act, 1986 filed by the complainant.
The fact of the case in brief is that the complainant being the mother of one Biswajit Mondal since deceased residing at Fatal Square Traffic Police, Lal Bazar, Kolkata.
The death certificate of deceased Biswajit Mondal issued by KMC and the post mortem report have been collected from O/c traffic police.
It is further stated by the complainant that deceased Biswajit Mondal had a mediclaim insurance policy of Rs. 3,00,000/- being policy No. 0G-17-1000-6401-0080-5071 for the period of 28.03.2017 to 27.03.2018 and the policy named was Group personnel accident policy purchased by him on 09.04.2018. The complainant claimed the amount from the OP insurance Co. but the OP Insurance Co. without knowing actual facts negligently repudiated the claim of the complainant on the ground that the nominees name “Anjali Mondal” and “Anjli Mandol” are totally different so, the insurance co. denied the medical insurance amount . The OP insurance Co. denied the claim of the complainant with a direction to submit proper document i.e. Adhaar card, Pan Card, and documents of SBI. Subsequently, in compliance to the direction of the OP insurance Co. the complainant submitted all the required documents with the demand of claim of Rs. 3,00,000/- and declared that Anjali Mondal and Anjli Mandol are the same and identical person but the Insurance Co. again repudiated the claim of the complainant on 09.05.2018 on the self same ground.
It is further stated that on 03.11.2017 at about 22.15 hrs. The complainant’s son Biswajit Mondal was driving his vehicle being No. WB 11A 6850 Tata 709 on Kalakar Street from North to South direction in rash and negligent manner and when reached in front of premises No. 21 on Kalakar Road, Kolkata made an accident by one motor cycle bearing No. WB 2AG1346 from its back. As a result, Biswajit Mondal fell down on the road along with his motor cycle and sustained serious injury on his person. Immediately, after the accident he was taken to Medical College Hospital, Kolkata where he was declared as brought death.
The complainant further stated in his petition that her claim is genuine and the OPs insurance co. is bound to need the claim of the complainant but the OPs repudiated the claim and did not pay any heed to the repeated request of the complainant. By such conduct, the OPs caused negligence, harassment and mental agony to the complainant which amounts to deficiency in service on the part of the insurance Co. Hence, the petition of complaint is filed by the complainant against the OPs company with a prayer to give direction to the Insurance Co. to pay claim of amount of Rs. 3,00,000/- along with interest @ 9 % p.a. to the complainant till the date of payment. The complainant further claimed compensation of a sum of Rs. 1,00,000/- from the OPs Insurance Co. due to harassment mental pain and agony along with litigation cost of Rs. 20,000/-.
The OPs 1 and 2 have contested the claim application by filing a Written Statement/WV denying all the material allegations levelled against them.
It is stated by the OPs that the allegation made in claim application are false and the case is not maintainable in the eye of law.
It is further stated that the case is bad for mis-joinder of necessary parties. It is further case of the OPs that admittedly, the mediclaim policy in question was issued in favour of the Biswajit Mondal since deceased vide policy No. OG -17-10006401-00805071 for the period 28.03.2017 to 27.03.2018 for group personnel accidental policy and the name of the nominee was mentioned as Anjali Mondal as mother not as Anjli Mandol.
It is stated by the OPs that the name of the nominee made by Biswajit Mondal during his life time was Anjli Mandol and the policy copy was very much within the custody of son of the complainant which was within the knowledge of the complainant. But the complainant never tried to take any fruitful step for rectification of the name of the nominee before the Insurance Co. Moreover, the complainant did not submit any document before the Insurance Co. for showing any proof of the fact that “Anjali Mondal” and “Anjli Mandol” are the same and identical person. No such document has also been filed by the complainant before this forum during the course of hearing of this case.
It is further stated by the OPs that they never repudiated the claim of the complainant. The complainant falsely stated that the claim has been repudiated by the OPs rather the OPs mainly OP Insurance Co. asked the complainant to produce the required documents i.e. attested copy of DSLR/Chemical Analysis Report. The OPs Insurance Co. had closed the claim of the complainant as the complainant/insured had not proved the documents even after requirement/reminder but the OPs are always ready to assess the claim of the complainant/insured upon receipt of the documents as per terms, condition and limitation of the company.
It is further stated by the complainant that the complainant is not entitled to claim any compensation of Rs. 1,00,000/- claim of Rs. 3,00,000/- which interest 9 % p.a. and she is also not entitled to get litigation cost because she failed to prove her case by giving supporting documents. Thus, the case is liable to be dismissed with cost.
In view of discussion made above, the points consideration are as follows.
- Is the case maintainable in its present form and law?
- Has the complainant cause of action to file the case?
- Is the complainant a consumer?
- Is there any deficiency in service on the part of the OPs?
- Is the complainant entitled to get reliefs as prayed for.?
Decision with Reasons.
All the points of consideration are taken up together for convenience of discussions and to avoid unnecessary repetitions.
From the materials on record and after considering the position of law, it is held by this commission that the case is maintainable in eye of law and this commission has jurisdiction to try this case.
From the materials on record, it appears that the complainant’s case is that she is the mother of one Biswasit Mondal since deceased admittedly who purchased a policy issued by the OP insurance Co. vide policy No. OG-17-1000-6401-0080-5071 for the period 28.03.0217 to 27.03.2018 for group accidental personnel policy.
It is the further case of the complainant that on 03.11.2017 for her son Biswajit Mondal met an road accident and died at about 2.01 hrs. Thereafter, she collected the death certificate and PM report of the deceased from the concerned authority and placed the claim of a sum of Rs. 3,00,000/- to the OPs on 09.04.2018 and the OP insurance Co. repudiated the claim on the ground that the name of the complainant has been mentioned as nominee in the insurance policy as “Anjli Mandol” as the mother of deceased but the complainant placed her document like Adhaar card and other documents where in her name has been mentioned as “Anjali Mondal”. The complainant claimed that she submitted all the required documents reports before the OP insurance co. but the insurance co without considering those document as repudiated her claim on the plea that the name as mentioned in the insurance policy of the complainant as nominee is “Anjli Mondal” not “Anjali Mondal” so, due to difference of the name the insurance co. was not in a position to allow the claim of the complainant.
The complainant claimed in her BNA and petition of complaint that she submitted all the required documents before the OP insurance Co. along with her claim and also submitted the required documents before the forum along with petition of complaint to support her claim. But form the documents i.e. the photocopy of adhaar card of the complainant. It appears that the name of the complainant has been mentioned in the petition of complaint and in the adhaar card as “Anjali Mondal” and in the passbook of saving’s books account in SBI her name has been mentioned as Anjali Mandol but in the insurance policy her name has been mentioned as “Anjali Mandol” as the mother of her son Biswajti Mondal since deceased.
So, it is fact that the spelling of the name of complainant is found different in the insurance policy and in the adhaar card , bank document and other documents. The complainant should have take proper steps to establish that Anjali Mondal and Anjli Mandol is/are same the identical person but she did not take that fruitful step to prove that Anjali Mandol and Anjli Mondal is same and identical person who is the nominee in the alleged insurance policy purchased by her son Biswajit Mondal since deceased.
Under such circumstances, this commission is of view that the Insurance Co. rightly repudiated the claim of the complainant as she could not be able to prove that Anjali Mondal and Anjli Mandol is same and identical person.
On that point, this forum is also of view that though the complainant is a consumer under the OP Insurance Co. but the OP Insurance Co. has/had no deficiency in service on their part. The claim of the complainant has been repudiated by the Insurance Co. at the fault of the complainant because she could not be able to take proper step to prove her claim. Under such circumstances, it is held by the Forum that the complainant failed to prove her case beyond all reasonable doubts and is not entitled to get the reliefs as prayed for.
The case is properly stamped.
All the points are considered and decided accordingly.
Hence,
Ordered
That the case be and the same is dismissed on contest against the Opposite Parties.
Copy of the judgment be supplied to the parties free of cost as mandated by the CP Act. The Judgement be uploaded forthwith on the website of the commission for perusal of the party.
