Sri Utpal Kumar Bhattacharya, Member

Instant Appeal u/s 15 of the C.P Act, 1986 has been filed challenging the judgment and order dated 10.11.2017 passed by the Ld. District Forum, Murshidabad in Complaint Case bearing No.CC/100/2016 dismissing the complaint without cost.

The brief fact of the case was that the Appellant/Complainant’s husband was a driver who had his life insured by the policy sponsored by the Respondent/OP Insurance Company with coverage of Rs. 3,00,000/- and having validity for a period on and from 01.03.2012 to 28.02.2015. The said husband of the Appellant/Complainant had met with an accident during the period of validity of the policy while driving his car which he had purchased taking loan from the Cholamondalam Investment and Finance Limited. He died in the said accident leaving behind his wife as his legal heir. The incident was diarized at Samserganj Police Station and a police case was initiated under No.260/2012 dated 15.11.2012.

The Appellant/Complainant then filed the claim of Rs. 3,00,000/-, being the coverage for life in terms of the subject policy that her deceased husband had during his lifetime with the Respondent/OP Insurance Company.

The Respondent/OP Insurance Company, however, did not sanction the claim in spite of repeated persuasion made physically and through formal communications and legal notice by the Appellant/Complainant. Ultimately, the Respondent/OP Insurance Company repudiated the claim on the ground that the husband of the Appellant/Complainant who was driving the vehicle at the time of the accident was not having a valid driving licence. Subsequently, it was revealed that the Respondents/OPs settled the claim and paid the claimed amount of Rs. 3,00,000/- with the Cholamondalam Investment and Finance Limited, the financier of the loan, without giving any intimation of their such action to the Appellant/Complainant.

The Appellant/Complainant observed in the above activities of the Respondents/OPs a serious deficiency in rendering services and resorting to unlawful trade practices as well and accordingly, filed before the Ld. District Forum the Complaint Case which was disposed of by the Ld. District Forum through the impugned dismissal order.

Heard Ld. Advocates appearing on behalf of both sides. The Ld. Advocate appearing on behalf of the Appellant/Complainant submitted that the decision of the instant issue depended upon the sole point as to whether the accidental benefit in respect of the policy insuring life should go to the financier or legal heirs of the deceased.

Referring to the impugned judgment and order at running page 10, para 2, the Ld. Advocate submitted that question of valid licence of the driver running the vehicle should not arise on the instant issue as the claim did not relate to the reimbursement of the cost needed for repairing the damage of the vehicle caused due to the impact of the accident. As he continued, since the issue was related to the accidental benefit, the legal heir of the deceased only was entitled to get the payment of compensation and none else.

The Ld. Advocate drew the notice of the Bench further to para 8 of the judgment at running page 10 to mention that the Respondent/OP, with a view to depriving the Appellant/Complainant of his genuine claim communicated negating the proposed reimbursement and at the same time sanctioned the entire amount of Rs. 3,00,000/- as reimbursement and paid the said amount to its sisterly organization, the Cholamondalam Investment and Finance corporation Limited on 21.12.2013 through cheque No. 449911 dated 23.12.2013.

As he continued, the payment claimed to have been made to the financier, left reason for suspicion in want of corroborative documentary evidence. As he went on, payment, if at all made, was made clandestinely beyond the knowledge of the Appellant/Complainant who was officially communicated about the repudiation of the claim on the ground that the driver was driving the vehicle without valid driving licence. This, as submitted, was a clear instance of unlawful trade practice resorted to by the Respondent/OP Insurance Company.

The Ld. Advocate, with his submission as above, prayed for the Appeal to be allowed setting aside the impugned judgment and order.

The Ld. Advocate appearing on behalf of the Respondent/OP, in his very short submission, pleaded his inability to pay the insurance claim in view of the fact that the claim was already paid to the financier earlier in terms of the policy condition.

Perused the papers on record and considered submissions of the Ld. Advocates appearing on behalf of both sides. It was an admitted fact that the accident had taken place and the husband of the Appellant/Complainant died in the accident within the period of validity of the policy assuring life of the said husband to the extent of Rs.3,00,000/-.

It was also an admitted fact that the Respondents/OPs received the claim from the legal heir wife of the deceased but refused to accord approval to the claim on the ground that the deceased who was driving the vehicle at the relevant point of time, was not having any valid driving licence.

What appears peculiar to us, the Respondents/OPs made formal communication conveying repudiation of the claim to the Appellant/Complainant on the ground mentioned above but, subsequently acknowledged the fact of payment of the insured amount to the financier of the loan advanced to the husband of the Appellant/Complainant, since deceased. The transaction appeared to have been made keeping the Appellant/Complainant in the dark. This meant that the claim did not have any demerit for being repudiated.

The Respondents/OPs claimed that the payment of the insurance amount was made to the Appellant/Complainant on the strength of the policy terms. The record, however, revealed no such policy term.

The practice that the Respondents/OPs adopted, as evolved from the above decision, was not transparent from any point of view as this way they (i) deprived the Appellant/Complainant her legitimate claim and (ii) they, in all likelihood, intended to suppress the fact of transaction to the Appellant/Complainant with a view to keeping her indebted to the Respondent/OP Insurance Company in respect of the loan that her deceased husband had taken for the purchase of the vehicle even in spite of the fact that the entire Insurance amount was paid to the Financier by the Insurance Company.

It did not need any more elaboration to make it clear that the claimed amount being related to the personal accident, the legal heir, that is, the Appellant/Complainant, being the wife of the deceased herein, was entitled to get it and none else. The Appellant/Complainant had made an effort to adjust the amount against the loan as it normally happens in case of reimbursement of the cost needed for repairing the accidental damage of the vehicle and that too keeping the Appellant/Complainant in the dark about the transaction.

We are afraid, we are not in agreement with the impugned judgment and order and intend to set aside the same under the facts and circumstances narrated above allowing the Appeal.

Hence,

Ordered

that the Appeal be and same stands allowed in part. The Respondents/OPs are hereby directed to pay Rs. 3,00,000/- to the Appellant/Complainant along with a compensation of Rs. 25,000/- within 45 days from the date of the impugned judgment and order, failing which simple interest @ 9% p.a. shall accrue to Rs. 3,25,000/-, being the total payable amount from the date of default till the entire amount is fully realized. The impugned judgment and order stands set aside.