Date of Filing: 01.03.2017 Date of Final Order: 08.12.2017
Sri Debangshu Bhattacharjee, Member
The brief facts of the complaint are that the complainant filed a complaint u/s 12 of the Consumer Protection Act, 1986 against the opposite party, on the allegations that the complainant took insurance policy from the opposite party “Reliance life Insurance Company Ltd.” at Dinhata, Cooch Behar, vide policy No.52477923 and Client ID-4106976 and 94107056 against the sum assured of Rs.2 lakhs dated 18/01/2016. The father of the complainant also included in the above policy as beneficiery. The complainant had been regularly paying the installments to the opposite party towards the premium of the insurance policy to the tune of Rs.14,492.26/-. On 01/06/2016, the father of the complainant, Kumar Swapan Naryan done an operation of “prostate Gland (TURB)”. The complainant submitted the insurance claim dated 20/06/2016 along with requisite documents to the opposite party after maintaining all formalities as per requirement of the O.P. After that, the complainant visited the office of the opposite party in several times. The opposite party said to the complainant that the claim is under process. After few months the complainant received a telephone call from the Kolkata office of the opposite party to renew his policy. That time the complainant came to know that the Kolkata office of the opposite party had not yet received any claim document of the complainant from their Dinhata office. Despite passage of 8 months, not even a single penny has been paid to the claimant by the opposite party nor do they repudiate the claim. On 10/02/2017 a request was registered by the complainant in the office of the Assistant Director of CA & FBP, Cooch Behar, for mediation but all efforts were in vain.
Finding no other alternative the complaint submits the complaint petition before this forum and prayed that the opposite party be directed to pay Rs.59,515/- to the complainants and Rs.40.000/- as compensation for mental harassment along with litigation cost.
Notice of the complaint was served upon the opposite party who filed written reply and contested the complaint of the complainant. The O.P stated that the complaint has been filed on false and malicious grounds and it is only an abuse of process of law. The complaint filed by the complainant does not fall within the definition of consumer dispute under the Act. There was neither any unfair trade practice nor deficiency in service on the part of the opposite party. The O.P in their written version stated that the claim of the complainant in question falls within the two year waiting period in the policy terms and conditions (5.4) and privileges within referred to the policy document and the same was communicated to the complainant vide letter dated 27/02/2017 . The O.P prayed for dismissal of the case
Both the complainant and the OP participate in the hearing of argument. The Ld. Agent for the OP has not filed the evidence on affidavit and written argument and prays for treating their written version as evidence and written argument.
On the basis of above versions of both parties, the following points are framed for proper adjudication of the case.
POINTS FOR CONSIDERATION
- Is the Complainant Consumer as per provision under Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Has the O.P any deficiency in service, as alleged by the Complainant?
- Whether the Complainant is entitled to get any relief/reliefs, as prayed for?
DECISION WITH REASONS
Point Nos.1.
The Ld. Agent for the Complainant submits that Complainant is a consumer under the OP as defined under Section 2(1) (d) (ii) of the C.P. Act, 1986 as the Complainant deposited a sum of Rs.14492.26/- as a premium of his insurance policy to the O.P. The O.P issued policy document in the name of the complainant. On perusal of the complaint petition, w/v, documents, evidence and on a careful consideration over the submission of both sides, this Forum is of the opinion that the Complainant is a consumer under the OP in the light of provision under Section 2(1) (d)(ii) of the C.P. Act, 1986.
Point Nos.2.
The Ld. Agent for the Complainant submits that this Forum has ample jurisdiction to entertain the complaint as the address of the OP is within the territorial jurisdiction of this Forum and cause of action also arose within territorial jurisdiction of this forum and the claimed amount is also within the pecuniary limit of the District Forum. On a careful consideration, we are of the view that this Forum has both pecuniary and territorial jurisdiction to entertain the complaint.
Point Nos.3 & 4.
Both the points are taken up together for the sake of convenience and to avoid repetition.
The O.P pleaded that they rejected the claim of the complainant according to the policy agreement (Annexure-12) clause-5 serial no.5.4 wherein it is clearly stated that two year waiting period is applicable for the treatment of BPH and underwent for TURP. But Rejection of claims on purely procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. The insurers must not repudiate such claims unless and until the reasons of delay of repudiation are specifically ascertained, recorded. In this case the O.P never informed the matter to the complaint before filing the case. According to the O.P the same was communicated to the complainant vide letter dated 27/02/2017. But no evidence of delivery or receiving such letter is produced by the O.P.
In this case the complainant submitted the insurance claim dated 20/06/2016 along with requisite documents to the opposite party after maintaining all formalities described by the O.P and after that the complainant visited the office of the opposite party in several times. It is urged that the opposite party said to the complainant that the claim is under process and they already send the document of the complainant for settlement. After few months the complainant received a telephone call from the Kolkata office of the opposite party to renew his policy. That time the complainant came to know that the Kolkata office of the opposite party yet not received any claim document of the complainant from their Dinhata office. Despite passage of 8 months, not even a single penny has been paid to the claimant by the opposite party. On 10/02/2017 a complainant was registered by the complainant in the office of the Assistant Director of CA & FBP, Cooch Behar for mediation. The Assistant Director of CA & FBP, Cooch Behar issued letter (161/COB/CA & FBP Dated 15/02/2017) to the O.P to attend the meeting on 23/02/2017 at 01 P.M. In the note sheet (Complaint index No.1083/98/CICC/16-17) it is clearly mentioned that “the opposite party called over telephone at 13:20hrs Smt. Rituparna Chakraborty, official of O.P informed that they cannot appear for mediation due to shortage of stuff. She also informed that the said claim was saint again to claim office, Kolkata in the month of January 2017. Previously it was returned back by postal department due to wrong PIN. It may take time to settle the case” (Annexure 1-12 of the complainant).
Be that as it may, on foregoing discussion, circumstances to the case, together with the attitude and thoughts of the parties in litigation we have reason to believe that there is deficiency in service of the O.P and he is liable to compensate for this.
As it has already been proved that the O.P has deficiency in service, the Complainant is entitled to get relief with compensation.
Thus, both the points are decided in favour of the Complainant.
In the result the complainant case is succeeds in part.
Hence,
It is Ordered,
That the present Case No. CC/30/2017 be and the same is allowed on contest against the O.P in part with cost of Rs.5,000/-.
The O.P. hereby directed to pay compensation of Rs.20,000/- to the Complainant by 45 days, failing which he will pay Rs.50/- to the Consumer legal aid account for each day’s delay.
Let plain copy of this Order be supplied to the parties concerned by hand/by Post forthwith, free of cost for information & necessary action. The copy of the Final Order will also be available in the following Website:
confonet.nic.in.
Dictated and corrected by me.
