Orissa

Cuttak

CC/140/2014

Sumitra Sahoo - Complainant(s)

Versus

Branch Manager,Sahara India Pariwar - Opp.Party(s)

R K Pattanaik

20 Dec 2017

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

C.C No.140/2014

Sumitra Sahoo,

W/O:Late Prakash Chandra Sahoo,

At:Sreehari Bhawan,Agriculture Colony,

Nayabazar,Dist:Cuttack.                                                            … Complainant.

 

                                Vrs.

 

 

1. Branch Manager,Sahara India Pariwar,Choudhury Bazar,Infront of Dargha Bazar P.S,

Near Big Bazar,Cuttack.

 

2. The Zonal Manager,Sahara India Pariwar,

Rasulgarh,Bhubaneswar,

Dist:Khurda.

 

3. The Sr. Divisional Manager,

National Insurance Company Ltd.,

Having its Divisional Office

No.4,43 Jeevan Bhawan,Hazrat Ganj.

Lucknow-226001.                                                                  … Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Sri Bichitra Nanda Tripathy, Member.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:   24.09.2014

Date of Order: 20.12.2017.

 

For the complainant:               Sri R.K.Pattnaik,Adv. & Associates.

For the O.P No.1 & 2 :             Mr. S.Nanda,Advocate & Associates.

For the O.P. No.3   :                  Mr. B.N.Udgata,Adv. & Associates.

 

 

Sri Bichitra Nanda Tripathy,Member.

                The case is against deficiency in service on the part of O.Ps.

1. In nutshell, the case is that the husband of the complainant Late Prakash Chandra Sahoo had invested money with Sahara India under Sahara Swarna Yojna and Sahara Rajat Yojna vide A/c No.13522004704, 13529203033, 13522508175, 13523402342, 13522909933 for Rs.14,700/-, Rs.9087/-,Rs.12,400/-,Rs.6,800/- & Rs.6,600/- respectively at Choudhury Bazar Branch of Sahara India.   Smt. Sumitra Sahoo,W/O Prakash Chandra Sahoo was the nominee in all such deposits accounts. The deposits were made up to June,2011 and Prakash Chandra Sahoo died in a road accident. (The details of deposit amount and name of nominee is vide Anenxure-1).  Smt. Sumitra Sahoo,(complainant )being the nominee applied to O.P No.1 for settlement of death claim against all such Accounts and also for closure of such deposit accounts as per terms & conditions sl. no. 17 & 18 of such deposits.  As per the said terms and conditions in case death of a depositor occurs after 12 months of the scheme an amount equivalent to 5%of the advanced amount would be payable to the nominee in each month for 82 months and the deceased coupon holder shall also be entitled for insurance, compensation to be paid to the nominee to the tune of Rs.3,00,000/- and Rs.1,00,000/- respectively.(Annexure-2).  The complainant intimated the O.P on 14.07.2011, on 24.08.2011, on 24.10.2011 & on 25.10.2011 to release the death benefits but the O.Ps remained silent over the matter.(Annexure-3 series).   The complainant came to know on 20.4.2013 that the insurance company has rejected the accidental insurance claim on the ground that the death information was furnished to the insurance company late.(Annexure-4 series).  The rejection of such claim was already conveyed to O.P No.1 on 12.09.2011(Annexure-5).  The complainant vide her letter dt.22.04.2017 intimated O.P No.1 that she was no way responsible for such rejection of insurance claim and also requested O.P No.1 to settle the claim at the earliest( Annexure-6).  Finding no other way, the complainant has taken shelter under this Forum.  She has prayed to direct the O.Ps to pay the total claim as indicated in the claim form amounting to Rs.4,00,000/-, interest as applicable @ 9% per annum from the date of claim till final payment, compensation for mental agony Rs.50,000/- and cost of litigation Rs.10,000/-.
2. O.P. No.1 & 2 vide their written version dt.12.02.2015 have intimated that Sri Prakash Ch. Sahoo had advanced Rs.9087/- under silver year Labh Yojana sceme vide A/c Control No.13529203033 on 24.11.2003 at Branch office at Choudhury Bazxar.  The facility of accidental death benefit as mentioned under terms and conditions of Silver Year Labh Yojana scheme, provided by the O.Ps 1 & 2 is a free of change service and is an additional benefit.  As such the booking holder Late Prakash Ch. Sahoo and his nominee Smt. Sumitra Sahoo,( the complainants) are not consumer of the company in respect of this facility.  The O.Ps had taken special contingency policy with National Insurance Company Ltd. to provide insurance coverage to its employees, Agents, Associates, Journalist, Sarnchar Sathis and regular depositors/investors, advance booking holders subject to the terms and conditions of insurance policy.  The policy was taken by the O.Ps on payment of premium at their own cost without charging any premium or any part thereof from the insured booking holders.  It was a 3^rd party insurance contract and the O.Ps(1 & 2) are not liable for entertaining the claim of the complainant.  The role of O.P No.1 & 2 is simply that of facilitator and to forward the claim to insurance company i.e. O.P No.3.  The beneficiary can claim directly from O.P No.3 on happening of certain events.  (Policy vide Annexure-2).  The Group Insurance Policy was granted by O.P No.3 under which the Personal Accident claim of advance booking holder was covered.  Thus O.Ps (1 & 2) are not the service provider, nor has any say in decision making on payability of accidental death help.  The claim of the beneficiary has been rejected by the O.P No.3 vide letter dt.12.09.2011 (Annexure-3).  As such the dispute is between the complainant and O.P No.3 but the complainant  has wrongly impleaded O.P No.1 & 2 in the present complaint.  The claim of the complainant was lodged within time and she was asked to furnish all the relevant documents within stipulated time to the office of Insurance Company i.e. O.P No.3 but the complainant did not furnish the above documents within stipulated period for which the claim of the complainant was repudiated due to non-submission of such documents.
3. O.P No.3 vide their written version dt.03.02.2017 has intimated that the complainant or her husband (deceased) has not taken insurance policy from O.P No.3.  GPA/SCP Policy was sold by O.P No.3 to Sahara India to cover their investors and employees etc. for personal accidental benefits.  O.P No.3 has never made any agreement with the complainant or with her husband and as such no liability is attached if any against the O.P No.3 Insurance Company Sahara India might have entered into any agreement with its investors but the same do not form a part and parcel of any policy of O.P No.3.  Due to delay in submission of claim with O.P No.3 the same was rejected.  The case of the complainant as has been filed is also barred by limitation under the policy if any as well as under the consumer Protection Act as the claim has been repudiated since 12.09.2011 and as such the case as filed against O.P No.3 is liable to be dismissed.  Moreover, neither the complainant nor the Sahara India has produced any policy showing the contract between the complainant or her husband with the O.P No.3 to attract the liability of the O.P No.3.  Rather as per Annexure-1 & 2 the Sahara India/O.P No.1 &2 have agreed to pay the complainant as per the terms and conditions of the said floated scheme.
4. We have gone through the case records in details and heard the advocates from all sides at length.  We have observed that the husband of the complainant Sri Prakash Ch. Sahoo had deposited a sum of Rs.9087/- with O.P No.1 on 14.11.2003 vide receipt No.38366097158 and vide control No.13529203033.  He met with a road accident and passed away on 23.06.2011.  As per terms of policy  a sum of Rs.2,00,000/- is payable as  accidental death benefit to the nominee of the deceased coupon holder if accidental death occurs after 4 years and up to 10 years of making the policy.  Since the death of Late Prakash Ch. Sahoo had occurred after 7 years of making the policy, his nominee is entitled to receive insurance compensation worth Rs.2,00,000/-.  From the letter of the complainant it is clear that the death intimation was given to O.P No.1 on 14.07.2011 which the O.Ps(1 & 2) have admitted.  The complainant had also submitted copy of FIR, copy of death certificate, legal heir certificate etc. to O.P No.1 vide her letter send on 24.8.2011.  Vide letter dt.03.10.2011 the Zone office of Sahara India,Bhubaneswar has intimated Regional office, Cuttack that the death of esteemed depositor Late Prakash Ch. Sahoo incurred on 23.06.2011 was not furnished to the Insurance Cell earlier.  However, following the letter received from their end, the information was furnished from zone office to insurance cell on 05.09.2011.  But the concerned department has furnished the information to concerned insurance company as per information received from other sources on 03.09.2011.  But as the information was received late, the concerned insurance company has cancelled the claim.(Annexure-4  page-22as submitted by the complainant ).  Vide letter dt.21.10.2011, the Zone office of Sahara India,Bhubaneswar has intimated Regional office, Cuttack to appraise why the death of the esteemed depositor Sri Prakash Chandra Sahoo/13529203033 was not furnished through proper channel to C.O,Lucknow in time(Annexure-4,page-23 as submitted by complainant .  The claim of Late Prakash Chandra Sahoo was repudiated by O.P No.3 on 12.09.2011 since the information relating to the death of late Sahoo was furnished after due date. (Annexure-5,page-24 as submitted by the complainant. [Vide letter dt.19.01.2012 the Zone office, Bhubaneswar has requested to Region office, Cuttack to furnish the requisite comment on the matter.  (Annexure-5 page-25 as submitted by the complainant.    Vide letter dt.30.11.2012 O.P No.1 has intimated Region Office, Cuttack that they have received the documents for death maturity advice in the end of July,2011 and documents were forwarded on courier dt.09.08,.2011 for death maturity advice.  But regarding the death help and accidental claim they received some documents through post on 25.08.2011(FIR report, Death certificate, Legal heir certificate and Paper cutting of accident) and on 17.09.2011(Post mortem report and inquest report) and nominee application on 24.10.2011 and such documents were submitted on courier on 24.11.2011 for death claim and accidental claim advice issue.(Annexure-5 page-26 as submitted by complainant).  The O.Ps have not said anything regarding such annexure 4 & 5 as submitted by the complainant nor raised any objection whereas such letters were issued by the office of the O.Ps only.  Thus it is clear that O.P No.3 has rejected the claim since the death information was not furnished in time by O.Ps 1 & 2. (Annexure-4,page-22 & 23 as submitted by the complainant).  It is also observed from letter dt.30.11.2012(Annexure-5,page26) of O.P No.1 that excluding nominee application all other documents were supplied to O.P No.1 by the complainant on 17.09.2011.  Since the death of the depositor Prakash Ch. Sahoo was occurred on 23.06.2011, and the deposit value was already paid to the nominee of the coupon holder Late Prakash Ch. Sahoo , on 24.10.2011 basing on the documents supplied earlier we conclude that nominee certificate was already obtained from the complainant prior to 24.10.2011.  The O.P No.1 has also failed to prove that they have asked the complainant to produce some more documents required (if any) rather the complainant had requested the O.P NO.1 to settle her claim vide her several letters.  Such documents were also submitted to O.P No.1 within 90 days of the death.  But the claim, was repudiated by O.P No.3 after 80 days.  Hence O.P No.1 is responsible for not furnishing the death information to concern insurance company in time.   As per the terms of agreement made with the complainant by O.P No.1 & 2 regarding the said Rajat Yojna Policy, written notice regarding the accidental death is to be given within 30 days from the date of death and all other related documents were supposed to be submitted within 90 days.  The death incurred on 23.06.2011 and the claim was repudiated by O.P Insurance Company on 12.09.2011 i.e. after 80 days.  The complainant had not made any agreement with O.P No.3 and it is O.P No.1 & 2 who made the agreement with O.P No.3.   Therefore, the terms and conditions of O.P No.3 were known to O.P No.1 & 2 and not to the complainant. Hence O.P No.1 & 2 are responsible for repudiation of the claim by O.P No.3.  The O.Ps 1 & 2 had made a contact with the husband of the complainant while depositing the money that the benefits such as buying product/booking a house/commercial unit of the O.Ps will be available for the coupon holder.  Apart from such benefits the nominee(s) of the coupon holder were also entitled for death help and accidental death benefits.  The accidental benefits payable under the present case is Rs.2,00,000/- since the death of the depositor was occurred after 7 years of depositing the money.  The complainant has not produced any other receipts relating to any other deposits made by her deceased husband other than control No.13529203033 dt.24.11.2013 which was for Rs.9087/-.  Sahara India Parivar had made a contact with O.P No.3 for such accidental death insurance wherein the coupon holder was not a party.  As per the agreement made between the coupon holder and Sahara India, O.Ps 1 & 2 are to release the Accidental insurance benefit to the nominee of the coupon holder i.e. complainant.  It has been decided by Hon’ble High Court of Orissa vide W.P© No.27646 of 2013 on 16.10.2014 that “Investment in the particular scheme is by way of contract in between the coupon holder and opposite party, therefore, the present petitioners are bound by the terms of the said contract and it cannot avoid for payment under any circumstances.  However, it is open for the petitioner to get the paid amount reimbursed from the insurance company by making a proper application.”

ORDER

Basing on the facts and circumstances as stated above O.P No.1 & 2 shall pay the complainant a sum of Rs.2,00,000/- along with interest @ 9% w.e.f 17.09.2011 (from the date of submission of documents as per Annexure-5,page-26 of the complainant/as per letter dt.30.11.2012 of O.P No.1) till date of final payment.  O.P No.1 & 2 will also pay a sum of Rs.10,000/- towards cost of litigation to the complainant.  All above noted payments shall be made to the complainant within a period of 45 days of receipt of this order, failing which the complainant is at liberty to take shelter of this Hon’ble Forum as per C.P.Act,1986.

Typed to dictation, corrected and pronounced by the Hon’ble Member in the Open Court on this the 20^th day of December,2017 under the seal and signature of this Forum.

 

   (Sri B.N.Tripathy )

                                                                                                            Member.

                                                                                                                                  

                                                                                                     (  Sri D.C.Barik )

                                                                                                          President.

                                                                                                     (Smt. Sarmistha Nath) 

                                                                                            Member(W).