: FINAL ORDER :
DATE OF FILING: 27.08.2015
ORDER No. 37
DATE. 25.09.2017
Shri Asoke Kumar Das – President
Complainant’s case in short is that Kalyan Sarkar husband of the complainant died in a road traffic accident on 06.12.2013. During lifetime he purchased one SBI General’s Personal Accident Insurance master policy No. 137300-0000-00 which was valid from 26.02.2013 to 25.02.2014, sum assured was Rs. 4,00,000/- selecting his wife, the petitioner as her nominee. The complainant submitted her insurance claim but the OPs Insurance Company paid no heed to her claim till date. Hence, this case. Complainant has prayed for payment of Rs. 4,00,000/- with interest.
Only OP No. 1, i.e., Branch Manager, SBI General Insurance, Santipur Branch has contested this case by filing a written version denying and disputing, inter alia, the claim and contention of the complainant with prayer for dismissal of the case with cost.
The specific stand of the OP is that the case is premature one and that the complainant has failed to provide two documents namely copy of indoor case papers of hospitalization and final police report with proper attestation and for this they could not consider the claim application of the complainant and that there is no deficiency in service from their part as alleged.
POINTS FOR CONSIDERATION
- Is the case maintainable?
- Is the complainant a consumer?
- Are the OPs liable for deficiency in service and/or unfair trade practice as alleged?
- Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
All points are taken up together for consideration and decision.
Now, after due consideration of all the materials on record i.e., the petition of complaint, the written version, documents filed by parties, the written notes of argument and oral argument advanced by the Ld. Lawyers of the both sides, we find that the complainant has not filed either original policy or the copy of the policy. We now find that the OP Insurance Company gave a letter to Kalyan Sarkar, husband of the complainant on 11.12.13 intimating the details of his policy and that is verified with the original with signature of the Branch Manager, SBI Santipur Branch. Now from this letter dtd. 11.12.13, we find that the name of the insured is Kalyan Sarkar and his master policy number is 137300-0000-00, the sum assured was Rs. 4,00,000/- and the policy was valid from 26.02.2013 to 25.02.2014. Now from the copy of Death Certificate issued by Kolkata Municipal Corporation, we find that Kalyan Sarkar, S/o Kumud Sarkar died on 06.12.13 at NRS Medical College and Hospital, Kolkata. Therefore, it is clear that the insured Kalyan Sarkar died when the policy was valid. It appears further in the column of nominee relationship, ‘spouse’ is written. It means that the complainant, Sutapa Sarkar, widow wife of Kalyan Sarkar is the nominee of the policy and as such she has filed this case as nominee of her deceased husband Kalyan Sarkar as well as beneficiary. Now it appears from the documents filed by the complainant that the complainant had submitted all relevant papers to the Branch Manager, SBI General Insurance, Santipur Branch, Nadia along with her request letter for accidental claim on 09.12.2014. Furthermore, she has filed copies of her letter dtd. 09.12.2014 and copies of all other documents along with the petition of complaint at the time of filing of this case and those documents were received by the OPs along with the notice. In spite of that the OP took no step to settle the claim of the complainant, the widow wife of the insurer Late Kalyan Sarkar and due to such inaction of the OP to settle her claim the complainant, the widow wife of the insured since deceased was compelled to file this case.
In our considered opinion such inaction on the part of OP Insurance Company to settle the claim of the complainant certainly comes within the purview of deficiency in service. We find and hold further that the case is maintainable and the complainant is a consumer, the OPs are liable for deficiency in service as alleged by the complainant and the complainant is entitled to get the reliefs as specified below. All points are disposed off. In the result the case succeeds.
Hence it is,
Ordered,
That the case/application is allowed on contest against the OP No. 1 and ex parte against OP No. 2 with litigation cost of Rs. 2,000/-. The OPs are hereby directed to pay the entire sum assured Rs. 4,00,000/- and the aforesaid litigation cost of Rs. 2,000/- to the complainant, Sutapa Sarkar within 30 days from the date hereof failing which the entire amount will carry interest @7% p.a. till realization and the complainant shall be at liberty to realize the same in accordance with the provision of Consumer Protection Act, 1986.
Let plain copy of this final order be supplied to the parties / their Ld. Advocates / agents forthwith free of cost or send by ordinary post.
