C.F. CASE No. : CC/09/76
COMPLAINANT : Sulata Das
W/o Bhakta Kumar Das
Vill. Dhubulia, (Baghajatin Colony)
P.O. & P.S. Dhubulia, Dist. Nadia
OPPOSITE PARTIES/OPS: 1. Divisional Manager,
National Insurance Co. Ltd.
Div. III, 8 No. India Exchange Place,
Kolkata – 700 001.
: 2. Branch Manager,
Golden Multi Services Club of G.T.F.S.
Ranaghat Branch,
Near Ranaghat Station Road,
Dist. Nadia
PRESENT : KANAILAL CHAKRABORTY PRESIDENT
: KUMAR MUKHOPADHYAY MEMBER
: SMT SHIBANI BHATTACHARYA MEMBER
DATE OF DELIVERY
OF JUDGMENT : 10th March, 2010
: J U D G M E N T :
In brief, the case of the complainant is that her son Late Sanjoy Das purchased a Janata Personal Accident insurance policy from the OP, National Insurance Co. Ltd. on 08.06.01 and the sum assured was Rs. 1,00,000/- and the said policy is valid upto 07.06.2016. It was purchased through GTFS, Ranaghat Branch. On 19.11.03 the policy holder, Sanjoy Das died in an accident regarding which Kaliganj P.S. case No. 187/2003, dtd. 19.11.2003 was started U/S 279/304(A) I.P.C. After his death, the complainant being the nominee of the policy submitted claim application before GTFS along with the original documents such as (1) Insurance Certificate, (2) Death Certificate, (3) F.I.R., (4) Final Report and (5) Post Mortem Report. The GTFS sent a letter to her on 17.03.05 intimating to produce the original death certificate to the OP Insurance Co. and also the original final report. Thereafter, she submitted both those documents to the GTFS and National Insurance Co. Ltd. She requested the OP No. 1 & 2 to settle her claim time and again, but to no effect. On 18.05.05 the National Insurance Co. Ltd. sent a letter to her stating that as she informed the OP regarding the death of her son after 3 months 25 days of that accident, so she violated the policy condition and hence her claim was decided as “no claim”. She met the OP Insurance Co. time and again, but to no effect. On 30.12.08 she submitted an application before the OP No. 1 to get the claim amount at which the OP Insurance Co. sent a letter on 31.03.09 asking her to submit copy of voter identity card, copy of employees, salary certificate / income certificate and D/L of the deceased. On 28.04.09 she submitted all the documents to the OP Insurance Co. Again on 15.06.09 the OP Insurance Co. by a letter asked her to submit some documents which were already submitted earlier. So having no other alternative she has filed this case praying for the reliefs as stated in the petition of complaint.
OP National Insurance Co. Ltd. has contested this case, inter alia, stating that the case is not maintainable in its present form and nature. It is also barred by limitation as on 18.05.05 this OP intimated the complainant that her claim was “no claim”. As the case is not filed within a period of two years since that date, so the case is barred by limitation. The claim application was not filed within the statutory period as per policy condition. So this complainant has no cause of action to file this case and the same is liable to be dismissed against him.
The OP, GTFS has filed a separate written version, inter alia, stating that one Sanjoy Das purchased a Janata Personal Accident insurance policy from the OP No. 1 through him on 08.06.01 and the insured amount was of Rs. 1,00,000/- in which the present complainant was the nominee. He has also stated that Sanjoy Das expired in a road accident and thereafter, the complainant filed a claim application along with the required documents to him which he forwarded to the OP Insurance Co. But OP No.1 by a letter dtd. 18.05.05 intimated that as the claim application was received after due time, so it was not considered by him which is not a valid ground. Besides this, it is his submission also that as per MOU between this OP and OP No. 1 the claim of the complainant is to be settled by the OP Insurance Co. and GTFS has no liability in this matter. So the complainant has no cause of action to make him a party in this case and hence, it is liable to be dismissed against him.
POINTS FOR DECISION
Point No.1: Has the complainant any cause of action to file this case?
Point No.2: Is the complaint barred by limitation?
Point No.3: Is the complainant entitled to get the reliefs as prayed for?
DECISION WITH REASONS
All the points are taken up together for discussion as they are interrelated and for the sake of convenience.
On a careful perusal of the petition of complaint along with annexed documents and the written versions filed by the OPs and also after hearing the arguments advanced by the ld. lawyers for the parties it is available on record that Late Sanjoy Das purchased one Janata Personal Accident insurance policy from the OP No. 1 on 08.06.01 with a sum insured of Rs. 1,00,000/- and the policy is valid upto 07.06.16. The complainant, Sulata Das is the nominee of that policy also vide 'Annexure – 1’. 'Annexure – 2’ is the copy of FIR which shows that on 19.06.03 an accident was held at Kaliganj and in that accident one Sanjoy Das was injured and expired. Regarding this accident Kaliganj P.S. case No. 187/2003, dtd. 19.11.2003 was started against the driver of the offending bus U/S 279/304(A) I.P.C. 'Annexure – 3’ is the post mortem report and 'Annexure – 4’ is the copy of final report which speaks that charge-sheet is submitted by the I.O. against the driver one Nilmoni Halder U/S 279/304(A) I.P.C in this case. In this accident, policy holder, Sanjoy Das expired. There is no denial on the side of the OP Insurance Co. regarding this accidental death of the policy holder Sanjoy Das. The only point agitated by the ld. lawyer of the OP Insurance Co. at the time of argument is that the case is barred by limitation as the cause of action of arose on 18.05.05, but the case was filed on 15.09.09. Admittedly the OP Insurance Co. sent a letter to the OP on 18.05.05 intimating that as she intimated about the accident after 3 months 25 days from the date of accident, so it attracted violation of condition mentioned above and they closed her claim as “no claim”. But from 'Annexure – 4’ it is available that on 30.12.08 the complainant again filed an application before the OP Insurance Co. to consider her case. From 'Annexure – 14’ it is available that on 31.03.09 the OP Insurance Co. sent a letter to the complainant intimating to send some documents for further action towards processing of the claim in question and the documents were viz., (1) attested copy of the ration card, voter identity card of the deceased (2) final police report (3) post mortem report, (4) copy of Bank pass book of the nominee, (5) salary certificate / income certificate, (6) local panchayat certificate regarding status of the nominee, (7) original JPA Certificate and (8) D/L of the deceased person. In this letter it is also stated that intimation was given to this OP after 3 months 25 days and no reasonable explanation was provided to them for delay. So she was asked to clarify the same. From 'Annexure – 15’ it is available that the complainant submitted all the documents mentioning in 'Annexure – 14’ to the OP National Insurance Co. Ltd. through GTFS and the OP duly received those documents on 28.04.09. Regarding late information she has stated in this letter that on 19.01.09 she intimated about this accident to GTFS through her lawyer. She has also stated that she was mentally imbalanced due to sudden death of her only son. For which she could not submit the claim application in due time. 'Annexure – 16’ says that the OP Insurance Co. again sent a letter to this complainant on 05.06.09 asking to submit all those previous documents. So considering the 'Annexure – 14, 15 & 16’ we find that as per prayer of the complainant the case was reopened by the OP Insurance Co. for further consideration, but ultimately nothing was intimated to the complainant whether it was at all considered by the OP Insurance Co. or not.
Therefore, in view of the above discussion it is our considered view that the case is not at all barred by limitation as after 31.03.09 the case was filed on 15.09.09. Besides this, the cause of delay is explained by the complainant in her letter which we hold as quite satisfactory. It is decided by the Hon’ble High Court, Calcutta in a case as reported in 2005 (3) CHN page 154 where the Hon’ble Court decided “Respondent should have been appreciated the fact that a reasonable time is necessary to overcome such an abnormal situation happening in the family and therefore the aforesaid alleged unintentional delay which was again beyond the control of the claimant should not be regarded as a valid ground for receiving and or denying the claim of the complainant in connection with the condition of insurance policy requiring intimation of accident within one calendar month is directory and not mandatory.”
As per MOU between the OP No. 1 & 2 we find that the OP No. 1 is liable to settle the claim of the complainant, but he has not settled her claim till to date. So we have no hesitation to hold that it is a gross deficiency in service on the part of the OP Insurance Co. As the complainant has become able to prove her case, so she is entitled to get the reliefs as prayed for. In result the case succeeds.
Hence,
Ordered,
That the case, CC/09/76 be and the same is decreed on contest against the OPs. Complainant do also gets a decree of Rs. 1,00,000/- + Rs. 5,000/- for deficiency in service and harassment caused to her by the OP No. 1 + litigation cost of Rs. 2,000/-. The OP No. 1 is directed to pay the decretal amount of Rs. 1,07,000/- to the complainant within a period of one month since the date of passing this judgment, in default, the decretal amount will accrue interest @ 9% per annum since this date till the date of realization of the full amount.
Let a copy of this judgment be delivered to the parties free of cost.
