JUDGEMENT
This is an application U/s 12 of the C.P. Act, 1986.
The complainant’s short case in hand is that the complainant’s husband (since deceased) made a policy (Policy No.100300/47/01/9600022/01/96/30097) with the O.P.s which was valid from 23.6.2002 to 22.6.2012 under Group Janata Personal Accident Insurance Policy issued by the O.P. No.1 in favour of the O.P. No.2 and in that policy the complainant was the nominee.
Due to the ill luck of the complainant the insured (Naba Kumar Ghosh) was expired in a train accident on 6.3.2006 at about 22.45 hrs. An unnatural death case bearing No.36/2006 dated 6.3.2006 was lodged before the Burdwan GRP. The post mortem was done in Burdwan Medical College & Hospital on 7.6.2006. Being an ill fated widow of a pre-matured deceased husband the complainant became totally upset. More over at the time of accident the victim was 35 years old. At that time the complainant put in a mental and financial hardship with her two minors due to that premature accidental death of her husband. She was unable to inform the matter to the O.P. due to her mental condition.
On 12.9.2006 she made intimation before the O.P. No.1 along with some documents and supply the copy thereof the O.P. No.2. The O.P. No.2 issued the claim form. Being a housewife with little bit of education could not be able to collect the documents in the time stipulated by the person of the O.P. No.2 orally. At last she was able to collect the documents as per instruction of the persons of the O.P. No.2 and again submitted the same along with the claim form and the original policy on 14.11.2006. It is pertinent to mention here that along with intimation letter dated 12.9.2006 all the Xerox copies of the documents were furnished and along with claim form were submitted. The O.P. No.2 vide their letter dated 15.12.2006 forwarded the claim form, original policy and attested copies to the O.P. No.1 vide their Memo GTFS/CLAIMS/TG/JPA/37801 dated 15.12.2006. Another copy of the same supplied to the complainant by the O.P. no.2.
Since after intimation and several letters by the complainant along with co-villagers and relatives several time visited the office of the O.P. No.2 as well as O.P. No.1 at Durgapur and Calcutta Office for settlement of her claim but the men and agent of the O.P.s did not pay any heed to such words of a poor, helpless widow. The complainant made several representations (14.7.08, 14.7.09, 11.1.10) to the O.P. but there was no response from other side and at last sent a Lawyer’s notice under registered post but in that case also the O.P.s do not bother to settle the claim. Finding no other alternative the complainant compelled to file this case before this Ld. Forum for relief.
The O.P. No.1 contesting the case by filing written version, denying inter-alia all the material allegation as leveled against him. This O.P. further stated that the claim of the complainant is hopelessly barred by limitation as the alleged accident took place on 6.3.2006 and she lodged the claim on 12.9.2006 but she filed the present case on 8.5.2013 i.e. much after the stipulated period of two years from the cause of action, as such the claim is barred under Section-24 of the C.P.Act.
As per terms of the GTFS policy the alleged accidental death of the insured should have been reported forthwith to the company and not later than 30 days in case of any cogent reasons for delay but in the present case the petitioner, as it appears, informed such accidental death on 6.3.2006 to this O.P. only on 28.8.2006 and that too without offering any explanation as to such huge delay. As such there is gross violation of the terms of the policy for which her claim was not entertainable as per policy.
This O.P. also submits that there is no deficiency or unfair trade practice on the part of this O.P. and as the complainant violated the terms of the GTFS policy, she is not entitled to get any benefit out the GTFS policy. It is pertinent to mention here that O.P. No.2 acted beyond its authority and jurisdiction and detrimental to the interest of this O.P. As such any such act made or done by them beyond their authority and jurisdiction cannot be warranted by this O.P. and the O.P. No.2 is only responsible for that, for which they could be dealt with as per law. It is absolutely an illegal and without jurisdiction act by the O.P. No.2 in issuing claim from after the stipulated period as per terms, as alleged by the petitioner and for such act the O.P. No.2 only will be held responsible. Save and except the allegations which have been specifically admitted by this O.P. in the present written version all other allegations thereof are deemed to have been denied by this O.P. and prays for dismissal of the case.
The O.P. No.2also contested the case by filing written version and submitted that in the instant case the O.P. No.2 to their best ability and sincerely have extended their all co-operation and assistance to the complainant and there has been no negligence or deficiency in service on their part and as such the complainant cannot have any grievance whatsoever against the O.P. No.2 and the complainant accordingly not entitled to any relief as against the O.P. No.2.
Point for consideration in this case is;
- Whether there is any deficiency in service acted by the O.P.s in this case?
DECISION WITH REASON
Admittedly there was a GTFS policy in the name of deceased Naba Kumar Ghosh, who was expired on 6.3.2006 and that death was unnatural death. Post Mortem was done in Burdwan Medical College and Hospital on 7.6.2006. The claimant being an unfortunate wife filed this case on 8.3.2013 when she had loses her faith upon the O.P. to settle the case. It is true that some delay was happened in sending the claim application but we should not forget that it is very difficult for a little learning lady having lost her better half very recently, to find out all the formalities which is required to file the claim. So the thrust of argument advanced by the Ld. Advocate of the O.P. that claim application was not filed in time has no legs to stand because looking to the purpose and nature of policy and when premium was paid the complainant should not be deprived of the benefit under the policy on the ground of delay in submitting the claim form. The Hon’ble National Commission while disposing the Revision Petition No. 1754/2010 have held the same view in a case where delay was more than three years, in the instant case only six months. So, this present case is in better footing.
More over, the O.P. did not settle the claim even in form of repudiation. Thus, the claim of barred by limitation U/s 24A of the C.P. Act will not attract and the cause of action is still continuing. We must have to say that non-settlement of the claim by the O.P. Insurance Company is a glaring example of deficiency in service. So, Insurance Company (O.P. No.1) is hereby directed to settle the claim at least the amount of sum assured. This direction is made in view of the abovementioned direction of Hon’ble National Commission.
With that observation, it is
ORDERED
that the application U/s 12 of the C.P. Act is allowed on contest against the O.P.s. The O.P. No.1 is directed to settled the claim (sum assured) within one month from the date of this order in the light of the observation made in above along with mental pain and harassment of Rs.10,000/- and litigation cost of Rs.2000/- positively. Failing which, amount of harassment will be Rs.50,000/- and interest will carry @ 12.5% p.a. from the date of submission of claim form i.e. 12.9.2006 to till its realization. The O.P. No.2 is also directed to see that further harassment should not be happened in the matter of settlement in the light of our observation made in above, if failed then O.P. No.2 will also be liable to pay Rs.5000/- in Consumer Legal Aid Account, Burdwan for his unfair trade practice thrown to the complainant’s husband to get the policy. In default the complainant is at liberty to execute the order through this Forum. Let the plain copy of this order be given all the parties free of cost. The office is directed to hand over this plain copy to the Ld. Advocates of O.P. No.1 & 2 so that the spirit of order may not be vitiated in any stage.
