Date: 14-11-2014

Sri Debasis Bhattacharya

This appeal is directed against the order dated 23-04-2013 in Case No. 65/2012, passed by the Ld. District Forum, Uttar Dinajpur, whereby the complaint case has been allowed on contest against the OPs.  Being aggrieved and/or dissatisfied with the same, the OP Nos. 1&2 thereof have preferred this appeal.

Brief fact of complaint case is that son of the Complainant, Nirmal Pahan, since deceased, took an insurance policy being no. OG-07-2401-9961-00002046/6739 for a sum assured of Rs. 1,00,000/- and the said policy was valid for the period from 15-05-2006 to 14-05-2011.  His son, who was a contract labour, died on 08-05-2011 when some unknown miscreants hit his head with iron rod.  After the accidental death of his son, the Complainant approached the OP No. 3 for insurance benefit, who in turn forwarded the claim intimation to the OP insurer vide letter dated 04-02-2012.  The Complainant subsequently submitted claim form together with other documents to the OP No. 1 on 07-02-2012.  However, the OP has not settled his insurance claim, hence the case.

Case of the OP Nos. 1 &2, on the other hand, is that they asked the Complainant to send some essential required documents, but the Complainant failed to supply the same to the insurance company and due to non-submission of required documents, the OP insurer repudiated Complainant’s claim.

Point for consideration in this appeal is whether the impugned order is in order or the same suffers from any kind of infirmity.

Decision with reasons

           Ld. Advocate for the Appellants has submitted that there was inordinate delay on the part of the Complainant in giving intimation about the incident i.e. death of insured.  It is a condition precedent to provide timely intimation about the incident to the insurer and any lapses on the part of the Claimant in this regard invariably makes a claim null and void. In the instant case, while Complainant’s son died on 08-05-2011, intimation to this effect was given through the OP No. 3 i.e. GTFS, after a lapse of nearly 09 months on 04-02-2012.  Therefore, in terms of Clause 01 of the Policy, they repudiated the said claim and although such fact was categorically mentioned in paragraph 10 of their Written Version, yet the Ld. District Forum did not take such vital aspect into consideration while adjudicating the case, thereby totally erred in the matter.  He has relied upon the decisions of Hon’ble Supreme Court reported in AIR 1999 SC 3252, AIR 2009 SC 2834 and I (2009) CPJ 6 (SC); of Hon’ble National Commission in RP No. 3101/2013, and RP No. 3900/2011; and of this Commission in FA/906/2012.

            Ld. Advocate for the Respondent No. 2, however, has submitted that it took considerable time for the bereaved family to overcome the trauma of losing the only bread-winner of their family, who was murdered by miscreants while working as a contract labour in Tamil Nadu.  As a result, the delay occurred in giving intimation to the insurer through them.  The untimely death of the insured at such a young age turned the situation of the family members beggars description as their very survival was put at stake.  Further, they belong to a rustic village community and make their ends meet through cultivation.  As an illiterate person, it was not possible for the Complainant to comprehend the intricate details of the insurance policy, and therefore, anyone of reasonable prudence would appreciate that the delay in giving intimation about the incident was not deliberate. The Ld. District Forum quite reasonably appreciated such compelling factors and allowed the complaint case, which should be sustained in toto.

            Documents on record, particularly the Death Report, clearly go to show that the insured died accidentally (murdered).  The Claim Closure letter dated 14-02-2012, issued by   the insurance company only state belated intimation of incident as the cause for repudiating Complainant’s claim.  So, it can reasonably be presumed that the insurer did not find fault with the claim of the Complainant in any other aspect. So, let us see whether such repudiation is in order under the law or not.

            Strong reliance of the insurance company on condition no. 1 of the policy under the caption ‘Notice of Claim’ appears to be the sheet anchor of their case.  No doubt, said clause does cast a duty upon the claimant to give intimation about the incident/accident within 30 days of its occurrence, however, reading between the lines of this clause makes it abundantly clear that this is not sacrosanct. The phraseology used under this clause is unequivocal in its content that if reasonable cause is shown for belated reporting of an incident, this clause cannot be used in detriment to the interest of a bona fide claimant. 

            In the case in hand, it is claimed that the deceased insured was the sole bread-winner of the family. Any person with slightest human instinct would appreciate that it takes a considerable time for the bereaved family members to come to terms with the hard reality, more so if their dear one met a premature accidental death at the tender age of only 23 years.  The thumb impression of the Complainant put on various documents go to show that he is an illiterate person and significantly, this has not been challenged by the insurer by placing any counter document to prove otherwise.  It is too much to except of such a person to figure out the complexities of terms and conditions of an insurance policy written in English. Above all, while the death of an earning member has every potential to ruin the financial health of the surviving family members, no one in his right frame of mind would invite trouble by sitting idle instead of adhering to the terms and conditions of the policy. So, we find no good ground to accept this as a deliberate act on the part of the Complainant.

          One of the driving forces behind opting for an insurance policy is to safeguard the interest of immediate family members from inevitable financial distress that looms large following the death of an insured, if he/she happens to be an earning member of the family. The delay in providing intimation about the incident did not affect the merit of Complainant’s claim in anyway.  Therefore, the rigidity shown by the insurer in repudiating Complainant’s claim through a complete misinterpretation of one of the inherent policy clauses that is otherwise directory in nature, is very unfortunate, which cannot be accepted under any circumstances. 

           In such facts and circumstances, the impugned order, appears to be perfectly in sync with the principles of natural justice and so there is no need to tinker with the same in any manner and hence, upheld.       

          In the result, the appeal fails.

Hence,

ORDERED

           that the appeal be and the same is dismissed exparte against the Respondent No. 1 and on contest against the Respondent No. 2, but without any cost.  The impugned order is hereby affirmed.