West Bengal

Birbhum

CC/16/2022

Srimati Paul - Complainant(s)

Versus

General Manager, National Ins. Co. Ltd - Opp.Party(s)

Amit Dutta.

01 Aug 2024

ORDER

Shri Sudip Majumder- President-in-Charge.

            The complainants/petitioners file this case U/S 35 of Consumer Protection Act, 2019. The fact of the case in brief is that the one petitioner/complainant, Srimati Paul, permanent resident of Vill.- Karangapara, P.O.- Khajuri, P.S.- Kundahit and Dist.- Birbhum, Tarun Paul was the owner of the Motor Cycle being Regn. No. JH 21E 9660 and the said vehicle was covered with insurance policy being policy No. 36140031186700235882 under the OP. That the said policy was valid from 25/10/2018 to 24/10/2019 and the sum assured of the policy is Rs. 15,00,000/-.           

            It is the further case of the complainant that the initially the policy was purchased in the name of one Somnath which is being reflected in the face of the policy, but subsequently said policy was made in the name of Tarun Pal by the endorsement request of said Somnath which will be revealed from the letter of acceptance of endorsement request dated 25/10/2018 issued by the OP.

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It is the next case of the complainant that the insured Tarun Pal (hereinafter be called the L.A) died leaving behind his wife Srimati Paul @ Srimati Paul and one son Tanmoy Paul and one daughter namely Mou Maji as his only legal heirs and representatives and as such they are all the beneficiary of the

policy. Be it mentioned here L.A nominated his wife namely Srimati Paul @ Srimati Paul (Complainant No. 1) as nominee of aforesaid policy.

            It is the specific of the case of the complainant that on 29/12/2018 at about 10:45 A.M. while the L.A was returning from Suri (W.B) after visiting hospital in Suri, near Patharchapuri bypass on Suri- Chandrapur Road, P.S. Chandrapur, Dist. Birbhum, W.B. a Mahindra Pick up Van being Regn. No. WB538971 dashed back side of Motor cycle of the L.A was injured and he was immediately taken into Suri Sadar Hospital by the local people where he died in course of treatment.

            The accident occurred under Chandrapur P.S. within the District- Birbhum and as such the cause of action of this case arose within the jurisdiction of this Ld. Commission. Thereafter P.M was done over the dead body of said Tarun Pal (L.A) by the autopsy surgeon of Suri Sadar Hospital on 29/12/2018. Immediately after the accident the police and also insurance company were informed by the complainant. That the Suri police started a U.D. case being Suri P.S. U.D case No. 497/2018 dated 29/12/2018.

            Thereafter, the complainant being the nominee and beneficiary of the L.A submitted the claim form duly filled up along with all the relevant documents in support of personal accident claim in respect of death of the L.A. Thereafter, one Ajoy Kumar Jha the investigator of the OP insurance company had been to the premises of the complainant and investigated the matter and after completion of the investigation he submitted his report before the Branch Manager National Insurance Company Ltd, Dumka on 28/01/2021.

            The investigator Ajoy Kumar Jha reported in his report dated 28/01/2021 that the policy being No. 36140031186700235882 owned by the L.A and the bike also owned by the L.A and the further reported that death of L.A Tarun Pal in road accident is true. The OP insurance company after receiving all the relevant documents along with claim form as well as report of the investigator Ajoy Kumar Jha did not consider the claim of the complainant and they repudiated the claim through their letter dated 14/06/2021 on flimsy ground.

Hence, after finding no other alternative the complainant is compelled to file this case before this Forum/Commission for proper reliefs and he prayed the Commission:-

  

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 “(a) To pass order directing the OP to pay Rs. 15,00,000/- as death claim of the insured.

2. To pass order directing the OP to pay interest @ 12% p.a. on Rs. 15,00,000/- since the date of claim preferred.
3.  To pass order directing the OP to pay a sum of Rs. 20,000/- as compensation for harassment and mental agony.
4. To pass an order directing the OP to pay Rs. 10,000/- as litigation cost.
5.  Other relief or reliefs.”

The OP insurance company stated in Page 2 of their written notes on argument as:

“That after receiving the above claim file and on scrutiny of the above claim OP National Insurance Company Ltd. Observe that on verification of the vehicular document as well as verification of all others documents submitted by the petitioner properly. “On scrutiny it appears from the relevant papers that the alleged policy is not in the name of LA” Hence it is evidence that, which is violation of policy condition and OP Insurance Company very rightly repudiate the said claim due to “VIOLATION OF POLICY CONDITATION”.

OP files written version and written notes on argument. But, no evidence-in-chief filed by the OP.

            Complainant submitted evidence-in-chief. Complainant submitted written notes on argument. Some documents have also been filed by the complainant’s side and those are compared with the original ones. Thereafter, Ld. Advocates for the both parties made oral argument in support of their case.

            Heard Ld. Advocates for the both parties.

            Considered.

            Perused all the document.

Points for determination/Issues

1.  Whether the complainant is a consumer as per definition of the term ‘Consumer’ of the C.P Act. ?
2. Whether this Commission has jurisdiction to try this case?
3. Whether there is any deficiency in service on the part of the OPs?
4. Whether the complainant is entitled to get any other relief or reliefs as prayed for?

                                                              Decision with reasons

Point No. 1:

            Tarun Pal was the policy holder being policy No. 36140031186700235882 under the OP and after his death the complainants are the beneficiary of the policy and as such the complainants are consumer

 

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under the OP and the OP is the service provider of the complainants. Hence, the complainants are consumer as per Sec. 2(7)(ii) of the Consumer Protection Act, 2019.

Point No. 2:

            The OP/Insurance Company repudiated the claim of the complainants through their letter dated 14/06/2021 and the case was filed on 09/02/2022 and as such the instant complainants have been filed within the statutory period and as such it is clear that the instant complaint is not bared U/S 68 of the C.P. Act, 2019.

Point No. 3:

            We have gone through the documents of the record and considered the arguments of both parties. It appears that the dispute relates to the name of the insured/Life Assured. The insurance covers the personal accident claim for the owner cum driver of the vehicle being Regn. No. JH 21E9660. There is no

dispute that the owner of the vehicle/motor cycle was Tarun Pal and his wife is Srimati Paul. There is also no dispute as to the point that the said Srimati Paul is the nominee of the insurance policy under the OP/National Insurance Co. Ltd. being No. 36140031186700235882. We have perused the Aadhaar Card of Srimati Paul which depicts that her husband is the said Tarun Pal (since deceased)/Life Assured.

            The insurance was also a valid one at the time of accident of Tarun Pal. The investigation report in respect of the accident made by the assigned person of the OP/Insurance Company, Ajoy Kumar Jha dated 28/01/2021 duly admitted that the concerned policy No. was owned by the Life Assured and the owner of the bike was the said life assured and the death has occurred to the life assured Tarun Pal due to road accident.      

            It is the argument of the Ld. Advocate of the OP side that the policy was not purchased in the name of Tarun Pal i.e. the husband of the complainant No. 1. It was purchased in the name of one ‘Somnath’ which is violation of policy condition, and thus the complaints are not entitled to get any benefit of the insurance.

            The complainants have shown us a letter of acceptance of Endorsement Report dated 25/10/2018 of the OP, accepting the change of the name from ‘Somnath’ to Tarun Pal. The Ld. Advocate for the OP side has strongly objected on the genuinity of that document.

            As per our observation, the OP/Insurance Company is not free from the liability of such defect in the name of the insured/Life Assured. While bringing the person to the insurance coverage it was the duty

 

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of the OP to verify the same with the documents of the vehicle in question being No. JH21E9660. Without verifying the same the OP cannot take any premium of the said insurance policy. The OP/Insurance Company is already aware about the defect in the name of the insured through the report of their appointed Inspector Ajoy Kumar Jha dated 28/01/2021.

            Further, it appears to us that the OP has neglected their duty to confirm the identity of the insured as without any title one ‘Somnath’ cannot be the name of a person. It is also settled that while making any insurance the identity of the insured should be properly verified by the insurer through proof of his identity and proof of his address. But, here the OP/Insurance Company continued to benefit of premiums without verifying properly the person concerned. In this respect the OP is deficient and negligent in service. The OP cannot escaped from his liability of giving coverage of the insurance merely on a latent

mistake of the name of the insured which can be rectified through the corroborating other documents like wife/nominees name, owner of the vehicle No. that met with an accident etc. Hence, we direct the OP/Insurance Company to bring necessary correction in the name of the insured from ‘Somnath’ to Tarun Pal depending on the aforesaid circumstantial documents and to pay the sum assured of the death claim to the complainants in equal proportion after completion of other formalities if any.

OP members file their written version and written notes on argument but no evidence-in-chief in support of their case has yet been filed by the OP sides. Only written version has no value unless the contents thereof are established by evidence.

It is proved beyond all reasonable doubt that there is/was deficiency in service as per Sec. 2(11) of the C.P. Act, 2019. Moreover it is a case of unfair trade practice as per   Sec. 2(47) of C.P. Act, 2019 on the part of the OP/Insurance Company.

Hence, from the above discussion it is proved that the complainant has able to prove her case beyond all reasonable doubt.

Point No. 4:

From the documentary evidence as available in the case record, it is crystal clear that the complainants are the beneficiary of the policy and as such the complainants are consumer under the OPs and the OP members are the service provider of the complainants/consumer of the said policy.

 Also in this case, it is proved that there is deficiency in service on the part of the OP/Insurance Company.

Hence, the complainants are entitled to get relief or compensation as prayed for.

Thus, all the points are decided in favour of the complainants.

Complaint is sufficiently stamped and proved beyond all reasonable doubt.

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  In the instant case as per view of the Hon’ble Apex Court in several cases the interest will be given @ 9% p.a. from the date of filing of this case.

            In our opinion, 9% interest on insurance claim is enough as relief in form of compensation. Hence, additional relief in form of compensation should not be awarded to the petitioners.

Hence, it is,

            O R D E R E D,

                                        that the instant C.C. Case No. 16/2022 be and same is allowed on contest with cost.

The OP members are jointly or severally directed to pay Rs. 15,00,000/- (Fifteen lakh only) as death claim of the insured to the complainants named Srimati Paul, Tanmoy Paul and Mou Maji along with interest thereon @ 9% p.a. calculating on and from 09/02/2022 (i.e. from the date of filing of this case) till realization.

          The OP members are jointly or severally directed to pay Rs.5,000/- (Five thousand only) as cost of litigation to the complainants/petitioners named Srimati Paul, Tanmoy Paul and Mou Maji.

The entire decree will be complied by the OP members jointly or severally within 45 (Forty five) days from this date of order, in default, the complainant is at liberty to put this order to execution in accordance with law.

The instant case is thus disposed of.

Let a copy of this order be given/handed over to the parties to this case free of cost.