Complainants Smt. Rekha Singha by filing this complaint has submitted that op no.1 is the Insurance Company and op no.2 is United Bank of India in whose favour the vehicle is hypothecated as per loan agreement.
Fact remains that insured Swapan Singha, husband of the complainant (since deceased) purchased a motor vehicle Insurance Policy being No. OG-10-2401-1803-00011515 valid from 29.12.2009 to 28.12.2010 against the vehicle No. WB-04E-2217 and as per policy the insurer liability for Personal Accident for the owner-driver is Rs. 2,00,000/-.
Truth is that the said Swapan Singha died in a road traffic accident on 24.09.2010. Complainant is a simple house wife and due to the sudden death of her husband she was completely in grief and shocked and nothing was known about the policy or other documents. So, subsequently complainant came to learn from UBI that vehicle was hypothecated to the UBI and UBI is collecting EMI per month and it is insured and after getting such information, complainant knew about LIC policy with Bajaj Allianz and then complainant submitted claim in respect of LIC of the op through UBI and bank sent the claim form along with all documents to the Bajaj Allianz insurance on 08.07.2011. But Insurance Company repudiated the claim on 14.10.2013. In the meantime the vehicle’s insurance coverage was from 29.12.2009 to 28.12.2010 and the insured Swapan Singha died on 25.10.2010 and thereafter the said policy renewed on 29.12.2010 after knowing the death of insured and till date the Bajaj Allianz General Insurance Co. Ltd. renewed the said policy in the name of dead person and that the complainant knew that her husband’s accident benefit coveres in the vehicle’s insurance policy when she went to the lawyer on November, 2012 then she claimed to the Insurance Co. on 08.01.2013 but till that date the op did not respond.
Complainant is illiterate, simple housewife and cannot write or read and she can sign only in Bengali, as such she intimated to the insurance company so late and there was no laches for filing the same and willful laches or negligence on the part of the complainant and in the circumstances for repudiating the claim arbitrarily and also for causing much loss to the complainant, this complaint is filed for redressal.
On the other hand op by filing written statement submitted that op specifically asserted that the entire allegation is false and fabricated and truth is that no doubt Swapan Singha had motor vehicle policy with Bajaj Allianz being policy No. OG-10-2401-1803-00011515 in respect the vehicle bearing Registration No. WB-04E-2217 for a period from 29.12.2009 to 28.12.2010.
Fact remains that Swapan Singha died in a motor vehicle accident on 25.09.2010. But complainant informed the op about the said accident after passing of more than 836 days i.e. more than 2 years and 3 months. But in the instant case there was a violation of the above terms of the policy and the nominee of the insured intimated the op insurance company after 2 years and 3 months from the date of accident and as such the complainant is not legally entitled to get any amount from the insurance company as there is violation of terms and conditions of the policy.
Moreover as per Personal Accident Coverage following conditions have to be complied. 1) Owner-Driver is the registered owner of the vehicle insured, 2) the owner-driver is the insured named in this policy, 3) the owner-driver holds effective driving license, in accordance with provisions of Rule 3 of the Central Motor Vehicles Rules 1989, at the time of accident and so for non-compliance of the above matter, the claim was repudiated and there is no legal ground on the part of the op and there was no negligence and deficiency on the part of the op for which the present complaint should be dismissed.
Decision with reasons
On comparative study of the complaint and written version including the admission of the op and further hearing the Ld. Lawyers of both the parties, we are of conclusion finally that no doubt the vehicle bearing No. WB-04E-2217 was insured under the op for a period from 29.12.2009 to 28.12.2010 and owner of the vehicle was Swapan Singha and insured was also Swapan Singha including that vehicle. No doubt the policy was Personal Accident Coverage Policy.
Another factor is that the insured Swapan Singha died in a Motor Vehicle accident on 25.09.2010 that means within the valid coverage period of the policy Swapan Singha died. Undisputed fact is that after lapse of 2 years and three months claim was submitted by the present complainant and no doubt complainant is a lady having no literacy except she knows how to sign in Bengali.
Invariably it is impossible for the wife of Swapan Singha to know everything and in the village status wives are not aware of such business of Swapan Singha and about his insurance policy etc. But when she came to know from the UBI in whose favour the said vehicle was hypothecated that there is a policy and it was be reported to the insurance company. Then the wife of the deceased submitted the claim application through the bank. Fact remains that there was some responsibility on the part of the bank for reporting the death report. But that was not reported by the bank authority. But contention of the bank authority is that if it is not reported by the family, then how it would be possible to report it to the insurance company and when bank authority claimed for EMI, thereafter the lady came and they learnt that he had insurance policy. Thereafter complainant submitted the said claim for which there was a delay. But question is on the ground of technicalities only the claimant’s claim shall be frustrated and insurance company shall have to get the benefit. But that is not the intention of the social legislation of insurance and it is the observation of the Hon’ble Supreme Court that when it is a social legislation, them the insurance company shall consider it socially, morally, brushing aside such sort of technicalities in a particular case and in the present case, it is proved that complainant is a very poor lady having no literacy and she has no knowledge about the different type of procedure in filing application of claim and she was guided by the bank and she filed it.
So, we find that the delay was not for her laches. If actually there was such a delay in that case, it was the duty of the op to give the complainant a chance to explain the delay but that has not been done and considering all those facts and also considering the observation of the Supreme Court and findings, we are confirmed that in such sort of case there is no ground to repudiate the claim on the ground of mere delay. Because it is a social legislation and in the particular case it was impossible for such a lady to approach before the insurance company who only knows to sign but nothing more.
Fact remains that insurance companies are established on the basis of the Insurance Act 1947. Then invariably the insurance company has his social liability to give a chance to the complainant to explain the delay but that was not given and it was repudiated. But such sort of technicalities truthful claim cannot be repudiated by any insurance company on the ground that he was a regular depositor of premium in respect of insurance of the vehicle along with the Personal Accident Coverage Policy of the driver-owner and admitted position is that complainant’s husband was a driver-owner and he was covered aby the insurance policy as per Accidental Insurance Coverage policy.
Admitted position is that the insurance policy was valid up to date of death. Then only for technicalities it was not just on the part of the op to repudiate the claim in such a fashion. But we are aware of the fact that all those private insurance companies have shut up their eyes to show their moral and social responsibility. But they are only collecting the premium for running business to create capital which is like Kabuliwala for which in fact in India insurance business has now come to such a position only for getting money from the depositors. But they are not in the field to give relief to the insured because they are always hunting for technical defects. So that they must not have to open their strong room for disbursement of the claim. It is a known fact to all that in case of mediclaim or insurance policy of accidental death or for theft of vehicle and other matters, insurance companies are found kept dumb when claim is made by the affected insured.
If it is continued, invariably days will come when all over India revolution will be held against all the banks and insurance companies against their such sort of immoral activities and immoral trade by squeezing the consumers in such a manner. But truth is that neither Fora nor the Government administration have their any sort of prompt action to give support to the consumers in this regard. At the same time there is no Centrally Consumer Policy in India. Whereas in other countries they published their yearly consumer policy along with inter departmental consumer policy to protect the interest of the consumers. But in India there are so many gatherings, workshop etc. but consumers’ right are not being protected even after enactment of the C.P. Act 1986. There is no such sound approach from the Fora or from the consumer association for which all over India the number of filing complaint is very meagre, poor, and wretched in all respects.
But particularly we are not unmindful to the fact that we are here and there to protect the interest of the consumer. Technicalities cannot anyway curtail the right of the consumers to get any insurance claim if it is found valid and invariably we are convinced that it is our duty to protect such an illiterate lady having her capacity only to sign to give her relief properly. No doubt for such technicalities we may adopt a rational approach for standard claim which can easily be granted. Even if MACC cases some variations are being followed for years together and Hon’ble Supreme Court passed in so many judgements that it is specifically mentioned if there is technicalities, op may deduct some portion of the total claim and relying upon this observation of the Supreme Court and that is the decision of the Supreme Court, we are directing the op to pay Rs. 1,50,000/- as accidental coverage on the date of death of Swapan Singha when the insurance was valid on the death of insured on 25.10,2010. When the insurance coverage was valid from 29.12.2009 to 28.12.2010. Fact remains that in State Commission Case No. FA No. 08 of 2008 filed on 20.08.2008 at State Commission under the similar type of case allowed compensation along with cost etc. and that appeal was preferred against complaint No. 84/2007 passed by DCDRF, Paschim Medinipur. Similarly State Commission also passed such sort of judgement in SC Case No. FA 908/2012 filed on 27.11.2012 and disposed on 22.11.2013 and allowed that claim.
At the same time it is found that as per settled principle of laws, the cause of action will arise from the date of repudiation till the time of claim preferred by the complainant are disposed by the appellant one way or other the cause of action would continue. At the same time as per Limitation Act, claim of any insurance policy holder can be made within three years from the date of death and the decision or where the claim of the policy denied or either partly or wholly that is specifically observed by the Hon’ble High Court in a ruling reported in 2010 (4) WBLR Cal 617. Now the Ld. Lawyer for the op cited one ruling reported in FA 321 of 2005 passed by National Commission on 09.12.2009 and submitted that on ground of repudiation for limitation cannot be decided. But in that case it was cause of theft and as per policy condition, the information must be sent within shortest possible time to the insurance company.
Considering that fact and present fact and circumstances we find that we cannot compare the present fact with fact as disclosed in FA No. 321/2005 for which said judgement is not applicable in this case. On the other hand judgement of State Commission support the view of this Forum.
Accordingly the complaint succeeds.
Hence, it is
ORDERED
That the complaint be and the same is allowed with cost of Rs. 10,000/- against the ops.
Ops are hereby directed to pay a compensation of Rs. 1,50,000/- as final settlement of claim for accidental insurance coverage of Swapan Singha and same shall be paid to the complainant along with litigation cost i.e. total Rs. 1,60,000/- within one month from the date of this order, in default, penal interest at the rate Rs. 200/- per day shall be assessed till full satisfaction of the decree and if penal interest is collected it shall be deposited to this Forum.
Ops is hereby directed to comply the order very strictly within the stipulated time, in default penal action shall be started against the op for which op may be imposed further penalty and fine u/s 27 of C.P. Act, 1986.
