C.F. CASE No.                      :            CC/2013/75       

COMPLAINANT                  :           Jagattara Bibi,

                                                            W/o Lt. Sirafat Sekh,

                                                            Vill & P.O. Plasseypara,

                                                            P.S. Tehatta, Dist. Nadia

                                                            Pin 741155

• Vs  –

OPPOSITE PARTIES/OPs   :     1) Manager,

                                                            Reliance General Insurance Co. Ltd.

                                                            49, Dobson Road, 2^nd Floor,

                                                            Howrah, 711101

                                                        2)             Manager,

                                                            Reliance General Insurance Company Ltd.

                                                            Himalaya house, 5^th Floor,

                                                            38B J.L. Nehru Road, Kolkata 700071

                                                        3) The Manager

                                                            Golden Multi Services Club Ltd.

                                                            Krishnagar Branch,

                                                            P.O. Krishnagar, P.S. Kotwali,

                                                            Dist. Nadia, PIN - 741101

PRESENT                    : SHRI PRADIP KUMAR BANDYOPADHYAY, PRESIDENT

      : SMT REETA ROYCHAUDHURY MALAKAR, MEMBER

                             : SHRI SHYAMAL KUMAR GHOSH, MEMBER

DATE OF DELIVERY                                             

OF  JUDGMENT                         :    29^th August,2014

:    J U D G M E N T    :

This is an application under Section 12 of the Consumer Protection Act, 1986 filed by the complainant against the OPs praying for refund of Rs. 3,00,000/- along with interest @ 10% p.a. and cost of Rs. 1,00,000/-. 

The brief facts of the case is that the complainant’s husband viz. Sirafat Sk. has obtained Insurance Policy certificate being No. 014979687/703090129643Y1 for the period from 03-01-2011 to 02-01-2012, through G.M.S.C, OP No. 3 herein during his life time, wherein the sum insured was Rs. 3,00,000/- . After payment of necessary premium amount, the policy holder viz. Sirafat Sk. died on 08-03-2011 in an accident and to that effect Kaliganj P.S. Case No. - 125/2011 dated 08-03-2011 U/S 279/304 I.P.C. was started. The post mortem of deceased policy holder was held at Nadia Dist. Hospital on 08-03-2011 vide P.M No. 259/2011. After death of policy holder, his wife viz. Jagattara Bibi Complainant / nominee informed the matter to OP No. 3,  G.M.S.C.   Thereafter, the OPs /  Insurance company supplied the claim form to the complainant.  The said claim form, duly filed up along with necessary document was submitted before the office of OP No. 3, G.M.S.C. within proper time.  The said claim form along with all documents has already been sent to the office by OP / Insurance company situated at Himalaya House, Kolkata – 71 as per letter dated 19-09-2011 issued by OP No. 3, G.M.S.C.   OP-3 G.M.S.C also informed the complainant regarding sending all documents along with claim form to the office of OP / Insurance Company as per letter dated 19-12-2011 issued by OP No.-3 G.M.S.C.  The claim of complainant was repudiated by OP / Insurance Company  (Himalaya  House , Kolkata-71 ) as per letter dated 28-09-2011 on the ground that there was a delay of 198 days regarding sending the information to OPs causing gross violation of terms and condition of policy.  It was totally baseless and wrong as the information was sent to the office of OP No. 3 within proper time. The cause of action was arisen on 28-09-11.  There is a gross negligence and deficiency in service on the part of OPs.  Hence the case along with prayer for relief mentioned in the relevant portion of the complaint.      

     OPs (Reliance General Insurance Co.) contested this case by filing written version stating, inter alia, that the OP No. 1 issued a JPA policy in favour of Sirafat Saikh being policy No. 70309012964341 for the period from 03.01.11 to 02.01.12 subject to the terms and conditions.  The time limit was prescribed for intimation of loss as set out in 20 days in the policy and certificate.  The OPs Insurance Company also averred that they have received the intimation from the complainant after 198 days instead of 20 days causing gross violation of terms and conditions of the said policy.  The repudiation of claim has been made rightly and legally.  There is no gross negligence and deficiency in service on the part of the OPs Insurance Company.  So the present complaint is liable to be rejected with cost. 

     OP No. 3 GMSC also contested this case by filing written version stating, inter alia, that the OP No. 3 can never be liable to settle the claim of the claimant.  In short, the authority to settle the insurance claim lies solely with the insurer (i.e., OPs No. 1 & 2).   So their names may be expunged / struck down from the cause title as they had no role regarding settlement of the claim.  

     Now this Forum is to consider the following points. 

POINTS FOR DECESION

1. Point No. 1:   Whether the complainant can be termed to be a consumer as per

provision of Consumer Protection Act, 1986.

2. Point No. 2:   Whether there is any gross negligence or deficiency in service on

the part of the OPs or not.

3. Point No. 3:   Whether the complainant is entitled to get any relief as prayed for

or not.

REASOND DECISIONS

            The record gives indication that the complainant is substantiating his claim submitted certain documents.  The OPs also submitted several documents in respect of their defence.  Perused all documents including complaint, written version etc. also perused the written argument filed by the complainant on 22.07.14 and written argument filed by OPs Insurance Company on the self same date on 22.07.14.  Objection filed by OP No. 3, GMSC was to be treated as written argument as per submission of ld. Counsel for OP No. 3 which was also perused by us carefully. 

Point No. 1:

                        In the instant case Sirafat Sk. since deceased obtained a policy bearing certificate No. 014979687/703090129643Y1, on payment of necessary premium against the sum insured of Rs. 300000/-.  The commencement of said policy was 03.01.2011 which is clearly revealed from policy certificate.   As per this certificate it is also clear that the complainant viz Jagattara Bibi has figured as a nominee of the assured.  As per certificate of death, it is also fact that Sirafat Sk. expired on 08.03.2011.  After death of Sirafat Sk., his wife i.e. the present complainant may approach before the proper Forum for getting her relief mentioned in the complaint.  So in view of the status of the complainant and her relationship with the respective OPs, has been found to be a consumer in terms of the provisions of Sec. 2(1)(d)(ii) of the Consumer Protection Act, 1986 for the purpose of this proceeding.  Point No. 1 is thus, disposed of. 

Point Nos. 2 & 3:

            In the instant case the moot question is that how far the ground of delayed claim is to be considered.  It is admitted position that Sirafat Sk has obtained J.P.A. Policy during his life time.  It is also admitted that he (Policy order) died on 08.03.11 which is during the policy period i.e., from 03.01.2011 to 02.01.2012.  The policy holder died due to road accident by truck being No. WB/57A/4340 which is clearly revealed from FIR No. 125/11 dated 08.03.11of Kaliganj P.S.   Thereafter ASI of Police, Kaliganj P.S. submitted the final report on 22.02.12 u/s 279/304 I.P.C., wherein it was found that during investigation & as per statement of witness, there was a sufficient evidence against the accused Raju Haque which established the prima facie charge against him (i.e. accused).  The Policy Holder died due to shock & haemorrhage which is antemortem & accidental in nature which is also admitted as per Post-Mortem report being No. 259/11 dtd. 08.03.11.  The whole fact is not only admitted by the ld. Counsel for complainant, but also admitted by the ld. Counsel  for both OPs.

            Now the question arises regarding delayed information to the OPs.  as per letter dtd. 19.12.11 issued by GMSC, it is clear that the necessary documents such as complete filled up claim form, original insurance certificate, Xerox copy of death certificate, P.M. report, Bank Pass Book, driving license etc. have already been sent to the office of OPs / Reliance Insurance Company.  It also appears from the letter dtd. 28.09.11 issued by OPs / Reliance Insurance Company that the claim was repudiated on the ground of delayed intimation (i.e., OPs received the intimation after 198 days instead of stipulated 20 days as per norms).  In Oriental Insurance Company ltd. and another vs. Sevati Sahau & Ors., 2014 (2) CPR 19 (Chhatt), Hon'ble Chattisgarh State Commission, Raipur held that a nationalized Insurance Company is not required to resort to plea of limitation to defect just claim of citizens.  The policies were obtained by insured through OP / Insurance Company was not right to repudiate claim of complainants on ground of delayed intimation.  So in the instant case, the policy holder viz., Sirafat Sk died on 08.03.11 due to accident and when he died; the insurance policy was effective & the said policy was in force. 

            In Reliance General Insurance Company Ltd. vs. Sri AVVN Ganesh, (Revision Petition No. – 3572 (2011) wherein Hon'ble N.C.D.R.C., New Delhi held that the delayed intimation of death of the insured due to injuries he suffered on account of the accident cannot be held to be ruinous to the insurance claim because the facts & circumstances of the death were clearly established.  Therefore, unlike in case of theft of movable insured property, the delay in intimation was not prejudicial to the Insurance Company in that it was not prevented, because of the delay, from carrying out any investigation into the facts & circumstances leading to the insurance claim to satisfy itself it the accident and consequent loss fell within the substantive conditions of the Insurance Policy.

            Moreover, the terms & conditions laid down in the policy certificate, as per our view, are not mandatory in nature.  These are regulatory in nature.  Where the case of death by accident is genuine one, in the said situation the repudiation on the ground of delay in intimation is not just and proper.  Because rejection of claim on purely technical grounds in a mechanical fusion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.  In the instance case, when the accident occurred, his family members were naturally highly occupied in the place of Hospital, in the place of police station and at last in place of court of law, which were beyond control of the family members of deceased insured and for these valid reasons they were not in a position to inform the matter forthwith within stipulated period of time before the office of Insurance Company.

            As per our view in the instant case, mere the ground of delay in intimation does not prevent to get the valid claim of the complainant.  There is a clear gross negligence & deficiency in service on the part of the OPs / Insurance Company.  The complainant is entitled to get relief against the OPs / Insurance Company.

            OP No. 3 G.M.S.C. has no role to settle the claim as this institution can act only as an agent of OPs.  So OP No. 3, GMSC is not at all responsible and liable for the said event.

            So it should be the duty of OPs (Insurance Company) to pay the insured amount of  Rs. 3,00,000/- to the complainant.  Point Nos. 2 & 3 are thus decided on the basis of above observation.  The case succeeds. 

           Hence,                                               

                                                              Ordered,

That the case CC/2013/75 be and the same is allowed on contest against the OPs without cost.  The OPs (Insurance Company) are hereby directed to pay the insured amount of Rs. 3,00,000/- to the complainant within 45 days from the date of this order, otherwise, an interest @ 10% p.a. shall be charged upon the awarded amount till full satisfaction. 

Let the copy of order be delivered to the parties free of cost.