West Bengal

Paschim Midnapore

CC/176/2016

Saraswati Kalsar - Complainant(s)

Versus

Manager, SBI General Insurance Co.Ltd. - Opp.Party(s)

27 Apr 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.                             

Bibekananda Pramanik, President,

Pulak Kumar Singha, Member

and

Smt. Sagarika Sarkar, Member

    

Complaint Case No.176/2016

 

Saraswati Kalsar, W/O Lakshan Kalsar, Vill. Shripur,

P.O. Ghatal, P.S. Ghatal, Pin-721212,

Dist-Paschim Medinipur…..….………Complainant

Versus

1. Manager, S.B.I. General Insurance Co.Ltd. ,  4^th Floor, Block-B,

          Apeejay House, 15 Park Street, Kolkata-16.

        2) Branch Manager, State Bank of India, Ghatal Branch,

             At- Konnagar, P.O. & P.S. Ghatal, Pin-721212,

Dist- Paschim Medinipur………….Ops.

 

 For the Complainant:   Mr. Apurba Chakraborty, Advocate.

 For the O.P.             :   Mr. Pinaki Sengupta,     Advocate.                         

 

                                                 Decided on: -27/04/2017                             

ORDER

 Mr. Pulak Kumar Singha, Member :  This is a complaint case U/S 12 of the C.P. Act, 1986.

               In short the case of the complainant is that the complainant’s son had one savings Bank A/c at State Bank of India, Ghatal Branch P.O. Ghatal, Dist. Paschim Medinipur i.e. with Op. no.2. The said A/c holder Arup Kalsar since deceased had purchased one insurance policy of sum assured of Rs. 2,00,000/- being policy No. 143820-0000-00 from

Cond……………….P/2

( 2 )

 Op. no.1 through Op. no.2 over savings A/c of said Arup Kalsar. The said A/c holder of Op. no.2 died on 27/02/2015. The complainant was the nominee of deceased Arup Kalsar and she lodged claim for getting insurance benefit from Op. no.1 and submitted relevant documents to Op. no.2. But Op. no.1 did not pay heed to settle the claim of complainant for which complainant appears before this Forum for getting redressal as per prayer of her complaint.

             Op. no. 1 contested the case by filling written version denying the allegations of complainant stating inter alia that the complaint is barred by limitation. That the claim was intimated over telephone on 23/07/2015 but no documents has been submitted. This Op. has been rejected the claim as per terms of the policy condition. This Op. has no deficiency of service and the present case is not entertained.

             Op no.2 contested the case by filing written version stating inter alia that this Op.no.2 has no deficiency of service.  Op. No.1 is the insurer of the complainant and Op. no.1 is liable to pay compensation. This Op prayed for dismissal of the case.

                                                   Points for decision :-

1. Whether the case is barred by limitation?
2. Whether the Ops are liable to pay the compensation to the complainant?
3. Whether the complainant is entitled to get the insurance claim amount from Ops?

                                      Decision with reasons

We have perused the document i.e. S.B.I pass book of deceased Arup Kalsar, PA Insurance cover confirmation, letter of Op no.1, death certificate, P.M report, charge sheet, seizure list and letter of complainant.  Complainant by filing a complaint stating that her son had a savings bank account with accidental insurance cover over the said account being savings account no.33200156127 with op nos.1 and 2 and insurance policy no.143820-0000-00 valid for the period from 22/12/2014 to 21/12/2015.  Both ops have filed written version but adduced no evidence on their side.  Complainant adduced evidence and ops have cross examined the witness.  Op no.2 admitted that they have received the relevant documents from complainant and it also corroborate by op no.1.  Op no.1 by filing w/v stated that as they have not received any documents regarding claim, so op no.1 has no deficiency in service.  Op no.1 also stated in their w/v that they have repudiated the claim by their letter dated 6/5/2016 due to non receipt of document.  Op no.2 by filing w/v stated that op no.1 is the insurer and they are liable to pay the compensation. 

Cond……………….P/3

 

( 3 )

               From the case record and w/v of op no.1 , we find that complainant lodged claim to the op no.1 through op no.2 , with all relevant documents after the death of insured person and op no.1 admits that they have rejected the claim vide their letter dated 6/5/2016 and this complainant has filed this case on 8/11/2016.  The insured person died on 27/02/2015 and claimed lodged within short period to the Ops. and case was filed on 08/11/2011 i.e. within two years from the date of cause of action so there is no question of limitation. It is admitted by the Ops. that Arup Kalsar had accidental insurance cover through his savings bank account and it appears from the documents that said Arup Kalsar died on 27/2/2015 due to motor vehicle accident and in this respect police case has started and charge sheet also submitted by the concerned police station and P.M examination also held.  So accidental death is proved of deceased Arup Kalsar and as per policy condition the legal heirs or nominee is entitled to get the insurance amount.

                  In this case, complainant is the mother as well as the nominee of her deceased son Arup Kalser and she is entitled to sum assured from Op. no.1 i.e. Insurance Company.  The complainant is an illiterate rustic village women and she had no clear conception that who will pay the compensation and she never get in touch with op no.1 so she had submitted to relevant documents of accidental death of her son to op no.2 where the deceased had bank account and op no.2 also delivered the documents to op no.1.  It is very usual practice that op nos.1&2 have a tie up for the purpose of their business relation for such op no.2 debited the premium amount from the accounts holder’s account and sent the amount to the op no.1 and after receiving the premium amount the op no.1 issued the insurance policy.  As op no.1 received claim intimation from complainant and also through op no. 2 so, op no.1 could easily collect documents from op no.2 as they received premium amount from op no.2.  It is clear avoiding tendency to settle the claim by the insurer where claimant is an illiterate women, having no knowledge about the system of claim settlement.  But in business relation there is a very good tie up between op nos.1 & 2.  In usual practice we find that insurer always ready to accept the premium amount from the intending policy holder like deceased but they are very reluctant regarding the settlement of claim.  It appears from the case record that op no.2 never denied that they have not received any documents regarding insurance claim from the complainant rather op no.2 stated in their w/v that op no.1 is the insurer of deceased and they are liable to pay

 

Cond……………….P/4

 

( 4 )

compensation.  Op no.2 should also take care for processing the claim with op no.1 as both the ops have a good tie up relation for the purpose of development of their insurance business.  Complainant herself also sent a letter requesting to op no.2 to arrange for payment of compensation but  O.P. no.2 kept silent over the matter.

                 In view of the discussions here in before we find both the Ops. have deficiency of service and they deliberately harassed the complainant and negligent regarding settlement of claim for which complainant sustained immense mental pain and agony and huge monetary loss. For such act of Ops. negligence and deficiency of service is proved. So the complainant is entitled to get an order and compensation as prayed for.

                   In result, the case succeed.

                                               Hence,                                      

                                                         Ordered

                    That the instant case be and the same is allowed on contest against Op. nos. 1 and 2 with cost of Rs. 5,000/- each.

                   Op. no.1 is directed to pay Rs. 2,00,000/-(Two Lakhs) as sum assured amount to the complainant within one month from the date of this order.

Op. no.1 and 2 are jointly and severally are directed to pay an amount of Rs. 20,000/- as compensation for causing mental pain, agony, harassment and monetary loss to the complainant within the stipulated period in default Ops. shall be liable to pay 9% interest of total awarded amount till realization of full satisfaction.  

                   

Dictated and Corrected by me

      

                Member                                               Member                             President

                                                                                                                     District Forum

                                                                                                                 Paschim Medinipur