Heard the learned counsel for both the sides.
2. This appeal is filed U/S-15 of erstwhile Consumer Protection Act,1986(herein-after called the Act). Hereinafter, the parties to this appeal shall be referred to with reference to their respective status before the learned District Forum.
3. The case of the complainant, in nutshell is that the complainant alongwith deceased son Deepak Das insured their lives with OP-Insurer in respect of accidental death/loss of limits/permanent total disablement for sum assured of Rs.1,00,000/- each and received the policy under Annexure-1. The policy was purchased through OP No.1 &2 under Janata Personal accident insurance policy. It is alleged inter-alia that the policy was purchased for the period covering risk from 23.06.2003 to 22.06.2018.
4. It is alleged inter-alia that during subsistence of the policy the, insured Dipak died on 19.12.2006 due to snake bite. After that the complainant being father made claim application and other documents to OP No.1 & 2 who sent same to OP No.3 & 4 for settlement of the claim. After receipt of the claim, the OP No.3 & 4 remained silent for long time and lastly informed the complainant that the claim application has been received beyond the specified time under the term and condition of the policy from the date of death of the deceased. The OP repudiated the claim without application of mind and without considering the relevant document. Thereafter the complainant being the nominee of his son filed the present complaint.
5. The OP No.1 & 2 filed written version admitting the case of the complainant that the deceased son Deepak Das being the beneficiary under Janata Personal Accident insurance policy had purchased the policy for Rs.1.00 lakhs covering the period from 23.06.2003 to 22.06.2018. It is also averred that after receipt of the claim application and other relevant documents they have sent it to OP No.3 & 4 for settlement. So, he submitted that they have no any claim in this case except the claim by OP No.3 & 4.
6. OP No.3 & 4 filed joint written version stating that the present complaint is liable to be dismissed because of the non-joinder of the necessary party. Their claim is that though the death of Deepak Das occurred on 19.12.2006 due to snake bite but the claim and other documents only received on 24.11.2007 for which they have repudiated the claim.
7. After hearing both the parties, learned District Forum was pleased to dismiss the claim.
8. Learned counsel for the appellant submitted that learned District Forum has committed error in law by not considering the written version with proper perspectives. He submitted that the complainant has informed OP No.1 & 2 for settlement of the claim on 29.12.2006 and they sent same with documents on 12.03.2007. The condition of memorandum of understanding between the OP No.1 & 2 and OP No.3 & 4 to purchase the Janata Personal accident insurance policy and the time limit as governed thereunder binding on parties. There is also agreement between the OP if the valid claim is allowed by OP No.3 & 4, the entire claim would be payable by OP No.3 & 4 Since, the complainant is not a party to the memorandum of understanding, any sort of terms and conditions are not binding on the complainant or the insured who died. Therefore, he submitted that he has informed on time to OP No.1 & 2 and same has already been forwarded to OP No.3 & 4 who falsely alleged that they have received same on 29.11.2007. Therefore, he submitted that learned District Forum ought to have gone through the material on record but he has never applied judicial mind to the fact and law. Therefore, he submitted that the impugned order should be set-aside by allowing the appeal.
9. Learned counsel for the respondent No.1 & 2 submitted that they have already filed the written version stating the entire facts. They admit the case of the complainant and submitted that this is a fault of the insurer for not settling the claim.
10. Learned counsel for respondent no.3 & 4 submitted that they have issued the policy to the OP No.1 & 2 and under that policy the complainant and his minor son are the beneficiaries. He also stated that they have received the insurance claim much later and due to lapse of time they are not able to collect the material for the loss and as such they have repudiated the claim. Learned District Forum has rightly passed the impugned order.
11. Considered the submission of learned counsel for the respective counsels, perused the DFR and impugned order .
12. Learned District Forum has passed the order only on the ground that the complainant has not informed or filed the claim application within time before the OP No.1 & 2 who also did not file same before the OP No.3 & 4 within time for which they have repudiated the claim. Now the only question arises whether the complainant has informed about the death of the beneficiary Deepak Das within time or not.
13. The insurance policy shows that upon the happening of any event giving rise to claim under the policy, insured must give notice then to the insurer forthwith and same should be given with valid reason within one month after event which may give rise to claim under the policy. As such the information by the claimant must be sent within one month to the insurer. The policy does not disclose to whom the policy holder would inform because here there are two beneficiaries and OP No.1 & 2 are also the master policy holders.
14. Be that as it may, the recent affidavit made by OP No.1 & 2 are clear that the complainant informed the OP No.1 & 2 about death of the deceased on 29.12.2006. The death certificate shows that death of the deceased occurred due to snake bite on 19.12.2006. So, the complainant has informed within 30 days to the OP No.1 & 2 who also informed OP No.3 & 4 on 12.03.2007. In between 29.12.2006 to 12.03.2007 there is also good explanation with regard to collection of the medical certificate of the deceased,other documents etc. Since, the learned District Forum has not considered all the facts and law, we are inclined to observe that there is no violation of the terms and conditions of the policy condition by the complainant and the impugned order is liable to be set-aside. It is well settled in law that non-settlement of the claim by the insurer for a long period on filmsy ground is itself a deficiency in service on the part of the OP. We have relied on the decision of Gurmel Singh-Vrs-Branch Manager,National Insurance Co.Ltd. of Supreme Court of India vide Civil Appeal No. 4071 of 2022 decided on 20th May,2022.
15. In the result, the impugned order is set-aside and the appeal is allowed consequently and the complainant is entitled to sum assured from OP No.3 & 4 as per their medical certificate issued on 01.07.2001 whereunder it is written that for non-settlement of any claim whatsoever the responsibility and liability with them and none else. So the OP No.3 & 4 are directed to pay the sum assured of Rs.1,00,000/- to the complainant within a period of 45 days from today, failing which it will carry interest @ 12 % per annum. Besides the complainant is also awarded cost of Rs.20,000/- to pay to the complainant by the OP.
In the result, the appeal is allowed. No cost.
Free copy of the order be supplied to the respective parties or they may download same from the confonet or webtsite of this Commission to treat same as copy of order received from this Commission.
DFR be sent back forthwith.
