SRI JIBAN KRUSHNA BEHERA, MEMBER (I/C)
The complainants have filed this complaint petition, U/s-12 of C.P.Act-1986, (here-in- after called as the “Act”) alleging “deficiency-in-service” against the Opp. Parties claiming compensation.
2. The factual matrix of this case is that on 5.11.2014 the parent of the complainants so also their elder brother died in a motor accident near Barunagadia under Basta PS, Balasore while they returned from Cuttack to their home by a Bolero bearing Regd. No.OD-01D-9043 being dashed by a truck bearing Regd. No.OR-07W-9940. An FIR was lodged before Basta PS which was registered vide Basta PS Case No.232 dated 5.11.2014. The parents of the complainants namely Arati Das and Himansu Sekhar Das were insured under Group Janata Personal Accident Policy bearing No.100300/47/01/96/30009 for the period covered from 8.4.2002 to 7.4.2017 under OP No.1 through OP No.3 & 4 and the life assured Himansu Sekhar Das and Arati Das being the husband and wife were nominee to each other in case of death of one.
Thereafter, the complainants applied for the accidental death benefit in respect of their deceased mother Arati Das to the OP No.1 through OP No.4 along with all the relevant documents on 3.7.2015. OP No.4 has forwarded their claim form to the OP No.1 on 8.7.2015. Again, on compliance to the instruction of OP No.1, the complainants have sent all other documents to OP No.1 on 11.1.2016 through the OP No.4. But the OP No.1 & 2 remained silent over the matter till date for which the complainants are sustaining financial loss and suffering from mental agony, which otherwise amounts to deficiency in service. Hence, this case.
3. OP No.2 did not appear in this case, for which he was set ex parte. OP No.1 appeared and filed his version. OP No.1, denying all the averments made in the complaint, has stated, inter alia, that the Insurance Company has no nexus with the complainants as the JPA policy effective from 8.1.2001 to GTFS through OP No.1 to cover beneficiaries of GMSC on receipt of premium as per terms and condition of MOU. Accordingly, GMSC members for availing of the insurance coverage and FMSC will coordinate with the Insurance Company who covered the deceased Himanshu Sekhar Das and his wife deceased Arati Das under Group JPA Insurance Policy bearing No.1003/00/47/01/9600022/96/30007 for the period from 8.4.2002 to 7.4.2017 for sum insured of Rs. 4,00,000/- and Rs.1,00,000/- respectively. Further, the complainants are not the nominee of deceased Arati Das under the said Group JPA Policy. It is stated that complainant No.1 has only lodged the claim for death benefit of deceased Arati Das without disclosing the fact that there are other legal heirs and to that effect no affidavit of disclaimer has been submitted before them for which the matter could not be settled. Hence, the question of harassment and deficiency in service does not arise at all. That apart, the claimants have not produced all required documents for settlement of the claim. It is further stated that the complainant No.1 has intimated the fact of death of deceased Arati Das to OP No.1 through OP No.3 on 13.5.2015 i.e. after 5 months of the death of the deceased and thereby they have violated the terms and conditions of the policy. Hence, the OP No.1 prayed to dismiss the case with cost.
4. In the present case, OP No.3 & 4 appeared and filed their joint version wherein they have specifically stated that the parent of the complainants were covered under the same JPA Insurance policy from the OP-Insurance Company which was covered from 8.4.2002 to 7.4.2017 for sum insured of Rs.4,00,000/- and Rs.1,00,000/- respectively and both of them died on a road accident on 5.11.2015 and the complainants are their legal heirs. The OP-Insurance Company empowers them to extend insurance coverage to its members, hence the OP-Insurance Company has exclusive right to settle the claim. On the other hand, they have no role to play regarding settlement of claim, payment of insurance claim and delay in settlement of the claim or rejection of the claim. They are only the facilitator to the insurance coverage granted by the OP-Insurance Company. It is admitted by these Ops that to obtain benefit under the policy in question from the OP-Insurance Company the nominee claimants are running from pillar to post and being aggrieved they have approached before this Commission. The case is filed within the jurisdiction of this Commission and the settlement of the claim is beyond their authority.
5. In view of the above averments of parties, the points for determination in this case are as follows:-
(i) Whether the complainant is a consumer or not?
(ii) Whether the complainant has cause of action to file this case?
(iii) Whether this consumer case is maintainable?
(iv) Whether there is any deficiency in service on the part of the OPs?
(v) Whether the complainant is entitled to get the relief, as sought for?
(vi) To what other relief(s), the Complainant is entitled to?
F I N D I N G S
6. On a meticulous scanning of the documents produced on behalf of the respective contesting parties, admittedly it is found that the deceased parent of the complainants had obtained Insurance Policy bearing No.1003/00/47/01/9600022/96/30007 granted by the OP-Insurance Company and Himanshu Sekhar Das and Arati Das, the parents of the complainants, were covered under Group Janata Personal Accident Insurance covered from 8.4.2002 to 7.4.2017. Both the life assured along with their son admittedly died on 5.11.2014 in a road accident near Barunagadia under Basta PS, Balasore while they returned from Cuttack to their home by a Bolero bearing Regd. No.OD-01D-9043 being dashed by a truck bearing Regd. No.OR-07W-9940, as reflected from the FIR lodged before Basta PS registered vide Basta PS Case No.232 dated 5.11.2014. Photocopy of the death certificate issued by the competent authority also shows the date of death of deceased Arati Das. From the above, it is held that OP-National Insurance Company had issued the policy bond in question in favour of deceased Himanshu Sekhar Das and Arati Das and their death occurred when the policy was valid.
7. In the present case, OP No.1 & 2 are sister concerned whereas OP No.3 & 4 are also sister concerned. OP No.1 has agitated that they have no role to play in the matter as they have not issued the policy bond, rather, it was issued through the OP No.3 & 4. On perusal of the documents relied on by the OP No.3 & 4, it is seen that National Insurance Company Limited vide their memorandum dated 17.7.2001 have empowered them to cater personal line insurance policies like personal accident insurance policy to their members. In the present case, it is admitted by Ops that deceased Himanshu Sekhar Das and Arati Das were the members under them. Further, the Insurance Company vide their letter dated 30.9.2000 and dated 17.7.2001 agreed to allow the OP No.3 & 4 to extent the insurance coverage of Personal Accident Policy to their members. In their letter dated 17.7.2001, Insurance Company authorized the OP No.3 & 4 to collect premium from the members of the club on behalf of their company and remit them and the Insurance Company will extent the desired insurance coverage to the members. No doubt, the deceased parent of the complainants had purchased the insurance policy in question from the OP No.1 & 2 through the OP No.3 & 4. As it is seen, the OP No.3 & 4 are playing the role of a mediator between the customers and Insurance Company and the question of profit is best known to the Insurance Company. To sum up the issue, it is held that OP No.1 & 2 have issued the Policy Bond in question in favour of deceased parent of the complainants either through the OP No.3 & 4 or direct to the parent of the complainants. On the other hand, Ops did not have raised any objection to the effect that the Policy bond in question has not been issued by the OP-Insurance Company. That apart, OP-Insurance Company have not also raised any claim that they have no knowledge about the insurance policy in question in favour of the life assured Arati Das. Further, OP No.3 & 4 have admitted that OP-Insurance Company have exclusive right to settle the claim, payment of insurance claim and rejection of the claim and they are only the facilitator to the insurance coverage granted by the OP-Insurance Company. It is also admitted by OP No.3 & 4 that to obtain benefit under the policy in question from the OP-Insurance Company the nominee claimants are running from pillar to post and being aggrieved they have approached before this Commission. From the above discussions, it is held that the OP-Insurance Company are liable to settle and pay the death benefits in respect of the policy in question and the OP No.3 & 4 have no role to play in the matter.
8. Regarding the disbursement of the death benefit under the Insurance Policy of this case, admittedly, the OP-Insurance Company has not yet repudiated the claim of the complainants, rather, it has not been settled for not submission of the required documents. But at the same time, it is required to be threshed out whether the claim is not settled due to the fault on the part of the OP-Insurance Company or otherwise. It is claimed by the OP-Insurance Company that the complainant No.1 has only lodged the claim for death benefit of deceased Arati Das without disclosing the fact that there are other legal heirs and to that effect no affidavit of disclaimer has been submitted before them for which the matter could not be settled. It is further claimed that the complainant No.1 has intimated the fact of death of deceased Arati Das to OP No.1 through OP No.3 on 13.5.2015 i.e. after 5 months of the death of the deceased and thereby they have violated the terms and conditions of the policy. In this regard, it is seen that complainant No.1 had sworn an affidavit before the Executive Magistrate, Balasore on 14.10.2015 for the purpose of claim amount for the death of his mother Arati Das and obtained one Inheritance Certificate from the competent authority dated 4.6.2015 along with one certificate issued by Gram Panchayat regarding legal heir, which was found to have been forwarded to the OP-Insurance Company by OP No.3 & 4. On the other hand, it is seen that complainant No.1 is the only son of deceased life assured, who was perhaps aged about 24 years at the time of demise of his parent. After the sad demise of his parent, a boy, at this age, not only became helpless in the society but also might have lost his cognizance in respect of his future. In that situation, collection of all relevant documents, as demanded by the OP-Insurance Company, is out of imagination. However, it is seen that the complainant No.1 has collected all the required documents and submitted the same before the OP-Insurance Company though the OP No.3 & 4 and in the aforesaid background, the delay, as agitated by the OP-Insurance Company sounds no good. In the above facts and circumstances, it cannot be said that the complainants are not entitled to get the death benefit of their deceased life assured mother Arati Das. But, as it is seen that the OP-Insurance Company has withheld the claim of the complainants in flimsy grounds since 2015 till today which should have been settled just after receiving all the documents.
9. From the above discussions made in the foregoing paragraphs, this Commission is of the considered opinion that the complainants have cause of action to file the case and the case is maintainable. It is further held that the OP No.1 & 2 are deficient in rendering their service towards the complainants. Consequently, the complainants are entitled to get the reliefs, as claimed for.
Hence, it is ordered –
O R D E R
The case of the complainants be and the same is allowed on contest against O.P No.1 & on ex-parte against O.P No.2 and dismissed against the O.Ps No.3 & 4. The O.Ps No.1 & 2 are hereby directed to:-
- pay the sum assured amount of Rs.1,00,000/- along with other benefits as per Policy Provision in respect of policy No. 100300/47/01/96/30009 to the complainants with interest @ 9% per annum from 05.11.2014 till its actual realization.
- pay compensation of Rs.50,000/- towards harassment, mental agony along with litigation cost to the complainants.
All the aforesaid ordered amounts will be paid by the O.Ps No.1 & 2 to the complainants within 45 days from the date of receipt of this order, failing which the complainants are at liberty to realize the same from the O.Ps No.1 & 2 through the process of law.
Pronounced in the open Court of this Commission, this day i.e. the 11th day of November, 2024 given under my signature & seal of the Commission.
