In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 110 / 2008 1) Md. Sabed Ali, Vill. Bagila, P.O. Patnour, P.S. Karandighi, Dist. Uttar Dinajpur, Pin-733201. ---------- Complainant ---Verses--- 1) National Insurance Co. Ltd., 1, Shakespeare Sarani, Kolkata-71. 2) The Sr. Divisional Manager, National Insurance Co. Ltd., 1, Shakespeare Sarani, Kolkata-71. 3) The Golden Trust Financial Services, 16, R.N. Mukherji Road, Kolkata-700001. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattachatya, Member. Order No. 1 5 Dated 1 5 / 0 1 / 2 0 1 0 . Instant case arises out of the petition of complaint u/s 12 of C.P. Act, 1986 filed by Md. Sabed Ali of village-Bagila, P.O. Patnpur, P.S. Karandighi, Dist. Uttar Dinajpur, Pin-733201 on 9.4.08 against (1) National insurance Co. Ltd., Division-III at 1, Shakespeare Sarani, 6th floor, Kolkata-71, (2) Senior Divisional Manager, National Insurance Co. ltd., Division-III at 1, Shakespeare Sarani, 6th floor, Kolkata-71 and (3) Proforma o.p. viz. Golden Trust Financial Services, at 16, R.N. Mukherjee Road, Kolkata-1 with a prayer to pass order directing the o.p. nos.1 and 2 to pay the complainant the sum assured in the policy amounting to Rs.2 lakh along with interest of 18% p.a. from the date when it became due till payment. Specific case is that Md. Alim, the deceased was a member of Golden Multi Services Club of Golden Trust Financial Services (GTFS), proforma o.p. no.3 and was extended with insurance coverage under a policy, viz. Group Janata Personal Accident Insurance Policy of o.p. no.1 through the o.p. no.3 and the complainant is a nominee in such policy. The particulars of such policy is given below : Policy no. – 100300/47/01/9600022/02/96/30208 Serial no. – 01445019/102030626585 Period of cover – 23.9.2002 to 22.9.2007 (midnight) Policy amount – Rs.2,00,000/- Risk covered – Accidental death/loss of limbs/permanent total disablement.(annex-A-1). On 1.4.03 at about 06-00 hrs. in the morning the son, viz. Md. Alim while moving towards Jamsedpur from Baharagora driving trailor a bearing no. HR 38E/7164 was collided with a truck bearing no.WB 33/3103 which was coming from the opposite direction with rash and negligent manner. As a result, the driver of the said trailer, i.e. the son of the complainant sustained severe injuries on his person. Local people immediately took him to M.G.M. Medical College Hospital, Jamsedpur and thereafter for better treatment he was transferred to Alam Nursing Home, Islampur, Dinajpur, W.B. where he expired on 12.4.03. One Bikram Murmu of Chingora, P.S. Baharagora, Dist. Purba Singbhum lodged a report to Baharagora P.S. and a case had been registered being Baharagora P.S. C/no. 34/03 dt.1.4.03 u/s 279/337/338/427 IPC (annex-A-2). Post Mortem was held over the dead body of the said deceased on 13.4.03 at Islampur S.D. Hospital, Uttar Dinajpur and in the said P.M. Report , it was opined that due to shock as a consequence of severe wounds and intestinal injury. Antimortem in nature. Injury may be due to RTA (annex-A-3). The Sub-Registrar (Birth & Death), Raniganj Gram Panchayat, P.O. Patnpur, Dist. Uttar Dinajpur, Health Deptt. issued a death certificate on 16.4.03 in respect of the death of Md. Alim (annex-A-4). Owing to some discrepancies in respect of the name of the deceased son of the complainant which had been recorded in the P.M. Report and the discharge certificate, the complainant rectified those discrepancies by affirming an affidavit that Md. Alim, Abdul Alim and Abdul Halim was the same and identical person (annex-A-5). After giving intimation of the unfortunate death of his son by the complainant to GTFS proforma O.P. no.3 on 11.7.03, he was advised by them to submit claim form duly filled in along with relevant papers / documents for processing the accidental death claim of his deceased son. Accordingly, the complainant submitted his claim form to the o.p. no.1 through GTFS, proforma o.p. no.3 on 15.12.03 after dully filled in the claim form along with all relevant documents for immediate settlement of the claim and his claim had been registered by GTFS as GTFS claim reference no.NIC/JPA/2004/339 and GTFS after proper verification forwarded the said claim form along with relevant papers to o.p. no.1 for settlement of the complainant’s claim in due time. After expiry of more than six months from the date of submission of claim papers, the o.p. no.2 on 15.2.05 by issuing a letter to the complainant intimated that his claim has been repudiated as ‘no claim’ since he has violated policy condition no.1 by submitting his claim intimation on 11.7.03, i.e. he has intimated the accidental death of the insured person after 3 months 10 days from the date of accident (annex-A-6). Immediately after receiving the said repudiation letter from the o.p. no.2, the complainant replied the same by issuing a letter to the o.p. no.2 that since the accident took place at Jamsedpur which was far from his place of residence, it took naturally much time to obtain copy of FIR, charge sheet and other related documents. Apart from that he had to obtain the copy of death certificate and P.M. Report from the hospital and Panchayat concerned. It is also worth mentioning that after the sudden death of his son, the complainant became mentally imbalanced and much time was required to recover from mental trauma (annex-A-7). In this case, no efforts had been taken by the o.p. nos.1 and 2 in the event of such mishap in the complainant’s family to look into the reasonable cause justifying the delay, if any. In this manner, the o.p. nos.1 and 2 h have violated the principles of “natural Justice and Equity”. The o.p. nos.1 and 2 in their policy condition no.1 have quoted that such claim intimation shall have full particulars of the claim. Therefore, they failed to appreciate that in an accidental claim, the details/full particulars of an accident were to be obtained from the different departments/authorities over which the claimant or any member of the deceased’s family had any control. Unless the particulars of the claim are made available, it is not possible for the complainant to submit the claims (annex-A-7). In spite of all these facts, the claim is repudiated by o.p. nos.1 and 2. Hence, the case has been filed by the complainant u/s 12 C.P. Act, 1986. Decision with reasons :- Perused the petition of complaint, w/v of proforma o.p. no.3, affidavit of evidence of complainant, BNA of the complainant and proforma o.p. no.3 and documents on record. It is a fact that a Group Janata Personal Accident Insurance Policy bearing no.100300/47/01/9600022/02/96/30208 was purchased by the deceased declaring Md. Sabed Ali as his nominee for the period from 23.9.02 to 22.9.17 (midnight) for Rs.2,00,000/- on the risk covered against accidental death/loss of limbs/permanent total disablement (annex-A-1). The policy holder met with a motor accident on 1.4.03 at about 06-00 hrs. in the morning in the area of Baharagora under Jamsedpur vide Baharagora P.S. case no.34/03 dt.1.4.03 u/s 279/337/338/427 IPC lodged by one Bikram Murmu of Chingora, P.S. Baharagora, Dist. Purba Singbhum, (annex-A-2). The injured was taken to M.G.M. Medical College Hospital, Jamsedpur by the local people. The injured policy holder was t hereafter shifted to Alam Nursing Home, Islampur, Uttar Dinajpur, W.B. where he expired on 12.4.03 (annex-A-3, A-4). The claim was submitted to the o.p. nos.1 and 2through proforma o.p. no.3 along with relevant papers which was admitted by proforma o.p. no.3 (annex-A-6). The delay in submitting the claim within one month from the date of occurrence has been well explained by the complainant by his letter dt.15.2.05 addressed to the o.p. no.2 (annex-A-7). In this connection, the observation of Hon’ble Supreme Court of India reported in the case of United India Insurance Co. Ltd. v. Manubhai Dharmasinhbhai Gajera and others (Hon’ble Supreme Court) (CP), P.794, is worth mentioning. In its observation, the Hon’ble Supreme Court of India opines that no escape from the fact that the o.p. nos.1 and 2 being the nationalized insurance company are “State” within the meaning of Article 12 of the Constitution of India. Being a State, they have a different role to play. Fairness or reasonableness on their part must appear in all their dealings. Functions of the insurance companies are also governed by their statute. Insurance Act applies to them. Public sector insurance companies also bound by the directions issued by the General Insurance Corporation as also the Central Government. A contract of insurance, therefore, must subserve the statutory provisions. It must also necessarily be construed having regard to the larger public policy and public interest. It may also be worth mentioning here that if nationalized insurance companies repudiate the claim on the ground of delay in submitting the claim, ignoring the fact that the delay in submitting the claims is inevitable, then it is not only inhuman but also goes against the directive principle of the Constitution of India. If this attitude of the nationalized insurance companies continues, then the people belonging to the middle income and lower income group will be less interested in taking such policy. Except proforma o.p. no.3 who forwarded the claim form after looking into the details to o.p. no.1, no w/v was filed by o.p. nos.1 and 2 which indicates that they had nothing to state against the allegations brought by the complainant. In fact, o.p. nos.1 and 2 have waived their right to controvert the allegations brought by the complainant by not filing w/v far to speak of affidavit of evidence and BNA. Thus, the complainant succeed the case. Hence, ordered, that the o.p. nos.1 and 2 are directed jointly and /or severally to (a) pay Rs.2,00,000/- (Rupees two lakhs) only being the assured money as per policy towards the accidental death of the policy holder, (b) pay compensation to the complainant to the tune of Rs.25,000/- (Rupees twenty five thousand) only and (c) pay litigation cost of Rs.5000/- (Rupees five thousand) only within thirty days from the date of communication of this order and in default, the aforesaid amounts will carry an interest @ 10% p.a. till its recovery in full. Fees paid are correct. The case is thus disposed of from this Forum. Supply certified copy of this order to the parties on receipt of prescribed fees. ____Sd-_____ ____Sd-______ MEMBER PRESIDENT | 
