In the Court of the Consumer Disputes Redressal Forum, Unit -I, Kolkata, 8B, Nelie Sengupta Sarani, Kolkata-700087. CDF/Unit-I/Case No. 285 / 2008 1) Mr. Narendra Kumar, Vill. Tilakpura, P.O. Amhara, Nawatpur, Patna, Bihar. ---------- Complainant ---Verses--- 1) M/s. National Insurance Co. Ltd., 3, Middleton Street, Kolkata-71. 2) M/s. Golden Multi Services Club Ltd., S.B. Mansion, 16, R.N. Mukherjee Road, Kolkata-700001. ---------- Opposite Party Present : Sri S. K. Majumdar, President. Sri T.K. Bhattacharya, Member Order No. 1 4 Dated 0 9 / 0 3 / 2 0 1 0 . Instant case arises out of the petition of complaint filed by the complainant Narendra Kumar on 19.8.08 u/s 12 of C.P. Act, 1986 against (1) National Insurance Co. Ltd., 3, Middleton Street, Kolkata-71 and (2) Golden Multi Services Club Ltd., S.B. Mansion, 16, R. N. Mukherjee Road, Kolkata-1 with a prayer to direct the o.ps. to make payment of Rs.5,00,000/- as per policy of his deceased wife Saroj Devi along with compensation of Rs.10,000/- for harassment and sufferings of the complainant and to pass such other order/orders for the ends of justice. Specific case is that the complainant, husband of Saroj Devi since dead, purchased an insurance policy being Janata Personal Accident Insurance Pllicy bearing no.100300/42/04/8200012 for the period from 1.9.04 to 31.8.14 from o.p. no.1 through o.p. no.2 vide its endorsement no.100300/42/04/82/30072 for Rs.5,00,000/- in the name of Saroj Devi with Narandra Kumar, the complainant as nominee (annex-A). On 6.8.07 at 4-00 p.m. Saroj Devi, the wife of the complainant, sustained head injuries by falling from the bamboo stairs coming down from the roof of the residential house at Vill- Tilakpara, P.O. Amhara, P.S. Nawatpur, Dist- Patna, Bihar and succumbed to the injuries in spite of he treatment by the Dr. Phani Bhusan Acharya of Bihata, Patna. In this regard, the death certificate was also given by the said doctor (annex-C). The complainant immediately after this mishap on 5.9.07 by way of claim intimation form informed the o.p. no.1 through his Patna office who asked the complainant to inform the matter to Kolkata office, i.e. office of o.p. no.1 at Kolkata for claim (annex-D & D1). Accordingly, the complainant sent the claim form duly filled in with all particulars to o.p. no.1 at Kolkata by regd. post with a/d on 7.9.07 (annex-E & E1). Copy of the same was also sent to o.p. no.2 by regd. post with a/d on 8.9.07 (annex-E & E2). The o.p. no.2 on receipt of the copy of the claim form from the complainant on 10.9.07 at Kolkata immediately forwarded the same to o.p. no.1, Sr. Divisional manager, National Insurance Co. Ltd., Division-III, 8, India Exchange Place (Gr. Floor), Kolkata-1 for further processing the matter favourably (annex-G). But the complainant instead of getting the claimed amount from o.p. no.1, received a letter no.100300/GTFS/GPA dt.5.5.08 from o.p. no.1 intimating the complainant that his claim being time barred and for non submission of certain required documents has become “NO CLAIM” (annex-F). In view of this position, Mr. K. Pandey, ld. Advocate for the complainant issued a demand notice dt.26.6.08 to o.p. no.1 with a copy to o.p. no.2 by regd. post with a/d on 26.6.08 (annex- demand notice of the ld. Advocate, H1 & H2). The o.p. no.2 in their letter dt.1.7.08 responded to the above noted demand notice intimating that they were forwarding the said legal notice of the ld. Advocate to o.p. no.1 for taking appropriate action in this matter with a copy to the complainant with a request to furnish the desired papers and information to o.p. no.1 for doing their needful in the matter (annex-J). But o.p. no.1 in spite of receiving the said demand notice, did not make any response. Hence, the complainant filed this case u/s 12 of C.P. Act, 1986. Decision with reasons :- Perused the petition of complaint, w/v of o.p. no.2, evidence on affidavit of the complainant, reply on affidavit by the complainant, affidavit of evidence by o.p. 2, BNA of o.p. no.2 and complainant and documents on record. O.p. no.1 was absent from the outset of this case and for which ex parte order was passed against o.p. no.1 vide order no.6 dt.9.3.09. It is evident from the above and records that the demand notice of the ld. Advocate for the complainant was initiated on 26.6.08 to which no response was made by o.p. no.1 and the petition of complaint was filed on 19.8.08 and as such, the petition of complaint was filed within prescribed time limits. This apart, the claim intimation form was sent by the complainant to the o.p. no.1 at Kolkata office through their Patna office after 6 days from the prescribed date laid down in the policy. The o.p. no.1 was also mentioning that the complainant submitted the documents after a lapse of 8 months and 23 days from the date of demise of the wife of the complainant on 6.8.07. It is worth mentioning that the complainant intimated the sudden accidental death of his wife at her younger age to the Patna office of o.p. no.1 at first and then on the instruction of the Patna office, the complainant sent the claim form to o.p. no.1 at Kolkata office. The o.p. no.2 in all their statement had all along supported the cause of he complainant with a request to the o.p. no.1 to deal the matter of the claim of the complainant favourably. In this connection, the decision of the Hon’ble Supreme Court of India in United India Insurance Co. Ltd. vs. Manubhai Dharmasinbhai Gajera and others as reported in (Supreme Court) (CP) p-794 is worth mentioning “No escape from the fact that the appellants are ‘State’ within the meaning of Article 12 of the Constitution of India – being a ‘State’ they have a different roles to play– Fairness and 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 this 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”. From the records, it is evident that the o.p. no.1 has not filed w/v in spite of receipt of the notice vide order no.5 dt.27.1.09. For non appearance of o.p. no.1 since the initiation of the case and non-submission of w/v, ex parte order against o.p. no.1 was passed vide order no.6 dt.9.3.09. By their non-appearance and non-submission of w/v the o.p. no.1 have waived their right by themselves to defend the case against the allegation of the complainant. Rather it indicates that they have nothing in their hands to controvert the allegations of the complainant. It is also evident from the documents on record that the complainant not only informed the o.p. nos.1 and 2 regarding the accidental death of his wife, but also informed the same to the Gram Panchayet Mukhia (annex-B1), Gram Panchayet Sarpanch (annex-B) and Gramin Police (annex-B2) immediately after the sad demise of his wife at her young age. The complainant also sent the death certificate no.677058 dt.12.8.07 issued by the cremation authority (annex-BA attached with evidence on affidavit of the complainant), death certificate issued by Dr. Phani Bhusan Acharya dt.6.8.07 (annex-C) and claim information sent by the complainant to the office of o.p. no.1 of Patna dt.5.9.07 (annex-D) with the claim form sent to o.p. no.1. The o.p. no.2 in his evidence on affidavit has stated that they act as insured’s facilitator and are not the authorized agent / corporate agent / institutionised agent of o.p. no.1 for the said insurance coverage to its member, without having any liability about the settlement of the claim (annex- Annex-II of w/v of o.p. no.2). The also state that after the accidental death of Saroj Devi, they forwarded some essential supporting documents to o.p. no.1 vide their letter dt.29.4.08 requesting for early settlement of the claim (annex-III of evidence on affidavit of o.p. no.2). In its BNA, the o.p. no.2 has brought a most pertinent question which is as follows – “it is important to point out that it is the usual practice of insurance company to repudiate claims if the claimant does not send intimation to the insurance company within one calendar month from the date of accident of death, as the case may be. It is unclear……. as to how delayed information can adversely affect the insurance company, so much so, that they go to the extent of repudiating a claim. The time limits stipulated are not at all practicable to comply with for variety of reasons, leaving the claimant on the path of harassment, leading to extreme step of repudiation of claim on filmsy technical grounds, undermining the spirit of insurance of coverage. After a family faces an accidental tragedy that leaves a person (often the only earning member) permanently disabled or results in death, being concerned about an insurance policy and complying with it’s stipulated time limits is usually the last recourse that crosses the minds of the bereaved family members. Keeping these harsh truths of life in their minds, the framers of these conditions had also made accommodation for delay in intimation by using the words ‘unless reasonable cause” is shown, the insured should within one calendar month after the event which may give rise to a claim under this policy give written notice to the company with all particulars of the claim. Unfortunately, of late, insurance companies are all too busy to repudiate claims on trivial technical grounds”. The delay which was not long on the part of the complainant in submitting the claim form should be considered on ground realities. It is to be perceived that with sudden accidental death of the wife at her younger age, the husband of the deceased wife, i.e. the complainant became perplexed and under trauma, which is quite natural. In this situation no human being, but a brutal one, could think of sending of either intimation to the insurance company or sending claim form to o.p. no.1. This state of mind of the complainant should be considered by the o.p. no.1 on compassionate ground. This should also be done in view of the observation of Hon’ble Supreme Court of India in United India Insurance Co. Ltd. vs. Manubhai Dharmasinbhai Gajera and others (Supreme Court) (CP) page 749, the details of which is noted above. In view of the above, we are of the opinion that the o.p. no.1 being the nationalized organization should have compassion for the insured ignoring the trivial technicalities, which is the motto of the Hon’ble Supreme Court’s decision noted above. Thus, we are of the opinion that the complainant succeeds the case. Hence, ordered, that o.p. no.1 is directed to pay (1) Rs.5,00,000/- (Rupees five lakhs) only due to be payable against the Group Personal Accidental Policy of Saroj Devi with National Insurance Co. Ltd. within thirty days from the date of communication of this order and in default, the amount will carry an interest @ 10% p.a. till the full recovery of the amount, (2) compensation amounting to Rs.10,000/- (Rupees ten thousand) only for mental suffering and harassment of the complainant within thirty days from the date of communication of this order and in default, the amount will carry an interest @ 10% p.a. till the full recovery of the amount and (3) litigation cost of Rs.Rs.5000/- (Rupees five thousand) only within thirty days from the date of communication of this order and in default, the amount will carry an interest @ 10% p.a. till the full recovery of the amount. 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
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