This is a complaint U/s 12 of the Consumer Protection Act, 1986 with a prayer directing the O.P. No.1 and 2, National Insurance Company Limited to pay Rs.5,00,000/- as claim amount and proper compensation for harassment and also for litigation cost of Rs.5,000/- from O.Ps.

The complaint, Pahiran Nesa wife of Late Jumaruddin @ Md. Jamiruddin is resident under Chopra PS of district Dinajpur. Her husband purchased an insurance policy of National Insurance Company Limited through its agent O.P. No.3, Golden Trust Financial Services being policy No.100300/47/01/960022/03 /96/30291, valid from 23.11.2003 to 22.11.2018, sum assured at Rs.5,00,000/-. The petitioner is the nominee of this policy. Husband of the complainant died on 24.02.2011 following motor accident on 23.02.2011 and a police case was initiated on 23.02.2011. After incident she informed the matter to the insurance company and made a claim for the sum assured in the policy. On 05.08.2011 O.P. No.3, GTFS issued a letter informing that the complainant would be asked to submit claim papers within 15 days and she complied then O.P. No.3 on 02.09.2011 issued further letter in this regard. That complainant is not so literate person. Lastly O.P. No.1 issued a letter informing complainant that they note her inability to submit IT return and that if she agrees to settle the claim on compromise basis requesting her to get in touch with the competent authority during office hours. The complainant continuously contacted with O.P. No.3, GTFS, but no action has been taken for payment of the sum assured. That, cause of action arose on and from 30.07.2013 when last letter was issued by O.P. No.3 and thereafter day by day and she filed the instant case with the above mentioned prayer.  

O.P. No. 1 & 2, National Insurance Company Limited contested this case by filing written version and stated that the case is barred by limitation and it is bad for non-joinder of necessary parties and O.Ps. denied the cause of action of this case etc. That the O.P. company received the claim of the petitioner and issued a letter dated 13.03.2013 after verification of the file, and asked the claimant some documents like IT return of 2003 – 04 within 15 days. As the petitioner failed to submit the income proof of the deceased husband of the petitioner, this O.P. could not settle the claim. That the O.P. has no other deficiency or negligence in service and prays for dismissal of this case.

O.P. No.3, Golden Trust Financial Service admitted that husband died on 24.02.2011 following a road accident and FIR has lodged. That this O.P. as insured facilitator and not as authorized agent or corporate agent of insurance company for the said insurance coverage to its member without having any liability of settlement of the claim. The O.P. No.3 has no role to play to settle the claim, as O.P. No.1 and 2 are the authority to settle the claim. Therefore, the petitioner is not entitled to get any relief from this O.P.

 To establish the complaint case, complainant has relied upon an affidavit-in-chief sworn by her upon some documents and upon her own statement recorded as statement of P.W.1.

DECISIONS WITH REASONS

The complainant has submitted a bunch of documents which are (1) copy of policy certificate, (2) copy of letter, (3) copy of death certificate, (4) FIR, (5) Voter Card of deceased to establish her case. Let us see how for the complainant has been able to prove her case.

We find from the documentary evidence on record that the husband of the complainant was a policy holder under the O.Ps. during his life time and at the time of his death the said policy was in force; the complainant is the nominee of the said policy and the policy holder died on 24.02.2011. There is document in record which shows that after the death of her husband, complainant submitted claim form or corresponding documents to get death benefit from the O.Ps. Although she stated in her content of complaint that she submitted the claim form before the O.Ps. just after her husband’s death and for collection of death benefit her last corresponds with the O.Ps. even after 30.07.2013. The contents of her complaint also corroborate her affidavit-in-chief which she submitted before this Forum. After accident she obviously informed the matter to the Insurance Company as well as GTFS. The GTFS by letter dated 02.09.2011 redirected the complainant with photocopy of proposal Form for processing of the claim at earliest. The FIR, PM report are the supporting evidence of the accidental death.

The Insurance Company repudiated the claim only on the ground that complainant failed to submit IT return of the deceased for the year 2003 – 04. Therefore, the ground of repudiation is very formal in nature and the company cannot avoid its liability only on this ground. O.P. did not adduce any evidence in their favour to repudiate the claim.

The complainant examined herself as witness by swearing in an affidavit. She has also been cross examined. Admittedly her husband died following a motor accident. Admittedly she makes her claim before the O.Ps. and submitted the claim form accordingly with all documents. We find nothing to disbelief the evidence. The evidence as well as documents corroborates each other and complainant has been able to make out a prima-facie case to get an order in her favour. Considering all facts, circumstances, evidences - oral and documentary, we are constraint to hold that the complainant has a good case to succeed.

In the result the complainant is entitled to get the relief according to the following order:

That the consumer complaint being No. 39/2014 is allowed on contest against the O.P. No.1 & 2, National Insurance Company Limited and dismissed against O.P. No.3. O.P. No.1 and 2 are directed to pay the assured sum of the policy i.e. Rs.5,00,000/- together with interest at the rate of 9% per annum from the date of this order till realization. The complainant do also get an order for compensation of Rs.5,000/- and litigation cost of Rs.2,000/- against the O.P./ Insurer and these amount also be paid within one month from the date of this order. In case of non-payment of the aforesaid amount in the manner stated above the complainant may put the order into execution.

Fees paid are correct.

Let copies of this order be supplied to the parties free of cost.