Orissa

Dhenkanal

CC/6/2017

Rinki Rout Sitha And Sangram Sitha - Complainant(s)

Versus

National Insurance company Ltd. - Opp.Party(s)

27 Oct 2017

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, DHENKANAL

                                                        C.C.Case No. 06 of 2017

1) Rinki Rout @ Sitha W/o Late Kanan Kumar Sitha,

2) Sangram Sitha,  S/o Late Kanan Kumar Sitha,

    Vill: Ankarantipur, PO: Siminai,

    P.S: sadar, Dist: Dhenkanal

   Presently residing, At: Baniabahal,

   PO: Hulurusingha, Dist: Angul

   The Complainant No.2 being the minor is  represented

    Through his mother guardian Rinki Sitha                          ….......Complainants

                                                                              Versus

National Insurance Company Limited,

A Govt. of India undertaking having it s head Office

At. 3 Middleton Street, PO: Box. No. 9229,

Kolkata-700071, Represented through its

Branch Office Senior Manager, Dhenkanal Branch,

At: South Madhuban, Kunjakanta,

PO/Dist: Dhenkanal                                                                  ….......Opp. Party

Present: Sri  Badal Bihari Pattanaik, President,

                Miss Bijaya Laxmi Satapathy, Member

Counsel: For the complainant:  A.K.Rath & Associates

                For the Opp. Party:  S.P. Singh & Associates

Date of hearing: 18.10.2017

Date of order: 27.10.2017

                                                                              JUDGMENT

Sri Badal Bihari Pattanaik, President

              The complainant has filed the present case   U/s 12 of Consumer Protection Act, 1986 filed by the complainant alleging deficiency in service by the opp. Party  claiming compensation  and the sum assured under the impugned policy.

              1) Very briefly, the case of the complainants stated are that    late Kanan Kumar Sitha     the late husband of complainant No.1 and father of the complainant No.2 who was working as an employee of Anchalika Mohavidyalaya, Pragyan Vihar, Dhenkanal and was a member of the Insurance Policy No.163801/47/13/9600000146 on payment of annual premium of Rs. 60/-  for the period from 28.3.2014 to 27.3.2015.  The sum assured   under the policy for one lakh.  The Policy holder deceased husband of the complainants had paid the premium amount regularly till his death towards the Janata Accident Policy.  It is stated that while the policy was in force Kanan Kumar Sitha the husband of the complainant died on 5.6.2014 in a road accident.   After the death of the policy holder Kanan Kumar Sitha serious dispute arose in the family of the complainant for which the Sister-in-law, brother-in-law drove her from the matrimonial house.  They forcibly kept the vehicles, and other household accessories as well as the landed properties of deceased Kanan Kumar Sitha.   Therefore, the complainant took shelter in her father’s house at Angul for which various litigation cropped up at Dhenkanal Court under the provisions of Domestic Violence Act, U/s 498 (A) of I.P.C as well as other Civil Litigations for which the complainant could not get the policy certificate or any other papers which were in the matrimonial house at Ankarantipur.  In the month of February-2016, with the help of Sadar Police the complainant returned to the matrimonial home and thereafter she came to know about the Janata Personal accident Policy as mentioned above.  After knowing about Insurance Policy the complainant on 3.3.2016 wrote letter to the Opp. Party for supply of claim form to get the benefits under the policy. The complainant lodged claim before the Opp. Party but the Opp. Party without proper enquiry or without going through the plight of the complainant repudiated the claim vide letter No.163801/Claim/PA/196/2016 Dt. 28.9.2016 on the ground that the claim has been made after a gap of 637 days from the date of death.    The fact of insurance policy obtained by the late husband of the complainant was not known to her.  As per the Janata Personal accident policy the O.P is liable to pay the sum assured under the policy.  The Janata Personal Accident Policy is a benevolent insurance benefit to its citizens of the Central Government, implemented through the Insurance Companies.  It is further stated that Purna Chandra Sitha, the father of deceased Kanan Kumar Sitha was nominee of the said policy and is dead in the meantime excepting the complainant there are no other legal heirs of the deceased policy holder.  So the complainants are liable to get the benefits under the policy.  Due to non-payment of the legitimate insurance dues covered under the above policy, the complainant sustained great loss.  Therefore, the complainant has come up before this Forum seeking for a direction to the O.P to pay a sum of Rs. 1,00,000/- covered under the Janata Personal accident Policy No. 163801/47/13/9600000146.  Besides, the complainant claims compensation of Rs. 20,000/- towards interest and costs. The contents of the petition are supported by affidavit. 

              2) The Opp. Party appeared and filed written version.  It is in the version of the Opp. Party that the petitioner has no cause of action to file the case.  The cause of action being on 5.6.2014 the case is hopelessly barred by limitation and is not maintainable.  The intimation of death of regarding the death of Mr. Kanan Kumar Sitha was intimated by the petitioner No.1 to the O.P.    The O.P does not know whether the late insured died of accident or not.  It is admitted that the death of the insured on 5.6.2014 is not within the knowledge of the Opp. Party.  It is further stated that the death of the insured being 5.6.2017 was intimated by the complainant No.1 only on 3.3.2016 i.e. after a long gap of 637 days from the date of death.  Since the claim was not made in due time or intimation was given to the O.P regarding  the death of the insured and since the claim was lodged after the stipulated period prescribed under the policy the claim was repudiated because of abnormal delay in lodging claim  and it was intimated to the complainant accordingly.  Since the claim has been repudiated with reasons no amount of deficiency in service can be attributed to the O.P.   The Opp. Party has stated that the insurance company is under obligation to pay the claim of insured if it confirms to the policy condition and the rules and regulations in force.  It is the duty of the nominee or any legal heir to make a claim within the stipulated period as prescribed under the policy and as per the terms and contract but in the instant case the claimant has acted against the terms and conditions of the contract of the policy for which the claim was rejected. .  It is admitted that  one Kanan Kumar Sitha has obtained a Janta Personal Accident cover from the Opp. Party bearing Policy No.163801/47/13/9600000146 on payment of annual premium of Rs. 60/- and the period from 28.3.2014 to 27.3.2015.  As per the insurance policy in the event of death of the insured the nominee is to get a sum of Rs. 1,00,000/-.  The policy has lapsed since 27.3.2015.  On 3.3.2016 the complainant No.1 made an application to the Opp. Party stating therein that her deceased husband died on a road accident on 5.6.2014 who was having a JPA Policy and accordingly a claim was submitted.  On receipt of the insurance claim form and after scrutiny it was revealed that the claim has been made after a gap of 637 days from the date of death for which the claim was rejected and accordingly the decision was intimated to the complainant on 28.9.2016.  Further it is stated that it is mandatory for a claimant to intimate the death of an insured immediately or latest within 30 days from the date of death to the company which has not been done in this case.  In view of the abnormal delay as there was contractual violation and there was no scope for the company to find out the truth the claim has been rejected as per law and there is no deficiency in service.  Accordingly, it is pleaded to dismiss the case.  The contents of the written version are supported by affidavit.

              3)  On the aforesaid pleadings of the respective parties the only point needs our consideration as to whether the repudiation of the claim of the complainant by the Opp. Party is justified? Admittedly   late Kanan Kumar Sitha had obtained a Janta Personal Accident cover from the Opposite Party bearing Policy No.163801/47/13/9600000146 on payment of annual premium of Rs. 60.00 and the period was from 28.3.2014 to 27.3.2015. It is also an admitted fact that as per the Insurance Policy in the event of death of the insured his nominee is to get a sum of Rs. 1,00,000/-.  The sole allegation of the complainant as advanced by the learned advocate for the complainant that   the late husband of the complainant Kanan Kumar Sitha was an employee of Anchalika Mohavidyalaya, Pragyan Vihar, Dhenkanal  who had obtained the impugned insurance policy on payment of premium of Rs. 60/- for the period from 28.3.2014 to 27.3.2015 for a sum assured of Rs. 1,00,000/- and while the policy was in force the insured  Kanan Kumar Sitha died on 5.6.2014 in a road accident.    After the death of the deceased Policy Holder serious dispute arose in the family of the complainant for which the complainant took shelter in her father’s house at Angul.  In the month of February-2016 with the help of Sadar Police the complainant returned to the matrimonial home and thereafter she came to know about the Janta Personal accident Policy obtained by her husband.  After getting information about insurance Policy the complainant submitted the claim for payment of the death benefits under the Policy which was repudiated by the Opp. Party arbitrarily for which the complainant has come up before this Forum seeking for a direction to the Opp. Party for payment of the claim amount under the policy.  On the other hand the learned counsel appearing on behalf of the Opp. Party argued that there is no deficiency in service and the Opp. Party has rightly repudiated the claim of the complainant as     the complainant No.1 intimated the O.P regarding the death of the Policy holder only on 3.3.2016 i.e. after a long gap of 637 days from the date of death i.e. 5.6.2014.  Since the claim was not made in due time or intimation was given to the O.P regarding death of the insured violating the terms and conditions of the Policy the claim has been repudiated with reasons and there is no deficiency in service.  On the above rival contentions of the respective parties we have gone through the documents available on record.  The Xerox copy of the Insurance Policy vide Exbt-2 discloses that  Mr. Kaanan Kumar  Sitha during his life time had obtained  Individual Janta PA  on payment of premium of Rs. 60/-.  The policy further discloses that it was in force for the period from 28.3.2014 to 27.3.2015.  The complainant No.1 on 3.3.2016 intimated the Opp. Party regarding accidental death and also requested for supply of claim form vide Exbt -3.  Exbt -5 is the Legal Heir Certificate issued by the   Tahasildar, Odapada dated 21.9.2015 which discloses that Rinky  Rout @ Sitha  and Sangram Sitha  are the legal heirs of the deceased Policy holder.  Exbt-1 is the Xerox copy of the death certificate issued by the competent authority which discloses that the deceased Kanan Kumar Sitha died on 05.06.2014.  Ext.4 discloses that the Opp. Party issued the letter dated 28.9.2016 repudiating the claim of the complainant on the ground that in the instant case the complainant has intimated about the death of Mr. Kanan Kumar Sitha on 3.3.2016 which is after a gap of 637 days (amost two years) from the date of death and thus violated the condition No.1 of the Policy issued to the insured.  The Opp. Party has also mentioned the Condition No.1 of the Policy issued to the insured  in the letter stating there in that” Upon the happening of any event which may give  rise to a claim under this Policy written notice with full particulars must be given to the company immediately.  In case of death, written notice also of the death must unless reasonable cause is shown be so given before interment cremation and in any case within one calendar month after the death and in the event of loss of sight or amputation of limbs written notice thereof must also be given within one calendar month after such loss of sight or amputation.   The Opp. Party has not filed any document in support of his stand except the written version supported by affidavit.  On our perusal of the documents filed by the complainant and the complaint petition we find that the Opp. Party has repudiated the claim of the complainant solely on the ground of delay in intimation as regards to the death of the deceased policy holder and violated the terms and conditions of the Policy Condition No.1 of the Policy issued to the insured.  This the only ground for repudiation of the claim of the complainant.  There is no dispute as regards to the death of the policy holder on the date as has been intimated by the complainant in her letter dated 3.3.2016.  There is also no dispute as regards to the legal heir certificate issued by the competent authority and the death certificate.  There is also no dispute as regards to the policy which was obtained by the deceased policy holder for the period from 28.3.2014 to 27.3.2015. Admitted the deceased policy holder died on 5.6.2014 during the policy period.   On the above admitted factual aspects it is to be seen as to whether the Opp. Party has rightly or wrongly repudiated the claim of the complainant and as to whether the complainant has shown sufficient and reasonable cause   for the delayed intimation as regards to the death of the deceased policy holder in writing?  The complainant No.1  in her complaint  petition  at para-4 has categorically pleaded that after the death of the Policy holder serious dispute arose in the family of the complainant for which the sister-in-law, brother-in law drove her from the matrimonial house.  They forcibly kept the vehicles, and other household accessories as well as the landed properties of deceased Kanan Kumar sitha.  Finding no other way the complainant took shelter in her father’s house at Angul.  For that matter various litigation cropped up at Dhenkanal Court under the provisions of domestic Violence Act, U/s 498 (A) of I.P.C as well as other civil litigations.  So the complainant could not get the policy certificate or any other papers which were in the matrimonial house at Ankarantipur.  In the month of February-2016, with the help of Sadar Police the complainant returned to the matrimonial home and thereafter she came to know about the Janta Personal accident Policy and thereafter the fact of death was intimated to the Opp. Party on 3.3.2016.  The contents of the complaint petition of the complainants are supported by affidavit and there is nothing to disbelieve the submissions of the complainant as regards to the cause of delay in intimating to the Opp. Party regarding the death of the insured deceased policy holder.  Except the delay in intimation there is also no other technical grounds for repudiation of the claim as has been advanced by the Opp. Party.  In the instant case the complainant has also categorically stated and has shown reasonable and sufficient cause for the delay in intimating to the O.P as regards to the death of the deceased policy holder.  Now therefore, after taking into consideration of the admitted factual aspects of the case as has been advanced by both the parties and the documents available on record we are of the view that the complainant has shown reasonable and sufficient cause for the delay in intimating to the O.P as regards to the death of the policy holder.  We also observed after careful examination of the factual aspects and the documents available on record that the complainants are having just and genuine claim.  Therefore, the just and genuine claim of the complainants should not rejected on technical grounds.   Further it cannot be said that the Opp. Party is in deficiency in service when the decision was taken in accordance with the terms and conditions of the policy.   However, after taking into consideration and on our careful examination of the factual admitted facts and the documents available on record, we come to a conclusion that the Opp. Party is liable to pay the death claim under the Policy to the complainants.  Hence ordered.

                                                                      ORDER

              The complaint is allowed on contest in the light of the observations made in the preceding paragraphs.  In the result, the   Opp. Party is directed to pay the Capital Sum Insured of Rs. 1,00,000.00 (Rupees one lakh) to the complainant within a period of one month from the date of receipt of this order failing which the Opp. Party shall be liable to pay interest @ 12% per annum over and above the sum assured  from the date of repudiation till its payment. In the peculiar facts and circumstance a sum of Rs. 1,000/- (Rupees one thousand) only  is also awarded towards cost of the litigation which shall be paid by the Opp. Party to the complainants.

 

(Miss Bijayalaxmi Satapathy)                                                              (Badal Bihari Pattanaik)

              Member                                                                                                  President