The case of the complainant, Smt. Arati Debnath, W/o. Late Sushil Debnath, is that Sushil Debnath (now deceased), husband of the petitioner purchased 6 Room Nights under the scheme Delight Holiday on 02-06-2009 by depositing a sum of Rs.5,500/- bearing Member Folio No.COO-69146 for a tenure of 6 years and 3 months with maturity date on 02-09-2015 from the branch office of Cooch Behar of Pan Card Clubs Ltd. The Complainant is the recorded nominee of the scheme of Delight Holiday purchased by the husband of the complainant covering 6room nights. There is a business tie amongst the companies of the O.Ps and accordingly a GPA-UN Named Policy was issued to the complainant’s husband bearing Policy No.110800/42/08/03/ 00003806 covering insurance of the type personal Accidental Death Insurance and the sum insured to the tune of Rs.50,000/- and thereafter the renewal policy being No.121700/48/2011/11015 issued by the O.P. No.2. The said policy was for the period of 18-03-2011 to mid night of 17-03-2012 and the O.P. No.2 was liable to pay Rs. 50,000/- towards normal risk.
It is the further case of the complainant that on 23-02-2012 her husband, Sushil Debnath met an motor accident on N.H.31 and sustained injury all over his body. He was brought to M.J.N. Hospital, Cooch Behar and succumbed to injuries there and GD being No. Kotwali P.S GD No.1214 dated 23-04-2012 has been lodged.
It is also further case of the complainant that the complainant being wife and nominee of deceased Sushil Debnath submitted claim application in prescribed form with relevant documents.
But the O.P. No.1 & 2 have not paid to the complainant the claim amount towards the death claim of complainant’s husband. Then the complainant lodged a complaint before the office of the Assistant Director, Consumer Affairs & Fair Business Practices, Cooch Behar Regional Office, B.S. Road bearing complaint index No.660/207/CICC/2013-14 and accordingly a tripartite meeting for amicable settlement on 14-02-2014 but unfortunately the meeting ended in vain.
It is the further case of the complainant that there are deficiency in service on the part of both the O.P. No.1 & 2 since both the O.Ps have not yet been able to settle the claim of the complainant inspite of a tripartite meeting causing a great harassment to the complainant and by the acts of the O.Ps, the complainant has become mentally upset. The O.Ps are playing foul role in carrying their business.
Hence filed this case praying for issuing a direction upon the Opposite Parties to pay the Complainant (1) a sum of Rs.50,000/- along with interest accrued thereon from the claim date towards the death claim in terms of the policy under Delight Holiday for purchasing 6 room nights bearing Folio No.COO-69146 dated 02-06-2009 and GPA Policy No.121700/48/2011/11015, (2) Rs.1,00,000/- as compensation for mental pain, agony & unnecessary harassment for unfair trade practice and deficiency in service of the O.Ps., (3) Rs.30,000/- towards litigation costs, besides other relief(s) as the Forum deem fit, as per law & equity.
O.P. No.1, Pan Card Clubs Ltd. has contested the case by filing W/V denying all material allegation of the complaint, contending inter-alia that the case is not maintainable and the complainant has no cause of action.
It is the specific case of the O.P. No.1 that they had taken Group Personal Accident Insurance for its applicants from the O.P. No.2, Oriental Insurance Co. Ltd. for the period from 18/03/2011 to 17/03/2012 being Policy No.121700/48/2011/ 11015 and issued by Oriental Insurance Co. Ltd., Maker Bhavan No.1, 5th Floor, New Marine Lines, Mumbai, Maharashtra-400020. The O.P. No.1 has paid the premium for the same under which deceased applicant/member was covered.
It is the further case of the O.P. No.1 that Mr. Shushil Debnath died on 24-02-2012. The complainant submitted documents to the O.P. No.1 on 23-04-2012. The claim of the complainant was forwarded to the Oriental Insurance Co. Ltd. by the O.P. No.1 on 28-04-2012. The O.P. No.2 i.e. Oriental Insurance Co. Ltd. by its requirement letter dated 11-06-2012 requested for original death certificate and other documents duly translated in English. The O.P. No.1 submits that the complaint filed by the complainant ought to be directed only against O.P. No.2, as the accidental death insurance claim is to be settled by Oriental Insurance Co. Ltd.
Ultimately the O.P. No.1 submitted that there was no deficiency in service on the part of the O.P. No.1 and the case is liable to be dismissed against them.
O.P. No.2, The Oriental Insurance Co. Ltd. has contested the case by filing W/V denying all material allegation of the complaint, contending inter-alia that the case is not maintainable and the complainant is not a consumer under the O.P. No.2 insurance company.
It is the specific case of the O.P. No.2 that admittedly the O.P. No.1, Pan Card Clubs Ltd., Cooch Behar issued a Group Personal Accident Insurance Policy No. 121700/48/2011/11015 for the period from 18/03/2011 to 17/03/2012 for its member Late Sushil Debnath and sum insured under the policy Rs.50,000/-.
It is the further case of the O.P. No.2 that it is also one of the conditions of Group Personal Accident Insurance Policy that any incident which may give rise to a claim henceforth inform the insurer in writing and the claimant should be submitted his completed claim Forum along with all relevant documents including original policy within 60 days of the date of accident. The complainant mentioned, the date of incident was 23-02-2012, sent/submitted on 27-04-2012 and insurer received it on 02-05-2012. She claimed 60 days after the date of accident.
It is the further case of the O.P. No.2 that this O.P in writing inform the O.P. No.1, Pan Card Clubs Ltd. by a letter dated 11-06-2012 requires necessary documents to process the death claim of Sushil Debnath. On 06-09-2012 it was informed the O.P. No.1 to comply the requirements to process the claim within 7 days otherwise this O.P may have to close the file with remarks as no claim. So, this O.P had no alternative except close the claim file for non-submission of required documents and ultimately closed. As per the policy clause, claim from and list of documents should be submitted to the company within 60 days of the date of accident.
It is also the case of the O.P. No.2 that this O.P is not liable to make any payment under this GPA Policy for the accidental injury of insured as there is/are specific violation/breach of policy condition and ultimately, the O.P. No.2 prayed for dismissal of the case.
In the light of the facts and circumstances the following moot points came out for consideration to reach a just decision.
POINTS FOR CONSIDERATION
- Is the Complainant is a Consumer of the O.Ps as per Section 2(1)(d)(ii) of the C.P. Act, 1986?
- Has this Forum jurisdiction to entertain the instant complaint?
- Have the Opposite Parties any deficiency in service as alleged by the Complainant and are the opposite parties liable in any way to compensate the Complainant?
- Whether the complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
We have gone through the record very carefully and also perused entire Xeroxed/original documents in the record and heard argument of both parties.
Point No.1.
It is the case of the O.Ps that the deceased husband of the complainant Sushil Debnath was not consumer under them. So, this Consumer Forum has no jurisdiction to try this case.
Evidently deceased Sushil Debnath purchased 6 rooms nights under the scheme Delight Holiday on 02-06-2009 by depositing a sum of Rs.5,500/-.
Admittedly there is business tie between O.P. No.1 & 2 and GPA-UN named policy was issued infavour of the deceased and he was under Personal Accident Death Insurance scheme and O.P. No.2 was liable to pay Rs.50,000/- towards normal risk and O.P. No.1 paid premium to the O.P. No.2 regarding deceased. If that be so the O.Ps cannot deny that the deceased was not a consumer under them.
Point No.2.
Both the O.Ps have their office within Cooch Behar district. So, this Forum has territorial jurisdiction to try this case.
Total valuation of this case is Rs.1,80,000/- which is far less than maximum limit of jurisdiction of this Forum i.e. Rs.20,00,000/-.
So this Forum has also pecuniary jurisdiction to try this case.
Point No.3 & 4.
It is the case of the complainant that her husband deceased Sushil Debnath purchased 6 rooms nights under the scheme Delight Holiday on 02-06-2009 by depositing a sum of Rs.5,500/- bearing number Folio No.COO-69146 for a tenure of 6 years and 3 months with maturity date on 02-09-2015 from the O.P. No.1, Pan Card Clubs Ltd., Cooch Behar.
‘Annexure-A & B’ of the complainant i.e. original Policy Certificate and Money Receipt show that deceased Sushil Debnath purchased 6 rooms nights under Delight Holiday on 02-06-2009.
It is the case of the complainant that there is a business tie amongst the companies of the O.Ps and accordingly a GPA-UN Named Policy was issued to the complainant’s husband bearing Policy No.110800/42/08/03/00003806 covering insurance of the type personal Accidental Death Insurance and the sum insured to the tune of Rs.50,000/- and thereafter the renewal policy being No.121700/48/2011/ 11015 issued by the O.P. No.2. The said policy was for the period of 18-03-2011 to mid night of 17-03-2012 and the O.P. No.2 was liable to pay Rs. 50,000/- towards normal risk.
Both the Ops in their written version clearly admitted that the O.P. No.1 had taken Group Personal Accident Insurance for its applicants from the O.P. No.2, Oriental Insurance Co. Ltd. for the period from 18/03/2011 to 17/03/2012 being Policy No.121700/48/2011/11015 and issued by Oriental Insurance Co. Ltd., Maker Bhavan No.1, 5th Floor, New Marine Lines, Mumbai, Maharashtra-400020. The O.P. No.1 has paid the premium for the same under which deceased applicant/member was covered and sum assured under the policy was Rs.50,000/-.
‘Annexure-6’ of the O.P. No.2 i.e. GPA-UN named policy schedule shows under Table-1 (SI) sum assured was Rs.50,000/-.
So, it is clear that at the time of death i.e. on 23-02-2012 the deceased was under valid insurance coverage of Rs.50,000/-.
It is the case of the complainant that her husband Sushil Debnath on 23-02-2012 had met an accident on NH-31 and succumbed to injury at M.J.N Hospital, Cooch Behar.
‘Annexure-E’ of the complainant is Death Certificate which reveals that Sushil Debnath had died on 24-02-2012 at M.J.N Hospital, Cooch Behar. ‘Annexure-J’ of the complainant is certified copy of the Post Mortem Report of deceased shows that Post Mortem was held on the body of Sushil Debnath on 24-02-2012 and Autopsy Surgeon opined that death was accidental in nature and due to shock and hemorrhage. ‘Annexure-F’ of the complainant is the copy of GD Entry No.1214 dated 23-04-2012 lodged by the complainant Arati Debnath before Kotwali P.S., Cooch Behar which shows that her husband Sushil Debnath had died on 24-02-2012 due to accident case by unknown vehicle.
So, it is clear from the above discussed documents that husband of the complainant Sushil Debnath had died on 24-02-2012 due to accident.
It is the further case of the complainant that she has filed claim application in prescribed form but the O.P. No.1 & 2 did not pay the said claim amount.
‘Annexure-3’ of the O.P. No.2 shows that the complainant has filed said claim application.
It is the case of the O.P. No.1 that the claim application was filed before them on 23-04-2012 and the same was forwarded to the O.P. No.2 insurance company on 28-04-2012. The O.P. No.2 also by its letter dated 11-06-2012 requested to submit original Death Certificate and other documents and the O.P. No.1 has performed their duty by forwarding the application and documents to the O.P. No.2 and they have no liability.
On the other hand it is the case of the O.P. No.2 that according to the complainant her husband had died on 23-02-2012 but she submitted claim application on 27-04-2012 and the same was received by the O.P. No.2 on 02-05-2012. She was to submit claim application within 60 days from the date of accident. But the application was filed after prescribed period.
By sending letter dated 11-06-2012 the O.P. No.1, Pan Card Clubs Ltd. was requested to submit necessary documents and on 06-09-2012 by sending another letter O.P. No.1 was requested to submit necessary documents within 7 days failing which claim was to be treated as ‘No Claim’.
‘Annexure-4’ of the O.P. No.2 i.e. e-mail dated 06-09-2012 shows that the O.P. No.1 was asked to submit necessary documents within 7 days in default they have to close the claim case.
‘Annexure-5’ of the O.P. No.2 i.e. letter dated 22-07-2014 shows that Divisional Incharge, D.O., Siliguri was informed by Mumbai office of the O.P. No.2 insurance company that the case of deceased Sushil Debnath was closed for non-submission of required documents.
On the other hand the Ld. Agent/Advocate of the complainant submitted that non-submission of application within alleged stipulated time is not fatal when accidental death of the husband of the complainant is amply proved.
In support of his contention he cited a ruling reported in 2013(I)CPR 91(HP) where in a case of repudiation of death claim on the ground of delay, Hon’ble State Commission pleased to hold that delay in informing insurer about date of death may be ground for repudiation of claim in case where there is serious dispute about death or cause of death of insured person, but not a case like present one, where there is no doubt that insured employee had died and her death was accidental.
We find that certainly in present case accidental death of the husband of the complainant has been established from Death Certificate, Post Mortem Report and copy of GD Entry.
So, we have no other alternative but to rely upon the ruling cited above and to hold that delay in submitting application and documents within stipulated time is no ground for repudiation of the claim of the complainant and there was deficiency in service on the part of the O.Ps, specially on the part of the O.P. No.2 who repudiated the claim and the complainant is entitled to get relief against the O.Ps.
Thus the case succeeds.
ORDER
Hence, it is ordered that,
That the DF Case No.33/2014 be and the same is allowed on contest with cost of 5,000/- against the O.P. No.2 and on contest against the O.P. No.1, in the circumstances, without any cost. The O.P. No.2 is directed to pay Rs.50,000/- as compensation as sum assured for the deceased Sushil Debnath together with interest @8% to be calculated from 13-09-2012 i.e. from the date of repudiation of the claim by the O.P. No.2 to the complainant within 30 days from this order. The said O.Ps are further directed to pay compensation of Rs.10,000/- to the complainant under the heading of harassment, mental agonies and sufferings. If the O.P. No.2 fails to pay the aforesaid amounts and the O.P. No.1 in view if its role proved to have played in originating the Insurance policy, fails to make it done to pay the same by the O.P. No.2 within the stipulated days, each of the O.Ps are to pay Rs.200/- as fine for each day’s delay and the amount to be accumulated shall be deposited in the State Consumer Welfare Fund, W.B. accordingly.
Let plain copy of this Final Order be supplied, free of cost, to the concerned party/Ld. Advocate by hand/be sent under Registered Post with A/D forthwith for information and necessary action, as per Rules.
Dictated and corrected by me.
President President
District Consumer Disputes District Consumer Disputes
Redressal Forum, Cooch Behar Redressal Forum, Cooch Behar
Member Member
District Consumer Disputes District Consumer Disputes
Redressal Forum, Cooch Behar Redressal Forum, Cooch Behar
