West Bengal

Birbhum

CC/87/2016

Kafarul SK - Complainant(s)

Versus

Sr. Div Manager, National INS Co Ltd - Opp.Party(s)

Sanjit Kr Achatya

10 Aug 2022

ORDER

Smt. Sukla Sengupta-President.

            The fact of the case in brief is that the complainant Kafarul Sk. has filed their petition of complaint U/S 12 of the C.P. Act 1986 as amended update alleging interalia that being a resident of Village- Sontsal, P.O. Makdamnagar, P.S. Md. Bazar Suri, Dist. Birbhum i.e. within the jurisdiction of this Forum/Commission that his son Mujarul Sk. was the Good Life Card Holder. He obtained that “Good Life Card Holder” praying proper fees. That “Good Life Card Covered” the personal accident Insurance Policy being passport No. MBLJA06AKEGB02621 and as such Mujarul Sk. was the insured under the OP/Insurance Company.

            It is further stated that on 16/07/2015 as about 17:00 hours, the insured Mujarul Sk. was going to Dewcha by his own motor cycle and on the way to Dewcha he met an accident and received severe bleeding injury on his person. There after he was taken to Suri Sadar Hospital, Birbhum the M.O. referred him to Burdwan Medical College and Hospital but on the way to Burdwan Hospital the physical condition of Mujarul Sk. was detoriated and again he came back to Suri Sadar Hospital. The M.O of Suri Sadar Hospital declared Mujarul Sk. as dead on 16/07/2015 at 21.40 hours.

            Suri police started U.D. case and submitted the final report to that effect the present complainant being the father and beneficiary of the insured Mujarul Sk. since diseased informed the insurance company and submitted the claim with all relevant documents to the OP but the OP did not pay any heed to the words of the complainant rather the OP sent a letter dated 04/05/2016 to the complainant claiming

the chemical analysis report of viseera with final cause of death of the insured Mujarul Sk. along with the legible copy of FIR. The complainant could not be able to supply the same.

            So, the case of the cause of action arose on and from 16/07/2015.

            The OP No. 1 National Insurance Company Limited has contested the case by filing a written version denying all the material allegations leveled against it is the Ops case that the complainant has no cause of action to file this case and the claim is bad by the principles of estoppels, waiver and acquiescence, barred by limitation and thus the same is not maintainable in its present form law.

            It is also the Ops case that the case bad for non-joinder and miss-joinder of necessary parties as the policy was insured to Hero Motor Corporation Ltd. (Formally Hero Honda Motors) covering personal accident under table-1 in the event accidental death liability of their “Good Life Card Program” and as such the case is not maintainable without making as party the Hero Motor Corporation Ltd.

            It is also the Ops case that the entire material allegations are false and fabricated. It is the further case of the OP that the complainant submitted a claim to the OP National Insurance Company Ltd. for obtaining compensation of Rs. 1,00000/- (One lakhs) for the death of his son Mujarul Sk. who died in an accident and he was a “Good Life Card Holder” under a policy having accidental death coverage, the complainant submitted relevant documents and on perusal of said documents it is found that the chemical analysis report of viseera with final cause of death and copy of FIR have not been submitted. So, the OP No. 1 sent letters to file complainant vide latter dated 04/05/2016, 28/05/2016 and 23/05/2016 to submit the relevant document to settled the claim with ultimatum that if said required documents mentioned above shall not be filed within 15 days from the date of order of last reminder the claim will be closed but the complainant failed to submit the documents so the insurance company has no other alternative but close the claim.

            It is also the Ops case that the insurance company repudiated the claim rightly and there was no deficiency on its part as no cause of action arose on and from 16/07/2015. Thus the complainant is not entitled get the relief as prayed for and the OP insurance company has no liability to settle the claim as submitted by the complainant.

            Thus the case is liable to be dismissed.

            In view of the above stated pleadings following issues are framed:

1. Is the case maintainable as per law?
2. Has the complainant any cause of action to file this case?
3. Is the complainant a consumer as per C.P Act 1986?
4. Is there any deficiency of service on the part of the OP members?
5. Is the complainant entitled to get the compensation as prayed for?
6. To what other relief or reliefs is the complainant entitled to get?

          

        

  Decision with reason.

            All the issues are thus taken up together for convenience of discussions and to avoid unnecessary repetitions.

            From the materials on record it appears that the cause of action arose on 16/07/2017 on which date diseased/insured Mujarul Sk. met a motor cycle accident on the way to Dewcha within the jurisdiction of this Commission and the purchased he “Good Life Card Holder” which was covered under personal accident insurance policy being passport No. MBLJA06AKEGB02621 valued of Rs. 1,00000/-(One lakh) and the complainant filed the case on 27/07/2016 i.e. well within the limitation period. Then it can be held by this Commission that the case is well maintainable in the eye of Law.

            It has already been discussed above that the cause of action of this case arose on 16/07/2015 when the insured Mujarul Sk. met and accident and succumbed to such injury sustained by him during the road accident and his father being the beneficiary submitted the claim application to the OP insurance company as the diseased was “Good Life Card Holder” valued of Rs. 1,00000/- on payment of proper fees from Hero Motor Corporation which was covered under personal accident insurance policy being passport No. MBLJA06AKEGB02621 as such he was the insured under the OP insurance company and in so many words the complainant being the beneficiary legal hair of the diseased as his father is a Consumer under the OP insurance company and the OP insurance company is the service provider.

            On careful consideration of materials, evidence and documents filed by the complainant it appears that the “Good Life Card Holder” i.e. diseased Mujarul Sk. met and road accident in 16/07/2015 when he was on the way to Dewcha by his motor cycle from the FIR we have got the support that on 16/07/2015 at 17.00 hours Mujarul Sk. met a motor cycle accident on the way to Dewcha and received serious injury bring person subsequently he was succumbed to such injury and the attending doctor of Suri Sadar Hospital declared him dead from which no cloud of suspicion has been custed in the mind of the Commission that the death of the “Good Life Card Holder” Mujarul Sk. was caused by the injury sustained by him during a motor cycle accident on the way to Dewcha on 16/07/2015 at 17.00 hours.

            Ld. Advocate for the OP insurance company raised question that without having the Chemical explanation report of the viseera of the diseased it cannot be said that the death of the diseased caused by road accident or by motor cycle accident on the way to Dewcha. He further argued that the cause of death has not been mentioned in postmortem report of the deceased.

            Ld. Advocate for the complainant argued that any sort of lacuna on the part of any institution cannot deprived any person i.e. the diseased Mujarul Sk. or the unfortunate complainant from his legitimate claim.

           

In the instant case the complainant being the legal hair of the beneficiary of Mujarul Sk. since diseased has submitted the claim application of the policy valued of Rs. 1,00000/- before the OP National Insurance Company and the OP by taking several pleas tried to deprive the complainant from his claim and ultimately did not pay any heed to the claim which compelled the complainant to file his case before this Commission. When it has already been held by this Commission that the diseased Mujarul Sk. being the “Good Life Card Holder” who purchased the same on payment of proper fees and which was covered personal accident insurance policy was a consumer under the OP insurance company and the complainant being the legal hair as well as the beneficiary of the diseased is a consumer under the OP insurance company and the OP insurance company is the service provider.

            So, when from the documents an available in the case record it is crystal clear that Mujarul Sk. purchased the “Good Life Card Holder” on payment of proper feeds and when it is admitted from the end of the OP insurance company that it was covered personal; accident insurance policy then the complainant is entitled to get the claim from the OP as a consumer and the OP being the service provider is bound to pay the claim to the complainant.

            Hence, in view of the discussion made above this Commission is of opinion that the OP insurance company being the services provider to the consumer complainant did not satisfy the claim of the complainant and harassed him. The OP insurance company also caused mental pain and agony by making several quires to the complainant with and intention not to satisfy his claim which cannot be indulged by this Commission.

            In view of the discussion made above it is revealed that the complainant is a consumer within the meaning of C.P Act 1986 amended up todate and the OP insurance company is a service provider it is also held by this Commission that complainant entitled to get relief as prayed for.

            In view of the discussions made above it is opined by the Commission that the complainant could be able to prove her case beyond the shadow of all reasonable doubt and is entitled to get the relief as prayed for.

            The case is properly stamped.

            Thus all the issues are decided in favour of the complainant.

            Hence, it is,

            O R D E R E D,

                                    that the instant C.C. Case No. 87/2016 be and same is allowed in part on contest with cost against the OP members.

The complainant do get the decree in part as prayed for.

 

 

 

 

The OP members are jointly or severally directed to pay compensation of Rs. 1,00000/-(One lacks) as insurance claim to the complainant along with interest @ 9% p.a. of the said amount from the date of filing till realization of the amount.

The OP members further directed to pay a sum of Rs. 8,000/-(Eight thousand) to the complainant as litigation cost.

The decree will be complied with by the OP members within 45 (Forty five) days from this date of order in default the complaint would be entitled to get interest on the entire decreetal amount @ 6% p.a. from the date of default till realization.

If the OP members failed to comply the decree the complainant is at liberty to execute the same through court.

The instant case is thus disposed of.

Let a copy of this order be given/handed over to the parties to this case free of cost.