West Bengal

Bankura

CC/9/2023

Barnali Chatterjee - Complainant(s)

Versus

The Br. Manager, United India Insurance Company Ltd. - Opp.Party(s)

Subrata Kumar Chakraborty

09 Aug 2023

ORDER

   IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA

  Consumer Complaint No. 09/2023

Date of Filing: 24/01/2023

Before:                                        

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant:  Ld. Advocate  Subrata Chakraborty

For the O.P. : Ld. Advocate Pulak Kumar Singha

Complainant  

1. Barnali Chatterjee,W/O-  Lt. Dhananjoy Chatterjee

2. Shilpa Chatterjee, D/O -  Lt. Dhananjoy Chatterjee

3.Soumyadeep Chatterjee, S/O-  Lt. Dhananjoy Chatterjee, (Petitioner No.3 is minor and represented by petitioner No. 1), All are residents of Fansi danga, Sukanta Pally, Near Sati Ghat, P.O., P.S. & Dist.- Bankura- 722101.

Opposite Party

1.The Br. Manager, United India Insurance Company Ltd. Durgapur Branch Office, ‘Tapas Bhaban’ 1^st Floor, ( B.S.N.L. Office Building), Bhiringee, Durgapur, Dist- Paschim Bardhaman . Pin- 713213

2.The Divisional Manager, United India Insurance Company Ltd. Divisional Office, City Centre, Durgapur, Dist- Paschim Bardhaman. Pin- 713216                                                                                                                                            

 FINAL ORDER / JUDGEMENT                   

                                                                                                                                        

Order No.08

Dated:09-08-2023

Both parties file hazira through advocate.

The case is fixed for argument. After hearing argument from both sides the Commission proceeds to dispose of the case as hereunder.

The Complainant’s case is that Dhananjoy Chatterjee since deceased who is husband of Complainant No.1 and father of Complainant No.2 & 3 has an Insurance policy No. being 0315083118P110440723 valid from 18/11/2018 to 17/11/2019 with Personal Accident Cover of Rs.15 Lakh issued by O.P. Insurance Co. for his own Motor Cycle No. being WB-40-N-8515. On 03/07/2019 at about 1.45 p.m. the Insured Dhananjoy Chatterjee was proceeding towards his home from his working place at Durlovpur and when he reached near Heavy More F.C.I. Godown under Bankura P.S. one Motor Cycle No. being WB-68Q-8876 dashed him from back side with high speed and as a result the Insured received severe injuries on his body and he was admitted to BSMCH, Bankura where he succumbed on the same day evening. An F.I.R. was lodged with Bankura P.S. on 05/07/2019 No. being Bankura P.S. Case No.142/19, dt.05/07/2019 u/s 279/304 A IPC.  On18/09/2020 claim application was forwarded to the O.P. Authority claiming Personal Accident Cover for Owner driver for Rs.15 Lakh but the same was repudiated on the ground of long delay in submission of the claim application. The Complainants however  tried their level best to get the claim amount from the O.P. through correspondence of Lawyer but the O.P. did not change their decision. The Complainant has therefore approached this Commission for appropriate relief.

.O.P. contested the case by filing written version taking the same plea of long delay in intimation and submission of claim application to the O.P. Authority and hence the Complainant are not entitled to get the relief as prayed for.

                                                                                                                                                                                        Contd……p/2

                                                                                                        Page: 2

-: Decision with reasons: -

The Commission has carefully and minutely examined the entire case and found that no dispute has been raised on behalf of the O.P. regarding the entitlement of the claim covered under the said Policy but their only contention is with regard to the belated submission of claim application.

The deceased Insured is the owner cum driver of his Motor Cycle possessing valid Driving License and other requisite documents and as such he is entitled to Personal Accident cover for Owner driver to the tune of Rs.15 lakh as per terms and conditions of the Insurance Policy under reference.

It is no doubt true that there has been an inordinate delay of about one year in submitting the claim application with the O.P. Now the question is whether the O.P. has the authority to turn down the claim of the Complainants on such ground if it is otherwise maintainable.

As stated above F.I.R. has been lodged on 05/07/2019 after two days of the accident and there cannot be said any delay in lodging the F.I.R. but as regards delay in submission of claim application it may be mentioned here that after the death of the Insured in such a road accident the family members i.e. the Complainants were in painful mood and had no practical experience to approach the competent authority for completion of the process. It is not always possible for the family members to take prompt steps after the death of the Insured for any official process and formality and such delay is not intentional but under compelling circumstances such delay may occasion which may be ignored if the claim is otherwise genuine.

In this regard IRDAI Authority has cautioned the Insurance Companies not to refuse claim benefits to the claimants merely on delay ground if the claim is otherwise maintainable. Relevant portion of Circular issued by the IRDAI Authority No. being IRDA/HLTH/MISC/CIR/216-09/2011, dt. 20/09/2011 is reproduced below: -

“Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained,  recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time”

It is therefore clear from the above mentioned Circular that Insurance claim cannot be mechanically repudiated merely on the ground of delay if the claim application is found maintainable otherwise.

This position has also been reiterated by the Hon’ble Supreme Court in Omprakash Vs Reliance General Insurance reported in (2017) 9 SCC 724 in the following words: -

“…if the reason for delay in making a claim is satisfactorily explained such a claim cannot be rejected on the ground of delay. It would not be fair and reasonable to reject genuine claim which had already been verified and found correct by the Investigator…..”

                                                                                                                                                                                           Contd……p/3

Page: 3

In this case the P.M. report is quite satisfactory citing the cause of death due to effects of anti-mortem head injury. No Surveyor’s report of the O.P. Insurance Co. is forthcoming to disprove the claim of the Complainants. If the factum of accident is not doubtful and the Policy and the Driving License of the Insured is valid there cannot be any legal bar to get the Insurance claim under Personal Accident Cover even if there is delay in intimation and submission of the claim application.

This is not a case of delayed justice but it is a case of delayed process not initiated from the end of the claimants but the Insurance Co. has also a duty to take notice of such accidental death through their Official mechanism particularly when Personal Accident Cover is involved.

Intimation to the O.P. Authority by claim application is merely a procedural formality and any lapses or delay on the part of claimants in following this procedure should not be viewed as a breach of the Policy but it should be considered with lenient attitude when the only bread earner loses his life in such accident leaving behind the unfortunate claimants with no hope of survival and subsistence.

Thus taking into consideration the facts and circumstances of the case with holistic approach the Commission decides to allow the claim of the Complainants.

Hence it is ordered……..

That the case be and the same is allowed on contest against the O.P.s

O.P.s are directed to pay to the Claimants Rs.15 Lakh in equal proportions within one month from this date in default the decretal amount may be realized in due process of law.

Both parties be supplied copy of this Judgement free of cost.

                                                                                                   

 ____________________                _________________           _________________

HON’BLE   PRESIDENT          HON’BLE MEMBER        HON’BLE MEMBER