West Bengal

Dakshin Dinajpur

CC/20/2023

Smt. Purnima Saha, W/O- Sri Pradip Saha - Complainant(s)

Versus

The Branch Manager, Chola MS General Insurance - Opp.Party(s)

Anish Das

29 Sep 2023

ORDER

 The instant case has been initiated by the complainant U/S – 35 of C.P. Act, 2019 against the Opposite Party claiming Rs.15,00,000/-(principle amount), compensation - Rs 50,000/- & Litigation Cost – Rs. 30,000/-  Total = Rs15,80,000/- with interest @ 12% P.A .

The complainant is the mother of late Pranab Saha . The policy was issued in favour of deceased Pranab Saha’s Motor cycle vide no. W.B 62-N/6772 and the said vehicle was insured with the Chola MS General Insurance Company Ltd vide policy no.3410/00533830/000/00 dated 26.10.2021 to cover up the period of 26/10/2021 to 25/10/2022 by observing all formalities. Therefore, O.P. is the insurer.

  That on 17.06.2022 the son of the complainant, Pranab saha while driving his vehicle met with a road traffic accident caused due to dashing by another bike at village Saheb kachhari para under Balurghat under Balurghat police station. Due to such accident the son of the complainant died on spot sustaining various injury in his head and body. In this regard the father of the complainant lodged a complainant before I.C. Balurghat P.S. on 17.06.2022. Accordingly, on the basis of the written complaint, one criminal proceeding was initiated vide P.S. CASE NO. 417of 2022 dated 17.06.2022 under Sec. 279/427/304A I.P.C. After proper investigation the charge-sheet was submitted on 31.08.2022 vide no.580/2022.

 That as the road traffic accident was occurred during the tenure of the policy. Immediate after such untoward woeful occurrence of death of the son of the complainant, the matter was informed to the concern authority of policy issuing office of Cholamandalam MS General Insurance Company Ltd on several dates viz 03.12.2022 &20.02.2023.

  That   the complainant also submitted a claim intimation letter intimating her grievance on 03/12/2022 to the opposite party as policy issuing office as per requirements of the concerned office enclosing all the documents.

  As per the  policy norms and regulations the complainant being the mother of the deceased son is the legal heir according to Hindu succession Act and entitled to get the death benefit of P.A.to owner cum driver amounting to Rs 1500,000/-. But despite having knowledge of the demise of the son of the complainant as per the claim intimation letter from the complainant on 03.12.2022 &20.02.2023.The opposite party neither have replied nor taken any steps to disburse the P.A. amounting to Rs 1500,000/-.

That despite having concrete knowledge of the demise of the complainant’s son, the O.P. side did not take any step to disburse the amount of compulsory P.A. as per norms and regulation of policy in favour of the complainant nor to repudiate the claim of the claimant till to date.

The complainant requested the O.P.by approaching the grievance to the O.P. to settle the claim several times, but the O.P. did not opine any views considering the documents, rather they kept mum.

 That being aggrieved with the inhuman behavior of the O.P. the complainant is suffering from mental pain and agony. After receiving all the necessary documents from the complainant the O.P.  did not make any response .It is very painful for the complainant . For all this illegal activities of the O.P., the complainant is bound to file this case against the O.P. before this consumer commission for proper redressal.

 It appears from the case record that notice was issued to the Opposite Party and the said notice was duly served upon them. After  receiving notice, the Opposite Party  appeared before this Commission but did not filed written version so, the case is proceeded ex parte against the Opposite Party  by vide order no.05 dated 17/07/2023.

To prove her case, the complainant has submitted evidence on affidavit along with the following documents-

(i)Xerox copy of F.I.R. Balurghat P.S case no.417/2022 dated 17.06.2022. 

            (ii) Xerox copy of chargesheet no.580/2022 dated 31/08/22.

(iii)  Xerox copy of the seizure list dated 28/08/2022.

(iv)  Xerox copy of the seizure list dated 24/08/2022. .

(v) Xerox copy of R.C. Book vehicle bearing no.WB-62M-6772(M/C)       

 vi)  Insurance policy of the vehicle bearing no.WB-62M-6772(M/C)         

         vii) Legal Heirs certificate of Pranab Saha issued on 03/03/2023.

           viii)    Xerox  Death certificate of Pranab Saha  DATED 07/12/2022.            

         ix) Claim letter dated 03/12/2022 with postal acknowledgement.

         x) Claim letter dated 20/02/2023 with postal acknowledgement .

         xi) Post Mortem Report of Pranab Saha dated 17/06/2022.

 

        In view of the above mentioned facts, the following points are cropped up for consideration.

                                      POINTS FOR CONSIDERATION

      1) Whether the complainant is a consumer to the opposite party?

      2) Whether there is any deficiency in service on the part of the opposite party?

      3) Whether the complainant is entitled to get any relief/reliefs as prayed for?

 

                                      DECISION  WITH  REASONS

 

         We have heard the argument by Ld. Advocate of complainant at length. We have also gone through the evidence on affidavit and written argument. We also perused the documents filed by the complainant.  

            At the time of argument the Ld. Lawyer appearing for the complainant narrated the fact of the case as mentioned in the complaint. He further submitted that the claim of the complainant is legal, genuine and the opposite party is liable to pay the claim amount as per their own undertaking laid down in the policy.

Now, let us discuss all the points one by one.

 

Point No.01:

On perusal of the materials on record, it appears from the documents that the complainant’s son namely Pranab Saha(Deceased) was insured with O.P., insurance company vide policy no- 3410/00533830/000/00 dated 26.10.2021.  If this be so, then it is clear that the complainant is a consumer to the opposite party according to sec 2(7) of the consumer protection Act 2019.

 

Point No.02 &03:

            Both the points are taken up together for discussion for the sake of convenience and brevity.

 It is fact that the complainant‘s son deceased Pranab Saha purchased a Insurance policy vide no- 3410/00533830/000/00 dated 26.10.2021 which was valid for the period from 26/10/2021 to 25/10/2022 from the O.P. . The sum insured was Rs.15,00,000/-. This insurance policy is a package policy, it also covers 3^rd party liability, own damage coverage and also personal accident coverage of owner cum driver.

 The complainant’s son Pranab Saha died on 17.06.2022 due to road traffic accident. After the death of Pranab Saha, the complainant informed the matter of accidental death to the Balurghat Police Station on 17/06/2022  and a criminal proceeding was started.

That on 17.06.2022 the son of the complainant, Pranab saha while driving his vehicle met with a road traffic accident caused due to dashing by another bike at village Saheb kachhari para under Balurghat under Balurghat police station. Due to such accident the son of the complainant died on spot sustaining various injury in his head and body. In this regard the father of the complainant lodged a complainant before I.C. Balurghat P.S. on 17.06.2022. Accordingly, on the basis of the written complaint, one criminal proceeding was initiated vide P.S. CASE NO. 417of 2022 dated 17.06.2022 under Sec. 279/427/304A I.P.C. After proper investigation the charge-sheet was submitted on 31.08.2022 vide no.580/2022.

That as the road traffic accident was occurred during the tenure of the policy. Immediate after such untoward woeful occurrence of death of the son of the complainant, the matter was informed to the concern authority of policy issuing office of Cholamandalam MS General Insurance Company Ltd on several dates viz 03.12.2022 &20.02.2023.

 That  the complainant also submitted a claim intimation letter intimating her grievance on 03/12/2022 to the opposite party as policy issuing office as per requirements of the concerned office enclosing all the documents.

As per the  policy norms and regulations the complainant being the mother of the deceased son is the legal heir according to Hindu succession Act and entitled to get the death benefit of P.A.to owner cum driver amounting to Rs 1500,000/-. But despite having knowledge of the demise of the son of the complainant as per the claim intimation letter from the complainant on 03.12.2022 &20.02.2023.The opposite party neither have replied nor taken any steps to disburse the P.A. amounting to Rs 1500,000/-.

 That despite having concrete knowledge of the demise of the complainant’s son, the O.P. side did not take any step to disburse the amount of compulsory P.A. as per norms and regulation of policy in favour of the complainant nor to repudiate the claim of the claimant till to date.

   The complainant requested the O.P.by approaching the grievance to the P.A. to settle the claim several times, but the O.P. did not opine any views considering the documents, rather they kept mum.  Finding no other alternatives, the complainant files this case.

  From the above discussion, we found that the insurance company i,e O.P. had issued a insurance policy in favour of the deceased which covers personal accident claim of owner cum driver with a sum assured of Rs 15,00,000/- for the life risk of the insured .The insured  Pranab Saha died on 17.06.2022 due to road traffic accident. Thereafter, the matter was informed to the Balurghat Police Station and a criminal case was started vide P.S. CASE NO 417/2022 DATED 17.06.2022. Thereafter, a claim intimation letter dated 03/12/2022 was sent to the office of opposite party enclosing with all the documents. But thereafter no response was given from the insurance company despite receiving the aforesaid claim letter. As the complainant is a rustic villager and did not know about the norms and regulations of the aforesaid company.

Lastly, the complainant sent a reminder letter on 20.02.2023 to the O.P. and asked about his bona-fide claim. The complainant files all the documents relating to the above stated descriptions. The O.P. neither informed nor sends any reply, rather kept mum. The insurance company neither repudiates the claim of the complainant nor allow the claim and make payment of the sum assured of the deceased policy. Therefore, we found that there lies gross negligence as well as deficiency in service on the part of the O.P.  The O.P. after receiving the claim intimation from the complainant neither responded nor gave any reply regarding the procedure of the claim.   

  As O.P. did not contest the case in spite of appearing in the case, so, the case of the complainant cannot be disbelieved.

             We relied on the observation taken by the Apex court in  Insurance Company vs Harcharan Chand Rai Chandan Lal,IV(2004)CPJ 15(S) and National Insurance Company VS Laxmi Narain Dhut III(2007) CPJ 13(SC) where it has held that the policy is a contract between the parties and both the parties are bound by terms of contract.   Under such circumstances, it appears that the insurer violated the terms and condition framed by it.  Therefore, we found that there lies gross negligence in service on the part of the O.P. Under the above circumstances, the complainant is entitled to get the relief.

 Accordingly all the points are decided in favour of the complainant.

 

Hence, it is

                                                                O R D E R E D

 

That the consumer complaint case No 20/2023 is allowed ex-parte against O.P. in part with cost .   The opposite party is directed to pay Rs 15,00,000/- (rupees fifteen lakh) only as principal claim ( total sum assured) against policy No. 3410/00533830/000/00 dated 26.10.2021 along with interest @8% per annum from the date of this order till the realization by issuing an account payee cheque in favour of the complainant.

The opposite party is further directed to pay  Rs 5000/- (rupees five thousand only)as litigation cost by issuing an account payee cheque in favour of the complainant within 45 days from the date of passing of this order failing which, the complainant is at liberty to execute the order according to law.