IN THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MURSHIDABAD AT BERHAMPORE.

             CASE No.  CC/10/2017.

 Date of Filing:                    Date of Admission:                Date of Disposal:

     25.01.17                                      03.02.17                                 23.10.19

Complainant: 1.Mridula Das, W/o Lt. Ganesh Das

                        2. Amit Kumar Das

                        3. Riya Das, both are S/o & D/o Lt. Ganesh Das

                        Beldanga Ashrampara, PO&PS-Beldanga,

Dist- Murshidabad, Pin-742133

-Vs-

Opposite Party: 1. The Branch Manager

                        National Insurance Co. Ltd.

                        Sahid Surya Sen Road, PO&PS-Berhampore

                        Dist-Murshidabad, Pin-742101

                       2. The Branch Manager

                        Golden Trust Financial Servises.

                        16, R.N. Mukherjee Road (1st Floor)

                        Kolkata-700001

Agent/Advocate for the Complainant               : Sri. Saugata Biswas.

Agent/Advocate for the Opposite Party No.  1  : Sri Ajoy Kumar bhattacharya       

Agent/Advocate for the Opposite Party No2     : Smt Sampa Roy

                         Present: Sri Asish  Kumar Senapati………………….....President.                              

                                          Smt. Aloka Bandyopadhyay……………………..Member.

FINAL ORDER

 Asish Kumar Senapati, Presiding Member.

            One Mridula Das and two others (here in after referred to as the Complainants) filed the case against the Branch Manager, National Insurance Co. Ltd. and another (here in after referred to as the OPs) praying for compensation alleging deficiency in service.

   The sum and substance of the complaint case is as follows:-

            The Complainants being the legal heirs of late Ganesh Das filed the case against the OPs alleging that Ganesh Das had a Janata Personal Accident Insurance Policy being No. 100300/47/01/9600022/01/96/30133 valid from 23.07.02 to 22.07.17 under the O.P. No.1 and the Complainant No.1 was the nominee of the said policy.

            The said Ganesh Das murdered on 28.02.11 at Beldanga and the Complainant made an application as nominee of Ganesh Das on 09.04.15 claiming insured sum of 2,00,000/-. The OP No.1  investigated the matter on receipt of the claim application and repudiated the claim vide letter dated 20.03.15 stating that the death of Ganesh Das was suicidal in nature. The investigation and medical report of Ganesh Das suggested that death of Ganesh Das was due to Asphyxia caused by hanging and it was homicidal in nature. Accordingly, the Complainants prayed for direction upon the OP No.1 claiming compensation of Rs.2,00,000/- with an interest @ 10% per annum and a sum of Rs.60,000/- for mental pain and agony.

            The OP No.1 contested the case by filing written version on 01.08.17 contending that the case is not maintainable as it is barred by law of limitation as no cause of action arose on 20.03.15. It is the case of the OP No.1 that Ganesh Das committed suicide and it appears from the PM report prepared by Dr. S.K. Bhunia. The OP No.1 prayed for dismissal of the complaint with cost.

            The OP No.2 also contested the case by filing written version on 01.08.17 contending that Ganesh Das had a Janata Personal Accident Insurance Coverage from National Insurance Co. Ltd. under a Group Insurance  scheme through the facilitation of Golden Multi Service Club of the OP No.2 and the Complainant No.1 was the nominee of Ganesh Das. The OP No.1 has an exclusive right and authority of entertain, process and settle of any claim and the OP No.2 has no role to play in this regard. The OP No.2 prays for dismissal of the complaint.

            On the basis of the above version the following points are framed for proper adjudication of the case :

Points for consideration

1. Isthe Complainant a consumer under the provision of the CP Act, 1986?

2. Has this Forum jurisdiction to entertain the complaint?

3. Has the OP any deficiency in service, as alleged?

4. Is the Complainant entitled to get any relief, as prayed for?

Point no.1

The Ld. Advocate for the Complainants submits that the Complainants are consumers as heirs of Ganesh Das who hired services of the OPs for consideration.

On going through the complaint, written version and other materials on record and on a careful consideration over the submission of both sides, we find that the Complainants are consumers in terms of section 2 (I )(d) (ii) of the C.P.Act, 1986.

Point No.2

The Ld. Advocate for the Complainants submits that the cause of action arose within the territorial jurisdiction of this Forum and the claimed amount is also within pecuniary limit of the District Forum.

On a careful consideration over the materials on record, we find that the cause of action arose within the territorial jurisdiction of this Forum and this Forum has pecuniary jurisdiction to entertain the complaint.

Point No.3&4

The Ld. Advocate for the Complainant submits that the Complainant No.1 lodged the claim on 09.02.15 and the OP No.1 repudiated the claim on 20.03.15 on the ground that the insured committed suicide on 28.02.18 and the death was not resulted solely and directly from any accident caused by external, visible and violent means. He argues that it is true that PM report by Dr. S. K. Bhunia suggested suicidal death of Ganesh Das but the Police Authority referred the matter for final opinion to the Superintendent cum Vice Principal of NRS Medical College and Hospital, Kolkata and the Medical Superintendent Cum Vice Principal of NRS Medical College and Hospital opined in his report dated 12.05.18 that the deceased died due to ligature strangulation which was homicidal in nature. It is urged that the OP No.1 repudiated the claim by ignoring the report of the Medical Superintendent cum Vice Principal of NRS Medical College and Hospital, Kolkata dated 12.05.11. It is submitted that the OP No. 1 has deficiency in service and the Complainants are entitled to get the insurance coverage of Rs.2,00,000/- and compensation of Rs.60,000/- for mental pain and agony against the O.P. No. 1.

                      In reply, the Ld. Advocate for the OP No.1 submits that according to the Complainant No.1, her husband Ganesh Das died on 28.02.11 but she filed claim form along with some documents including the PM report on 09.02.15 i.e. after a lapse of about 4 years and the only reason assigned by her is that she had no helping hand and she was in mental shock. It is further contended that the Complainant No.1 submitted the PM report prepared by Dr. S.K. Bhunia from which it is clear that the death of Ganesh Das was suicidal in nature. He argues that the OP No.1 has rightly repudiated the claim vide letter dated 20.03.15. He submits that the Complainants are not entitled to get any relief against the OP No.1.

     The Ld. Advocate for the OP No.2 submits that Ganesh Das purchased a group insurance policy of the OP No.1 through OP No.2 and the OP No.2 has no liability to settle the claim of the Complainants. She submits that the OP No.2 is an unnecessary party and the Complainants have not prayed for any relief against the OP No.2.

     We have gone through the written complaint, written version, evidence of the Complainants and written argument filed by the Complainants and xerox copies of documents filed by both sides. Admittedly, Ganesh Das died on 28.02.11 and the Complainant No. 1 is the nominee of the group insurance policy of Ganesh Das. The Complainant No.1 lodged the claim on 09.02.15 ( Annexure-1) after a lapse of about 4 years from the death of her husband along with the following documents:-

A letter regarding late submission of claim file.
Photocopy of certificate of death (attested).
Attested photocopy of voter ID card of Insurer.
Attested photocopy of ration card of Insurer.
Photocopy of nominee in passbook.
FIR and Final investigation report (attested).
Post Mortem Report (attested)
Panchayet Certificate regarding status of nominee.

We find that the Complainants stated that the death of Ganesh Das was homicidal in nature and it also appears from the final opinion as to the cause of death of Ganesh Ch. Das as opined by Professor Lakshmi Kanta Ghosh, Medical Superintendent cum Vice Principal, NRS Medical College and Hospital, Kolkata dated 12.05.11 but it is very strange to note that the Complainants have failed to establish that the final opinion as to cause of death of Ganesh Ch. Das as opined by Lakshmi Kanta Das dated 12.05.11 was communicated to the OP No.1 for settlement of the claim. We find that the Complainant No.1 lodged the claim on 09.02.15 i.e. after lapse of about 4 years from the date of her husband along with a letter regarding late submission of claim and the OP No.1 repudiated the claim on the ground that the death of Ganesh Das on 28.02.11 was suicidal in nature which  was not covered under the purview of the Insurance policy. From the contents of the letter dated 20.03.15, it is clear that the OP No.1 had entertained the claim of the Complainant No.1 by condoning the delay in filing the claim.

We have already held that the Complainants have failed to establish that they communicated the final opinion as to cause of death of Ganesh Das to the OP No. 1. We think that the OP No. 1 had no scope to consider the final opinion as to cause of death of Ganesh Das as opined by Professor Lakshmi Kanta Ghosh, Medical Superintendent cum Vice Principal, NRS Medical College and Hospital, Kolkata dated 12.05.11.

In our considered opinion, the Complainant No.1 may be directed to submit the final opinion as to cause of death of Ganesh Ch. Das as opined by Lakshmi Kanta Ghosh, Medical Superintendent cum Vice Principal, NRS Medical College and Hospital, Kolkata to the OP No.1 by 30 days from the date of this order for reconsideration and the OP No.1 may be directed  to reopen the Claim No.100300/47/2012/9690000256, Policy No. 100300/47/01/9600022/01/96/30135 and to dispose of the claim by 60 days from the date of receipt of the final opinion as to cause of death of Ganesh Ch. Das from the Complainant No.1.

We think that the Complainants are not entitled to get any relief against the OP No.2.

Reasons for delay

              The Case was filed on 25.01.17 and admitted on 03.02.17 . This Forum tried its level best to dispose of the case as expeditiously as possible in terms of the provision under section 13(3A) of the CP Act,1986. Delay in disposal of the case has also been explained in the day to day orders.

              Fees paid are correct.

              In  the result, the complaint case succeeds in part. Hence, it is

                          ORDERED

     that the Consumer Complaint No. CC/10/2017 be  and the same is hereby allowed in part on contest against the OP No. 1 without cost and dismissed on contest against the OP No.2 without cost.

The Complainant No. 1 is directed to submit the final opinion as to cause of death of Ganesh Ch. Das as opined by Lakshmi Kanta Ghosh, Medical Superintendent cum Vice Principal, NRS Medical College and Hospital, Kolkata dt 12.05.11 for reconsideration to the OP No.1 by 30 days from the date of this order and the OP No.1 is directed to reopen the Claim No.100300/47/2012/9690000256, Policy No. 100300/47/01/9600022/01/96/30135 and to dispose of the claim in accordance with rules by 60 days from the date of receipt of the final opinion as to cause of death of Ganesh Das from the Complainant No.1.

     Let plain copy of this order  be supplied free of cost, to each of the parties / Ld. Advocate/Agent on record, by hand  /by post under proper acknowledgment  as per rules, for information and necessary action.

The Final Order will also be available in the following Website:

    confonet.nic.in

Dictated & corrected by me.

          President

  Member                                                                                                President.