Date of Filing: 07.03.2014 Date of Final Order: 24.04.2015
The brief facts of the present case, as culled out from the record are that the complainant’s husband during his life time purchased a Policy which was covered by personal accidental death insurance namely Room Night bearing No.32370042110100000001, sum insured Rs.1,00,000/- from Pancard Clubs Ltd., Cooch Behar Branch through the agent, Anayara Khatun of Pancard Clubs Ltd., Cooch Behar Branch i.e. O.P. No.4 which is issued by the O.P. No.3 and validity period of the said policy from 18/03/2013 to 17/03/2014 and the O.P. No.1 issued a certificate in the name of complainant’s husband, Ashraful Alam.
On 24/04/2013 Ashraful Alam, husband of the complainant died in a motor vehicle accident and in this respect a FIR has been lodged with Boxirhat P.S. Case No.74/2013 dated 24/04/2013 u/s 279/304(A) IPC and G.R. Case No.162/2013.
After the death of the complainant’s husband, the complainant submitted her claim with relevant documents before the office of the Pancard Clubs Ltd., Cooch Behar Branch. But the O.P. No.1 did not response regarding personal accidental death insurance claim of the complainant. Then the complainant communicated with the O.P. No.1 on several occasions but the O.P did not give any satisfactory reply about her claim and for that lastly on 15/01/2014 the complainant went to the office of the O.P. No.1 and requested them to settle her claim amount but in vain. Thereafter, the complainant issued demand notice on 22/01/2014 & 28/01/2014 through Lawyer against the O.P. No.1 & 2. The O.P. No.2 answered the notice that their clients are not involved in any insurance business. Their clients buys/procures Group Personal Accidental Death Insurance Policy from third party i.e. the O.P. No.3, The New India Assurance Co. Ltd. (hereinafter referred to as NIAC) also they stated that the clients have paid the premium for the relevant year to NIAC on behalf of applicants including the deceased Ashraful Alam. The further stated that the complainant’s husband was covered under the group personal accidental death insurance bought by their client from NIAC for its applicants. For such deficiency in service and negligence adopting by the O.Ps, the complainant suffered a great financial loss, unnecessary harassment mental agony and pain as the complainant is a nominee of the said policy.
Hence, finding no other alternative the complainant filed the present case praying for issuing a direction upon the Opposite Parties (i) Rs.1,00,000/- for amount of personal accidental benefit with interest, (ii) Rs.25,000/- as compensation for mental pain, agony and unnecessary harassment, (iii) Rs.15,000/- for financial loss & (iv) Rs.10,000/- towards litigation costs, besides other relief(s) as the Forum deem fit, as per law & equity.
The O.P. Nos.1 & 2, Pancard Clubs Ltd. have contested the case denying all material allegation of the complaint contending inter-alia the case is not maintainable and the complainant has no cause of action to bring the case.
It is the specific case of the O.P. No.1 & 2 that the original fact of the case is that the O.P. No.1 & 2 have not collected any premium amount from the deceased applicant/claimant towards the Group Personal Accidental Death Insurance.
It is the further case of the O.P. No.1 & 2 that they had taken Group Personal Accident Death Insurance for its applicants from the O.P. No.3 for the year 2013-2014 and paid the premium for the same under which deceased applicant was covered. Accordingly, the entire responsibility for processing of insurance claims is with the O.P. No.3. The O.P. No.2 states that the complainant has failed to submit requisite documents to process the claim from the O.P. No.3 as per the requirement letters also they stated that the complainant only submitted documents on 06/06/2013 and never came forward to submit required documents to claim accidental death benefits from the O.P. No.3. The O.P. No.2 further stated that neither they act as an insurance agent nor they are in any way connected with the operations of the O.P. No.3, they assist its applicants as per conduct between the applicant and the O.P. No.3. Accordingly, as per the terms & conditions of the applicant the Hon’ble Forum at Mumbai can only deal with this matter.
It is the case of the O.P. No.1 & 2 that the O.P. No.2 is providing insurance to its applicants free of cost from the O.P. No.3, hence the Consumer Protection Act, 1986 is not applicable to the O.P. No.1 & 2 when the O.Ps are not receiving any consideration/premium towards the group accidental death insurance coverage of applicant as stated hereinabove. Hence, the complainant is not consumer of the O.P. No.1 & 2 and the present complaint is not maintainable and liable to be dismissed with cost.
The O.P. No.3, The New India Assurance Co. Ltd., Mumbai has contested the case denying all material allegation of the complaint contending inter-alia the case is not maintainable and defect of parties.
It is the specific case of the O.P. No.3 that the complainant did not submit the (i) Original Insurance Policy, (ii) First Information Report (FIR) duly attested by the concerned police authority, (iii) Inquest Report (Panchnama) duly attested by the concerned police authority, (iv) Post Mortem Report duly attested by the concerned police authority and (v) Original Death Certificate in support of her claim in spite of several reminders dated 19/07/2013, 23/08/2013 23/09/2013 and lastly on 17/10/2013.
It is the case of the O.P. No.3 that the complainant did not comply the requirements of the above O.P in spite of several requests, though Personal Accidental Death Policy was in force covering the date of accident and issued by the above O.P, could not settle the claim of the complainant. Therefore there is no alternative way to this O.P except repudiate the claim and close the claim file as No Claim. The O.P. No.3 also stated that the complainant did not give any information about the incident within 7 days from the date of accident and she submitted her claim with insufficient documents on 06/06/2013 at Pancard Clubs Ltd. i.e. after 42 days from the date of accident, which was should be filed within 30 days from the date of incident. The O.P. No.3 further stated that the complainant is not entitled to get relief from this O.P as prayed in her complaint. Accordingly, the O.P. No.3 prayed for dismissal of the present case with cost.
The O.P. No.4, Anayara Khatun has contested the case denying all material allegation of the complaint contending inter-alia the case is not maintainable and defect of parties.
It is the specific case of the O.P. No.4, Anayara Khatun, neither she is agent of Pancard Clubs Ltd. nor issued the said policy cum certificate to the complainant. At the time of filing this complaint petition the complainant filed a Xerox copy of policy which reveals that Marzina Begam is an agent/marketing person of the said policy and she had no negligence or deficiency in service towards the complainant and thereby the claimant is not entitled to get any compensation as claimed or any part thereof from this O.P. No.4. Lastly the O.P. No.4 prayed for struck off the name of the O.P. No.4, Anayara Khatun from this complaint petition.
In the light of the contention of the complainant, the following points necessarily came up for consideration.
POINTS FOR CONSIDERATION
- Is the Complainant is a Consumer 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 by repudiating the claim of the Complainant and are they liable in any way?
- Whether the Complainant is entitled to get relief/reliefs as prayed for?
DECISION WITH REASONS
We have gone through the record very carefully, perused the entire documents in the record also heard the argument by the parties.
Point No.1.
In the case in hand the husband of the Complainant during his life time obtained a policy from the Opposite Party No. 1&2 through the O.P. No. 4 issued by the O.P. No. 3. The Complainant is the nominee of the deceased policy holder. Thus, the relation between the O.Ps and the Complainant as came to be established we are in view that the Complainant is the Consumer of the O.Ps.
Point No.2.
The branch office of the O.P. No.1 is situated within this district and the complaint value is far less than the prescribed limit for which this Forum has pecuniary as well as territorial jurisdiction to try the case.
Point No.3 & 4.
It is the case of the complainant that the complainant’s husband during his life time purchased a Policy which was covered by personal accidental death insurance namely Room Night bearing No.32370042110100000001, sum insured Rs.1,00,000/- from Pancard Clubs Ltd., Cooch Behar Branch through the agent, Anayara Khatun of Pancard Clubs Ltd., Cooch Behar Branch i.e. O.P. No.4 which is issued by the O.P. No.3 and the O.P. No.1 issued a certificate in the name of complainant’s husband, Ashraful Alam.
‘Annexure-1’ is original Policy Certificate of Ashraful Alam for sum insured Rs.1,00,000/- with premium Rs.10,920 issued by the O.P. No.1, Pancard Club for the period 25/10/2012 to 25/01/2016 for personal death insurance coverage.
‘Annexure-2’ is one Xerox copy of formal FIR and FIR of Boxirhat P.S Case No.74/13 dated 24/04/2013 u/s 279/304 A, which reveals that one Taslim Miah lodged the said complaint alleging his nephew Ashraful Alam sustained grievous injuries while he was proceeding with his motor cycle being No. WB-64 E/5559 and dashed by pickup van being No. WB-63/4960.
‘Annexure-3’ is copy of Seizure List by which motor cycle of the deceased and affinitive vehicle along with documents are served by police.
‘Annexure-4’ is Post Mortem Report which reveals that Asraful Alam had died on 24/04/2013 due to motor accident.
‘Annexure-5’ is Final Report of Boxirhat P.S U/D Case No.15/13 and P.S Case No.74/13 which reveals that the said case ended in charge sheet u/s 279/304 A IPC.
‘Annexure-7’ is the Death Certificate of Asraful Alam.
‘Annexure-6’ is the Advocate’s Letter dated 11/02/2014 issued by Anant C Singh Advocate to Mr. Maklesar Rahaman Advocate of the complainant.
So, it is clear from above documents that on 24/04/2013 Asraful Alam had died due to motor accident within coverage period of insurance policy.
‘Annexure-II’ of the O.P. No.3, insurance company reveals that on 28/05/2013 the complainant Rejina Bibi submitted death claim of her husband with some documents and O.P. No.3 received the same.
‘Annexure-I’ of the O.P. No.3 i.e. receipt of O.P. No.1, Pancard Club reveals that on 06/06/2013 the complainant submitted some documents to the O.P. No.1 and the O.P. No.3 received the same.
It is the specific case of the O.P. No.3 that the complainant did not give any information about the incident within 7 days from the date of accident and she submitted her claim with insufficient documents on 06/06/2013 at Pancard Clubs Ltd. i.e. after 42 days from the date of accident, which was should be filed within 30 days from the date of incident and ultimately the O.P. No.3 could not settled the claim due to insufficient documents and finding no other alternative repudiated the claim.
It is the case of the O.P. No.3 that on 19/07/2013, 23/09/2013 and 17/10/2013 reminder were sent to the O.P. No.1, Pancard Club to submit necessary documents and in support of their contention.
They have filed ‘Annexure-III’ i.e. no claim information dated 23/11/2013. We find that there is mention in the said letter that reminder were sent to the O.P. No.1 on 19/07/2013, 23/09/2013 and 17/10/2013 but there is nothing to show that actually said reminders were sent to the O.P. No.1 or not.
Now question comes whether due to submission of death claim after statutory period, the said claim is liable to repudiate or not.
In this juncture, we can place reliance upon the ruling reported in 2013(I) CPR 91 (HP) where Hon’ble State Commission pleased to hold that in case of death of any person insured by vehicle accident cannot be ground of repudiation of claim if the claim is not placed within 60 days especially when the scheme of the policy nowhere provided that in case intimation was not given within one month as indicated, the insurer will be liable to pay the insurance money. Delay in informing the insurer about the date of death may be a good ground for repudiation of claim in case where there is serious dispute creating reasonable doubt about the death or cause of the death of the insured person but in a case like the case where the cause of death is not disputed one.
Since in the present case neither the cause of death nor the death of the husband of the complainant is disputed, the principles of the decision as above is squarely applicable to the instant case and thereby we safely hold that the O.P. No.3 acted illegally in repudiating the claim of the complainant and then the said O.P incidentally proved to be guilty of deficiency in service and adopting unfair trade practice.
Regarding O.P. No.1 & 2 i.e. Pancard Club, we find that they have performed their duty by sending application and other documents filed by the complainant to them to the O.P. No.3 time to time. So, there is no deficiency in service on the part of the O.P. Nos.1 & 2.
Regarding O.P. No.4, we find that she was made party to the case as marketing person of the O.P. No.1 & 2, Pancard Club. But original policy certificate reveals that there name of one Marzina Bibi has been written as marketing person. So, we do not find any case against her.
Accordingly, those points are decided in favour of the complainant.
Thus, the case succeeds in part.
ORDER
Hence, it is ordered,
That the case No. DF/14/2014 be and the same is allowed on contest with costs of Rs.5,000/- against the O.P. No.3, The New India Assurance Company Ltd. and dismissed on contest without any costs against the O.P. Nos.1,2 & 4.
The O.P. No.3 is directed to pay Rs.1,00,000/- as compensation as sum assured for the deceased Asraful Alam together with interest @8% to be calculated from 22/11/2013 i.e. from the date of repudiation of the claim by the O.P. No.3 to the complainant. The O.P. No.3 is further directed to pay as compensation of Rs.10,000/- to the complainant for harassment, mental agonies and sufferings.
The ordered amount shall pay to the Complainant directly by the O.P. No.3 within 45 days failure of which the said O.P shall have to pay Rs.100/- for each day’s delay and the amount to be accumulated shall be deposited in the “State Consumer Welfare Fund”, West Bengal.
Let plain copy of this Final Order be supplied, free of cost, to the concerned parties/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
