Ld Advocates for the parties are present. Judgement is ready and pronounced in open Commission.

BY - SRI.SAURAV CHANDRA, MEMBER

1. Brief facts of the Complainant’s case are that the Opposite Party No.1 & 2 is a Bank through which the Complainant’s husband insured his life under the KBL Suraksha Insurance Policy with the Opposite Party No.3 by way of auto deduction of insurance premium from his Saving Bank A/c # 4362500100707901 towards necessary remittance to the Opposite Party No.3.

2. The husband of the Complainant died on 05.09.2017 left behind the Complainant. The Complainant being the registered nominee lodged insurance claim with all relevant papers before the Op No.3 through Op No.1 but, they did not settled the claim. After several visits with the Op No.1, no fruitful result came out.

3. Therefore, the Complainant being harassed and neglected preferred to move before this Commission for necessary redressal.

4. So, from the bundle of facts arising out of the materials on record, the Op No.1 & 2, vide letter dated: 10.09.2018 has submitted the documents as required by the Op No.3 for settling the claim and therefore, circumstances of the case the cause of action of this case arose on and from 10.09.2018.

The Complainant, therefore, prays for:-

1. To pay the Claim Amount of Rs.10,00,000.00 towards accidental death.

2. To pay compensation of Rs.10,000.00 for mental agony.

3. To pay Litigation Cost of Rs.10,000.00 to the Complainant for conducting the case.

4. Any other reliefs as the complainant entitled to get as per the law and equity.

5. Notices were duly served upon the Ops against which Op No.3 contested and Op No.1 & 2 both have filed their Written Versions only.

6. While resisting the claim of the Complainant, the Op No.1 & 2 in their Written Version stated inter alia that the Op No.1 & 2 are not the insurer but only acting as a corporate agent of Op No.3 by forwarded the claim to the Op No.3 and has taken paramount care and diligently submitted the papers insuring the interest of the claimant. The Op No.1 & 2 vide letter dated: 10.09.2018 has submitted the documents as required by the Op No.3 but, due to non-submission of Viscera Report by the claimant, the said claim has not settled by the Op No.3.

7. Under the above Op No.1 & 2 prays for rejection of the petition filed by the Complainant with compensatory cost.

8. The Op No.3, while resisting the claim of the Complainant in its’ Written Version stated inter alia, that the Complainant did not intimated the Op No.3 after stipulated prescribed in policy terms and conditions of 15 days and in-spite of sending letter, the Complainant did not explain the cause of inordinate delay from the side of Complainant and which is violation of terms and conditions.

9. The Op No.2 further states, from the medical documents it is found that the Complainant is failed to supply of documents to prove the deceased and the said matter is suppressed by the insured in time of filling up Proposal Form. Moreover, in-spite of repeated requests, the Complainant did not submitted the required documents i.e. attested copy of KBL Insurance Certificate and Viscera Report through letter dated: 21.08.2018, 25.10.2018 and 13.11.2018.

10. Under the above Op No.3 prays for dismissal of the present case with costs.

11. Points for determination are:

1. Is the case maintainable in its present form and in law? 
2. Is the Complainant entitled to the relief(s) as sought for?

12. Decision with reasons

1. Both the points I and II, being inter related to each other, are taken up together for discussion for sake of brevity and convenience.

2. We have carefully perused the materials on record including Complaint on Affidavit, List of Documents including FIR, GD, Post-Mortem Report, Death Certificate, Address & Id Proof of the Complainant and deceased, Bank Statement, Written Versions of the Ops, Written Examination in Chief on Affidavit, Questionnaires, Reply along with all related papers and documents.

3. Having regards had to the facts and circumstances of the case in the light of evidence, it is evident that there is no dispute that Complainant is a consumer having grievances against the Ops, as such the case is maintainable in its present form and in law.

4. In the instant case, the Complainant produced the copy of Bank Statement of her deceased husband where Rs.115.00 has been debited by Op No.1 on 10.01.2017 towards KBL – Suraksha Insurance Premium from the Savings A/c No.4362500100707901.

5. It is evident from the Bank Statement of the deceased, the Op No.1 duly debited the Insurance Premium against the KBL – Suraksha Insurance Policy for the Year 2017 in which the husband of the Complainant died i.e. on 05.09.2017. Moreover, the Op No.1 & 2 duly forwarded the claim papers of the Complainant to the Op No.3 towards necessary settlement. Therefore, it cannot be said that the Op No.1 & 2 has any Deficiency of Service.

6. It is revealed that the claim of the Complainant is not settled by the Op No.3 for want to Viscera Report even after receiving all relevant documents in respect of the said claim i.e. copy of FIR, GD, Post-Mortem Report, Death Certificate, Address & Id Proof of the Complainant and deceased, Bank Statement etc.

7. From the above documents it is clearly established that the death was due to road accident by a vehicle. Moreover, from the Post-Mortem Report it is vividly mentioned that “the death was due to the effect of injury described above – ante mortem in nature.” In the 5^th Row of Post-Mortem Report under Column No.4 i.e. Stomach and its contents, it is categorically mentioned “Rice Compound”. Therefore, in the instant case, it is immaterial to ask for the Viscera Report from the Complainant. There is no iota of indication regarding any suicidal or homicidal death in the PM Report. There is also no indication to the effect that the deceased drunk any alcohol beyond the permissible limit causing violation of the insurance policy. As the Op No.3 has not settled the claim of the Complainant only for pending of Viscera Report assuming the death might be caused other than RTA, it was the duty of this Op to establish it’s defense against the claim by adducing any cogent evidence on it’s behalf. It is the duty of the investigating office to collect the Viscera Report if it is necessary for the trial, the Complainant has no obligation to collect the same and submit it before any forum. So, it appears that the Op No.3 has caused deficiency in service by not settling the claim of the Complainant basing on a flimsy ground of asking for a Viscera Report. The preponderance of evidence of record suggest that the death of husband of the Complainant is due to the cause of RTA i.e. Accidental Death.

8. KBL Suraksha is a unique personal accident insurance scheme for Savings Bank Account holders of Op No.1 & 2, coverage for Accidental Death only. The Sum Assured Value of which is Rs.10,00,000.00 under Plan – B with an Annual Premium of Rs.100.00 + Service Tax. In the Claim Procedure it is mentioned – “In case of accidental death of insured, the same should be intimated immediately to the M/s. Universal Sompo General Insurance Co. Ltd. (USGICL) and a written complaint should be lodged at the nearest police station. A Copy of First Information Report (FIR) along with other documents should be submitted immediately to USGICL by the nominee through KBL Base Branch for further processing.”

1. As per the observation of this Commission, the Complainant has duly complied all formalities as per the terms and conditions of Insurance but, in-spite of that she failed to get the claim from the Op No.3 on the ground of shreds logic like Viscera Report and KBL Insurance Certificate. The Certificate of said Insurance Policy can easily be checked/verified by the Op No.3 itself from its’ own record. Therefore, the Op No.3 is completely responsible and liable for not only Deficiency in Service but caused unnecessary harassment and mental pain of a helpless young Widow Nominee of the insured to whom the Op No.3 deprived from her legitimate claim in absence of her husband.

10. Now, coming to the matter of relief, the Op No.3 can’t get absolve themselves from mischief of harassment and Deficiency in Service. The Op No.3 is solely liable to pay the entire Claim of Rs.10,00,000.00 along with Simple Interest @ 8% per annum over the awarded amount from the date of filing of this petition till the date of actual realization in the nature of Compensation and Litigation Costs of Rs.7,000.00 to the Complainant within 30 days from the date of this order. As we do not find any element Deficiency in Service against Op No.1 and 2, the case is liable to be dismissed against them.

11. Accordingly, both the points are decided in favour of the Complainant.

•  Thus, the complaint case succeeds.

Hence, it is

        O R D E R E D

That the CC-537 of 2019 be and the same is allowed on contest against the Op No.3 and dismissed exparte against Op No.1 & 2.

1. The Op No.3 is directed to pay the entire Claim amounting to Rs.10,00,000.00 along with Simple Interest @ 8% per annum over the awarded amount from the date of filing of this Complaint till the date of actual realization in the nature of Compensation and Litigation Costs of Rs.7,000.00 to the Complainant within 30 days from the date of this order and Rs.7,000.00 towards Litigation Costs to the Complainant. The Op No.3 is directed to comply the above direction within 30 days from the date of this order.

1. The Complainant would be at liberty to put the order into execution u/s 71 of the Consumer Protection Act, 2019 and to initiate a proceeding u/s 72 of the Consumer Protection Act, 2019.

2. Let a copy of this judgment be provided to all the parties free of cost expeditiously upon compliance of all legal formalities. The judgment be uploaded forthwith on the website of the Commission for the perusal of the parties.

3. File be consigned to record section along with a copy of this judgment.