District Consumer Disputes Redressal Forum
Dakshin Dinajpur, W. Bengal
(Old Sub-Jail Municipal Market Complex, 2nd Floor, Balurghat Dakshin Dinajpur Pin - 733101)
Telefax: (03522)-270013
Present
Shri Sambhunath Chatterjee - President
Shri Siddhartha Ganguli - Member
Consumer Complaint No. 49/2014
Smt. Kalpana Chakraborty
W/o Late Goutam Chakraborty
Anadabagan,
PO & PS: Balurghat,
Dist. Dakshin Dinajpur ………………Complainant(s)
V-E-R-S-U-S
1. The Divisional Manager,
National Insurance Co. Ltd. VIII,
Division-III, Shakespeare Sarani, 6th Floor,
Calcutta – 700 071.
2. The Branch Manager,
Golden Multi Services Club of GTFS, Balurghat Branch
3 ½ No. More,
P.O: Balurghat, Dist.: Dakshin Dinajpur.
3. The Branch Manager,
National Insurance Co. Ltd., Balurghat Branch
PO & PS.: Balurghat.
Dist.: Dakshin Dinajpur. …………………Opposite Parties
Ld. Advocate(s):
For complainant …………… - Shri Anish Das
For OP Nos. 1 & 3 …………… - Shri Goutam Das
For OP No. 2 …………… - Shri Bidyut Kr. Roy
Date of Filing : 18.11.2014
Date of Disposal : 16.09.2015
Contd…P/2
Judgment & Order dt. 16.09.2015
Fact of the case in brief is that husband of the complainant insured his life under Group Janata Personal Accident Insurance being Policy No. 100300/47/01/9600022. After death of husband of the complainant, the complainant being the nominee of the deceased submitted all the relevant papers wherein it was mentioned that the death of husband of the complainant took place due to an accident. The complainant submitted an application for demanding the amount but the same was repudiated, thereafter the complainant sent a lawyer’s letter which was not answered by the insurance company. Being baffled to have any relief the complainant had to file this case before this Forum praying for giving direction upon the OP Nos. 1 & 3 to make payment of sum assured of Rs.3 lakh with interest and other benefit plus (+) costs of Rs.10,000/-.
National Insurance Company contested the case by filing written version wherein all the material allegations of the complaint. The insurance company stated that the complainant has failed to prove her case that her husband died due to an accident. JPA also covers the compensation is admissible for “death, permanent total disablement, loss of eyes of insured person resulting solely and directly from accident caused by external visible and violent means, subject to terms, conditions, exclusions of JPA insurance”. The complainant did not send a police report or any FIR copy for verification to the accident. In order to prove that the death of insured person took place due to accident cannot be found from the document namely police final report / charge sheet PM report etc. but no such documents were provided to the insurance company, as a result, it cannot be ascertained that the death of husband of the complainant occurred due to an accident.
OP No.2 filed a written version wherein it was stated that the OP No. 2 is not a necessary party and accordingly OP No. 2 claimed the
Contd…P/3
expunging the name of Golden Multi Services Club of GTFS (OP-2) and cannot be held liable for payment of compensation.
On the basis of the pleadings of the respective parties following points are to be determined:-
- Was the husband of the complainant died in an accident?
- Whether there was any deficiency in service on the part of OP No.1
- Whether the complainant will be entitled to get insured sum of Rs.3 lakh?
DECISION WITH REASONS
All the points are taken up together for avoidance of repetition of facts.
The Ld. Lawyer for the complainant argued that husband of the complainant had a policy and during continuance of the said policy, the said policyholder Goutam Chakraborty died in an accident. The complainant being the nominee of the deceased claimed sum assured and she submitted all the documents including the PM report, death certificate, and the claim made by the complainant to the insurance company to prove that death of the deceased took place due to an accident. In spite of receiving all those documents the insurance company failed to pay the sum assured and being aggrieved with the repudiation of the claim the complainant had to file this case.
Ld. Lawyer for the complainant in support of his contention cited several rulings as reported in 2008 (4) CPR 370 (NC), where it was held that just claim under a policy of insurance could not be permitted to be defeated on hyper technical grounds. Repudiation on the ground that copy of FIR not supplied – repudiation on the ground was unjustified Hardly be a ground (National Insurance Co. Ltd. V. Sukhdev Singh Gill, II (2006) CPJ 333).
Ld. Lawyer relied on a decision as reported in Oriental Insurance Co. v. Prakash Devi 2008 SCJ 788 II (2008) CPJ 267 (NC).
Contd…P/4
Ld. Lawyer also relied on several other decisions in support of the said contention that only on technical ground of not providing FIR and other papers claim of the complainant cannot be denied.
Ld. Lawyer for the OPs argued that in order to substantiate the claim of the complainant that her husband died in an accident to be proved the same, some documents are sine qua non i.e. FIR copy, inquest report, PM report, medical papers and copy of charge sheet, but here in this case excepting the PM report other documents have not been provided by the complainant. Moreover, though, the PM report was filed but in the PM report it was mentioned that death was caused due to an accident. Ld. Lawyer emphasized that the victim was at the time of death aged about 65 years and if he would have died in an accident the PM report ought to have mentioned the same but in the PM report from the opinion of the doctor it was found that the death occurred due to some injuries, but in the policy it was mentioned that the JPA policy under scope of cover states that compensation is admissible for “death, permanent total disablement, loss of eyes of insured person resulting solely and directly from accident caused by external visible and violent means, subject to terms, conditions, exclusions of JPA insurance”. In order to available of the benefit of the coverage of sum assured in case of death of complainant ought to have proved that death of the deceased took place due to an accident. Here in this case no such substantiate evidence has been brought before this Forum, simply because in the PM report it was mentioned that the death was caused due to impact of some injuries that ipso-facto does not prove that the death of the deceased occurred due to an accident, therefore, the claim made by the complainant from the insurance company was not accepted and the complainant will not be legally entitled to get the claim amount. Apart from the said fact the complainant did not come with clean hands to substantiate the said claim which justified the insurance company for repudiation of the claim.
Contd…P/5
Considering the submission of the respective parties and on perusal of materials on record, we find that husband of the complainant i.e. Goutam Chakraborty was a policyholder and during his life time insured his life under Group Janata Personal Accident Insurance. In order to prove the same the complainant filed a policy wherefrom it is found that period of the policy covered from 31.3.2004 to 23.3.2016. It is an admitted fact that Goutam Chakaraborty at the age of 65 years died on 30.4.2014. The complainant has stated that said Goutam Chakraborty died in an accident and after death of deceased the complainant filed some documents before insurance company and claim a sum of Rs.3 lakh, which was repudiated. On the perusal of the documents filed by the complainant it is found that the complainant though filed the PM report but no wherein the PM report it was mentioned that due to effects of injuries sustained by the deceased due to an accident the death took place. The complainant in the complaint as well as from the documents it was mentioned that initially the victim was sent to Balurghat State General Hospital wherefrom it was referred to Malda Medical College & Hospital but it is curious enough that the complainant could not file those papers either from the hospital of Balurghat or from the Malda Medical College & Hospital to substantiate the claim that the said Goutam Chakraborty died in an accident. Apart from, non filing of the FIR, inquest report and other documents, corroboration of death due to an accident of the victim could not be established if those documents would have been filed wherefrom we could have gathered the information that the death of the victim took place due to an accident.
The foundation of the claim in case of holding of such policy, the claimant should prove that the death took place due to an accident but no such evidence was led by the complainant to substantiate her claim. Therefore, we have no hesitation to hold that the complainant has failed
Contd…P/6
to prove her case and since she did not come with clean hands to get the relief from this Forum. In this respect we can also relied on decision as reported in III (2010) CPJ 123 (NC) and the ruling as cited by the Ld. Lawyer for the complainant are not applicable in this case.
Having regard to the facts and circumstances of the case stated herein above we hold that the complainant has miserably to prove her case to get any relief from this Forum.
Hence, it is
O R D E R E D
that the instant petition of complaint CC No.49 of 2014 is dismissed on contest.
Parties to bear their own costs.
Let a plain copy of this order be furnished to the parties forthwith free of cost.
Dictated & corrected
………Sd/-….…….
(Sambhunath Chatterjee)
President
I concur,
……Sd/-..……
(S. Ganguli)
Member
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