West Bengal

Paschim Midnapore

CC/145/2016

Shyamali Bakli - Complainant(s)

Versus

The Divisional Manager, National Insurance Co.Ltd. - Opp.Party(s)

Gobinda Prasad Jana

02 Mar 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

Bibekananda Pramanik, President

And

 Mrs. Debi Sengupta, Member

   

Complaint Case No.145/2016

 

             Shyamali Bakli, W/o Late Uttam Bakli, Village Murasti, P.O. Lowada, P.S. Debra,

             District Paschim Medinipur, West Bengal, PIN-1136.……………..……Complainant.

                                                                              Vs.

1)The Divisional Manager, National Insurance Co. Ltd., Division-III, 8, India Exchange Place, Ground Floor, Kolkata-700 001,

2)The Divisional Manager, National Insurance Co. Ltd., Medinipur Divisional Office, at Station Road, Medinipur, P.O. & Town- Medinipur, District Paschim Medinipur, West Bengal, PIN-721101,

3)The Divisional Manager, Golden Trust Financial Services, Divisional Office at 16, R.N. Mukherjee Road, Kolkata -700 001, West Bengal,

4)Branch Manager, Golden Trust Financial Services, Medinipur Branch Office, at Battala Chak, P.O. & Town-Medinipur, District Paschim Medinipur, West Bengal, PIN-721101....……….….Opp. Parties.

                                                    

              For the Complainant: Mr.  Gobinda Prasad Jana, Advocate.

              For the O.P.               : Mr. Swapan Bhattacharya, Advocate &

                                                  : Mr. Anath Bandhu Ghosh, Advocate.

 

Decided on: - 02/03/2017                               

ORDER

                          Bibekananda Pramanik, President :- Facts of the case, in brief, is that Uttam Bakli, since deceased, the husband of the complainant Shyamali Bakli, had taken a “Group Janata Personal Accident Insurance Policy” from the opposite party-National

Contd……………………..P/2

 

( 2 )

Insurance Company Ltd. through the opposite party nos. 3 & 4 Golden Trust Financial Services Ltd. vide certificate serial no.01265006/200102388528 and the number of that policy is 100300/47/2K/9601026/2K/96/00707 and the validity of the said policy was from 31/12/2001 to 30/12/2016.  The complainant is the nominee of the said policy. Unfortunately, on 04/12/2004 Uttam Bakli, the husband of the complainant, received a injury from a machine and on his way to hospital he died.  After his death, post mortem was held by medical officer of Medinipur Medical College & Hospital.  After the death of Uttam Bakli, a U.D. case was started by Kotwali Police Station u/s 174 Cr. P.C.  Immediately after the death of the  Uttam Bakli, the complainant, being the nominee of that policy, deposited the claim form in the office of the opposite party-Insurance Company and the said claim was registered vide no. GPA/JPA Claim no.100300/47/2014/96900000705 and thereafter the complainant also filed all required documents in the office of the opposite party-National Insurance Company.  Thereafter the opposite party-Insurance Company sent a letter to the complainant for further required documents and on 15/02/2016, the complainant sent a letter to the Insurance Company. Subsequently on 18/04/2016 & 11/05/2016, the complainant also sent letters for settlement of the claim but in spite of submission of all required documents, the opposite parties have not settled the claim which tantamounts to refusal of the claim and therefore the opposite party-Insurance Company  is guilty of deficiency in service on their part.  The complainant is a widow and rustic poor woman and she is passing her days with great financial stringency but the opposite party-Insurance Company has been harassing her in various ways for settlement of the claim.  Hence the complaint, praying for directing the opposite party-Insurance Company to pay the sum assured of Rs.50,000/- with interest @ 12% p.a. from the date of accident on 04/12/2004 and for an award of  Rs.30,000/- towards cost of litigation.

                  The opposite party has contested this case by filling a written objection.     

                   Denying and disputing the case of the complainant, it is the specific case of the opposite party-Insurance Company that the complainant has no reason to file the petition of complaint, that the present case is not maintainable, that the petition of complaint is barred by limitation and that the petition of complaint is liable to be rejected.  It is also the case of the opposite party-Insurance Company that the husband of the complainant died on 04/12/2004 and the complainant intimated to opposite party-G.T.F.S. on 01/01/2015 and the said opposite party-G.T.F.S. intimated to the opposite party-Insurance Company regarding the claim of the complainant on 01/01/2015 i.e. after lapse of 10 years from the date of death.  During process of claim, the opposite party-insurance co. found that the claim should have been intimated within 30 days / one calendar month

Contd……………………..P/3

 

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but the present claim has been submitted after lapse of 10 years  thereby violating the policy terms and conditions. In spite of repeated request and reminder letter dated 07/12/2015,  the complainant did not submit the original policy bond to the opposite party-Insurance Company for which they were compelled to close the file due to non furnishing of the aforesaid documents.  It is further stated that the present complaint is hopelessly barred under the provision of C.P. Act  as the present petition of complaint has been filed after lapse of 12 years.  Opposite party-Insurance Company therefore claims dismissal of the case.

                  By filing a separate written objection, Golden Trust Financial Services i.e. opposite party nos. 3 & 4 have contested this case.  Admitting the claim of the complainant, it is stated by the opposite party nos.3 & 4 that in spite of submission of all required document, the claim has not been settled by the opposite party-Insurance Company.  On 07/05/2015, the original claim form along with photocopies of policy certificate, general diary, death certificate, investigation report, post-mortem report, voter ID card and bank pass-book were submitted to the opposite party-National Insurance Company. Vide their letter dated 07/05/2015, opposite party-Insurance Company advised the complainant to submit the required claim-documents which are needed for settlement of the claim.  It is stated that for any accidental death claim, copy of final police report and original JPA/Group PA Certificate are very much required to determine the cause of death and identity of the insured.  Without those documents the settlement of the claim is difficult by the opposite-Insurance Company.  It is also stated by the opposite party nos.3 & 4 that they are unnecessary party in this case.

                 To prove her case, the complainant has tendered a written examination-in-chief,  supported by affidavit, as PW-1 and she was also examined on oath as PW-1.  During her evidence, few documents were marked as exhibit 1 to 12 respectively.  On the other hand, none of the opposite parties adduced any evidence either oral or documentary.

                                                                 Points for decision

1)Is the case maintainable in it’s present form and prayer ?

2)Is there any deficiency in service or unfair trade practice on the part of the opposite parties ?

3)Is the complainant entitled to get the reliefs, as sought for ?    

                   

Decision with reasons

  For the sake of convenience and brevity, all the above points are taken up together for consideration.

Contd……………………..P/4

 

( 4 )

                          It is not denied and disputed that during his life time, Uttam Bakli, since deceased, the husband of the complainant, obtained a  “Group Janata Personal Accident Insurance Policy” from the opposite party-National Insurance Company Ltd. through the opposite party nos. 3 & 4- Golden Trust Financial Services Ltd. and the complainant is the nominee of the said policy.  It is also not disputed that the husband of the complainant died on 04/12/2004.  Although in the petition of complaint, the complainant has stated that immediately after the death of  Uttam Bakli the complainant deposited the claim form in the office of the opposite party-Insurance Company but from her petition of complaint as well as from the documents filed by her in this case, we find that admittedly the complainant  for the first time submitted the claim of insurance before the opposite party-Insurance Company on 01/01/2015 through opposite party-G.T.F.S..  It is not the case of the complainant that the opposite party-Insurance Company has repudiated her said claim of insurance.  In their written objection, opposite party-Insurance Company has specifically stated that vide letter dated 07/12/2015, they asked the complainant to submit the original policy bond and other

documents for settlement of the claim but in spite of receiving the said letter, the complainant did not submit those required documents for which the opposite party-Insurance Company was bound to close the file.  The said letter dated 07/12/2015 has been marked as exhibit-3 in this case.  This document (Exhibit-3) goes to show that for the purpose of further action towards processing of the claim in question, few documents were required to be submitted by the complainant before the opposite party-Insurance Company.  Thereafter, as it appears from the documents, filed by the complainant, that some correspondence was made by the complainant through his advocate Gobinda Prasad Jana with the opposite party-Insurance Company and the last correspondence was made on 18/04/2016.  By sending those letters, it was requested to the opposite party-Insurance Company on behalf of the complainant to settle the claim within 15 days from the date of receipt of the last letter dated 18/04/2016. The present petition of complaint has been filed on 15/09/2016 alleging that in spite of receiving those letters, the opposite party-Insurance Company did not settle her             claim which tantamounts to refusal of claim  and therefore there is deficiency in service on the part of the opposite party.  Curiously enough, the complainant herself lodged her claim long after 10 years from the death of her husband and she is alleging that the opposite party-Insurance Company  are taking long time in disposal of her claim petition.  Be that as it may we find  the claim of insurance  has not yet been  repudiated by the opposite party-Insurance Company.  They should be given some reasonable time for settlement of the claim of insurance and mere delay of few months in disposal of the claim petition cannot be said to be deficiency in service on the part of the opposite party. Since the claim of insurance in

Contd……………………..P/5

 

( 5 )

question has not yet been repudiated by the opposite party-Insurance Company, so we are of the view that the complainant has no cause of action to file the present case and the opposite party-Insurance Company cannot be held to be guilty of deficiency in service.  The petition of complaint is therefore liable to be dismissed for want of cause of action.                                

                            All the points are accordingly disposed of.

                             In the result, the complaint case fails.

                                                           Hence, it is,

Ordered,

                                                                               that the complaint case no.145/2016  is hereby dismissed on contest but in the circumstances without cost.

                               Let plain copy of this order be given to the parties free of cost.

 

                 Dictated & corrected by me

                    Sd/-B. Pramanik.                        Sd/- D. Sengupta.                     Sd/-B. Pramanik. 

                            President                                 Member                                    President 

                                                                                                                         District Forum

                                                                                                                     Paschim Medinipur