Case No. CC/65/2021
COMPLAINANT :1. Smt. Amita Saha, @ Anita Saha
W/O Late Prokash Saha @ Prakash Saha,
Vill: Tarakdaspur, P.O. Mohatpur,
P.S. Chapra, Dist. Nadia, Pin-741164.
V-E-R-S-U-S
OPPOSITE PARTIES / 1.The Divisional Manager,
National Insurance Co. Ltd.,
Division-III, National Insurance Building,
Ground Floor, 8, India Exchange Place,
Kolkata-700 001.
2.The Branch Manager,
GTFS, Krishnagar Branch,
P.O. Krishnagar, P.S. Kotwali,
Dist. Nadia, Pin-741101.
3.The Manager,
GTFS Multi Services Ltd,
S. B. Mansion,
16, R.N. Mukherjee Road,
Kolkata – 700 001.
Ld. Advocate(s)
For Complainant: Makbul Rahaman
For OP/OPs : Dilip Kumar Saha
(2)
Date of filing of the case :06.08.2021
Date of Disposal of the case :12.09.2023
Final Order / Judgment dtd.12.09.2023
Complainant above named filed this complaint against the aforesaid opposite parties u/s 35 of the Consumer Protection Act, 2019 praying for direction to the OPs to pay the claim of the complainant, compensation amounting to Rs.50,000/-, cost of the case amounting to Rs.25,000/- and other reliefs.
She alleged that her husband Prokash Saha @ Prakash Saha since deceased , had purchased a Group Janata Personal Accident Insurance Policy of N.I.C.O vide policy no. 100300/47/2k/9601062/2k/96/006070 in the name of himself and in the name of present complainant jointly and the sum assurance was covered for Rs.50,000/- each through OP No.3. Said policy was valid for the period from 15.10.2001 to 14.10.2016. During the validity period of the said insurance policy, complainant’s husband Prokash Saha @ Prakash Saha died in an road accident on 10.09.2014 and petitioner claimed the policy amount but OP No.1 & 2 repudiated the claim and informed the complainant that they are unable to pay the policy amount as claim has filed after 4 years. Hence the complainant filed this case.
OP No.2 contests the case by filing a W/V. He denied the entire allegations made in the petition. But he further stated that OP No.3 is registered partnership firm and same was formed in the year 1995. On 01.01.2001 said firm entered into a MOU with the OP NO.1. By virtue of said MOU insurance coverage under the Group Janata Personal Accident Insurance Policy was extended to the members of the said club upon of receipt premium from respective members. Complainant is bound to prove the entire allegations which he stated in her petition of complaint. He prays for dismissal of the case.
Trial
During trial complainant filed affidavit in chief on 23.08.2023 and on that date OP No.2 was not present. Hence the OP No.2 did not get any chance to file questionnaire, so question of filing answer does not arise.
Documents
Complainant filed the following documents.
- Xerox copy of National Insurance Policy dated 14.10.2016........(One sheet)..........(Annex-1)
- Xerox copy of Death Certificate dated 10.09.2014.....(One sheet).......(Annex-2)
(3)
- Xerox copy of Post Mortem Report dated 11.09.2014........(One sheet)......(Annex-3)
- Xerox copy of FIR dated 18.09.2015.........(Four sheets)........(Annex-4)
- Xerox copy of Final Form/Report dated 17.09.2015........(Seven sheets).........(Annex-5)
- Xerox copy of application to OP No.2 from complainant.........(One sheet)......(Annex-6)
- Xerox copy of application to OP No.1 from complainant ..........(One sheet)......(Annex-7)
- Xerox copy of advocate’s Notice on behalf of complainant to OPs dated 24.03.2021..........(Two sheets)..........(Annex-8)
- Xerox copy of Postal Track Report ............(Two sheets)
10)Xerox copy of Voter Card of complainant..........(One sheet).........(Annex-9)
11)Xerox copy of Repudiation /Denial of dated 24.08.2018..........(One sheet)
Brief Notes of Argument
Complainant filed BNA.
Decision with Reasons
We have carefully gone through the petition of complaint filed by the complainant, W/V filed by the OP No.2, affidavit in chief filed by the complainant, documents filed by the complainant and BNA filed by the complainant. We have carefully considered these documents.
Moreover, affidavit in chief filed by the complainant is unchallenged testimony, so we do not find sufficient reason to disbelieve the same.
Placing reliance upon the affidavit in chief of the complainant and copy of policy issued by OP No.1 (Annexure-1), we find that complainant’s husband Prokash Saha @ Prakash Saha had purchased Group Janata Personal Accident Insurance Policy on 15.10.2001 and said policy was valid for the period from 15.10.2001 to 14.10.2016. OP No.2 in his W/V admitted the said fact.
On perusal of Xerox copy of death certificate (Annexure-2), Xerox copy of Post Mortem Report (Annexure-3), we find that said Prokash Saha @ Prakash Saha died on 10.09.2014 and he died due to accident and said accident was road traffic accident.
(4)
On perusal of Xerox copy of FIR and charge sheet (Annexure-4 and 5), we find that relating to aforesaid accidental death of said Prokash Saha @ Prakash Saha Kotwali P.S. started FIR No.759/2014 dated 10.09.2014 u/s 279/304 AI PC.
On perusal of Xerox copy of application of complainant, we find that she made prayer before OP No.1 & 2 and claimed the insurance amount.
On perusal of Xerox copy of Advocate’s letter dated 24.03.2021 (Annexure-8), we find that Ld. Advocate for the complainant served notice upon OP No.1-3 by the said letter Ld. Advocate requested the OP No.1-3 to settle the claim.
Perused the Xerox copy of letter issued by OP No.1 (Annexure-10) in favour of the complainant, we find that they repudiated the claim but refused to pay the policy amount as the matter was informed to them after 4 years .
On perusal of W/V of OP No.2 and aforesaid letter of OP NO.1, we find that they did not raise any question about the aforesaid policy or entitlement of the complainant about the policy amount relating to accidental death of Prokash Saha @ Prakash Saha but main contention of the OP No.2 is that as the complainant filed the claim application before the OP No.1-3 after lapse 4 years , so complainant is not entitled to sum assured of the aforesaid policy amounting to Rs.50,000/- relating to accidental death of Prokash Saha @ Prakash Saha.
Ld. Adv. for the complainant argued at the time of hearing that complainant on several occasions prayed for policy amount before the OP No.1-3. But complainant failed to produce any document in support of the fact that immediately after the death of Prokash Saha @ Prakash Saha, complainant filed the claim application before the OP NO.1-3 or any of them.
On perusal of annexure-10 that is the letter issued by representative of OP No.1 in favour of the complainant. It has stated over the said letter that complainant intimated them after lapse of 4 years . Perused the copy of Advocate’s letter dated 24.03.2021. Ld. Advocate for the complainant stated that immediately after the accidental death of complainant’s husband matter was informed to OP NO.1-2 relating to death of Prokash Saha @ Prakash Saha and complainant submitted claim application before them. But no date has mentioned over the said letter when complainant submitted the death intimation before the OP NO.1-2 and submitted claim application before the OP N.1-2. As per record Prokash Saha @ Prakash Saha died on 10.09.2014 and complainant filed this case on 06.08.2021.
Complainant stated in the petition of complaint that cause of action of this case has arisen on 10.09.2014 and thereafter, 24.08.2018 when
(5)
OP No.1 repudiated the claim. Complainant sent lawyer’s notice to the OP NO.1-3 on 24.03.2021.
On perusal of record, we find that complainant is the consumer and OP NO.1-3 are the service provider.
Considering the facts and circumstances of this case, documents on record and other materials on record, we find that complainant submitted claim before the OP No.1-3 after lapse of 4 years from the date of death of Prokash Saha @ Prakash Saha and complainant failed to assign any reason as to why she did not lodge the complaint in due time before the OP NO.1-3.
But incident of death of insured Prokash Saha @ Prakash Saha has been well established before this Commission by sufficient documents. So we think that delay of submission of claim before OP No.1-4 should be ignored.
In the result, present case succeeds.
Hence,
It is
Ordered
that the present case be and the same is allowed on contest against OP NO.1-3 but without any order as to costs.
OP No.1-3 jointly or severally are directed to pay amount of sum assured i.e Rs.50,000/- (Rupees fifty thousand) in favour of the complainant within 45 days from this day failing which complainant shall have liberty to put this order into execution.
Considering the facts and circumstances of this case no order is passed as compensation against the OP No.1-3.
Let a copy of this final order be supplied to both the parties as free of costs.
Dictated & corrected by me
............................................
PRESIDENT
(Shri DAMAN PROSAD BISWAS,) ..................... ..........................................
PRESIDENT
(Shri DAMAN PROSAD BISWAS,)
We concur,
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MEMBER MEMBER
(NIROD BARAN ROY CHOWDHURY) (MALLIKA SAMADDAR)
