DISTRICT CONSUMER DISPUTES REDRESSAL FORUM. BOLANGIR.
…………………..
Presents :-
- Sri A.K.Purohit, President.
- Smt. S.Rath, Member.
Dated, Bolangir the 20th day of February 2018.
C.C.No. 39 of 2016.
Sri Debaraj Sahu, age-51 years son of late Butu Sahu.
Village-Gunchitara, P.O.Muribahal P.S.Titilagarh,
Dist- Bolangir.
.. .. Complainant.
-Versus-
1.The General Manager, Reliance General Insurance Co.Ltd.
At- Flat No.301, III Floor, Krisha Block, Krishe Sapphire,
Madhapur, Hyderabad, Pin Code-500081.
2.Dy. Inspector General, CISF Unit DSP, Bhirangi More
Durgapur-03, Dist-Burdwan, State-West Bengal.
.. .. Opp. Parties.
Adv. for the complainant- Sriprakash Mishra.
Adv. for the O.P.No.1 - Sri R.K.Mohakur.
Adv. for the O.P.No.2 - None.
Date of filing of the case- 15.07.2016
Date of order - 20,02,2018
JUDGMENT.
Sri A.K.Purohit, President.
1. The father of the deceased policy holder has preferred this case alleging deficiency in insurance service. While working in the CISF, late Santosh Kumar Sahu had taken a policy under PMSP Accident insurance claim scheme vide policy No.1111342914000034 from the O.P.No.1. The assured amount for the said policy is Rs 3,00,000/- .The policy was renewed from time to time and during the subsistence of the policy the policy holder died due to cardiac arrest. The cardiac arrest is due to the shock caused in an accident in the bathroom of a train while he was coming to his village Gunchitara. After knowing about the insurance benefit of his son, the complainant duly applied for the claim, but his claim has not been considered by the O.Ps. Hence the complaint.
2. Both the O.Ps have filed their version separately. The O.P.1 denied the complainant’s allegations and submitted that, the date of accident is 1.3.2015 and the date of loss is 3.3.2015 and the policy was in force from 4.1.2014 to l3.1.2015. Hence the policy is not covered the death of the deceased Policy holder and the complainant is not entitled to the claim. According to O.P.No.2 the dispute is between the complainant and the insurance company and hence the O.P.2 is not liable for any claim of the complainant.
3. Further the O.P.2 submitted that as per the Rule of the Salary package account holder, the claim has to be submitted within 90 days of the death of the customer. But the complainant has not submitted any claim during that period. However as a welfare measure after receipt of the application from Niranjan Sahoo the O.P.2 has taken step for settlement of the claim, but the S.B.I. main Gate Branch, Durgapur verbally informed that the claim has not been considered due to non submission of the same within the prescribed time. Hence O.P.2 claims no deficiency in service on his part.
4. Before filing of the written statement the O.P.1 raised a preliminary objection relating to the maintainability of the case. To avoid piecemeal trial, the case is heard both on preliminary objection and on merit after filing of the written version by the O.P.1.
5. So far the preliminary objection is concerned the learned advocate for the O.P.1 submitted that, by the time of death of the policy holder the policy is not in force and hence the case is not maintainable. It appears from the material available on record that, according to the scheme of the SBI, the salary account of the CISP personnel have been converted to PMSP Account which are insured with accidental death insurance policy with the insurance company and according to the scheme the salary account of late Debaraj Sahu was converted to PMSP account and the accidental death benefit with the O.P.No.1 is valid from 4.1.2015 to 3.1`.2016. Admittedly the deceased policy holder was died on 3.3.2015,therefore the death is during the validity of the policy. Hence the case is maintainable.
6. Coming to the merit of the case, it is seen from the repudiation letter dated 28.5.2016 of the O.P.No.1 that, the claim has been repudiated on the grounds of non filing of the claim within the prescribed period and the death is not due to any accidental injury. It is evident from the documentary evidence available on record that, the death of the policy holder was on dt.3.3.2015 and the claim was submitted along with all documents on dt.16.5.2016. According to the terms and conditions of the policy the claim has to be intimated within 90 days and documents have to be submitted within 180 days of the death. In this case the claim intimation along with documents are submitted after 440 days of death. The delay of 440 days cannot be said to be reasonable There is no evidence available on record to show that the delay was reasonable
7. Coming to the next point of repudiation the complainant has pleaded that the deceased policy holder was died due to cardiac arrest It is also pleaded that, the said cardiac arrest is due to an accident in the bath room of the train where the deceased was returning to his village. There is no evidence available on record to show that the said accidental injury caused the death of the policy holder. As per the terms and conditions of the policy, the claim is payable, if the insured person shall sustain any injury resulting solely and directly from an accident. The accident was on dt 01.3.2015 and the death was on dt.3.3.15 due to cardiac arrest. This cause of death can not be said to be due to accident without any believable evidence. Hence the repudiation of the claim of the complainant by the O.P.1 is justified.
Accordingly the case of the complainant is dismissed..
Order pronounced in open Forum this the 20th day of February 2018.
(S.Rath) (A.K.Purohit)
MEMBER. PRESIDENT.
