DATE OF FILING: 22.08.2013.

  DATE OF DISPOSAL: 13.10.2016.

Dr. Alaka Mishra, Member (W).  

                        The complainant has filed this consumer complaint U/S 12 of C.P.Act, 1986 alleging deficiency in service against the Opposite Parties (for short, the O.Ps) and redressal of his grievance before this Forum.

                        2. Briefly stated the fact of the case is that the complainant’s late husband Satchidananda Mohanty is the policy Holder of the policy bearing No.10003/31/12/329117 commencement from 21.09.2011 to 20.09.2012.  The said policy was issued by the O.P.No.1 after receipt of the required premium for the purpose and O.P.No.2 as the Branch office maintained by O.P.No.1 for purpose of the insurance business. They deal within this area and also other areas as instructed by O.P.No.1, accordingly the Opposite Parties are aware of the existence of the said policy. The policy in question issued with personal accident coverage U/S III for the owner/driver (C.S.I.) for Rs.2,00,000/-(Rupees Tow Lakhs) as stated thereon. While the matter stood thus the policy holder late Satchidananda Mohanty faced the motor vehicle accident on 05.08.2012 occurred at about 9.30 P.M. on N.H. 5 near the Over-bridge of Pathara while the policy was in force and as such sustained injuries to his person for which he was referred to MKCG Medical College Hospital, Berhampur for necessary treatment and he died on the same day during course of treatment.   This fact was reported to the Gopalpur  Police Station as registered vide P.S. Case No. 92 dated 5.8.2012  U/S 279/338/304(A) I.P.C, and the postmortem was also made in connection to the said accident. The dependants of the deceased policy holder have made the O.D. claim on the strength of the policy in question which the O.Ps have also paid after the occurrence took place. Subsequently the complainant enquired from the O.P.No.2 regarding the present claim as per their instruction submitted the required claim application along with the relevant documents before the concerned authority who did not give any acknowledgement to the effect of receiving the claim application with the oral undertaking to process the same for payment but about one year is going to be completed but none of the Opposite Party paid the amount which the complainant is entitled to get on the strength of the policy in question and they are jointly and severally liable to pay the same nor even they have made any single correspondence in connection to the said claim amount for deficiency in service. The complainant issued advocate notice on dated 7.6.2013 by registered post with A.D. to the O.P.No.1 which was duly acknowledged. But the O.P. remained silent over the matter without giving any reply to the same and the demand as made in the said notice is not paid to the complainant till date thereby giving rise to mental agony of the complainant. In the present circumstance because she is suffering a lot and passing through very hard days after the sad demise of her husband due to accident as there is no other source of income available with her for the livelihood. So the O.P. are to pay compensation towards damages due to the reason that they have violated the terms of the above said insurance contract in question resulting in breach of the same.   Alleging deficiency in service on the part of the O.Ps the complainant prayed to direct the O.Ps to pay the personal  accident claim of Rs.2,00,000/- with up-to-date interest, Rs.50,000/- towards compensation and litigation cost of Rs.50,000/-in the best interest of justice.

            3. Upon notice the O.Ps filed version through his advocate.  It is stated that the averments made in the complaint are all not true and correct and those that are not specifically admitted herein are denied to have been denied and the complainant is put to strict proof of the same. The complainant has never intimated to the O.P.No.2 about the death occurred on 4.8.2012 and also not made any claim for the death of her husband with this O.P.No.1, and after long lapse of more than 11 months issued a notice through advocate on 7.6.2013 to the O.P.No.1 for the purpose of the present litigation a cause of action was attempted to invent by the present complaint, which did not possess any merit and hence the case against the O.P. is not maintainable. The cause of action against an Insurance company would arise when a claim is lodged after which either no decision is given or delayed decision is given or a claim is wholly or partially repudiated.  When no such claim is lodged for the damages of the motor cycle, occasion would not arise for this O.P. to give a response/decision. In the present case no such claim was ever raised with the Insurance Company (the O.P.No.2 the policy issuing Branch) for which no occasion arose before it to render any service. Hence the complainant is not backed by any legitimate cause of action. For the purpose of the present litigation a cause of action was attempted to invent by the present complaint, which did not possess any merit and there is no allegation of deficiency of service by the complainant and hence the case against the O.P. is not maintainable. Such vexatious creation of cause in bringing the present litigation be viewed with heavy hand and the complainant be asked to submit authentic evidence of lodging of claim before the Insurance Company. The averments made in the last Para of the complaint clearly show that the complainant has not lodged any intimation as well as claim before the O.P.No.1 till filing of the complaint. Hence the present claim is also not maintainable on the ground that as there is no slightest sign of deficiency of service on the part of the O.P.No.1 and also there is no allegation of deficiency of service in anywhere in the complainant. Hence the present claim is also not maintainable under the provision of the Act. The averments made in the complaint against the O.P are all baseless and created exclusively for the purpose of putting a claim. The complainant has not approached with clean hands and has played fraud, has misled, has adhered to all such frivolous activities, has deliberately suppressed the material evidence, has concealed the truth for the purpose of the claim. Hence the complainant is not entitled for any such relief. The complainant is not the sole legal heir/successor of the deceased. Hence the present claim is not maintainable and is liable to be dismissed in the interest of justice. 

            4. On the date of final hearing both the learned counsel were present before the Forum and submitted their case. We heard arguments at length from learned counsels for both parties. Complainant is a widow of deceased policy holder bearing policy No.10003/31/12/329117 commencing from 21.9.2011 to 20.9.2012. Policy holder died in a road accident on 05.08.2012 when the policy was in force. Complainant first intimated the matter to the O.P. with claim forms, but when did not settle the claim sent an advocate notice to the General Manager to settle the matter but the matter was not settled by them. As per written argument by O.P, complainant did not make any intimation to the Company regarding such matter. In the oral submission, the O.P. submitted that complainant received the amount for vehicle damage and complainant also admitted it. It is clear that the O.P. has settled the vehicle damage claim of the complaint.  But, on perusal of pleadings of parties and on verification of materials on case record, it reveals that the O.P. is yet to settle the personal accident claim of the complainant. The learned advocate for O.P. also not filed any documentary evidence with regard to settlement of personal accident claim of the complainant. In the above facts and circumstance the case, the Forum directs the O.Ps to settle the personal accident claim of the complainant.

            In the result we allow the case of the complaint. We direct the complainant to submit claim intimation before O.Ps if not submitted earlier within 15 days of receipt of this order.  After receiving the documents from the complainant the O.Ps are directed to pay personal accident claim of Rs.2,00,000/- (Rupees Two Lakhs) with interest @ 6% per annum from the date of filing of this complaint with effect from  22.08.2013. The O.Ps are also burdened with Rs.1000/- (Rupees One Thousand) towards the cost of litigation to be paid to the complainant within the same period.  The aforesaid amount (claim settlement and others) shall be paid to the complainant within 45 days from the date of receipt of documents from the complainant, failing which the complainant is at liberty to realize the said amount from the O.Ps under Section 27 of the Consumer Protection Act, 1986 along with penal interest at the rate of 7% per annum. The case is disposed of accordingly.

            The order is pronounced on this day of 13th October 2016 under the signature and seal of this Forum. Copy of the order supplied to the parties on free of cost.