Order No. 20 dt. 02/11/2016
The case of the complainant in brief is that the complainant of the complainant was insured with o.p. no.1 and purchased a USY policy from o.p. no.1 through o.p. no.2 and the sum assured was Rs.1,25,000/- and the said transaction was made on 24.9.10. Unfortunately the husband of the complainant met with an accident and he succumbed to injuries on 25.9.10 and the complainant claimed the sum assured through o.p. no.2. The complainant submitted the claim through o.p. no.2 and o.p. no.2 informed the o.p. no.1 that the claim of the complainant can be considered. In spite of the said letter from o.p. no.2, o.p. no.1 refused to pay the claim amount to the complainant. The complainant further stated that o.p. no.1 received the premium against the life insurance policy and as such, the repudiation of the claim was illegal and accordingly the complainant demanded the sum assured and also prayed for compensation and cost.
The o.p. no.1 contested this case by filing w/v and denied all the material allegations of the complaint. It was stated that the husband of the complainant Swapan Singha had subscribed USY policy with o.p. no.1 being policy no.OG-11-2421-6401-00003078 for the period from 1.10.10 to 30.9.11. The husband of the complainant died in a motor vehicle accident on 25.9.10. The complainant informed the o.p. no.1 about the said incident after passing of more than 10 months. After receipt of the intimation o.p. no.1 appointed an independent investigator Biswas & Associates to investigate the claim and the said investigator submitted his report on 12.9.11. The risk commencement date was from 1.10.10 to 30.9.11 and since the accident was not covered under the above policy the complainant is not legally entitled to get any amount from the insurance company and accordingly o.p. no.1 claimed that it was rightly repudiated and there was no deficiency in service on the part of o.p. no.1. In view of the said fact o.p. no.1 prayed for dismissal of the case.
The o.p. no.2 did not contest this case by filing w/v and as such the case has proceeded ex parte against the o.p. no.2.
On the basis of the pleadings of parties the following points are to be decided:
- Whether the husband of the complainant was covered with the insurance during the time of accident.
- Whether there was any deficiency in service on the part of the o.ps.
- Whether the complainant will be entitled to get the relief as prayed for.
Decision with reasons:
All the points are taken up together for the sake of brevity and avoidance of repetition of facts.
Ld. lawyer for the complainant argued that the husband of the complainant had an account with o.p. no.2 and being the account holder he paid the policy premium through o.p. no.2 on 24.9.10, the sum assured of Rs.1,25,000/- for accidental death or injury. Due to the accidental death of insured Swapan Singha by a motor vehicle accident on 25.9.10 the complainant informed the o.p. no.2 as the proposer of the policy on 1.10.10. The bank authority assured the complainant that necessary steps will be taken by the bank. Thereafter the complainant attended the bank several times for searching policy as bank the propoer of the policy and premium of policy debited from the insured’s bank account through ECS and credited to the insurer insurance company’s bank account. The bank forwarded the claim to o.p. no.1 on 8.7.11 and they admitted that the complainant has no latches and requested the insurer to satisfy the assured amount. The o.p. no.1 thereafter appointed an investigator who submitted report after inquiry, o.p. no.1 repudiated the claim of the complainant on the ground that the policy commenced on 1.10.10 after the death of the insured and the claim was made after committed delay. Ld. lawyer for the complainant emphasized that the complainant all through pursued the matter with o.p. no.2 and o.p. no.2 assured the complainant that she should be paid through ECS and she would also get the policy, but subsequently whenever the bank informed the o.p. no.1 regarding the amount deducted from the account of the complainant’s husband and the amount was deposited in the account of the bank, o.p. no.2 and considering the said fact the bank also requested the o.p. no. 1 to pay the sum assured. In spite of receiving the said letter o.p. no.1 did not release the amount therefore ld. lawyer prayed for relief.
Ld. lawyer for the o.p. no.2 opposed the claim of the complainant by submitting that the death of the complainant’s husband took place before the issuance of the policy and as such the complainant will not be entitled to get the claim as made by her. It was stated that the complainant does not come within the purview of the C.P. Act and there was no deficiency in service or any unfair trade practice in respect of the claim made by the complainant. It was specifically stated that the husband of the complainant had subscribed a USY policy for the period from 1.10.10 to 30.9.11 and the husband of the complainant died on 25.9.10 i.e. the policy was issued after the death of the said insured, therefore the complainant will not be entitled to get the claim and accordingly the claim of the complainant was repudiated.
Considering the submissions of the respective parties and on perusal of the evidence adduced by both the parties it is crystal clear that the husband of the complainant had an account with o.p. no.2. It is also an admitted fact that the complainant being the widow claimed the insured sum after the demise of her husband from o.p. no.2 since the amount was deducted from the account of the complainant’s husband on account of the USY policy premium. It is also found from the annex-A of the complaint whereby o.p. no.2 wrote a letter to o.p. no.1 with regard to the accidental death claim on life of Swapan Singha the husband of the complainant in respect of the SB A/C No.0127010397322 wherefrom it is evident that an amount of Rs.17/- was debited from the account of the husband of the complainant on 24.9.10 and the accident occurred on 25.9.10. From the materials on record it is also an admitted fact that the amount was deducted on 24.9.10 and the said amount was remitted to the account of the insurance company but unfortunately the policy was not issued by o.p. no.1. In support of the said contention regarding accidental death of the husband of the complainant, the complainant filed some documents including P.M. report, FIR, inquest report etc. wherefrom it is evident that the death was an accidental death and the policy covered the accident and the amount was deducted from the account of the husband of the complainant before his death and the bank recommended to o.p. no.2 for releasing the fund and it is also found from the materials on record that immediately after the death of the husband of the complainant she contacted the bank for realization of the assured amount and the bank assured her that the amount would be credited in her account, but nothing was done, subsequently bank informed the o.p. no.1 who subsequently denied the claim that it was not claimed within the statutory period, but from the facts and circumstances it is crystal clear that the complainant being rustic lady she had no conception wherefrom she would get the money for which she contacted the bank, as such some delay was committed. In this respect we can rely on a decision as pronounced by Hon’ble State Commission decided on 26.11.08 in respect of the SC Case No.FA/08/2665 wherein it was held that the event of insured against may be indicated in the policy solely by reference to the phrase injury by accident or by equivalent phrase accidental injury and on the question of interpretation of the meaning of the word accident even if it is held that there are two interpretations possible, the appropriate which favours the insured is to be accepted as decided by Apex Court in Skandia Insurance Co. Ltd. vs. Kokilaben Chandrabadan and others reported in (1987) 2 SCC 654. In view of relying on the said judgment passed by Hon’ble State Commission we hold that the complainant took all sorts of measures after the death of her husband with the bank and bank forwarded to the o.p. no.2 for favourable consideration of the claim of the complainant and it was also stated that the amount was deducted from the account of the insured before his death and the said amount was sent to the o.p. no.1 prior to the death of the husband of the complainant thereby the bank also wrote a letter to the insurance company for releasing the fund in favour of the complainant towards the insured sum but in spite of receiving the said letter o.p. no.1 did not release the said fund.
Having regard to the facts and circumstances we hold that the complainant will be entitled to get the sum assured in respect of the said policy of her husband and she will also be entitled to get the compensation for harassment as well as litigation cost. Thus all the points are disposed of accordingly.
Hence, ordered,
That the CC No.613/2013 is allowed on contest with cost against the o.p. no.1 and dismissed ex parte without cost against the o.p. no.2. The o.p. no.1 is directed to pay to the complainant a sum of Rs.1,25,000/- (Rupees one lakh twenty five thousand) only towards the assured sum along with compensation of Rs.10,000/- (Rupees ten thousand) only for harassment and mental agony and litigation cost of Rs.2000/- (Rupees two thousand) only within 30 days from the date of communication of this order, i.d. an interest @ 10% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.
Supply certified copy of this order to the parties free of cost.
