SRI NILAKANTHA PANDA, PRESIDENT
The Complainant has filed this complaint petition, U/s-12 of C.P.A.-1986 (here-in-after called as the “Act”), on dated 29/06/2017, alleging a “deficiency-in-service” by the O.Ps, where O.P No.1 is the Manager Legal, M/s IFFCO TOKIO General Insurance Company and OP No.2 is the Secretary, Sahada Service Co-operative Society. That, as per the complainant’s petition the cause of action arose on dated 26/12/2016.
That upon admission of the present case matter, the Ops were appropriately noticed along with copy of the complaint petition. The record says, the notice was served upon OP No.1 & it has appeared on dated 11/08/2017. The OP No.2 has appeared in this case on dated 11/09/2017.
The case of the Complainant, in brief is that, complainant’s deceased husband was a member of Service Co-operative Society of OP No.2 (Member No – 2249) governed by Balasore-Bhadrak Central Co-operative Bank Ltd, who acquired a crop loan under KCC Programme (KCC No.030101572), amounting to Rs.10, 000.00 from OP No.2 was covered under “group insurance” of OP No.1.
The deceased husband of the complainant was a farmer cum wood cutter by profession and he was maintaining his family as such. That on 22/04/2016, husband of the complainant, while cutting a tree, died being fell down from the same. That on receipt of that Parsuram Patra in an unconscious condition, the doctor of Basta CHC found it as “brought dead condition”. The post-mortem report submitted by the doctor reveals the cause of death was due to “haemorrhage shock with injury to the vital part of the body such as liver, brain & heart”. For that the same, Basta PS UD Case No.4 of 2016 was registered and upon investigation, as all the witness stated that the death was due to falling from tree only, the case was closed accordingly. Thereafter, the complainant made a claim for settlement and waiver of loan outstanding along with claim of insurance amount before OP No.2, who forwarded the same to Balasore-Bhadrak Central Co-operative Bank Ltd on 13/05/2016 for consideration. That the BBCC Bank, on identifying the Parsuram Patra, as one of the “insured person” has appropriately forwarded the claim to the OP-1, for doing needful ascribing policy no as 51556826 and claim no as 325/16-17/048.
That on receipt of said claim details and basing upon the survey report & other documents, the Op-1, concluded that the accidental claim suffers from want of evidence of “external injury” and was constrained to close the case as “No Claim” and issued letter to BBCC Bank in that manner. That in furtherance to that, the said BBCC Bank issued a letter to the Op No-2 on 12/05/2017, to contact & collect appropriate evidence to justify the death of Parsuram Patra was due to “accident & with external injury”. Therefore, the complainant, having been rejected by the OP No – 1, was constrained to knock out the door of this Commission with the prayer for relief, compensation and expanses, as stated in the complaint petition.Hence, this case.
That to substantiate the complaint, the complainant relied upon the following documents, which are placed in the record;
- Xerox copy of loan account
- Xerox copies of UD case records
- Death certificate of Parsuram Patra
- Legal heir certificate
- Xerox copies of connecting papers regarding taking loan
- Certificate issued by Sahada SCS Ltd
- Letter issued by CEO to the Branch Manager, BBCC Bank, Basta Branch
- Letter of OP No.1 issued in favour of BBDCC Bank, Balasore.
The Ops have appeared in this case through their counsels and filled their separate written versions within the statutory period.
The OP No.1, in his written version, denying the averments made in the complaint petition so also claims, demands, stated that the present case is not maintainable and there is no cause of action for filing this case and bad for non-joinder & mis-joinder of parties. It is specifically stated that the OP No.1 has not issued with any policy in question in favour of the complainant nor settled the claim as because the complainant is not a consumer under the OP No.1 so also her deceased husband. The OP No.1 has not insure loan of any loanee and the policy number as disclosed by the complainant, rather it is a Group Personal Accident Insurance Policy which the Secretary of Balasore-Bhadrak Central Co-operative Bank Ltd, Balasore Head Office has taken personal accident coverage of 226463 number of unnamed persons, who are farmers nor wood cutter, covering risk of death, permanent total disablement of the unnamed persons as mentioned under table of benefits of said policy so also does not cover any waiver of loan amount nor for payment of compensation to their legal heirs in the event of natural death of said unnamed persons. Further, the grounds of repudiation of the claim of the complainant is not contrary to the provision of Group Personal Accident Insurance Policy and does not amount to gross deficiency of service on the part of OP No.1. Further, the claim of the complainant is under the process before Balasore-Bhadrak Central Co-operative Bank Ltd, Balasore and not yet reached its finality. It is further stated that as per law the deceased husband of the complainant has not died due to external injury, rather died due to falling from the tree. Hence, the complainant is not entitled to the claim as sought for.
That to substantiate the OP No - 1, has relied upon the following documents, which are placed in the record;
- True copy of Group Personal Accident Insurance Policy Schedule
- Copy of No-Claim Letter issued to BBCC Bank
The OP No.2, in his written version, challenging the maintainability of the case, cause of action, denied the averments made in the complaint petition. The OP No.2 admitted that Parsuram Patra has taken crop loan amounting to Rs.10, 000.00 on 05/03/2016 as he was a member and KCC holder and his crop loan was insured under the OP No.1. The claim of the complainant for settlement & waiver of outstanding loan against her husband, OP No.2 has forwarded the claim of the complainant to its principal Balasore-Bhadrak Central Co-operative Bank Ltd. for disposal on 13/05/2016 intimating that deceased Parsuram Patra was under the policy No.51556826. As per inquest report of the local police, it was found that Parsuram Patra died due injury in internal vital part of body causing out of falling from a tree. The OP No.2 has discharged all his duty as per law and there has been no negligence on his part in payment of the compensation. No document has been relied in support of his case.
In view of the above averments of parties, the points for determination in this case are as follows:-
(i) Whether the Complainant is a Consumer as per C.P Act, 1986?
(ii) Whether there is any cause of action to file this case?
(iii) Whether this Consumer case is maintainable as per Law?
(iv) Whether the case is bad for non-joinder and mis-joinder of parties?
(v) Whether there is any deficiency of service on the part of the O.Ps to the Complainant?
(vi) To what other relief(s), the Complainant is entitled to?
F I N D I N G S
That upon meticulous examination of the Complaint Petition, Written Version/s of OP/s along with the documents / statements presented by the parties to this case matter, it is found that, the deceased husband of the complainant, was admittedly a KCC holder with the OP No – 2, which is a subsidiary of Balasore-Bhadrak Central Co-operative bank Ltd. That present “principal”, while disbursing crop loan to the aforesaid KCC holders, through its subsidiary OP No – 2, has obtain a group accidental insurance of those loanees, who availed the said loan facility. That group insurance was obtained with the OP No – 1, was for a period of one year from 20/08/2015 till 19/08/2016, covering life of policy holder for a sum assured of Rs 05,00,000/-. Hence it is concluded that the complainant is a consumer as per Sec 5(VI) of the C P Act.
That during the course of hearing of the case matter, the complainant’s advocate vehemently argued with related documents that the complainant has rightfully put its claim for getting the insured amount from the OP No – 1. That to authenticate its claim the complainant presented the earlier said documents in its support. Despite submission of earlier said documents with the OP No 1, the same rejected the claim on dated 26/12/2021, where from the cause of action arose.
The Op No – 1, who is the insurance company, has presented its various stands in it support, that the complainant, is not eligible to get the claimed insured amount. That as it is observed that the present case filled is within the permitted scope of the CP Act, hence it is maintainable under this Act.
However beyond all the grounds and arguments among the parties to this case matter, the OP No – 1, principally relied upon the clause number 10 & 11 of the Insurance policy Schedule, through which it intended to establish that the complainant has no ground to claim the insurance benefit, as the deceased husband of the complainant had no “external injuries” and cause of death is “not due to accident”.
That for appropriate & careful perusal of the clauses vis-à-vis documents / arguments presented by the parties, the said clauses are extracted here, as under;
“10. Injury – It means accidental physical bodily harm excluding illness or disease, sole and directly caused by external, violent and visible and evident means which is verified and certified by a medical practitioner”.
“11. Accident – It means a sudden, unforeseen and involuntary event caused by external, visible and violent means”.
That the intention of the above clause 10, is that the incurred “injury” must be caused out of accidental occurrence from an external visible sources, which resulted in to a bodily harm, not out of illness / disease.
Similarly the intention of clause no 11, is that “Accident” means unexpected, unanticipated, involuntary happening caused by visible and violent means.
That now upon comparing the above clauses vis-à-vis the submissions presented by the complainant, we observe that, on sudden falling from tree, the husband of the complainant incurred severe injury (haemorrhage) in the internal vital organs of the body. Similarly such falling from tree was not a jump rather it was unintentional abrupt happening, which is not a planned jump and not done wilfully. Hence it is established that the complainant’s husband appropriately incurred “injury”, which properly comes under the defined preview of the “Injury”, as depicted by OP No – 1.
That as regard to the clause “Accident”, we observe that while cutting tree on climbing on it, the husband of the complaint unknowingly & unexpectedly fell from tree and dashed with bare land. That this unprepared collision with bare land was an external affair, which was also witnessed by some nearby people. Hence it is established that said collusion of complainant’s husband with bare land amounts to an Accident, which comes under the defined preview of the “Accident”, as depicted by OP No – 1.
That basing on above analysis we arrive at the conclusion that the complainant’s husband was “injured” due to an “accident” which comes within the bracket of the clauses as depicted and relied by the OP No – 1.
So, now upon careful consideration of all the materials available in the case record vis-a-vis submission made by complainant & O.P No - 1, this Commission is of the unanimous opinion that the OP No 1 have not adjudicated their dispute properly before the Commission. There is no solution arrived by the O.P No - 1 for the loss sustained / suffered by the Complainant incurring out of repudiation of insurance claim, which legally termed as deficiency-in-service by the O.P No - 1. Hence, Ordered:-
O R D E R
Having regard to the judgement reflected above, the Complaint Petition of the instant Consumer bears merit and hence allowed on contest against O.Ps. The O.P No - 1 is hereby severally set liable for its deficiency of service. The OP No – 1 is hereby directed to release the insured amount of Rs. 05, 00, 000/- (Five Lakhs Only), along with interest @09.00% P.A., from the date of cause of action arose (26/12/2016) till the date of release of insured sum, within one month from receipt of this order. The OP No – 1, is further directed to pay a compensation of that amount to the complainant, which would be charged to complainant by the OP No – 2, as outstanding loan remained after demise of the complainant’s husband, if any.
That OP No -2, is hereby directed to intimate its full and final aforesaid dues receivable, to both the complainant and OP No -1, within two weeks from receipt of this order, so as to do the needful at their end towards compliance of this order.
That delay in any manner for compliance of this order, for both the OPs, shall carry fine of Rs 500/-, per day, payable by the defaulter OP/s to the complainant.
In case of failure by the O.Ps to comply the order within the aforesaid stipulated time frame, the Complainant is at liberty to realize the same amount from the O.Ps as per prevailing law.
Pronounced in the open Court of this Commission on this day i.e. the 10th day of April, 2023 given under my Signature & Seal of the commission.
