Orissa

Cuttak

CC/77/2017

Banita Behera - Complainant(s)

Versus

The Managing Director,SBI General Insurance Company Ltd - Opp.Party(s)

S Sahoo

27 Jun 2019

ORDER

IN THE COURT OF THE DIST. CONSUMER DISPUTES REDRESSAL FORUM,CUTTACK.

C.C No.77/2017

 

Banita Behera,

Res. at:C/o: Krushna Chandra Behera,

Ramagada,Tulsipur,Cuttack-753008.                                                        … Complainant.

                Vrs.

 

1.   The Managing Dai8rector-Cum-Chief Executive Officer,

SBI General Insurance Company Ltd.,

Head Office,”Natraj”,101,201 and 301,

Junction of Eastern Express Highway,

Andheri Kurla Road,

Andheri(East),Mumbai-400069.

 

     2.      The Deputy Vice President, Claim- Health,

S.B.I General Insurance Company Ltd.,

Head Office,”Natraj”, 101,201 and 301,

Junction of Eastern Express Highway,

Andheri Kurla Road,

Andheri(East),Mumbai-400069.

 

3.The Branch Manager,

S.B.I General Insurance Company Ltd.,

Local office at ATM Arcade Building,

Plot No.191,Unit-III,KLharavel Nagar,

Bhubaneswar.

 

                   4.       The Branch Manager,

State Bank of India,

Gandarpur Branch,

Gandarpur, Cuttack-753003.… Opp. Parties.

 

Present:               Sri Dhruba Charan Barik,LL.B. President.

Smt. Sarmistha Nath, Member (W).

 

Date of filing:     08.06.2017

Date of Order:   27.6.2019

 

For the complainant        :       Sagarika Sahoo,Adv. & Associates.

For the O.P.No.1,2 & 3.  :       Mr. A.A.Khan,Adv. & Associates.

For the O.P No.4              :       Mr. P.V.Balakrishna,Adv. & Associates.  

 

 

Sri Dhruba Charan Barik,President.

               The complainant having attributed deficiency in service and unfair trade practice to the O.Ps has filed this complaint against them seeking appropriate relief in terms of her prayer in the consumer complaint.

1. The facts of the case of the complainant, briefly stated, are that the husband of the complainant (herein after referred to as the deceased) had availed a Group Personal Accident Insurance Policy from the O.P,Insurance Company vide Master Policy No.137300-0000-00 for an assured amount of Rs.4,00,000/- by paying a premium of Rs.100/- to the O.P No.4 Bank.  The Insurance certificate was issued in favour of the deceased on 24.5.13.  Annexure-1 is the photo copy of the said insurance certificate.  Subsequently the deceased enhanced the insurance amount by paying a premium of Rs.500/- debited to his savings account No.30028264200 maintained with the O.P No.4 on 16.5.2016.  Thereafter the assured amount was enhanced to Rs.10,00,000/- instead of Rs.4,00,000/-.  Copy of certificate of the payment slip and acknowledgement slip are annexed herewith and marked as Annexure-2.

The deceased was a driver by profession.He was driving the ambulance bearing No.OR-05-T-6417 on N.H-16, Chennai-Calcutta road on 6.6.2016.On that date at about 15.30 hrs. near Korlam village of Sompeta Mandal,Srikakulam he lost balance over the vehicle and it got dashed against a pillar by the side of N.H.-16causing multiple injuries to him.One Pabitra Mohan Das, the co-driver also got injured in the accident who was in the same vehicle.The matter was reported by co-driver at Baruva police station in the district of Srikakulam and on 6.6.16 and the deceased was admitted to a Govt. Hospital at Baruva for treatment.He was later shifted to M.K.C.G Medical College & Hospital, Berhampur,Odisha for better treatment.Subsequently while the deceased was being shifted to S.C.B.Medical College & Hospital,Cuttack he succumbed to injuries on 7.6.16 at about 0.4 hrs.

On the basis of the report lodged by the co-driver, F.I.R No.25 of 2016 was registered at Baruva police station U/S-337 & 338 I.P.C read with Sec-184 of the M.V.Act on 6.6.2019.Subsequently during investigation, the case was altered to one U/S-304-A IPC read with Sec-184 of M.V.Act.

The body of the deceased was brought to casualty ward of S.C.B.Medical College and Hospital,Cuttack on 7.6.16 and the concerned Dr. Bikram Kar sent the casualty memo no.15/16 dt.7.6.16 to Mangalabag police station, Cuttack.On that basis concerned IIC registered P.S.U.D.Case No.845/16 dt.7.6.16 and thereafter all medical formalities were performed. Lastly Mangalabag police submitted final report to the concerned authority under U.D.G.R Case No.1032 of 16 in that case.

The complainant at that stage intimated the O.P, Insurance Company over phone to this effect and also lodged claim on 6.8.16.The O.P, Insurance Company thereafter asked the complainant to submit certain relevant documents regarding the case along with the claim form duly filled in vide letter dt.8.8.16.Annexure-3 is the photo copy of the said letter dt.8.8.16. In response to such letter the complainant vide her letter dt.4.2.17 submitted the required documents as mentioned therein and requested the O.P to settle the claim as early as possible.Copy of the letter dt.4.2.17 of the complainant along with documents has been filed and marked as Annexure-4 series.Again the complainant has received another letter dt.20.2.17 from the O.P.2 wherein he required further documents to process the claim.Contents of the said letter have been well mentioned therein.A reminder letter has also been sent by the O.P.2 on 5.4.17.Photo copy of the said letter dt.20.2.17, 27.3.17 and 5.4.17 have been filed and marked as Annexure-6,7 & 8 respectively.

On 12.4.17 the complainant sent a representation to the O.P, Insurance Company for early settlement of her claim.Copy of the said letter has been filed and marked as Annexure-8.The O.P,Insurance Company without going through the documents received by him again called for some more documents vide his letter dt.28.4.17 from the complainant to ascertain whether the deceased was under the influence of alcohol at the time of accident.Indoor case papers were also claimed in the aforesaid letter, copy of which has been marked as Annexure-9.The complainant vide her letter dt.28.4.17 submitted those documents after collecting them through an advocate-cum-investigator.The full description of the documents has been given in that letter which has been enclosed in this case.That letter and other documents have been marked as Annexure-10 series.The complainant was astonished to find that the O.P.2 yet again called for the similar documents vide his letter dt.11.5.17.It is a clear case to put the complainant to harassment and such action of the O.Ps are illegal which is tantamount to deficiency in service.Copy of the said letter dt.11.5.17 of O.P.2 has been marked as Annexure-11.In spite of receipt of all the relevant documents as called for by O.P.2, her claim was not settled and kept pending for more than one year.It is stated that the complainant is a poor and unemployed lady and has no source of income.She has a son who is visually impaired and fully dependant on her for his sustenance.It is also stated that O.Ps have violated the Regulatioin-9(5) of the Insurance Regulatory and Development Authority (Protection of Policy Holders interest) Regulation-2002.

It is the specific case of the complainant that despite the postmortem report received by the O.P.2 where from it is crystal clear that there was no iota of evidence of presence of alcohol in the stomach of the deceased, he has repeatedly insisted on the said documents with intent to cause undue harassment and mental agony to the complainant.As such the O.,Ps are liable for rendering deficient service to her and following unfair trade practice in the instant case.

Having no other alternative, the complainant then filed this case against the O.Ps with a prayer to direct them to settle the claim of the complainant within a period of one month by depositing the claim amount of Rs.10,00,000/- in her S.B.I Account.She has also prayed that the O.Ps who are jointly and severally liable, may be directed to pay Rs.50,000/- towards compensation and Rs.50,000/- towards litigation cost together with interest @ 10% per annum from the date ofdeath of the deceased till its realization in the interest of justice.

2. O.Ps.1 to 4 have contested the case.  O.Ps.1,2 & 3 have jointly filed the written version of their case and the O.P.4 has filed a separate written version in support of his stand.

The material averments in the complaint have been traversed in the written version of O.Ps 1 to 4 except those that have been specifically admitted herein.It is stated that the case is not maintainable both in fact and law and there is no cause of action to file this case.This authority lacks jurisdiction to entertain and try the consumer complaint.

It is further revealed from written version of their case that the death claim of the complainant was repudiated by the O.Ps vide letter dt.5.7.17 due to non-submission of the required documents and non-cooperation by the complainant.As such it is stated that there is no question of deficiency in service or unfair trade practice on the part of the O.Ps.They have filed copy of the insurance policy and policy conditions of the deceased which have been respectively marked as Annexure-A & A-1.The other documents which have been filed in this case indicate the correspondence between the parties and have been respectively marked as

Annexure-B,C series and D series.

In view of the above, it is prayed that the complaint filed by the complainant is vague and baseless and may be dismissed with cost.

So far as the written version of the O.P No.4 is concerned, it is specifically stated that the present case is not maintainable against O.P No.4 in any manner.No remedy is sought for against the O.P No.4 which is the State Bank of India,Gandarpur Branch and only monetary transactions have been made through O.P.4 on different dates towards payment of premium to the O.Ps.It is specifically stated that in absence of any averment with regard to deficiency in service or unfair trade practice having been made against O.P.4, the case is not legally sustainable and the same may be dismissed in the interest of justice.

3. We have heard the learned counsel for the complainant as well as for the O.Ps at length and gone through the case records and the annexures enclosed with it.

The crux of the matter is whether repudiation of the death claim of the complainant by the O.P. is legal and justified.On this point the learned advocate for the O.P. has categorically stated that such death claim was repudiated due to non-submission of required documents and lack of cooperation by the complainant.This fact of repudiation has been intimated to the complainant vide letter dt.5.7.17.That apart the learned advocate for the O.P,Insurance Company has clearly stated that vide letter dt.8.8.16(Annexure-3) postmortem report and other documents about the indoor treatment of the deceased were called for from the complainant with a view to arrive at a conclusion as to whether the deceased was under influence of alcohol or other intoxication at the time of admission.It is stated that in spite of repeated correspondences, the aforesaid documents were not sent to the O.Ps as called for.On this point, the learned advocate for the complainant has categorically stated that the entire G.R.Case record containing copies of postmortem report, F.I.R,M.L.C report, police report etc. have been sent to the O.P,Insurance Company vide letter dt.4.2.17(Annexure-4).Same documents along with the inquest report and other indoor case papers have also been submitted to the O.Ps on 28.4.17 vide Annexure-10.When all these documents were well within the possession of the O.P,Insurance Company there was no justification to repudiate the death claim of the complainant solely on the ground of non-submission of the required documents and lack of cooperation by the complainant especially when no iota of evidence is found from the postmortem report and inquest reportwith regard to presence of alcoholic substance in the stomach of the deceased. This fact is not satisfactorily answered to by the learned advocate for the O.P,Insurance Company.Rather it is a clear case of “Road Traffic Accident” as revealed from police papers. As such the repudiation of death claim as admitted by O.Ps1,2 & 3 in their written version is not legal and acceptable.Such activities of the O.P,Insurance Company has also caused harassment and mental agony to the complainant who is an uneducated and unemployed woman.The case of deficiency in service and unfair trade practice on the part of the O.Ps1,2 & 3 is satisfactorily proved.O.P No.4 who is a bank is not liable for it.Hence ordered;

                                                                                ORDER

The case of the complainant is allowed against O.Ps 1,2 & 3 and dismissed against O.P No.4 on contest.The O.Ps1,2 & 3 are directed to deposit the death claim amount of Rs.10,00,000/- in the bank account of the complainant as maintainedwith O.P No.4 and to pay compensation of Rs.50,000/- and litigation cost of Rs.10,000/- to the complainant in the interest of justice.This order shall take effect within a period of 30 days from the date of receipt of copy of this order.

                Typed to dictation, corrected and pronounced by the Hon’ble President in the Open Court on this the 27^th day of June,2019  under the seal and signature of this Forum.

                                                                                                                                                  

    (   Sri D.C.Barik )

                                                                                                                     President.

                                                                                                             (Smt. Sarmistha Nath)

                     Member(W)