Consumer Complaint No 31 of 2016
Date of filing: 29.02.2016 Date of disposal: 13.02.2017
Complainant: Shipra Pramanik, W/o. Late Ajit Kumar Pramanik, Vill. & PO: Bhuri, PS: Galsi, District: Burdwan, PIN – 713 406.
-V E R S U S-
Opposite Party: 1. The National Insurance Co. Ltd., Represented by its Divisional Manager, having its office at “Kundu Mansion”, 548, G. T. Road, Bhangakuthi, Burdwan, PIN – 713 101.
2. Golden Trust Financial Service, Represented by its Manager, having its office at 16, R.N. Mukherjee Road, Kolkata – 700 072.
Present: Hon’ble Member: Smt. Silpi Majumder.
Hon’ble Member: Sri Pankaj Kumar Sinha.
Appeared for the Complainant: Ld. Advocate, Suvro Chakraborty.
Appeared for the Opposite Party No. 1: Ld. Advocate, Ahi Bhushan De.
Appeared for the Opposite Party No. 2: Ld. Advocate, Bibhas Mondal & Monalisha Banerjee.
J U D G E M E N T
This complaint is filed by the Complainant u/S. 12 of the Consumer Protection Act, 1986, alleging deficiency in service, as well as, unfair trade practice against the OPs as the OPs did not settle her legitimate insurance claim till filing of this complaint.
The brief fact of the case of the Complainant is that the husband of the Complainant, since deceased obtained a group Janata Personal Accident Insurance Policy from the OP-1 through the OP-2 and the same was valid for the period from 23.12.2001 to 22.12.2013. Due to ill luck within the validity of the said policy the husband of the Complainant died on 24.09.2012 due to road accident. After the said incident the Complainant for getting the benefit of the insurance policy intimated the OPs. But unfortunately after lapse of about one year the OP-1 issued the claim form through the OP-2 in favour of the Complainant. The Complainant lodged the duly filled up claim form before the OP-2 along with all the relevant documents required by the OP-1 & 2 and the OP-2 on 29.08.2013 had received the claim form along with the documents. But very surprisingly instead of settling the claim of the Complainant both the OPs were dragging the matter by sending one after another letter to her asking several documents. The OP-2 sent all the documents along with the claim form to the OP-1 and sent a copy of the same to her. Thereafter on 03.12.2013 and 13.02.2015 the OP-1 sent two letters to the Complainant asking for submission of several documents most of were irrelevant. But inspite of receipt of those documents the OP-1 again sent a letter to the Complainant on 23.09.2015 asking for several documents. In this manner the OP-1 tried to drag the claim of the Complainant and for such action of the OP-1 the Complainant has been facing financial stringency day by day. As such attitude and action of the OP-1 can be termed as deficiency in service; hence for this reason the Complainant is entitled to get compensation from it. As her dispute had not been redressed by the OPs, hence the Complainant has approached before this Ld. Forum by filing this complaint praying for direction upon the OPs to pay her a sum of Rs.3, 00,000=00 towards her insurance claim, Rs.30, 000=00 as compensation due to deficiency in service, harassment, mental agony and pain and litigation cost of Rs.30, 000=00.
The petition of complaint has been contested by the OP-1 by filing written version contending that the husband of the Complainant, Ajit Kumar Paramanik, since deceased, took a Group Janata personal accident Insurance Policy from this OP, which was valid for the period from 23.12.2001 to 22.12.2013 for the sum assured of Rs.3, 00,000=00 and the Complainant was declared as nominee in respect of the said policy. Be it mentioned that though the actual name of the nominee is Shipra Pramanik, widow of late Ajit Kumar Pramanik, but the nominee has used her name in the petition of complaint as Sipra Paramanik and name of her husband has been written as Ajit Kumar Pramanik. For such discrepancies in the spelling in her name the Complainant is not entitled to get any benefit or relief in the present complaint. After scrutinizing the claim papers submitted by the Complainant to the OP-1 through the OP-2 the OP-1 requested the Complainant to arrange and send some relevant documents and papers i.e. Final Police Report, Photocopy of Bank Pass Book, Income Tax Return for the incoming year 2001-02 and onwards and the FIR etc and also required clarification regarding difference of age as per voter’s identity card and the death certificate of the deceased insured by issuing letters dated 03.12.2013, 13.02.2015 and 23.09.2015 within 15 days from the date of receipt of those letters, but inspite of receipt the same the Complainant did not submit the said relevant documents and papers within the stipulated time. As the OP-1 did not receive the above items from the end of the Complainant in due time the OP-1 was pleased to keep the claim as pending for non-compliance of the formalities by the Complainant without repudiating the same. Not only that the actual father’s name of the deceased insured was found different in different documents i.e. in the Death Certificate of the insured the father’s name of the deceased insured was found as Late Sastidhar Paramanik but the voter’s identity card of the deceased insured it was found as Shasthi Charan Pramanik and for this reason the OP-1 sought for some clarifications, but no clarification has yet been given by the Complainant to this OP. Moreover the correct address along with PIN Code were also not submitted which were found difference in different documents. But till date the Complainant did not comply with the said formalities and as the OP-1 did not receive the required documents and papers till date, it is not in a position to proceed with the claim file and the same is kept as pending for settlement due to non-submission of the relevant documents and papers. As the Complainant has failed to comply with the required formalities, hence she is not entitled to get any relief at this juncture through this complaint. According to the OP-1 as there is no deficiency in service on its part, the Complainant is not entitled to get any amount as compensation from it as sought for. The OP-1 has prayed for dismissal of the complaint with cost of Rs.10, 000=00.
The petition of complaint has been contested by the OP-2 by filing written version stating that it is acting as an agent of the OP-1 i.e. after collection of the premium amount from the intending insured the same is remitted to the Insurance Company, if any claim arises then after submission of the documents and papers along with the claim form by the Complainant the OP-2 used to send the same to the OP-1 for processing of the claim and after receipt of information about any incident from the insured the OP-1 conveyed the same to the Insurance Company and the Insurance Company issued the claim form to the Complainant through the OP-2. Therefore as per MoU this OP is acting as an agent of the OP-1, not as a claim settling agent of the OP-1. As the OP-2 remitted the premium amount to the OP-1 after collection of the same, hence it has no authority either to process the claim or to decide the same. As per the MoU the OP-2 has extended their hands to assist the intending insured, insured, his/her nominee and the Insurance Company. Within the four corners of the petition of complaint no allegation is made by the Complainant, but in the prayer portion the Complainant has sought for the reliefs from the both OPs. According to the OP-2 as there is no deficiency in service as well as unfair trade practice on its part, hence the Complainant is not entitled to get any benefit or relief from this OP. Prayer is made by this OP for dismissal of the complaint.
The Complainant has adduced evidence on affidavit along with several documents in support of her contention. The OP-1 has filed written notes of argument with a copy to the other side. The OP-1 has also submitted several documents by way of ‘firisty’ with a copy to the other side.
We have carefully gone through the record; papers and documents submitted by the contesting parties, WNA filed by the OP-1 and heard argument at length advanced by the Ld. Counsel for the parties. It is seen by us that there are some admitted facts in the case in hand i.e. the husband of the Complainant since deceased obtained one Group Janata Personal Accident Insurance Policy from the OP-1 through the OP-2, due premium amount was deposited by the Complainant to the OP-2, upon receipt of the said premium from the Complainant the OP-2 remitted the same to the OP-1, during opening of the policy the Complainant submitted all the relevant and required documents to the OP-1 through the OP-2, being satisfied with papers and premium amount the OP-1 issued the said policy in the name of the insured, the Complainant being the wife of the insured was declared as nominee in respect of the said policy, sum assured was of Rs.3,00,000=00, the policy was valid for the period from 23.12.2001 to 22.12.2013, during validity of the said policy the insured died due to road accident on 24.09.2012, FIR lodged, Post Mortem done, intimation was given by the Complainant about the death of the insured-her husband to the OP-1 through the OP-2, the OP-1 issued claim form, the Complainant lodged the insurance claim by filing the claim form along with relevant papers and documents in support of her claim with the OP-1 through the OP-2, after scrutinizing the claim form along with documents the OP-1 sent letters to the Complainant through the GTFS-OP-2 seeking for some other documents as mentioned in those letters for processing of her claim, out of the same the Complainant submitted some documents to the OP-1 through the OP-2, there are some discrepancies in respect of the spelling in the name and title of the Complainant, difference in the name of the of the deceased father of the deceased insured, discrepancy relating to the age of the insured, the Complainant did not provide all the required documents to the OP-1 and the claim of the Complainant has been kept as pending due to non-submission of the relevant and required documents by the Complainant. The allegation of the Complainant is that inspite of submission of the required documents to the OP-1 through the OP-2; the OP-1 did not decide her legitimate insurance claim till filing of this complaint inspite of several requests and written correspondences. The rebuttal case of the OP-1 is that as the Complainant has failed to provide all the required and necessary documents to it for processing and settlement of her insurance claim, hence without repudiating the same the OP-1 has kept the claim as pending on the ground of non-submission of the necessary documents. According to the OP-1 as and when those document will be received by the OP-1, the OP-1 will decide the claim. The case of the OP-2 is that as it has acted as an agent properly and no allegation is made by the Complainant in the petition of complaint, prayer is made by the OP-2 for dismissal of the complaint against it. Be it mentioned that the OP-2 has acted so that the Complainant will get her legitimate insurance claim from the OP-1.
We have noticed that after scrutiny of the claim form and documents provided by the Complainant it was found by the OP-1 that some other documents are relevant and necessary for processing of her claim and hence by issuing a letter dated 03.12.2013 the OP-1 directed the Complainant to submit some further documents i.e. (a) attested photocopy of ration cards, (b) voter identity cards, (c) PAN card, final police report/charge sheet through the Court (certified true copy), (d) attested photocopy of the post mortem report, (e) photo copy of Bank Pass Book of the nominee, (f) employee’s salary certificate/copy of Form-16 of I.T. return/income certificate for incoming year, (g) local Panchayat/ Municipal certificate regarding the incident & status of the nominee in original, (h) original JPA/Gr. P.A. (i) certificate, attested photocopy of the first information report and Ford Bayan. Out of those documents the Complainant submitted some documents, for the rest and for some additional documents letter was issued by the OP-1 on 13.02.2015 seeking for the remaining documents in proper format as per requirement and sought for some clarifications from the Complainant regarding the wrong spelling in her name and title, discrepancies in the name of the deceased’s father and the age of the deceased and correct address and PIN code of the Complainant. Out of those required documents and clarifications as the Complainant had failed to provide the same to the OP-1 within the stipulated period, the OP-1 issued final reminder on 23.09.2015 seeking the required documents and clarifications as mentioned above upon the Complainant and direction was made by the OP-1 to comply with the all formalities within 15 days from the date of receipt of the final reminder. But the Complainant had failed to comply with all the formalities and to remove the important defects hence the OP-1 without repudiating her insurance claim has kept the claim pending due to non-submission of the required and necessary documents by the Complainant. During argument the Ld. Counsel for the OP-1 has fairly submitted that as when the Complainant will comply with all the formalities as mentioned in the final reminder dated 23.09.2015, the OP-1 without wasting any further time will decide the claim of the Complainant. We have noticed upon perusal on the defects in the spelling of the name and title of the Complainant as well as the title of the deceased insured as given in the cause title of the Complainant, as mentioned in the written version of the OP-1, the Complainant by filing an application had prayed for amendment of the name and title of her and the titled of her deceased husband. By allowing the said application this Ld. Forum was pleased to hold that the actual name and title of the Complainant is as ‘SHIPRA PRAMANIK’ and the name and title of her deceased husband is ‘AJIT KUMAR PRAMANIK’. Not only that there are some anomalies in the name and title of the deceased father of the deceased insured i.e. in the Electoral Card it is mentioned as ‘Shashticharan Pramanik’ and in the death certificate of the deceased insured it is written as ‘Sastidhar Pramanik’, the age of the deceased is showing different in the voter identity card and the death certificate. Though the OP-1 has sought for the PAN card, IT return, Form-16 and driving license of the insured, but according to the Complainant he did not bear those documents as her husband was not a tax payer and having no driving license and for this reason she is not in a position to the said documents to the OP-1 as per requirement. It is also seen by us that the Complainant though supplied some documents, but the same were not in proper format. According to the OP-1 submission of the required documents in proper format is mandatory; otherwise question may be raised in future by the appropriate authority in respect of such action of the OP-1 as to why the claim has been decided inspite of non-submission of the required documents as per the terms and conditions of the policy. It is seen by us that till date the OP-1 showing good gesture did not repudiate the insurance claim of the Complainant and it is still pending so that the Complainant can get an opportunity to submit the required documents in proper format. As the door has not yet been closed, hence the Complainant is at liberty to submit the required documents before the OP-1 in view of the ‘Final reminder’ dated 23.09.2015 in proper format forthwith. The Complainant has prayed for compensation alleging deficiency in service against the OPs. After considering the facts and circumstances of the complaint and other related documents we have noticed that there is no deficiency in service on the part of the OP-2 and moreover no allegation has been made out by the Complainant in the petition of complaint against the OP-2. The OP-2 has acted as per the terms and conditions of the MOU, executed by and between the OP-1 and the OP-2. So in our view the OP-2 is not liable to make payment of any amount as compensation to the Complainant as prayed for. In respect of the OP-1 we are of the opinion that as the Complainant did not comply with the formalities as per direction of the OP-1-final reminder and has failed to submit the required and necessary documents to the Insurance Company inspite of issuance of written notice/letter to her till filing of this complaint and for this reason the OP-1 could not decide her claim case, hence we cannot hold that there is no deficiency in service as well as unfair trade practice on behalf of the OP-1. As the Complainant has failed to prove that there is deficiency in service on behalf of the OPs, hence the Complainant is not entitled to get any amount towards compensation as prayed for. As without complying with the formalities as per direction of the OP-1 the Complainant has initiated this complaint before this Ld. Forum, hence the Complainant is also not entitled to get any amount as litigation cost as prayed for.
Going by the foregoing discussion hence, it is
O r d e r e d
that the complaint is allowed on contest without any cost. The Complainant is directed to submit the required documents in view of the ‘Final Reminder’ dated 23.09.2015 in proper format within 30 (thirty) days from the date of passing of this judgment and upon receipt of those documents by the OP-1, the OP-1 shall settle the insurance claim of the Complainant to the tune of Rs. 3,00,000=00 within 20 (twenty) days from the date of receipt of the entire documents from the Complainant positively, in default, the above-mentioned amount shall carry penal interest @8% per annum for the default period. Considering the facts and circumstances of the case there is no order as to cost.
Let plain copies of this order be supplied to the parties free of cost as per provisions of law.
Dictated and corrected by me.
(Silpi Majumder)
Member
DCDRF, Burdwan
(Pankaj Kumar Sinha) (Silpi Majumder)
Member Member
DCDRF, Burdwan DCDRF, Burdwan
