IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KOTTAYAM
Dated this the 29th day of February, 2024
Present: Sri.Manulal.V.S, President
Smt.Bindhu.R, Member
Sri.K.M.Anto, Member
CC No.276/2023 (Filed on 24/08/2023)
Complainants : (1) Sudha Das W/o Late Das A.S,
Ashariparambil House,
Kattachira P.O,
Kidangoor, Kottayam – 686 572.
(2) Dhanya Das D/o Late Das A.S,
Kollalackal House,
Puthuppally P.O,
Puthuppally, Kottayam – 683 011.
(3) Divya Das D/o Late Das A.S,
Ashariparambil House,
Kattachira P.O,
Kidangoor, Kottayam – 686 572.
(All by Adv: Rajesh Pallat )
Vs.
Opposite party : The Oriental Insurance Company Ltd., Rep. by the Divisional Manager,
Divisional Office, Trio Chambers,
Kanjikuzhy P.O,
Kottayam – 686 004.
(By Adv: D. Zaibo)
O R D E R
Sri.Manulal.V.S, President
The complaint is filed under Section 35 of the Consumer Protection Act 2019.
Case of the complainants are as follows :
The complainants are the legal heirs of Late Das A.S, who died on 20-04-2021 due to the injuries sustained in a motor accident. The deceased was conducting a Provisional Store at Kattachira by name Divya Stores. He was a member of Kerala Vyapari Vyavasai Ekopana Samithi which is an organisation for merchants. The merchants in the locality under the aforesaid organisation, joined in a group insurance scheme with the respondent company by name Nagari Suraksha Group Policy and the deceased was also a person who covered under the policy. The claim amount for personal accident section is Rs.4 lakhs and hospitalisation is Rs.1,00,000/-. It is assured by the opposite party that in the event of the death of the insured person the opposite party will disburse Rs.5 lakhs towards claim amount to the legal heirs.
On 20-04-2021 when the husband of the first complainant was riding the motorcycle having Registration No.KL5-AF-6551 through Pala - Ettumanoor road another bike having Registration No.KL 67-B 6750 driven by another person in a rash and negligent manner hit on the bike of the husband of the 1st complainant and as a result serious injuries were sustained. He was taken to Medical College Hospital, Kottayam, but died on the same day.
After that the 1st complainant submitted a claim before the opposite party but the opposite party sent a letter demanding some documents and subsequently it was produced by the 1st complainant. But even after that the opposite party has not taken any steps to disburse the claim amount. The act of the opposite party in not disbursing the claim amount to the complainants amounts to deficiency of service and unfair trade practice. It is submitted in the complaint that the complainants suffered so much mental agony and pain and they are entitled for compensation from the opposite party. Hence this complaint is filed by the complainants to pass an order to direct the opposite party to pay an amount of Rs.5 lakhs with interest and to pay Rs.25,000/- as compensation along with Rs.10,000/- of cost of this litigation.
Upon notice from this Commission opposite party appeared before the Commission and filed version as follows :
The opposite party had issued Nagari Suraksha Group Policy in the name of Vyapari Vyavasai Ekopana Samithi covering the relevant period subject to the policy conditions. The deceased Das A.S was a person covered under the said policy. The death benefit was Rs.5 lakhs subject to the policy conditions. The insured Vyapari Vivasai Ekopana Samithi is not made a party to this proceedings and the complaint is barred for non-joinder of the necessary parties.
The accident was caused due to fault of the deceased himself. To the knowledge of the opposite party, the deceased was incapable of riding the vehicle and was not having a valid and effective driving licence to ride the said vehicle. On receipt of the claim from the 1st complainant the opposite party has duly processed the claim. Finding that certain material documents are necessary for the further processing of the claim the claimant was required to produce the same including the driving licence of the deceased if any vide letter dated 30-08-2021. But the claimant has not produced the said document so far. The opposite party could not process the claim further in the absence of the required documents. The allegation in the complaint that the complainant has produced the required documents is utter false. The opposite party has not repudiated the claim so far. The claim of the complainant was duly processed as per the terms and conditions of the policy. The opposite parties have rightly requested the claimant for production of the documents required for further processing of the claim. There is no deficiency in service or unfair trade practice from the part of the opposite party as alleged.
1st complainant filed proof affidavit in lieu of chief examination and marked Exhibits A1 to A4. Reji Koshy who is the Deputy Manager of the opposite party filed proof affidavit in lieu of chief examination and no documents marked from their side.
On evaluation of complaint, version and evidence on record we would like to consider the following points :
(1) Whether the complainant had succeeded to prove any deficiency in service or unfair trade practice on the part of the opposite party?
(2) If so, what are the reliefs and cost?
For the sake of convenience we would like to consider Point Nos.1 and 2 together.
POINTS 1 & 2 :-
The complainants are the legal heirs of the deceased Das A. S, who passed away on 20-04-2021, as a result of injuries sustained in a motor accident. The deceased operated a Provisional Store named Divya Stores in Kattachira and was a member of the Kerala Vyapari Vyavasai Ekopana Samithi, an organization for merchants. It is an admitted fact that opposite party had issued the Nagari Suraksha Group Policy in the name of Vyapari Vyavasai Ekopana Samithi, providing coverage for the relevant period, contingent upon the policy conditions. The deceased, Das A. S, was an individual covered under the afore-mentioned policy, with a death benefit of Rs.5 lakhs, subject to the policy conditions.
The complainants alleged that despite the submission of a claim by the 1st complainant to the opposite party, the opposite party responded by sending a letter requesting certain documents. The 1st complainant subsequently provided the requested documents. However, even after the submission of the required documents, the opposite party has failed to take any action to disburse the claimed amount. The opposite party contested the complaint, arguing that the accident occurred due to the deceased’s own fault and the deceased was incapable of operating the vehicle and did not possess a valid and effective driving license for it. Upon receiving the claim from the 1st complainant, the opposite party duly initiated the claim processing. However, recognizing the necessity of certain essential documents for further processing, including driving license held by the deceased, if available, the claimant was requested to provide them vide Exhibit A2 letter dated 30-08-2021. According to them the opposite party has not repudiated the claim so far.
It is pertinent to note that both the parties did not produce the terms and conditions of the Exhibit A1 policy. Without producing the terms and conditions of the policy we cannot held that whether the driving licence of the deceased is necessary for processing the claim for the death benefits under Nagari Suraksha group policy. However considering the nature and circumstances of the case and keeping the salutary principles of the Consumer Protection Act, we hereby direct the opposite party to process the claim of the complainants in accordance with the terms and conditions of the subject policy. Therefore we allow this complaint and pass the following order.
We hereby direct the opposite party to process the claim of the complainants within 30 days from the date of receipt of the documents which are requested by the opposite party vide Exhibit A2 letter. It is further directed that the complainants shall produce the documents which are requested to be produced by the opposite party vide Exhibit A2 letter within 15 days from the date of receipt of copy of this order to the opposite party. If the opposite party is failed to process the claim within 30 days from the receipt of the documents they are directed to pay Rs. 5,00,000/- together with 9% interest per annum from 30-08-2021 till realisation and to pay Rs.20,000/- as compensation to the complainants.
Pronounced in the Open Commission on this the 29th day of February, 2024
Sri.Manulal.V.S, President Sd/-
Smt.Bindhu.R, Member Sd/-
Sri.K.M.Anto, Member Sd/-
APPENDIX :
Exhibits from the side of the Complainant :
A1 - Copy of Nagari Suraksha Group Policy issued by
the opposite party
A2 - Copy of opposite party’s letter dated 30/08/2021
A3 - Copy of Licence
A4 - Copy of Legal Heir ship Certificate
Exhibits from the side of Opposite party :
Nil.
By Order,
Sd/-
Assistant Registrar
