DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION: BHADRAK
Dated the 19th day of February, 2021
C.D Case No. 47 of 2020
Present 1. Shri Basanta Kumar Mallick, Presiding Member
2. Afsara Begum, Member
Smt. Minati Rana
W/O Late Shyam Sundar Rana
Vill- Saripal
Po-Alauti, Via-Barapada , Ps- Bhadrak (R)
Dist: Bhadrak, Odisha
……………………. Complainant
(Versus)
1 The Secretary, Kenduapada Service Co-operative Society Ltd.
At/Po- Kenduapada, Via- Barikpur, Ps- Bonth, Dist- Bhadrak
2 Branch Manager, Balasore Bhadrak Central Co-operative Bank Ltd.,
Bonth Branch, Bhadark,
At/Po-Bonth, Dist- Bhadrak
3 The Chief Executive Officer (Secretary), Balasore Bhadrak Central Co-operative Bank Ltd.,
At- O.T Road, Po/Ps/Dist- Balasore- 756001
4 The Divisional Manager,
ORIENTAL INSURANCE Company Ltd.
Divisional Office, Police Line Square,
O.T Road, At/Po/Ps/Dist- Balasore- 756001
5 The Branch Manager,
ORIENTAL INSURANCE Company Ltd., Bhadrak
Branch Office, 1st Floor, R.C. Behera Complex,
Burma Bypass, Bhadrak,
Po/Ps/Dist- Bhadrak, Odisha
…………… Opposite parties
Counsel For Complainant: Muzahid Akhter Khan, Adv & Others
Counsel For the OPs No. 1, 2 & 3 : Sri T. K. Das, Adv & Others
Counsel For the OPs No. 4 & 5 : Sri A. K. Panda, Adv
Date of hearing: 08.02.2021
Date of order: 19.02.2021
BASANTA KUMAR MALLICK, PRESIDING MEMBER
The facts narrated in the complaint are that the husband of the complainant had been borrowing crop loan from OP No. 1 under Kissan Credit Card Scheme. Like previous years the husband of the complainant had availed crop loan of Rs 57,800/- for kharif 2017-18 and also paid KCC Insurance premium to OP No. 1 instantly. On 08.08.2018, the husband of the complainant while working in the crop field fell down due to snake bite. The people working nearby at the time of occurrence took him to Bhadrak District Head Quarter Hospital (DHH) where the patient was declared dead by the doctors attended him for treatment. Just after completion of cremation rituals the complaint, being the nominee and one of the legal heir, informed OP No. 1 about the death of her husband requesting onward transmission of information and also staked death claim for payment of compensation. Further the complainant also submitted all required documents, as instructed by OP No. 1, within a period of two months for settlement of death claim as the deceased borrower was covered under KCC insurance under Group Personal Accident Insurance Policy No. 345700/48/2018/230 which was valid from 18.08.2017 to 17.08.2018. Since then the complainant has been persistently requesting all opposite parties sincerely for settlement of the claim for accidental death of her husband but all of her efforts ended futile. Being aggrieved with the inaction of the O.Ps, the complainant was constrained to file this case in this Commission praying for a direction to the O.Ps for payment of claim equivalent to sum assured along with cost and compensation.
O.Ps vehemently objected the claim of the complainant and contested the case through their advocates. The Advocate for O.Ps No. 1, 2 & 3 submitted the written version in admitting that the deceased husband of the complainant had availed crop loan of Rs 57,800/- from OP No. 1 and had paid KCC Insurance premium on the date of availing of the crop loan and the said borrower died on 08.08.2018 while working in his crop filed as declared by the doctors of D.H.H Bhadrak. It is also admitted by OP No. 3 that the deceased husband of the complainant was covered under Group Personal Accident Insurance Policy (unnamed) vide policy No. 345700/48/2018/230 dr. 18.08.2017 which was valid up to 17.08.2018. During the validity period of the policy the husband of the complainant died due to snake bite and the claim proposal received from the complainant issued by OP No. 3 vide letter No. BBCCB/PPR2BDD 9177/2018-19 dt. 27.03.2019 has also been received by OP No. 4 with proper acknowledgement. It is pertinent to mention here that even after elapse of more than two years the insurer has neither repudiated the claim nor settled the death claim submitted by the insured. In the afore said situation the OP No. 4 has inordinately delayed the payment of claim amount which is the negligence of the said OP but not due to the deficiency of service of answering O.Ps and therefore the case against answering O.Ps be disallowed.
OP No. 4, in submitting written version, has denied all the allegations made in the complaint and also raised the question of jurisdiction and cause of action. It is also stated by the answering O.Ps that the insurance, being a legal contract between the insurer and the insured, both the parties have to act according to the terms and conditions of the policy and accordingly the answering O.Ps are not liable to pay claim if at all staked. Further it is submitted that there is no deficiency of service on the part of answering O.Ps as the insured has not lodged any claim proposal nor enjoys status of a consumer defined in CP Act, 2019. Whenever the claim has not been staked by the insured within the agreed time limit, the question of settlement of death claim does not arise and the complaint being bereft of merit is liable to be dismissed.
Heard the parties to this case, perused the pleadings, written versions and material evidence on record and observed as follows.
1. The evidences such as police investigation report, postmortem report and other documents pertaining to death confirms that the deceased husband of the complainant has died due to snake bite and preliminary information has been issued by the complainant to OP No. 3 & 4 through OP No. 1 after having written application from the complainant on 22.09.2018. In addition to such report, OP No. 2 has also submitted a claim proposal addressing to OP No. 3 on dt. 11.10.2018 for onward transmission towards settlement of claim. Further OP No. 4, after receipt of claim proposal from complainant through OP No. 1 & 2, submitted the claim proposal to OP No. 4 vide letter No. 9177/2018-19 dt. 27.03.2019 for settlement of death claim of the complainant. Hence the denial of receipt of death claim proposal by the insured is believed false and untrue and also believed that OP No. 4 has taken false plea to avoid settlement of claim of the complainant.
2. It is evident from the record that OP No. 4 has acknowledged receipt of the claim proposal on 27.03.2019 as found in the issue Register of OP No. 3 Bank. Hence the OP No. 4 insurer has properly planned not to settle the claim on the false and fabricated ground as a result of which a poor widow of the deceased borrower has been suffering for more than last two and half years.
3. The postmortem report issued by IIC of P.S Bhadrak (R) vide UID Case No. 72/2018 makes it clear that the death of Late Shyama Sundar Rana was caused due to bite of a poisonous snake and the inquest report of Bhadrak (R) P.S also conforms the death due to snake bite. When the cause of death is confirmed by the doctor conducting postmortem and the investigation conducted by local police, the objection raised by OP No. 4 is not sustainable and also meaningless.
4. In course of hearing, OP No. 4 objected in stating that the insured has violated the terms of the policy conditions wherein it is mentioned that the death intimation as well as claim proposal should be submitted within a month from the date of occurrence but on the other hand the letter of acceptance issued by the insurer attached to letter dt. 18th August, 2017 clearly proves that there should not be any time limit for submitting the claim documents. Therefore no valid and genuine ground is left for the insurer to not to settle the death claim of the complainant submitted by the insured. As regards cause of action it is evident that the case has been filed within 2 years from the date of death of husband of the complainant and therefore the date of cause of action cannot be disputed.
In view of the analysis of above facts, it is clearly understood that the insurer OP has intentionally and deliberately did not take any step for settlement of death claim of the complainant which amounts deficiency of service and unfair trade practice. Therefore OP No. 4 is liable to pay the death claim of the complainant along with cost and compensation. Hence ordered;
ORDER
In the result, the complaint be and the same is allowed against OP No. 4 with cost & compensation. OP No. 4 is directed to pay a sum Rs 5,00,000/- (Rupees Five Lakhs only) the sum insured of the policy along with Rs 10,000/- as compensation for mental agony and harassment and Rs 3,000/- as cost of litigation to the complainant within 30 days from the date of receipt of order failing which interest @ 7% P.A with quarterly rests shall be charged on the awarded amount from the date of order till the date of payment.
This order is pronounced in the open Court on this day of 19th February, 2021 under my hand and seal of the Commission.
