DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 29thday of May, 2020
C.D Case No. 07 of 2019
Present 1. Shri Raghunath Kar, President
2. Shri Basanta Kumar Mallick, Member
3. Afsara Begum, Member
Smt. Basanti Palai
W/o Late Gokulananda Palai
Vill: Urunia,
Po: Lunga,
Via: Edtal,
Ps: Basudevpur,
Dist: Bhadrak, Odisha
……………………. Complainant
(Versus)
1. The Secretary Kuruda Service Co-Operative Society
At/Po: Lunga,
Via: Edtal,
Ps: Basudevpur,
Dist: Bhadrak, Odisha
2. The Branch Manager, Balasore Bhadrak Central Co-Operative Bank, Basudevpur Branch
At/Po/Ps: Basudevpur,
Dist: Bhadrak
3. The Chief Executive Officer (Secretary) Balasore Bhadrak Central Co-Operative Bank Ltd.
At: OT Road Balasore,
Po/Ps/Dist: Balasore
4. The Office-In Charge, IFFICO, TOKIO GENERAL INSURANCE Company Ltd.
Balasore Branch, At: Barala Builiding, Kalidaspur,
Po: Nuasahi,
Ps: Sahadevkhunta,
Dist: Balasore 756003
……………………..Opp. Parties
Counsel For Complainant: Muzahid Aktar Khan, Adv
Counsel For the OP No. 1 & 2: Set Ex-parte
Counsel For the OP No. 3: Miss N. Paduka, Adv
Counsel For the OP No. 4: A. K. Chand, Adv
Date of hearing: 19.02.2020
Date of order: 29.05.2020
RAGHUNATH KAR, PRESIDENT
This dispute arises out of the complaint filed by the complainant alleging deficiency of service and unfair trade practice against the O.Ps.
The facts of the complaint are to the effect that the complainant is the widow of Late Gokulananda Palai who died in a road accident on 28.10.2015. Before accidental death, the deceased husband of the complainant had been availing crop loan from OP No. 1 for seasonal agricultural operation on payment of required premium of crop insurance and K.C.C insurance under Janata Personal Accident Insurance Scheme. Unlike previous years, the deceased husband of the complainant had also availed crop loan of Rs 11,700/- on 28.05.2015 during Khariff 2015 and had also paid required premium amount for crop insurance and KCC insurance to OP No. 1. After sad demise of the deceased borrower the complainant, after completion of funeral rituals, informed OP No. 1 and also staked her claim for Rs 5,00,000/- as death compensation. Subsequently the complainant collected required papers/documents from different offices and submitted to OP No. 1 for onward transmission to other O.Ps for settlement of claim. Since then the complainant ran from post to pillar and met all the O.Ps to know about the fate of the claim but failed to achieve any positive result. As a last attempt the complainant met an officer of OP No. 3 bank who was in charge of K.C.C insurance under JPA scheme. The said officer, AGM (Development) handed over a copy of the letter issued by OP No. 4 to OP No. 3 which discloses the fact of repudiation of the claim. The complainant, being shocked and disappointed, served notice upon the O.Ps through her advocate demanding settlement of claim within a period of 15 days but the O.Ps did not pay any heed to the notice and did not initiate any action for settlement of claim. Being extremely aggrieved with the action of O.Ps, the complainant preferred a dispute in the District Forum for deficiency of service and prayed for settlement of claim of Rs 5,00,000/-, the sum assured, and cost and compensation.
OP No. 1 & 2 neither appear before the Forum nor submitted any written version in response to notice served upon them by post for which both the O.Ps are set ex-parte. OP No. 3, the insured, objected the allegations of the complainant and contested the case. OP No. 3 in submitting written version, has raised the question of maintainability on the ground of status of the complainant as a consumer and has not specifically mentioned the date on which cause of action arose and has also denied to have caused any deficiency of service and resorted to any unfair trade practice. OP No. 3 has also admitted that it is the insured of the insurer (OP No. 4) under group insurance policy vide No. 51556826 commenced from 20.08.2015 and remained valid up to 19.08.2016. The coverage of the policy was extended to all the KCC borrowers (Unnamed) of OP No. 3 bank availed credit support during the policy period. The said OP has also admitted that the KCC borrower has died on 28.10.2015 due to road accident who was covered under insurance from the date of commencement of policy as the deceased had availed the loan on 28.05.2015 on payment of required amount of premium for KCC insurance before commencement of policy. It is also stated by the answering OP that as on date of death of the KCC borrower Late Gokulananda Palai, the total KCC borrower of the insured bank were Rs 2,32,397/- which is less than the numbers covered under insurance. The answering OP also disclosed that the deceased KCC borrower was covered under insurance on the date of commencement of the policy and repudiation of the claim by OP No. 4, the insurer, is unfair and illegal. Since the answering OP has not caused any deficiency of service and not resorted to any type of unfair trade practice, the allegations made against OP No. 3 is not tenable.
OP No. 4, the insurer, challenged the allegations of the complaint and contested the case. OP No. 4 stated in the written version that the complainant is not a consumer within the meaning of CP Act and also raised the question of cause of action for which the case is falling under bared by limitation and not maintainable in the present Forum. Further it is also stated that there is no deficiency of service on behalf of the answering OP nor has resorted to any unfair trade practice. In narrating the fact this OP contends that the warranty attached to the JANATA PERSONAL ACCIDENT POLICY held by the other O.Ps it reads as “Since the cover will be on unnamed basis, the entire strength of the employees under the proposed cadre/designation has to be covered. No selective will be allowed. The insured must maintain the relevant records and make the same available on request. If at the time of claim it is discovered that persons more than the group covered under the policy, the claim shall be repudiated”. It is further mentioned that the husband of the complainant died on 02.10.2015 due to road accident when the total KCC borrowers under insurance were Rs 2,31,404/- but as per GPA insurance policy bearing No. 51556826 the total members covered at the time of commencement of policy were Rs 2,26,463/- and additional numbers as on 09.09.2015 were Rs 4,941/- total of which comes to Rs 2,31,404/-. But as per bank’s record the total numbers of KCC borrowers as on the death of the husband of present complainant were Rs 2,32,397/-. Since the total numbers of KCC borrowers exceed the total members as mentioned in the policy, it compelled the present OP to repudiate the claim. In view of the above mentioned facts, the complaint does not bear any merit and liable to be dismissed.
Gone through the complaint, written versions submitted by the O.Ps, heard the counsels of complainant and O.Ps, perused relevant materials on record and observed the following issues need to be discussed for passing the order.
Admittedly the husband of the complainant was a borrower of O.Ps other than OP No. 4 who was covered under KCC insurance and has paid the premium required for such insurance. The said KCC borrower is admittedly died in a road accident on 02.10.2015 as against which the complainant, being the wife of the deceased, staked claim with the insurer (OP No. 4) through other O.Ps which was subsequently repudiated by the insurer.
1. During hearing, the complainant argued that her husband had borrowed loan from OP No. 1, 2 & 3 in the three tier Co-Operative credit system and has paid required amount of premium for KCC insurance under JPA insurance scheme. After demise of the borrower, the wife of the deceased staked claim before OP No. 4 for payment of compensation that is the sum insure of Rs 5,00,000/-. But instead of settlement of the claim, OP No. 4 repudiated on the ground of the numbers of KCC borrowers covered under insurance are less than the actual KCC borrowers of the OP No. 3. The complainant argued that the premium for such insurance was paid much before the commencement of the insurance policy and the name of her husband was covered at the time of taking up of insurance policy. Under such situation the complainant is entitled to get the claim. On the contrary the O.Ps submitted that since the number of actual KCC borrowers of OP No. 3 as on the date of death on the KCC borrower was 2,32,397/- as against the numbers covered under insurance were 2,31,404/- which shows that the number of KCC borrowers were more than the numbers covered under insurance. In contradicting the above statement of OP No. 4, the counsel of the complainant argued that this is a false plea taken by the insurer intentionally and willfully to avoid settlement of claim. But the actual fact is that the policy was taken up by the insurer on 20.08.2015 covering the total KCC members of Rs 2,26,463/- in which the name of the deceased is included in the aforesaid number as he had paid the required premium much before the policy was taken up. So there was no ground to repudiate the claim as mentioned in the written version. In the above premises the repudiation of claim by OP No. 3, the insurer, is unethical and illegal and also not tenable. Simultaneously the counsel of OP No. 3 argued that the husband of the complainant availed the crop loan of Rs 11,700/- on 28.05.2015 and has paid the amount of premium instantly as against which the insurance policy was taken up on 20.08.2015 that is much before commencement of the policy. As the borrower has paid the premium before commencement of policy, his name remains within the numbers covered under insurance on the date of commencement of policy the complainant is entitled to get the death claim.
Perused the materials on record and heard the counsels of the parties present. The materials available on record discloses that the husband of the complainant had availed crop loan on 28.05.2015 on payment KCC insurance premium on the same date which has been remitted to the O.Ps on the next date. The complainant, after demise of her husband, staked the claim with OP No. 1 which has subsequently been submitted to the insurer through OP No. 2 & 3 and has reached the insurer in time and the time factor is not disputed by OP No. 4. Hence the claim raised by complainant is genuine and the objection of OP No. 4 on this particular point is not sustainable.
2. On the point of barred by limitation and cause of action the complainant argued that he has immediately served the notice through her advocate on 08.11.2018 when the fact of repudiation came to her knowledge from one of the officers of OP No. 3 who made over a letter of repudiation on 28.09.2018 issued by OP No. 4 addressing to OP No. 3. Hence the actual cause of action started from 28.09.2018. The complainant has filed this case on 17.01.2019 for which this case does not fall under barred by limitation. Therefore the objection of O.Ps is not sustainable. In challenging the contentions of complainant, OP No. 4 raised that the actual death occurred on 28.10.2015 and if the case had been filed on or before 27.10.2017, the said case would have been treated as filed during the limitation period. But the present case has been filed in the month of January, 2019 for which it comes under barred by limitation and therefore not maintainable in the Forum. On perusal of records and after having heard the counsels of parties to this case it is observed that the case has been filed within the limitation period and also maintainable in the present Forum.
3. The counsel for OP No. 4 has quoted in the written version that since the covered will be on unnamed basis, the entire strength of the employees under the proposed cadre/designation has to be covered and no selectivity will be allowed and the insured has to maintain relevant records to make the same available on request. In this particular case the coverage of number of members at the time of opening of policy were Rs 2,26,463/- and subsequently added another 4941 numbers on payment of required premium as a result of which total number of insured persons reached at Rs 2,31,404/-. It is also mentioned in the policy condition that if at the time of claim it is discovered that the persons are more than the numbers covered under the policy and the claim of other members over and above the insured numbers of persons, as mentioned in the policy, shall be repudiated. In challenging the point of argument the complainant argued in stating that the claimant does not come under the excess numbers as he has paid the premium much before the policy was taken up. Secondly, OP No. 4 has never sought any information from the insured bank whether the complainant is one of the borrowers out of the excess number as stated in the policy conditions and as said by OP No. 4 in the written version. OP No. 3 has also submitted relevant documents pertaining to the number of KCC borrowers as on the date of commencement of policy is 2,24,356/- including the husband of the claimant and therefore there is no valid reason to repudiate the claim. On perusal of materials on record and evidence adduced by the complainant and OP No. 3 it is well proved that the husband of the complainant has paid the required premium amount to the O.Ps much before commencement of the policy and therefore the entitlement of complainant cannot be ignored, neglected and repudiated.
4. The most vital issue involved in this case is that OP No. 4 solely focused on the policy bond covers the employees only not the KCC borrowers. In exhibiting the policy bond OP No. 4 attracted the attention of the Forum claiming that the policy was taken up unnamed covering the employees of the bank only not the KCC borrowers who availed loan from OP No. 3 bank. Since the policy was for the employee’s lives, the survivors of employees only are entitled to get compensation for accidental death. On the contrary OP No. 3 & the complainant, in adducing evidence, claimed that during the policy period OP No. 4 has settled the claim of as many as 52 numbers out of 55 claims staked for the KCC borrowers by the nominees of KCC borrowers who succumbed to death due to accident. If the policy for the period of 2015- 16 was absolutely for the employees, how OP No. 4 paid the death claim to 52 numbers of KCC borrowers under the said policy. Therefore, it is crystal that the OP No. 4 has taken false plea to repudiate the claim of the complainant which is considered as illegal and such action of the said OP amounts to deficiency of service.
In view of the above analysis and the materials made available by the parties on the record, this Forum reached at the conclusion that the repudiation of claim by OP No. 4 is absolutely illegal and unlawful and liable to pay the sum insured amount to the complainant along with cost & compensation.
ORDER
In the result, the complaint be and the same is allowed against the OP No. 4 and dismissed against OP No. 1, 2 & 3 with cost and compensation. OP No. 4 is directed to pay a sum of Rs 5,00,000/- to the complainant together with Rs 6,000/- as compensation for mental agony and harassment and Rs 4,000/- as cost of litigation. This order must be complied within 30 days from the date of receipt of the order. Failure to comply the order within the above mentioned time, OP No. 4 shall be liable to pay interest @ 7% PA at quarterly rests on the claim amount from the date of staking the claim till the date of payment.
This order is pronounced in the open Forum on this day of 29th May, 2020 under my hand and seal of the Forum.
