West Bengal

Paschim Midnapore

CC/61/2017

Shri Atanu Das - Complainant(s)

Versus

The Senior Division Manager, National Insurance Co.Ltd. - Opp.Party(s)

02 Aug 2017

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM

PASCHIM MEDINIPUR.

                             

     Bibekananda Pramanik, President

and

Sagarika Sarkar, Member. 

 

Complaint Case No.61/2017

 

                          Sri Atanu Das & Sri Santanu Das, S/o late Pradip Kumar Das

                            and Smt. Tanushree Kirtania W/o-Sri Mrinal Kirtania,

                                          P.O.-Midnapore, P.S.-Kotwali,

                          District - Paschim Medinipur. …………..…Complainants.

                                                                 Vs.

1. The Senior Divisional Manager, Officer-in-Charge,

                                  National Insurance Company Ltd., Division-III,

                                National Insurance Building, 8, India Exchange Place,

                                 Ground Floor, Kolkata-700001;

2.   The National Insurance Company Ltd.,

      Branch Office at Station Road, Midnapore, P.O.-Midnapore,

      P.S.-Kotwali, Dist-Paschim Medinipur ....….….Opp. Parties.

                                                    

              For the Complainant: Mr. Swapan Kumar Dasmal, Advocate.

              For the O.P.               : Mr. Ashok Kumar Paul, Advocate.

 

Decided on: - 02/08/2017

                                

ORDER

                          Bibekananda Pramanik, President – Complainants namely Atanu Das, Santanu Das and Smt. Tanushree Kertania have filed this consumer complaint u/s 12 of the C.P. Act on 28/03/2017, alleging deficiency in service on the part of O.P.-National Insurance Co. Ltd. i.e. O.P. nos. 1 & 2.

Contd…………………..P/2

          

                                                                                                ( 2 )

  Facts of the case, in brief, is as follows:-

  Pradip Kumar Das, since deceased, the father of the complainants obtained a

policy from the O.P.-Insurance Company for a sum of Rs.5,00,000/-.  After his death, the complainants obtained a Succession certificate from the court of Ld. District Delegate, Paschim Medinipur in Succession case no.104/2013 and filed a claim petition in the office of the O.P.-Insurance Company for collecting the money of the said policy.  It is stated that the said policy was issued in favour of  Pradip Kumar Das as per rules and regulation and after proper verification and enquiries by the O.Ps.   All connected papers have already been sent to the Company and as such the company has no right to call or state that the impugned policy was obtained by practicing misrepresentation and misstatement.  In spite of repeated request, the O.P.-Insurance Company failed to make payment of the said policy on various pretexts and as such the O.P. no.1 has caused gross deficiency in service.  It is stated that from the materials on record placed by the complainant it would be apparent that O.P. no.1 repudiated the claim of  insurance illegally, willfully, whimsically and disobeying the contract with a view to harass the complainants.  Hence the complaint, praying for directing the O.P.-Insurance Company to pay the policy amount of Rs.5,00,000/- and an award of Rs.5,00,000/- towards harassment, damage, compensation and cost of the proceeding. 

                  The opposite party –Insurance Company has contested this case by filling a written objection.

                  Denying and disputing the case of the complainants, it is the specific case of the opposite parties that the present case is not maintainable, that the complainants have no cause of action to file this case and that the complaint is hopelessly barred by limitation.  It is stated that the insured died in a road traffic accident on 21/09/2010 but the claim was made after two years from the date of death of the insured and the complaint case is therefore liable to be summarily rejected.  It is also in the specific case of the O.P. that the deceased-insured obtained the policy by disclosing that his monthly income was Rs.10,000/- and basing upon such declaration,  the impugned policy was issued.  The Insurance Company is to act upon good faith and it’s officer are to rely upon the declaration made by the insured at the time of obtaining policy.  O.P. sent a letter dated 08/04/2015 to the complainants asking them to clarify the monthly income of the insured to be as Rs.10,000/- but from the I.T. return submitted by the victim for the assessment year 2001-2002, it would be found that he disclosed his gross income during the said year as Rs.34,576.15/- and so his monthly income comes to Rs.2,850/- and as such he was

Contd…………………..P/3

 

                                                                                               ( 3 )

legally entitled to purchase a policy of Rs.2,00,000/- and not of Rs.5,00,000/-.  By issuing the said letters, the O.P. wanted to know the cause and reason of such wrong statement made by the insured but the complainants failed to give any suitable reply to the same.  Thereafter the O.P. again by sending a letter dated 14/12/2015 intimated the complainants that since they failed to give any suitable explanation of such discrepancy so it was proposed that the said file will be closed as ‘no claim’.  On receipt of the said letter, the complainants sent a legal notice through their Advocate on 18/01/2016 to the O.Ps but in the said notice no explanation regarding such wrong statement of income of the insured was made.  It is stated that since the deceased insured obtained a JPA policy in question by false representation regarding his monthly income, so the complainants being his legal heirs are not entitled to get any relief as prayed for.  It is further stated that in the above circumstances it cannot be held that the O.Ps have any deficiency in service, as alleged.  O.Ps therefore claim rejection of the complaint with cost.   

 

                                                                 Points for decision

1. Is the case maintainable in it’s present form and prayer?
2. Is the complaint barred by limitation?
3. Are the complainants consumer under the provision of C.P. Act?
4. Is there any deficiency in service on the part of the opposite parties?
5. Are the complainants entitled to get the reliefs, as prayed for?

 

                   

Decision with reasons

For the sake of convenience and brevity, all the above points are taken up together for consideration.

     At the very outset, it is to be stated here that in this case neither the complainants nor the opposite parties adduced any evidence, either oral or documentary, but they have relied upon some documents, so filed by them in this case.

     It is not denied and disputed that Pradip Kumar Das, since deceased, obtained a JPA policy from the O.P.-Insurance Company.  From the copy of Succession Certificate as well as from the averments made by the complainants it appears that the present complainants are the legal heirs and representatives of the deceased insured Pradip Kumar Das.  So undisputedly, they being the beneficiary of the said policy, are the ‘consumers’ of the O.Ps. 

Contd…………………..P/4

 

( 4 )

     Maintainability of this case has been questioned on the ground that the deceased Pradip Kumar Das died on 21/09/2010 but the present claim was made long after two years from the date of his death. On this score, we find from a letter dated 18/04/2013, sent by the O.P-Insurance Company, that in the said letter O.Ps have referred about a letter dated 17/11/2011 and from the averments of the said letter dated 18/11/2013 we find reasons to presume that the complainants submitted claim of insurance before 17/11/2011 for which the O.Ps by sending the said letter dated 18/11/2013 informed the complainants that they have not yet received the required documents as asked by their letter dated 17/11/2011.  Therefore it cannot be held that the claim of the complainants is barred by limitation.

     Now above the allegation of deficiency in service on the part of O.P.-Insurance Company we filed that it is the case of the complainants that even after submission of order of succession certificate, the O.P.-Insurance Company failed to make payment of the policy money of Rs.5,00,000/- on various pretext  thereby causing gross deficiency in service. Although, neither the complainants nor the O.P. adduced any evidence in this case in spite of obtaining opportunity to adduce evidence, but from the respective pleadings of the parties as well as from the documents filed by them, we find that admittedly  Pradip Kumar Das, the deceased insured, obtained a JPA policy from the O.P. and the said insured died on 21/09/2010. From letter dated 18/04/2013, issued by the O.P.-Insurance Company, we find that before 17/11/2011 the complainants submitted claim of insurance for which the Senior Divisional Manager of the O.P. demanded some documents, including succession certificate in original.  According to the complainants, even after submission of succession certificate, the O.P.-Insurance Company neglected to settle the claim on various grounds. As against this, it is the case of the O.P.-Insurance Company that in the said succession case, they were not made party and mere grand  of succession certificate does not automatically confer any right to  get the amount paid from the O.P. and since  the O.Ps.  were not parties in that proceeding, so they are in no way bound by the same.  It is also the case of the O.Ps.  that the deceased-insured obtained the JPA policy from the O.P. on false representation regarding his  monthly income  as Rs.10,000/- although  from  his I.T. return for the assessment year 2001-2002 it is found that his gross total  income was  Rs.34,576.15/-  which means his monthly income was Rs.2,850/- and as such, he  was legally entitled to purchase policy of Rs.2,00,000/- and not Rs.5,00,000/-. Therefore the O.P by sending letters dated 08/04/2015 and 14/12/2015 asked the complainant Atanu Das as to why the claim shall not be repudiated on the ground of misrepresentation/misstatement of facts by reducing the sum assured. It was also

Contd…………………..P/5

 

 

                                                                                              ( 5 )

informed by the said letter dated 14/12/2015 by the O.P. that if no reply is given to that letter within 15 days then the O.Ps. will have no other alternative than to close the file as ‘no claim’. Complainants have not denied receipt of those two letters. It is also not the case of the complainants that they gave any reply regarding the said ground of misrepresentation/misstatement of facts by the deceased-insured. The complainants do not deny that the insured had shown his annual income as Rs.34,576.15/- for the relevant year. At the time of hearing argument, Ld. Lawyer for the O.P.-Insurance Company referred a decision of the Hon’ble NCDRC reported in 2015(1) CPR 584(NC). In the said ruling, Hon’ble NCDRC has been pleased to hold that the Respondent-insurance company was justified in repudiating the claim where misrepresentation regarding income details and educational qualification and employment has been made by the insured at the time obtaining the policy. Here in this case also the O.P.-Insurance Company has made out a case that although at the time of obtaining the policy, the  deceased-insured disclosed his monthly income as Rs. 10,000/- but from the I.T. return of the relevant year of the insured it was found that  his monthly income was Rs.2,850/- (aprox).  According to O.Ps., had the insured not misrepresentated  his income, he would not have granted his policy of Rs.5,00,000/- instead of Rs.2,00,000/- according to his income.  Complainants have given no explanation for such misrepresentation regarding the income of the deceased insured and they have also not denied the gross income of  the insured as declared in the I.T. return of the relevant year.

      In the above fact and  circumstances of the case and the discussions made above, we are of the view that there  is no deficiency in service on the part of the O.P.-Insurance Company  in repudiating the claim of insurance of the policy and therefore the petition  of complaint is liable to be dismissed.

     All the points are accordingly disposed of.

     In the result, the complaint case fails.             

                                                  Hence, it is,

                                                     Ordered,

                         that the complaint case no.61/2017  is hereby dismissed on contest but in the circumstances without cost.

                               Let plain copy of this order be given to the parties free of cost.

            Dictated and Corrected by me

                         Sd/-B. Pramanik.                       Sd/- S. Sarkar                       Sd/-B. Pramanik. 

                               President                                  Member                                 President

                                                                                                                          District Forum

                                                                                                                       Paschim Medinipur