West Bengal

Bankura

CC/43/2018

Smt. Madhuri Das - Complainant(s)

Versus

The Senior Divisional Manager National Insurance Company Ltd. - Opp.Party(s)

Subhsra Kanti Mukhopadhyay

30 Jan 2024

ORDER

                           IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA     

  Consumer Complaint No. 43/2018

                                                        Date of Filing: 19/07/2018                                                

Before:                                        

1. Samiran Dutta                            Ld. President.      

2. Siddhartha Sankar Bhui            Ld. Member. 

 

For the Complainant:  Ld. Advocate: Rupa Rani Mallick / Sayanton Chowdhury

For the O.P.:  Ld. Advocate: Ardhendu Sekhar Ghosh / Subhra Kanti Mukherjee

Complainant  

Smt. Madhuri Das, W/o- Bhaskar Das, Resident of Pratapbagan(North), Bankura, Sibsankar Girls’ School Lane, P.O.& Dt.-Bankura,  Dist- Bankura. Pin-722 101.               

Opposite Party 

1.The Senior Divisional Manager, National Insurance Company Ltd., D.O.-XVII, Belapur, Vindhya Commercial Complex, 5^th Floor, Plot No.-1, Sector II, CBD Belapur, Navi Mumbai, 400614.   

2. The Branch Manager, National Insurance Company Ltd., Bankura Branch, Chandmari Danga, Bankura, P.O. & P.S.- Bankura, Dist- Bankura    

 

FINAL ORDER / JUDGEMENT

Order No.62

Dated: 30-01-2024

Both parties file hazira through Advocate.

The case is fixed for argument.

After hearing argument from both sides the Commission proceeds to dispose of the case as hereunder: -

The Complainant’s case is that  her bachelor son Dipankar Das being an employee of State Bank of India, Banasuria Branch met with a road accident on 13/11/2016 at about 10.15 p.m. while he was returning home from his Branch Office by riding his own bike No. being WB 68N 5199, at that time a truck dashed him from behind as a result of which he fell down and received severe head injury and when taken to Bankura Sammilani Medical College & Hospital, (BSMCH), Bankura  he succumbed to the injuries at 12.35 Hrs.  on 14/11/16. Over the incident Bankura P.S. case No.341/16, dt.17/11/2016 was lodged u/s 279/304A/427 IPC. After one year of death of said Dipankar Das a card was found in the month of December, 2017 from his money bag which was issued on 03/2012 valid up to 3/2017 from which it is learnt that the deceased was the holder of State Bank Platinum International Debit Card No. being 45915300006 which provides Accidental death benefit insurance for Rs.5 Lakh under Policy No.262000/42//8200000341 issued by the O.P. Insurance Co. linked to his S.B.  A/c No.31548198292 with his own banker. Having learnt the above facts the Claimant being the mother of the deceased Dipankar Das submitted claim application to the O.P. Insurance Co. but the same was repudiated by letter dated: 22/03/2018 due to delayed intimation after lapse of 469 days. The Complainant has therefore approached this Commission for appropriate relief.

                                                                                                                                                                                        Contd……p/2

Page: 2

O.P. contested the case by filing a written version reiterating the same point as the ground of repudiation.  

                                                                                    -: Decision with reasons: -

Having regard to the facts of the case, submission, contention and documents from both sides the Commission finds that there is discrepancy with regard to the Policy No. as mentioned in the petition of complaint and RTI information dated: 12/09/2023 obtained from O.P./Insurance Co. communicated to the Complainant with the correct Policy No.02407004216000027 valid from 08/05/2016 to 07/05/2017 and the relevant Policy document attached therewith also shows the same policy No. SBI Authority is not a necessary party to this case and the Policy No. given by them in their RTI information dated: 07/09/2023 which is a different one from that of the O.P./Insurance Co. should be ignored for the purpose of disposal of this case as it is the O.P./Insurance Co. which is to disburse the insurance claim after allotment of Policy No. and accordingly Policy No. given by them as referred to above should be relied upon for the purpose of decision of this case.  U/s 23 of the Right to Information Act, 2005 no such order passed by the RTI Authority shall be called in question otherwise than by way of an appeal under that Act.    

Admittedly there is no dispute with regard to the factum of accidental death of deceased Dipankar Das and the entitlement of death insurance claim but the O.P./Insurance Co. has opposed the claim only on the ground of inordinate delay in submission of the claim but said delay has been satisfactorily explained in the petition of complaint as aforesaid. No delay could however be found with regard to the lodging of the F.I.R. Driving License of the deceased is on record seized by the Police valid from 29/08/2002 to 28/08/2021.

The aforesaid Policy document as obtained from O.P./Insurance Co. under RTI Act has specifically provided under Clause-12 of the terms and condition of the Policy that no claim should be rejected on account of delay in intimation of claim/submission of claim/documents as per IRDAI guidelines. This apart IRDAI Authority has cautioned the Insurance Co. to refuse claim benefit to the claimant merely on delay ground if the claim is otherwise maintainable. In this connection relevant portion of Circular issued by IRDAI Authority No. being IRDA/HLTH/MISC/CIR/216/09/2011, dt.20/09/2011is reproduced below: - 

“ ….therefore it is advised that all insurers need to develop a sound mechanism of their own to enable such claims with utmost care and caution. It is also advised that the Insurer must   not repudiate such claims unless and until the reason of delay are specifically ascertained, recorded and the Insurers should satisfy themselves that delayed claim would have otherwise been rejected even after reporting in time.” 

                                                                                                                                                                                  Contd……p/3

Page: 3

It is therefore clear from the above Circular that Insurance claim cannot be mechanically repudiated merely on the ground of delay if the claim application is found maintainable otherwise. This position has also been reiterated by the Hon’ble Supreme Court in Omprakash Vs. Reliance General Insurance reported in (2017) 9 SCC 724 in the following words: - 

“ …if the reason for delay in making a claim is satisfactorily explained such a claim cannot be rejected on the ground of delay….”

Thus considering the entire facts and circumstances of the case  the Commission is of the view that it is a fit case to favour the Complainant with the award of Insurance claim of Rs.5 Lakh as compensation on the accidental death of her bachelor son.

 

Hence it is ordered……..

That the case be and the same is allowed on contest but without cost. O.P./Insurance Co. is directed to pay to the Complainant Rs.5 Lakh as compensation on account of accidental death of the Insured deceased Dipankar Das within one month from this date I/D law will take its own course.

Both parties be supplied copy of this Judgement free of cost.

 

 ____________________                _________________         

HON’BLE   PRESIDENT           HON’BLE MEMBER