West Bengal

Bankura

CC/81/2023

Saini chakraborty - Complainant(s)

Versus

United India Insurance, Branch Manager - Opp.Party(s)

Suman Patra

11 Jul 2024

ORDER

      IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION, BANKURA

  Consumer Complaint No.81/2023

       Date of Filing:  05/09/2023

Before:                                        

1. Samiran Dutta                              Ld. President.      

2. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant:Ld. Advocate Jayanta Kumar Mukherjee

For the O.P.: Ld. Advocate Pulak Kumar Singha

 

Complainant:

1.Tapan Chakraborty, s/o Late Bholanath Chakraborty,at Nirisha, P.O-Bhattapara,P.S-Barjora, Dist-Bankura

2.Sadhana Chakraborty, w/o Tapan Chakraborty,at Nirisha, P.O-Bhattapara,P.S-Barjora, Dist-Bankura

3.Saini Chakraborty,W/O-Late Bijoy ChakrabortyR/O-Nirisha,  P.O-Bhattapara,P.S-Barjora,Dist-Bankura

4. Shreya Chakraborty,D/O-Late Bijoy ChakrabortyR/O-Nirisha,  P.O-Bhattapara,P.S-Barjora,Dist-Bankura

5. Rajdip Chakraborty, S/O-Late Bijoy ChakrabortyR/O-Nirisha,  P.O-Bhattapara,P.S-Barjora,Dist-Bankura

 

Opposite Party:

 1.United India Insurance Branch Manager,240/A Nutanchati Bankura, P.O & Dist-Bankura, Pin-722101,W.B.

2.United India Insurance Company Limited,Registered and H/O-24,Whites road,Chennai, Pin-600014                                                                          

FINAL ORDER / JUDGEMENT 

                                                                                                                                                         

Order No.10

Dated:11-07-2024

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 Complainants’ case is that Bijoy Kumar Chakraborty, predecessor- in- interest of the Complainants was the registered owner of a four wheeler Bolero pick up No. being WB-39-B-1721 duly insured with O.P./Insurance Co. Policy No. being 0315083119 P 110704402 valid from 18/11/2019 to 17/11/2020 with P.A. cover of Rs.15 Lakh. On 11/01/2020 the said insured met with a road traffic accident with another vehicle coming from opposite direction at about 12 O’clock at night at  Auora, G.T. Road, Giridih, Jharkhand                                                                                                                                                   

                                                                                                                                                                       Contd…..p/2

Page: 2

and as a result of such head on collision between the two vehicles the insured died on the spot and the insured vehicle was badly damaged which gave rise to Bagodar P.S. Case No.8/2020, dated: 11/01/2020 u/s 279/427/337/338/304A IPC. The incident was reported to the O.P./Insurance Co. followed by claim application but the same was repudiated by letter dated: 20/03/2023 on the ground of violation of Policy for delayed submission of claim application. The Complainants have therefore approached this Commission for appropriate relief.

O.P./Insurance Co. contested the case by filing a written version reiterating the same ground for repudiation of the claim.

-: Decision with reasons:-

Having regard to the facts of the case, contention, submission and documents on both sides   the Commission finds that admittedly Mr. Goutam Gorai was driving the ill-fated vehicle at the time of accident as is evident from the FIR itself.  Surveyor’s report dated: 02/04/2020 submitted before the Commission also supports the fact of driving status. Ld. Advocate for the O.P./Insurance Co. has drawn attention to the Policy condition where it is stated that in order to get P.A. cover claim the deceased insured must have Driving License and also be established in driving the vehicle at the time of accident. In this case insured deceased was no doubt in possession of valid Private & Commercial composite Driving License at the time of accident issued on 16/02/2010 valid till 15/02/2023 for NT and till 02/03/2023 for TR and he was not driving the vehicle but he was travelling in the vehicle by the side of the Driver Goutam Gorai according to the recital in the FIR.

Now the question is whether the deceased insured though  having valid Driving License on the date of accident is entitled to get P.A. Cover if he is not found driving the vehicle but sitting beside the actual Driver as co-driver.

General Resolution 36 of Indian Motor Tariff (IMT), 2002 has extended the benefit of P.A. Cover for such Owner-Driver which may be quoted as follows: -        

G.R.36:- Personal Accident Cover under Motor Policy (not applicable to vehicles covered u/s EF&G of Tariff for commercial vehicles)

A.Compulsory P.A. Cover for Owner Driver:

Compulsory Persoanal Accident Cover shall be applicable under both liability only and package policies. The Owner of insured vehicle holding an effective Driving License is termed as Owner-Driver for purpose of this Section. Cover is provided to the Owner-Driver whilst driving the vehicle including mounting into / dismounting from or travelling in the insured vehicle as a co-driver.                                                                                                                                                                                                          

                                                                                                                                                                                        Contd…..p/3

Page: 3

IRDAI has also adopted this principle of  P.A. Cover policy by extending the benefit of Personal Accident Cover (P.A. Cover) to such unfortunate deceased insured vide Reference No.IRDA Circular No.IRDAI/NL/CIR/MOTP/158/09/2018, dt.20/09/2018 the relevant portion of which reads as follows: -

General Regulation 36 of India Motor Tariff (IMT), 2002 mandates General Insurance Companies carrying on Motor Insurance business to provide compulsory Personal Accident Cover (CPA) for Owner-Driver under both liability only and package policies. The Owner of insured vehicle holding an effective Driving License  is termed as Owner-Driver for the purpose of this Section. The cover is provided to the Owner-Driver whilst driving the vehicle including mounting into/dismounting from or travelling in the insured vehicle as a co-driver.

In view of this clear provision of law supported by the decision of the Calcutta High Court dated: 29/08/2003 (United India Insurance Co. Ltd. Vs. Minor Tanushree Mukherjee & Ors.) reported in I (2005) ACC652 as referred to by the Ld. Advocate for the Complainants the instant complaint case is maintainable and ought to be allowed.

Ld. Advocate for the O.P./Insurance Co. has further contended that the claim is barred by limitation as claim application of P.A. Cover was preferred on 16/09/2021 long after the date of accident i.e. 11/01/2020 but it appears from the claim application of damaged vehicle that it was made on 24/01/2020 i.e. after about 13 days of the date of accident. It should be remembered that Policy condition No.1 has specifically stated that notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage. In this case the occurrence took place on 11/01/2020 and it was intimated to the Insurance Co. for the first time on 24/01/2020 with the claim of damaged vehicle. Subsequently death claim was preferred on 16/09/2021. Non-mentioning of the Personal accidental loss of life of the insured at the initial stage will not take away the right of the claimants to get the P.A. cover claim when specific P.A. cover claim was made thereafter on 16/09/2021.

Immediate reporting of the occurrence is the first and foremost criteria of the Policy condition No.1. In this case F.I.R. was  lodged immediately on the very date of the accident. It is immaterial when the claim application of the damaged vehicle or the personal accidental loss of life is forwarded to the Insurance Co. It is however true that inordinate delay in submission of claim application should be seriously viewed. It is needless to mention here that after preference of first claim application on 24/01/2020 wide spread COVID 19 Pandemic set in which continued unabated till the end of 2021.

According to the decision of the Apex Court in suo motu writ petition-3/2020 delay is condoned in every case of application before the Court/Tribunal/Authority as the case may be during the persistence of COVID 19 period and from that point of view the claim application of P.A. Cover of the Complainants ought not to have been rejected by repudiation letter dated: 20/03/2023 on delay point.

                                                                                                                                                                   Contd…….p/4

Page: 4

Be it further mentioned here that IRDAI authority has cautioned the Insurance Companies to refuse claim benefit to the claimants merely on delay ground if the claim is otherwise maintainable. In this connection relevant portion of circular issued by the IRDAI authority No. being IRDA/HLTH/MISC/CIR/216/09/2011, dt.20-09-2011 is reproduced below: -

 

“…..therefore it is advised that all Insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the Insurer ,must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the Insurers should satisfy themselves that delayed claim would have otherwise been rejected even if reported in time…..”      (underline is given by the Commission for the sake of emphasis)

It is therefore clear from the above mentioned Circular that Insurance claim cannot be mechanically repudiated merely on the ground of delay if the claim application is found maintainable otherwise.

Accordingly the Commission thinks it just and proper to allow the present application for P.A. Cover claim of Rs.15 Lakh in favour of the Complainants on the accidental death of the insured Bijoy Kumar Chakraborty. It is strange that O.P./Insurance Co. has been sitting over the matter for about 1/^½ year but was pleased to reject the claim ultimately.

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 Complainants or to their nominated person(s) in equal proportion a sum of Rs.15 Lakh as compensation for P.A.Cover of deceased Bijoy Kumar Chakraborty with litigation cost of Rs. 5,000/-within one month from this date in default law will take its own course.

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

____________________                _________________         

HON’BLE   PRESIDENT          HON’BLE MEMBER