IN THE CONSUMER DISPUTES REDRESSAL COMMISSION, KOTTAYAM
Dated this the 27th day of September, 2023
Present: Sri.Manulal.V.S, President
Smt.Bindhu.R, Member
Sri.K.M.Anto, Member
CC No.242/2022 (Filed on 16/11/2022)
Complainant : Dony Thomas S/o Joseph Thomas,
Thundiparambil House,
Kudamaloor P.O,
Aymanam, Kottayam - 686 017.
(By Advs: K.J. Devasia & Binoy Abraham)
Vs.
Opposite parties : 1. The Universal Sompo General Insurance
Company Limited,
Office No.103, Ist Floor, MIDC,
Central Road, Andheri East, Mumbai,
Maharashtra – 400093
Represented by the Regional Manager,
2. The Branch Manager,
Universal Sompo General Insurance
Company Limited,
2nd Floor, Grace Corner, K.K Road,
Kadavanthara Junction, Cochin - 682020.
3. The Manager,
Indian Overseas Bank,
Kottayam – 686 001.
(By Adv:Agi Joseph)
O R D E R
Sri.Manulal.V.S, President
This complaint was filed under Section 35 of the Consumer Protection Act 2019.
Case of the complainant is as follows:
1. The mother of the complainant Shiny Thomas was a policy holder under the IOB Suraksha policy( Personal Accident Claim) having policy number 3333/61168192/00/034 issued by the first opposite party. She took the policy under the scheme from the third opposite party. The sum assured was Rs.10 lakhs with a yearly premium of Rs.326/- which had been paid through her account at IOB bank. The complainant is the nominee in the above said policy. The policy was effective from 14/04/2020 to 13/04/2021. The said Shiny Thomas met with an accident while she was travelling as a pillion rider of a motorcycle bearing Registration Number KL05 AU 770 on 2/12/2020 at Ambadi Junction, Kudamaloor. She was immediately taken to the Medical College Hospital, Kottayam but died on 4/12/2020. The complainant made a claim with the opposite parties but the claim was repudiated by the first opposite party only on the reason that the accident and the death thereafter was informed to them only on 8/11/2021 that is after a lapse of 341 days from the date of accident without any justifiable reason and it is a violation of policy condition.
2. It is submitted in the complaint that the complainant was staying outside Kerala in connection with his employment and he was not able to proceed with the formalities of claiming insurance amount in time as lock down declared by both Central and State Governments due to Covid-19 pandemic. Moreover, he was advised that the limitation clause is not applicable since due to the outbreak of Covid-19 pandemic, the Honourable Supreme Court had suspended the period of limitation in respect of claims and the legal proceeding till 31/05/2022. It is alleged in the complaint that the ground for denial of policy benefits to the complainant is arbitrarily improper and not justifiable in law. The complainant is entitled to realize the insured sum of Rs.10 lakhs with interest from the opposite parties. The denial of the claim is a clear deficiency in service and unfair trade practice on the part of the opposite parties. Hence this complaint is filed by the complainant praying for an order to direct the opposite parties to pay Rs.10 lakhs to the complainant together with 12% Interest along with compensation of Rs.1,00,000/- and Rs.50,000/- as cost of litigation.
After the admission of the complaint, notices were duly served to the opposite parties. Notice was received by the first opposite party on 20/12/2022 and the second opposite party on 15/12/2022. Despite the receipt of notice from this Commission, first and second opposite parties neither care to appear before this Commission nor to file version. Hence first and second opposite parties were declared as exparte.
The third opposite party filed version contending as follows:
Universal Sompo General Insurance Company and Indian Overseas Bank are two difference legal entities. The third opposite party has no connection for day-to-day affairs and business of the first opposite party. The contract of insurance is a contract between the policy holder and insurance company. Hence if the claim is payable as per the terms and conditions of the policy and in such circumstances the first opposite party is liable to honour the claim. The third opposite party has no liability to pay or honour the claim. The third opposite party is an unnecessary party. To the knowledge of the third opposite party the reason for repudiation is true and correct. If there is any deficiency in service on the part of the first opposite party, the same has to be rectified by the first opposite party alone. The process for honouring the claim or repudiation of claim is the subject matter of the first opposite party. The third opposite party has no role on any of the said activity. There is no deficiency in service on the part of the third opposite party.
In this case the complainant filed proof affidavit. Exhibits A1 to A7 were marked from the complainant’s side. Deepak. T. who is the Senior Manager and Principal Officer of the third opposite party filed proof affidavit. No documentary evidence from the side of the third opposite party.
On evaluation of complaint, version and evidence on record we would like to consider the following points :
(1)Whether the complainant has succeeded to prove deficiency in service or unfair trade practice on the part of the opposite parties ?
(2)If so, what are the reliefs and cost ?
POINTS 1 & 2
The specific case of the complainant is that his mother named Shiny Thomas was a policy holder of the first opposite party vide Exhibit A1 policy. The insured met with an accident while she was travelling as a pillion rider of a motorcycle on 2/12/2020 and died due to the injuries sustained in the accident. Though the complainant lodged a claim with the opposite parties, the claim was repudiated by the first opposite party stating that the accident and the death was informed to the first opposite party only on 8/11/2021.
On perusal of Exhibit A1 we can see that Shiny Thomas was the insured and the sum assured was Rs.10 lakhs under the policy. It is further proved by Exhibit A1 that the policy was commenced from 23/04/2021 and the maturity date of the policy was 13/04/2022. On perusal of Exhibit A1 we can see that the complainant is the nominee of the insured. It is stated in Exhibit A1 that the details of the coverage as accidental death only.
Exhibit A3 is First Information Report filed by the Kottayam West Sub Inspector of Police before the Judicial First Class Magistrate Court III, Kottayam in Crime Number 1373/2020. It is proved by the Exhibit A3 that Shiny Thomas met with an accident on 2/12/2020 while she was travelling as a pillion rider of a motor cycle bearing Registration Number KL 5 AU 770 and sustained severe injuries to her. Exhibit A4 which is the Postmortem Certificate issued by the Medical Officer, Department of Forensic Medicine, Medical College, Kottayam prove that the said Shiny Thomas died due to the head injury sustained to her in the accident.
The first and second opposite parties repudiated the claim of the complainant. Exhibit A5 letter states that the claim was intimated to them after 341 days without any justifiable reason. In Exhibit A5 it is stated in the general condition of the claim procedure that claim shall be intimated to the Insurance Company immediately on occurrence of claim and in any case within 7 days giving full description of the medical treatment undertaken and the cause. It is further stated in Exhibit A5 that the claim form along with all the relevant documents shall be submitted with the insurance company not later than 30 days from the date of intimation. On perusal of Exhibit A1 Policy Certificate, we cannot see any of these conditions mentioned in policy certificate.
In Jaina Construction Committee Vs. Oriental Insurance Company Ltd., 2022 SCC Online SC 175, decided on 11.02.2022] Hon’ble Apex Court of India has held that :
“Of course, it is true that there was a delay of about five months on the part of the complainant in informing and lodging its claim before the Insurance Company, nonetheless, it is pertinent to note that the Insurance Company has not repudiated the claim on the ground that it was not genuine. It has repudiated only on the ground of delay.” ...
The Court, hence, concluded that when the complainant had lodged the FIR immediately after the theft of the vehicle, and when the police after the investigation had arrested the accused and also filed challan before the concerned Court, and when the claim of the insured was not found to be not genuine, the Insurance Company could not have repudiated the claim merely on the ground that there was a delay in intimating the Insurance Company about the occurrence of the theft. The Court, hence, set aside the order of NCDRC.
Here in case on hand it is proved by Exhibit A3 FIR that the same was registered on 4/12/2020 i.e., the date on which the said Shiny Thomas expired due to the injuries sustained in the accident. It is submitted by the complainant that he was outside Kerala in connection with his employment and he was not in a position to proceed with the formalities of the claim as lock down was declared by the Government due to the Covid-19.
Based on the aforesaid discussion and considering the nature and circumstances of the case, we are of the opinion that the first and second opposite parties have committed deficiency in service by repudiating the genuine claim of the complainant on flimsy reasons. Being the nominee of the insured under the policy the complainant is entitled to get the insured amount from the first and second opposite parties.
Therefore, we allow the complaint and pass the following order.
(1) We hereby direct the first and second opposite parties to pay Rs.10 lakhs (Rupees Ten Lakhs only) to the complainant with 9% interest per annum from 16/11/2022 i.e, the date on which the complaint is filed till realisation.
(2) We hereby direct the first and second opposite parties to pay Rs.25,000/- (Rupees Twenty Five Thousand only) as compensation for the mental agony and difficulties due to the deficiency in service of first and second opposite parties.
(3) We hereby direct the first and second opposite parties to pay Rs.3,000/-(Rupees Three Thousand only) as the cost of this litigation.
The order shall be jointly and severely complied by the first and second opposite parties within 30 days from the receipt of copy of this order failing which the compensation amount will carry 9% interest per annum from the date of this order till realisation.
Pronounced in the Open Commission on this the 27th day of September, 2023
Sri.Manulal.V.S, President Sd/-
Smt.Bindhu.R, Member Sd/-
Sri.K.M.Anto, Member Sd/-
APPENDIX :
Exhibits from the side of the Complainant :
A1 - Copy of Policy Certificate
A2 - Copy of Pass Book of the complainant’s mother
maintained with the 3rd opposite party bank
A3 - Copy of FIR
A4 - Copy of Postmortem Certificate
A5 - Copy of Repudiation letter dated 17/01/2022
A6 - Copy of Legal Notice dated 30/05/2022 issued by
the complainant
A7 - Reply Notice dated 28/07/2022 issued by the
opposite party
Exhibits from the side of Opposite parties :
Nil
By Order,
Sd/-
Assistant Registrar
