Consumer Complaint No.: 30/2007

 

Present (1) Sri S. K. Ghosh - Presiding Member

(2) Swapna Saha - Lady Member

 

Counsel(s) (1) Sri Anjan Kumar Chakraborty - Advocate for the complainant

(2) Sri Goutam Das - Advocate for the OP NIC

(3) Sri Bidyut Kumar Roy - Advocate for the OP GTFS

 

This is to consider an application U/s 12 of the C.P. Act, 1986 filed by the complainant claiming Rs.2,00,000/- (Rs. Two lakhs) only as well as interest, cost and compensation as against OPs.

Facts of the case, in brief, is that the complainant purchased a Janta Personal Accident policy for Rs.2,00,000/- (sum assured) for the period from 15.08.2002 to 14.08.2012. The said policy was purchased on 15.08.2002. Narayan Ch. Basak died on 04.06.2005 by motor accident and to that fact FIR was lodged by Sri Niranjan Basak younger brother of the deceased on the same day at Kumarganj Police Station. Smt. Anjana Basak, complainant, in the instant case, who is the wife of deceased Narayan Ch. Basak filed an application before the OP No.1 on 10.05.2006 claiming Rs.2 lakhs as a nominee. There was no response from the end of OP/NIC. The complainant sent reminder on several times but it is very much unfortunate that OP/NIC did not take any proper steps for the settlement of the disputes between the parties. Hence the application.

 

Ld. Counsel for OP/NIC contested this case by filing written version stating inter alia that the complainant died on 04.06.2005 and information of claim was sent to the company on 10.05.2006 i.e. after about more than 11 months delay from the date of alleged accident. So the complainant violated the terms and conditions of the policy prescribed by the insurance company. As per the terms and conditions, it was duty of the complainant to inform the matter forthwith to the company but the complainant did not take any proper steps. Thus, the complainant is not entitled to get any relief as prayed for. Secondly the Ld. Counsel for OP/NIC stated that as per Post Mortem Report of Narayan Ch. Basak, deceased, received no external injury or internal injury. Dr. also opined that Narayan Ch. Basak, deceased, died due to cerebral attack, so it is not a case of accident. Therefore the complainant is not entitled to get any relief as prayed for. There is no gross negligence or deficiency in service on the part of OP/NIC.

OP/GTFS also contested this case by filing written version stating inter alia that GTFS has no role to play in this regard or no authority being vested to them in so far as claim settlement/payment of insurance/delayed settlement of claim is concerned. Therefore, no liability attached to GTFS for the deficiency in service. OP/GTFS stated that on 04.06.2005 Mr. Narayan Ch. Basak died in a motor accident and a police complaint was filed accordingly by brother of the deceased. After the accident of Mr. Basak deceased all supporting documents including claim form have been submitted to OP/ NIC through GTFS for earlier settlement of claim. Subsequently, a reminder was also sent to OP No. (1) on 04.06.2007. GTFS further stated that the complainant is the wife of deceased Narayan Ch. Basak and is also nominee under the said policy. But withholding the settlement and payment of the claim to the insured without any reasonable cause amounts to deficiency in service on the part of insurance company. There is no role on the part of GTFS for the settlement of the disputes so their name should be expunged from the (cause title) of the complainant’s case.

In view of the contentions of the both parties following points arose for consideration :-

 

1. Whether the consumer-complainant is entitled to get any relief as prayed for?

2. Whether there is any deficiency in service or gross negligence on the part of OPs?

Decision with reasons:

Point Nos. 1 & 2:

Both parties filed relevant documents at the time of hearing which are kept with the record.

We heard contentions of Ld. Counsels for both parties and perused all material documents such as policy certificate, claim form, death certificate, FIR, charge sheet, police final report, PM report etc. produced before us with reference to relevant provisions of law.

We have considered the submission of both sides with reference to the materials on record.

The Ld. Forum at first perused the policy certificate vide Policy No.:100300/47/01/9600022/01/96/30160 covering the period from 15.08.2002 to 14.08.2012. It appears from the said certificate that Narayan Ch. Basak who is age of 40 years is insured person wherein the sum insured amounting to Rs.2,00,000/- as well as the name of complainant viz. Anjana Basak has been recorded / written as a nominee who is the wife of deceased Narayan Ch. Basak. Ld. Forum perused the letter dated 25.05.2006 issued by the GTFS though the said letter GTFS requested the complainant to submit the documents such as (1) completed claim form, (2) original insurance certificate (3) attested Xerox copy of death certificate, (4) attested Xerox copy of FIR (5) attested Xerox copy of final report of police issued by the Court of CJM, Dakshin Dinajpur, (6) attested Xerox copy of PM report and (7) attested Xerox copy of voter identity card of the deceased person as well as nominee. It is fact that Narayan Ch. Basak died on 04.06.2005. On the basis of the said letter dt. 25.05.2006 the complainant submitted filled up claim form before the OP Ins. Co. on 10.05.2006. At this stage the Ld. Counsel for OP Ins. Co. argued that there is a clear delay of 11 months. Ld. Counsel for OP Ins. Co. argued that complainant did not inform the matter / event within the stipulated period of time. So, the complainant violated the terms and conditions prescribed by the OP Ins. Co.

As per the quarries of GTFS the complainant at her best level tried to collect the documents mentioned above in details. It is the view of the Ld. Forum that some reasonable times should be given to the complainant for collection of the said documents. As per gravity of the facts and circumstances 1 (one) month or 90 days time is not sufficient for production of said documents from the end of the complainant before the OP concerned. It is also fact that the mental condition of the complainant was not normal, well and healthy due to death of her husband. It is admitted that there is a clear delay of 11 months in respect of submission of filled up claim form. But it is the view of the Ld. Forum that there is a valid reason for late submission of filled up claim form. So, the Ld. Forum comes into conclusion that 11 months delay is a reasonable delay in respect of collection of large number of documents demanded by OPs.

Ld. Forum also perused the letter-dated 01.06.2007 where the GTFS requested the OP/NIC for earlier settlement of claim and copy to the complainant. In the said letter it appears that OP/NIC took a long period of time but has failed to settle up the matter.

Now turning to the another point whether it is a case of accident or not as well as whether it is a case of cerebral attack or not ?

Ld. Counsel for OP Ins. Co. argued that it is not a case of accident. It is a case of cerebral attack. So the complainant is not entitled to get any relief as prayed for. Thereafter the Ld. Forum perused the order sheet of MAC Case 261 of 2005 passed by Sri T.K. Gupta Tribunal Judge, District Judge Court, Balurghat, Dakshin Dinajpur.

It is admitted fact that as per the PM Report, there was no external injury and Narayan Ch. Basak died due to intra cerebral haemorrhage which may occur in normal course as well as on receiving head injury by way of causing accident. In case of head injury in any accident it may be that there was no external head injury and that deceased Narayan Ch. Basak sustained internal haemorrhage. It is fact that the in the PM Report there was no any external injury but it is also fact that in the inquest report there was a small injury in the knee of the victim. It is also appears from the PM Report that about 50 ml blood clots are seen in the base of brain. It is true that in a case of fall from a moving vehicle some more external injury are expected but in case of absence of external injury the Ld. Forum cannot come into conclusion that there was no fall from the moving vehicle.

 

After observations of all documents the Ld. Forum comes into conclusion that deceased Narayan Ch. Basak was one of the passengers of the offending vehicle i.e. tractor bearing Registration No.:WB/61/1185 on the relevant date, time of place and deceased Narayan Ch. Basak fell down from the vehicle at Banskuri on account of road accident causing head injury/accidental injury. The said accident was caused due to rush and negligent driving by the driver of the offending vehicle. It is also fact that after accident Narayan Ch. Basak was admitted in the Balurghat Hospital and thereafter he died in the said hospital on 04.06.2005.

 

Now turning to another important point regarding repudiation of claim. The Ld. Counsel for OP Ins. Co. at the time of hearing argued that the complainant is not entitled to get any relief as prayed for as it is a case of cerebral attack. It is not a case of accident. But it is very much unfortunate that on the basis of argument/ plea the Ins. Co. does not repudiate the claim till today. It should be the duty of the OP Ins. Co. to inform the complainant regarding repudiation of claim. But the Ins. Co. does not take any proper steps or action till today regarding repudiation of the said claim causing also deficiency in service or gross negligence on the part of OP Ins. Co. In this respect the Ld. Forum asked the Ld. Counsel for OP Ins. Co. ‘why till today the OP Ins. Co. does not repudiate the claim of the complainant’. The Ld. Counsel for OP Ins. Co. has failed to give proper answer before the Ld. Forum. In this respect it is the view of the Ld. Forum that there is a gross negligence or deficiency in service on the part of OP Ins. Co.

From the above analysis in details, the Ld. Forum comes into conclusion that it is a case of accident and not a case of cerebral attack i.e. deceased Narayan Ch. Basak died due to road accident. So the plea taken by the Ld. Counsel for OP Ins. Co. that the deceased Narayan Ch. Basak died due cerebral attack is baseless.

 

Therefore the complainant is entitled to get relief as against OP NIC and there is a gross negligence or deficiency in service on the part of OP Ins. Co. There is no gross negligence or deficiency in service on the part of GTFS.

 

Therefore Point Nos. (1) and (2) are decided accordingly on the basis of above findings. Hence.

 

O R D E R E D

 

 

That the Consumer Complaint No. 30/2007 is allowed on contest with cost of Rs.1,000/- assessed by the Ld. Forum.

That the OP NIC is hereby directed to pay Rs.2,00,000/- (Rs. Two lakhs) only to the complainant towards claim amount within 40 days from the date of order.

That the OP Ins. Co. is hereby further directed to pay Rs. 2 lakhs towards claim amount + Rs.1,000/- towards cost i.e. the total amount of Rs,2,01,000/- to the complainant within 40 days from the date of passing final order. If not paid within the stipulated period of time the said amount shall bear interest @ 10% p.a. till full payment.

There is no gross negligence or deficiency in service on the part of GTFS.

That the case could not be disposed of within the specified period of time as Ld. Advocates took adjournments several times.

Let a copy of this order be supplied to the parties free of cost.

Both parties are directed to collect their copies within 7 (seven) days from the date of passing final order.

 

 

I agree,

By order of this Forum

(Swapna Saha) Lady Member District Consumer Disputes Redressal Forum Dakshin Dinajpur at Balurghat

(S.K.Ghosh) Presiding Member District Consumer Disputes redressal Forum Dakshin Dinajpur at Balurghat