DISTRICT CONSUMER DISPUTES REDRESSAL FORUM: BHADRAK
Dated the 24th day of February, 2020
C.D Case No. 73 of 2018
Present 1. Shri Raghunath Kar, President
2. Shri Basanta Kumar Mallick, Member
3. Afsara Begum, Member
Geetanjali Parida
W/o Late Panchanan Parida
Vill: Trisalpur,
Po: Rahanj,
Ps: Bhadrak (R),
Dist: Bhadrak ……………………. Complainant
(Versus)
1. Secretary, Rahanja Service Co-operative Society Ltd.
At/Po: Rahanja, Dist: Bhadrak
2. Branch Manager, Balasore Bhadrak Co-operative Central Bank Ltd.,
Main Branch, Bhadark,
At/Po/Ps/Dist: Bhadrak
3. Chief Executive Officer, The Balasore Bhadrak Co-operative Central Bank Ltd.,
Head Office, O.T Road, Balasore- 756001
4. The Authorized Signatory,
IFFCO-TOKIO General Insurance Company Ltd.,
Regd Office, IFFCO SADAN- C.I- District Center,
Saket, New Delhi- 110017 …………………………..Opp. Parties
Counsel For Complainant: Sri S. K. Nayak & Others, Adv
Counsel For the O.Ps No. 1: Sri C.R. Nath & Others, Adv
Counsel For the O.Ps No. 2 & 3: Md. Aktar Khan & Others, Adv
Counsel For the O.Ps No. 4: Sri A. Chand & Others, Adv
Date of hearing: 08.07.2019
Date of order: 24.02.2020
RAGHUNATH KAR, PRESIDENT
This dispute arises out of the complaint filed by the complainant alleging deficiency of service and unfair trade practice against the O.Ps. The facts of the complaint are to the effect that the complainant is the widow of late Panchanan Parida who was a bonafide member of Rahanja Service Co-operative Society Ltd. (OP No. 1) having his membership No. 283 and had been borrowing crop loan from the mentioned S.C.S Ltd. The deceased being a Kisan Credit Card (KCC) Holder had availed loan for kharif 2015 and his life was insured for a sum of Rs 5,00,000/- on payment of required premium to OP No. 1. But to his ill luck the said K.C.C borrower met an accident on 05.11.2016 while he was standing by the side of N.H- 16 on his own motorcycle as a motorcycle from behind dashed him severely inflicting injury. Other persons those who were witnessing the accident rushed to the spot and tried to rescue the victim and took him to D.H.H, Bhadrak for necessary treatment. The doctors at the outdoor admitted him and provided required medical aid immediately. In course treatment when the deceased did not respond to the treatment and the condition of the patient was found critical, the treating doctors referred the patient to S.C.B Medical Collage & Hospital, Cuttack. By the advice of treating doctors of D.H.H Bhadrak, the deceased was taken to S.C.B Medical Collage in an Ambulance where the patient was admitted and due treatment was given to the best ability of the treating doctors. While the patient was under treatment for a couple of days, he breathed his last on 08.11.2016 at 6 P.M. After the said demise of the patient the case was taken up by Mangalabag Police in registering a U.D Case and referred the body for postmortem.
The deceased is survived by his widow & daughter who remained engaged in funeral rituals for a period of 13 days after which they searched for the papers preserved by the deceased and came to know that the deceased had been availing loan from OP No. 1 and his life has been insured for a sum of Rs 5,00,000/- with OP No. 4. Without causing a day delay, the complainant and her daughter met OP No. 1 to know all about the insurance matter of the deceased and the secretary of the society immediately advised to give a written intimation about the death of her complainant’s husband. After receipt of the intimation, OP No. 1 passed on the information to the higher quarters including OP No. 4 and advised the complainant to collect required papers for settlement of the claim. The complainant, being a rustic lady, filed an F.I.R with local police i.e. I.I.C Bhadrak (R) on 19.11.2016 which was registered vide PS Case No. 643/2016. Since then the complainant tried her best to collect the required papers such as death certificate, postmortem report, inquest report etc. which took a little more time and submitted those papers to OP No. 1 requesting an early action for settlement of claim. Since then the complainant has been waiting for settlement of claim for more than a year and personally contacted OP No. 1 to 3 but all of her efforts yielded no result till 09.10.2018. Being aggrieved and disappointed by the acts of O.Ps, the complainant met OP No. 3, who is the insured of the policy, to know about the fact of the claim who intimated him that the claim has been repudiated as “No Claim” and also handed over a copy of the No Claim letter to the complainant for her reference. Being shocked the complainant finding no other remedy took shelter in the D.C.D.R.F Bhadrak in filing a case specifically praying for a direction to the O.Ps particularly OP No. 4 for settlement of claim along with cost and compensation.
All the O.Ps objected claim of the allegations of complainant and contested the case. OP No. 1, in submitting written version stated that the petition is not maintainable against the OP No. 1 on the ground of maintainability, cause of action and non-joinder of necessary parties. Overall the answering OP has stated that it has not neglected in performing its legitimate duties to transmit the claim proposal to the appropriate authorities after receipt of required documents from the complainant. Hence this case does not bear any merit against OP No. 1 to have caused negligence in providing proper service to the complainant and has at no point of time resorted to unfair trade practice.
OP No. 2 & 3, in submitting the written version, have stated raising the question of the status of the complainant as a consumer and as such this case is not maintainable against the answering O.Ps. These O.Ps denied the facts of contacting them in a regular interval for settlement of the claim and also contented in stating that the claim has been transmitted to the insurer i.e. OP No. 4 soon after receipt of the claim proposal with all required information. Although OP No. 3 transmitted the claim proposal, complete in all respects, of the deceased borrower within the stipulated period that is one year, OP No. 4, without considering the circumstances leading to delay in submission of documents by the complainant who is a rustic lady does not have the knowledge how to collect the required documents, repudiated the claim on the ground of late submission leaving the complainant to suffer. In addition to above facts OP No. 2 & 3 have also submitted that the National Commission and Hon’ble Apex Court have opined that if the claim is not staked within a period of two years will be liable to be repudiated and the claim would be treated as No Claim. Hence repudiation of claim is a clear violation of settled provisions of IRDA Rules.
OP No. 4, in submitting the written version, has raised the question of maintainability, cause of action and suppression of facts. Simultaneously the answering OP has also raised the question of the status of complainant as a consumer. Further it is also mentioned in the written version that the death occurred on 08.11.2016 but the claim has been raised on 07.11.2017 i.e. on the last day of one year to be lapsed. According to policy condition it was necessary to submit the claim proposal within one calendar month failing which the said claim would be treated as No Claim. Since the claim proposal reached with the answering OP on the last day of a year to be completed, there was no way out to consider the proposal other than to reject the same. In submitting as above the answering OP finally concluded that the complaint filed by the complainant is bereft of merit and liable to be dismissed.
Admittedly the deceased was a member and KCC holder under Rahanja Credit Co-operative Society whose life was insured under Group Personal Accident Insurance Scheme. It is also a fact that the deceased borrower and the husband of the complainant had borrowed loan from the aforesaid society and also paid the required premium for KCC insurance and admittedly died due to road accident.
Gone through the complaint of the complainant, written versions filed by O.Ps, perused materials on record and observed as detailed here under.
1. It is observed from the documents such as death certificate, inquest report obtained from the police and postmortem report issued by the doctor through police, there is nothing to doubt that the death was caused due to accident.
2. OP No. 1, 2 & 3 have clearly admitted that the claim has been staked with the insurer that is OP No. 4 within a period of one year although there was stipulation in the police paper to submit the claim proposal within one calendar month. In course of hearing the complainant submitted that the widow of the deceased, being a housewife having little knowledge about the financial transaction by her deceased husband with the SCS and life covered under insurance, initiated gathering information and collection of papers relevant to the claim proposal after 15 days from the date of death within which she was busy in performing the death rituals as per Hindu rites. After getting information from the Secretary of financing society she stared collecting the papers from different offices which consumed a lot of time due to her ignorance. Prior to collection of papers the complainant had submitted an intimation form duly filled in to the office of the secretary within a fort night from the date of occurrence and submitted all the required documents at the later stage. She was least aware about submission of documents and claim proposal to the appropriate quarters within one calendar month. When the claim was not settled within a period of one and half years, the complainant started to visit different offices of the bank to know about fate of the claim but did not yield any positive result. Lastly she met the CEO of the bank that is OP No. 3 who intimated her about the repudiation of the claim on the ground of late submission. On the other hand OP No. 4 objected in stating that the complainant has violated clause 7 of the policy conditions in submitting the claim on the last day of an year to be lapsed which debars her to get the claim settled.
3. The complainant further submitted that according to the provisions of IRDA rule and in accordance with the circular issued by IRDA addressing to all Life and Non-life insurers vide No. IDRA/HLTH/MISC/CIR/216/09/2011 dt. 20.09.2011 wherein it is mentioned as “The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances”. In the instant case the complainant being illiterate, consumed a lot of time to collect the documents from different offices and thereafter submitted the claim through proper channel which was required to be submitted within 30 days but the insurer has taken the plea of late submission is not a valid ground to repudiate the claim as the insured has passed away due to road accident. Further the death of the insured has been confirmed by the postmortem report and investigation conducted by the police. On the contrary the OP No. 4 took the plea of stipulated policy conditions which resulted in repudiation of claim.
4. The complainant as well as OP No. 3 submitted that the National Commission and the Apex Court of the Country have opined that if the death compensation is not claimed within a period of two years is liable to be closed as No Claim. But in the instant case the claim proposal complete in all respects has reached the OP No. 4, a day before lapse of one year. Therefore repudiation of claim is illegal and also outcome of whimsical decision of the insurer. Further the complainant and OP No. 3 have cited the decision of Hon’ble National Commission in revision petition No. 305/2011 decided on 15.02.2017 wherein it is held that “condition of giving intimation to insurance company within a specified number of days should not prevent the settlement of claim”. In addition to above decision the complainant & OP No. 3 also cited another decision of Hon’ble National Commission in first appeal No. 1641/2016 decided on 11.01.2018, “”rejection of claim on purely technical ground in a mechanical manner will result in loss of confidence of policy holders in the insurance industry”. That apart they have also cited another decision of Hon’ble National Commission pronounced on 19.07.2017 in revision petition No. 3228/2015, it is held that “since the complainant failed to prefer claim under group insurance policy on the death of her husband within two years, the claim is barred by limitation and delay of four years in intimation of death claim to insurance company may lead to dismissal”. It is understood from the above decision that the claim preferred within two years from the date of death would certainly be considered for settlement.
In view of the above analysis it is held that the OP No. 4 has intentionally and willfully treated the claim as “No. Claim” with ulterior motive which is an Act of deficiency of service and unfair trade practice. Therefore it is ordered;
ORDER
In the result the complaint be and the same is allowed against OP No. 4 on contest. OP No. 4 is directed to settle the claim of Rs 5,00,000/- in favour of the complainant together with compensation of Rs 5,000/- and Rs 4,000/- as cost of litigation. The claim amount as mentioned above as well as cost & compensation must be paid to the complainant within 30 days from the date of order failing which interest @ 9% PA with quarterly rests shall be charged till the date of payment.
This order is pronounced in the open Forum on this day of 24th February, 2020 under my hand and seal of the Forum.
