West Bengal

Bankura

CC/9/2022

Soma Pal - Complainant(s)

Versus

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

Subrata Kumar Chakraborty

19 Jan 2023

ORDER

IN    THE   DISTRICT   CONSUMER   DISPUTES   REDRESSAL COMMISSION BANKURA

Consumer  Complaint  No. 09/2022

Date of Filing : 18.02.2022

Before:

1. Samiran Dutta                              Ld. President.      

2. Rina Mukherjee                          Ld. Member. 

3. Siddhartha Sankar Bhui            Ld. Member.

For the Complainant: Ld Advocate Subrata Kr. Chakraborty

For the O.P. Ld Advocate Pulak Kr. Singha 

Complainant    

1. Soma Pal, W/O Late Santanu Pal,  Vill & P.O.Sihar, P.S.Kotulpur, District- Bankura.                                                                                                                                                  

2. Indranil Pal, S/O Late Santanu Pal,  Vill & P.O.Sihar, P.S.Kotulpur, District- Bankura.  

Opposite Party  

1.The Branch Manager, United India Insurance Company Limited, Durgapur Branch Ofice, Tapas Bhaban, 1^st Floor, BSNL Office Building, Bhiringee, Durgapur, Dist.Paschim Bardhaman, PIN- 713213                                                                                                                                                                            

2. The Divisional  Manager, United India Insurance Company Limited, Divisional Office, City Centre, Durgapur, Dist.Paschim Bardhaman, PIN- 713216              

                                                                                                JUDGEMENT                                                                                                                     

Dated:19-01-2023

This is an application under Section 12 of Consumer Protection Act, 1986 filed by the Complainants against the O.P./Insurance Company claiming Rs.15 Lakh as personal accident death benefit of the Insured together with compensation and Litigation cost.               

The Complainant’s case is that Santanu Pal, since deceased, an employee of W.B. Pharmasist, being the husband and father of Complainant No.1 & 2 respectively met with a road traffic accident on a collision with Scooty No. being WB 18V-2058 at Bulan Chandrapur under Madhabdihi P.S.when he was proceeding with his bike No. being WB 40 H 7132 towards Durgapur S.D. Hospital for his official work as a result of which he sustained fatal injuries. Said bike was insured with the O.P. Insurance Company Policy No. being 0315053118P114814786 valid from 17-02-2019 to 16-02-2020. Immediately after the accident the insured was admitted at Arambagh S.D. Hospital and thereafter shifted at CMRI Hospital, Kolkata and after a prolonged treatment there the said Sanatan Pal succumbed to his injuries on 20-12-2019.

The Complainant No.1 being a rustic and housewife and Complainant No.2 being a H.S. student at the relevant time were so shocked over the tragic incident that they were really upset and could not lodge the F.I.R. and Claim petition with the O.P. in due time. Subsequently through intervention of the well wisher an F.I.R. was lodged being Madhabdihi P.S. Case No.193/19, dt.23-12-2019 after the expiry of the insured at CMRI Hospital, Kolkata on 20-12-2019 and claim petition was preferred with the O.P. on 24-12-2020 but unfortunately the claim was repudiated by the O.P. authority by Letter dated: 23-06-2021 on the ground of inordinate delay in submitting the claim application.               

The Complainants have therefore approached this Commission for appropriate relief.

                                                                                                                                                                                      Contd……..p/2

Page: 2

The O.P./Insurance Co. contested the case by filing a written version raising the same plea for repudiation of the claim citing relevant terms and conditions of the Policy.

The Commission has carefully and minutely examined the entire case and found that no dispute has been raised on behalf of the O.P. regarding the entitlement of the claim covered under the said Policy but their only contention is with regard to the belated submission of claim application. The deceased Insured is the owner-cum-driver of his Motor bike possessing valid Driving License and other requisite documents and as such he is entitled to personal accident cover for Owner Driver to the tune of Rs.15 Lakh as per terms and conditions of the Insurance Policy under reference.

It is no doubt true that there has been an inordinate delay of about one year in submitting the claim application with the O.P. Now the question is whether O.P. has the authority to turn down the claim of the Complainants on such ground if it is otherwise maintainable.

As stated above FIR could not be lodged immediately after the accident as the family members of the deceased were then busy and concerned with the treatment of the Insured and they could find best possible time to lodge the F.I.R. only after the expiry of the Insured on 20-12-2019.

As regards delay in submission of claim application it may be mentioned that at the relevant time the Complainant No.2 was the H.S. student suffering mental agony due to untimely death of his  father and the Complainant No.1 being the wife of the Insured had the experience of painful anxiety throughout the year subsequent to the accident period.

This apart, 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.

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. It would not be fair and reasonable to reject genuine claim which had already been verified and found correct by the Investigator…..”

In this case the Investigator ‘s report dated:14-03-2021 is in the hand of the Commission which does not show any adverse remark with regard to the accident and the Policy document and connected relevant papers of the Insured vehicle save and except the delay in submission of the claim application. P.M. report also shows that the death is due to the effect of accidental injury.

                                                                                                                                                                                         Contd…….p/3

Page: 3

Thus, considering the entire facts and circumstances of the case and the legal aspect involved thereto the Commission is of the view that the Complainants are entitled to get the Death benefit claim of the Insured as prayed for.

 

                                              Accordingly it is ordered……

 

That the case be and the same is allowed on contest against the O.P.

The O.P.s are directed to pay to the claimants Rs.15,00,000/- in equal proportions within one month from this date in default the Decretal amount may be realized in due process of law.

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

 

                      ____________________                           _________________                                   _________________

                       HON’BLE   PRESIDENT                     HON’BLE MEMBER                               HON’BLE MEMBER