West Bengal

Dakshin Dinajpur

CC/80/2021

Sri Nikhil Laha, S/O- Mr. Nibaran Laha - Complainant(s)

Versus

The Reliance General Insurance - Opp.Party(s)

Nirmal Agarwal

18 Jan 2023

ORDER

The instant case has been initiated by the complainant U/S – 35 of C.P. Act, 2019 against the Opposite Parties claiming Rs.15,00,000/-(principle amount)  , Litigation Cost – Rs. 10,000/-  Total = Rs15,10,000/- with interest @ 12% P.A from the date of cause of action

The complainant is the father of late Papay Laha and also nominee of the insurance policy vide no.607322023120022826, valid from 02.02.2020 to 01.02.2021. The policy was issued in favour of papay laha’s Motor cycle vide no. W.B 62-G/0625 and it covers the personal accident claim of owner cum driver, with the sum assured of Rs.15,00,000/-for the life risk of the complainant’s son Papay Laha. This insurance policy is a package policy; it also covers 3^rd party liability. The complainant’s son Papay Laha died on 15.02.2020 due to road traffic accident

O.P.no.1 is the insurer, O.P.no.2 is the service provider of O.P. no.1 and O.P.no.3 is the agent of O.P.no.1.The complainant always made contact with O.P.no.1&2

  After the death of Papay Laha, the complainant informed the matter of accidental death to the insurance agent i,e,O.P.no. 3. And as per the instruction of O.P. no. 3 one P.A. claim registered through E-mail with O.P.no.1 by the registered mobile number of deceased Papay  Laha.

Thereafter as per the requirement of O.P. no.1, the complainant  submit necessary documents, claim form duly signed by the complainant ,Papay Laha’s Bed ticket of Balurghat Hospital duly certified as true copy by Superintendent of Balurghat Hospital, Emergency Ticket duly certified as true copy by superintendent of Balurghat Hospital,Daily clinical notes dated 16.02.2020, duly certified as true copy by superintendent  of Balurghat  district hospital,intake and output record dated 16.02.2020,duly certified as true copy by the superintendent of Balurghat hospital ,P.M. report of Papay Laha,cancel cheque vide no.344998 of Nikhil Laha, copy of G.D.E.no.1202 dated 19.02.2020, PANcard of Nikhil Laha to O.P.no.1through Indian postal service PODno.EW882560227 and Hyderabad office of O.P.no.2 who is the 3^rd party assessor of O.P.no.1,and received the same on01.03.2021and requested the complainant to wait for 10 days for the further up-date, through a message in mobile no.8918339044 and 8768851327.

 Then the complainant several times contact with O.P. no.2 &3 by mobile no.8918339044,8768851327 on o.p. no.1s toll free no.18003009, about his claim but all time they said that unable to say about the claim. After receiving the legal notice dated 27.01.2021 of the complainant ,O.P.no. 1&2 still remain silent about the claim.

             That being aggrieved with the inhuman behavior of the O.P.s the complainant is suffering from mental pain and agony. After receiving all the necessary documents from the complainant the O.P. no. 1 did not made any response .It is very painful for the complainant in this old age. For all this illegal activities of the O.P.s the complainant is bound to file this case against the O.P.s before this consumer commission.

It appears from the case record that notices were issued to the Opposite Parties 1,2 & 3 and the said notices were duly served upon them. Despite of receiving notices, the Opposite Parties 1&2 do not appeared before this Commission nor filed written version so, the case is proceeded ex parte against the Opposite Parties1& 2. O.P.no. 3 contested the case.

 

The O.P. No. 03 in his written statement has claimed that he was the agent of O.P.no.1 the insurance company Ltd. The complainant implicated O.P. no.3 in this case which cropped up between the complainant and the insurance company , wrongly due to misconceive, there is no role of the agent of the insurance company to settle the claim. The complainant’s son during his life time purchased a policy from O.P. company, in which O.P.no.3 performed the duty of mediator /agent at the time of purchase, it was done properly and the insurance policy was issued from the end of the insurance company rightly. After the death of the insurer, one agent may extend his hands to the bona-fide nominee for the settlement of the death claim .But this duty is not compulsory or binding upon the agent. Neither in statutory nor in customary,an agent become responsible for the settlement of the claim.   There is no negligence and liability from the side of O.P.No.03 because he is only agent of O.P.no.01. The complainant is not entitled to get any relief from O.P.No.03 because there is no negligence or laces on the part of O.P.No.03, so the petition is not maintainable and liable to be rejected against O.P.No.03.

 To prove his case, the complainant has submitted evidence on affidavit along with the following documents-

(i)  R.C.Book of M.C.NO WB-62-g/0625

            (ii)  Insurance Policy.

(iii)  P.M. report of papay laha

(iv) Death Certificate of Papay laha .

(v)Copy of F.I.R

         vi) Claim Form

         vii) Printed copy of the message      

          viii) Letter of Shivam service

         ix)  PAN Card of Nikhil laha

         x) Adhar card of Nikhil laha

         xi) G.D.Ecopy no.1202 dated 19.02.2020.

         xii) Letter of Balurghat hospital

         xiii) Xerox copy of treatment paper of balurghat Hospital.

         Xiv) Legal notice + Postal receipt

           O.P..No.03 also files evidence on affidavit .But no documents have been filed by O.P. No.03.

        In view of the above mentioned facts, the following points are cropped up for consideration.

                                      POINTS FOR CONSIDERATION

      1) Whether the complainant is a consumer to the opposite parties?

      2) Whether there is any deficiency in service on the part of the opposite parties?

      3) Whether the complainant is entitled to get any relief/reliefs as prayed for?

 

                                      DECISION  WITH  REASONS

 

         We have heard the argument by Ld. Advocate of both the sides, (complainant, O.P. No 03) at length. We have also gone through the evidence on affidavit and written argument. We also perused the documents filed by the complainant.  

            At the time of argument the Ld. Lawyer appearing for the complainant narrated the fact of the case as mentioned in the complaint. He further submitted that the claim of the complainant is legal, genuine and the opposite parties are liable to pay the claim amount as per their own undertaking laid down in the policy.

On the other hand, Ld. Advocate of the O.P.no.03 also narrated the defense case. He has stated that O.P.No.01 is the insurer of the complainant and o.p.no.03 is the agent of O.P.no.01. So he is performing the duties as the mediator/ agent between the complainant and O.P.no. 01. There is no negligence and liability of O.P.no. 03. Hence the case is not entertain-able & maintainable against O.P.no.03.

Now let us discuss all the points one by one.

 

Point No.01

On perusal of the materials on record, it appears that the opposite party no.03 has admitted in his written version, the complainant is insured with O.P.no.01, insurance policy no- 607322023120022826 through O.P.no 03. If this be so, then it is clear that the complainant is a consumer to the opposite parties according to sec 2(7) of the consumer protection Act 2019.

 

Point No.02 &03

            Both the points are taken up together for discussion for the sake of convenience and brevity.

 It is admitted fact that the complainant‘s son deceased papay Laha purchased a Insurance policy vide no.607322023120022826 which was valid for the period from02/02/2020 to 01/02/2021,from O.P. no.01, through his agent O.P.no.03 . The sum insured was Rs.15,00,000/-. This insurance policy is a package policy, it also covers 3^rd party liability, own damage coverage and also personal accident coverage of owner cum driver. 

 

 The complainant’s son Papay Laha died on 15.02.2020 due to road traffic accident. After the death of Papay Laha, the complainant informed the matter of accidental death to the insurance agent i,e, O.P. No.3. And as per the instruction of O.P. no. 3 one P.A. claim registered through E-mail with O.P.no.1by the registered mobile number of deceased Papay Laha.

 

Thereafter as per the requirement of O.P. no.1, the complainant  submit necessary documents, claim form duly signed by the complainant ,Papay Laha’s Bed ticket of Balurghat Hospital duly certified as true copy by Superintendent of Balurghat Hospital,Emergency Ticket duly certified as true copy by superintendent of Balurghat Hospital,Daily clinical notes dated 16.02.2020, duly certified as true copy by superintendent  of Balurghat  district hospital,intake and output record dated 16.02.2020,duly certified as true copy by the superintendent of Balurghat hospital  , P.M. report of Papay Laha,cancel cheque vide no.344998 of Nikhil Laha, copy of G.D.E.no.1202 dated 19.02.2020, PANcard of Nikhil Laha to O.P.no.1through Indian postal service PODno.EW882560227 and Hyderabad office of O.P.no.2 who is the 3^rd party assessor of O.P.no.1,and received the same on01.03.2021and requested the complainant to wait for 10 days for the further up-date, through a message in mobile no.8918339044 and 8768851327.   The complainant always made contact with O.P. no. 01 &02.

 Then the complainant several times contact with O.P. no.1 &2 by mobile no.8918339044, 8768851327 on O.P. no.1’s toll free no.18003009, about his claim but all time they said that unable to say about the claim. After receiving the legal notice dated 27.01.2021 of the complainant , O.P.no. 1&2 still remain silent about the claim.

            That being aggrieved with the inhuman behavior the O.P.s  the complainant is suffering from mental pain and agony.

            After receiving all the necessary documents from the complainant, the O.P. no. 1 did not made any response .It is very painful for the complainant in this old age.

 As O.P. No.01& 02 did not contest the case despite of valid service of notice, so, the case of the complainant cannot be disbelieved.

From the above discussion, we found that the insurance company i,e O.P.no.1 had issued a insurance policy in favour of the deceased which covers personal accident claim of owner cum driver with a sum assured of Rs 15,00,000/- for the life risk of the insured .The insured  Papay  Laha died on 15.02.2020 due to road traffic accident. Then P.A. claim was registered through Email to O.P. no. 01. Thereafter as per the instruction of O.P. no.01 all the documents were send to them through postal service. It was also admitted by Rcare health i,e, O.P.no.02 of this case in a message send by them stating that  Dear customer we are in receipt of the documents via POD no.EW882560227IN on 01.03.2021.you will receive further updates in next 10 days.

But thereafter no response was given from the insurance company i,e, O.P. NO. 01&02.

 

Lastly the complainant sends a legal notice through his advocate on 27.10.2021 to the O.P.s and asked about his bona-fide claim. The complainant files all the documents relating to the above stated descriptions. The O.P.s neither informed nor send any reply, rather kept mum. The insurance company neither repudiate the claim of the complainant nor allow the claim and make payment of the sum assured of the deceased policy. Therefore, we found that there lies gross negligence as well as deficiency in service on the part of the O.P. No.1 & 2.  

 

            We relied on the observation taken by the Apex court in  Insurance Company vs Harcharan Chand Rai Chandan Lal,IV(2004)CPJ 15(S) and National Insurance Company VS Laxmi Narain Dhut III(2007) CPJ 13(SC) where it has held that the policy is a contract between the parties and both the parties are bound by terms of contract.   Under such circumstances it appears that the insurer violated the terms and condition framed by it.  Therefore, we found that there lies gross negligence in service on the part of the O.P. No.1&2. Under the above circumstances the complainant is entitled to get the relief.

 

            In case of O.P.no.03, as the complainant has not sought for any relief against the O.P.  3. So, the case is dismissed against him.

 

             Accordingly all the points are decided in favour of the complainant.

 

 

Hence, it is

                                                                O R D E R E D

 

That the consumer complaint case No 80/2021 is allowed ex-parte against O.P.No.01&2 in part with cost and dismissed against O.P .No. 03.   The opposite parties No. 01&02 are jointly and severally directed to pay Rs 15,00,000/- (rupees fifteen lakh) only as principal claim ( total sum assured) against policy No. 607322023120022826 along with interest @8% per annum from the date of this order  till the realization by issuing an account payee cheque in favour of the complainant.

The opposite parties No. 01 &02 are further directed to pay  Rs 5000/- (rupees five thousand only)as litigation cost by issuing an account payee cheque in favour of the complainant within 45 days from the date of passing of this order failing which, the complainant is at liberty to execute the order according to law.