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2013 Supreme(Cal) 431
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, WEST BENGAL
Debasis Bhattacharya and Jagannath Bag, JJ.
THE NEW INDIA ASSURANCE CO. LTD. & ANR. - Appellants
Versus
ASHOK MALLICK & ANR. - Respondents
S.C. Case No. FA/310/2012
Decided on: 23rd July, 2013
N.R. Mukherjee, for the Appellants
Prasant Banerjee and Avik Kumar Dutta, for the Respondents
An insurance company cannot avoid its liability under a policy by demanding additional documents at the stage of settlement of the claim, especially when the genuineness of the claim is not disputed.
Headnote:
INSURANCE - GROUP JANATA PERSONAL ACCIDENT - DENIAL OF CLAIM - INSURANCE COMPANY REPUDIATED CLAIM ON THE GROUND OF NON-PRODUCTION OF DOCUMENTS - HELD, THE INSURANCE COMPANY CANNOT AVOID ITS LIABILITY AS THE POLICY WAS ISSUED IN FAVOUR OF THE DECEASED.
Fact of the Case:
The wife of the Complainant died in a road accident and he filed a claim for the insured sum of Rs. 5 lacs under the Group Janata Personal Accident Insurance Policy. The insurance company repudiated the claim on the ground that the Complainant failed to produce necessary documents to substantiate the claim, including proof of relationship between the deceased and the Proforma OP, who was the employer of the deceased.
Finding of the Court:
The Commission held that the insurance company could not avoid its liability as the policy was issued in favour of the deceased and the genuineness of the road accident was not disputed. It also held that the insurance company's demand for additional documents at the stage of settlement of the claim was improper and unnecessary.
Issues: 1. Whether the insurance company was justified in repudiating the claim on the ground of non-production of documents? 2. Whether the Complainant was entitled to the insured sum under the policy?
Ratio Decidendi: The Commission relied on the decisions of the Hon'ble Calcutta High Court and Section 45 of the Insurance Act to hold that the insurance company's demand for additional documents at the stage of settlement of the claim was improper and unnecessary. It also held that the insurance company could not avoid its liability as the policy was issued in favour of the deceased and the genuineness of the road accident was not disputed.
Final Decision: The Commission dismissed the appeal filed by the insurance company and upheld the order of the District Forum directing the insurance company to pay the insured sum of Rs. 5 lacs to the Complainant along with interest and compensation.
The Order of the Commission was delivered by :
Bhattacharya, Member.––This appeal is directed against the order dated 26.03.2012 in Case No. 65/2011 passed by the learned District Forum, Howrah. By the impugned order, the learned District Forum has allowed the complaint on contest with costs against the OP Nos. 1 & 2 and dismissed against the Proforma OP No.3 without cost. The Complainant was held to be entitled to the insured sum of Rs. 5 lacs against her Policy No. 4751220001799/E. No. 47-30834 together with interest @ 10% per annum since 08.03.2009 till full payment by the OP Nos. 1 & 2. The OPs were directed to disburse the insured amount to the claimant together with interest as directed within one month from the date of the order failing the amount shall carry interest @ 12% per annum. The Complainant was held further entitled to a compensation of Rs. 50,000/- (Rupees fifty thousand) and litigation cost of Rs.10,000/- (Rupees ten thousand) from the OP Nos. 1 & 2 within one month from the date of the order failing the amount shall carry interest @ 10% per annum till full satisfaction. Being aggrieved and dissatisfied with it, the OP Nos. 1 & 2 thereof have preferred this appeal.
2. The case of the Complainant/Respondent No.1 in his petition of complaint, in nutshell, is that his wife Susmita Mallick (since deceased) had during her life time secured one Group Janata Personal Accident Insurance Policy from the OP No.1 through the Proforma OP No.3, being No. 4751220001799/E. No.47-30834, of an insured sum of Rs. 5 lacs (Rupees five lacs) for the period from 01.06.2900 to 31.05.2015, to which the Complainant was made the nominee. On 08.03.2009, his wife and others were proceeding from Bandel, Hooghly towards Midnapore along NH-6 by a Tata Indica car bearing No. NB-16T-9860, which suddenly dashed a lorry from behind near Jindabazar within the Panskura P.S. As a result, the said car was badly damaged and four persons, including the wife of the Complainant died on the sport and two others severely inured. The incident was reported by the Complainant to the Officer-in-Charge, Panskura P.S., Midnapore (East) and accordingly, Panskura Case No. 57/09 dated 08.03.2009, under Section 279/338/304A/427, IPC was started and G.R. No. 306/09 was registered. Post Mortem Report being No. 146 dated 09.03.2009 was submitted opining, inter alia, that the death was due to multiple injury and the injuries are ante mortem in nature. A death certificate was issued in usual manner on 26.03.2009. The unfortunate incident was intimated to the OP Nos. 1 & 2 on 23.04.2009 by the Complainant. He submitted duly filled in claim form, along with all the relevant papers which was asked for by the OP No.2, through the OP No.3, on 02.07.2009 for onward transmission to the OP Nos. 1 & 2, which was forwarded to the OP No.2 vide letter dated 08.07.2009. As there was no response by the OP Nos. 1 & 2, Complainant made several representations dated 29.10.2009, 27.11.2009 and 03.02.2010 requesting to settle the claim, but they sat over the matter without any steps towards settlement of the claim. Accordingly, he approached the Office of the Insurance Ombudsman for settlement of the claim by filing an application on 16.03.2010, in which an order was passed directing the Insurer to decide the claim on merit in accordance with the guidelines issued by the Hon'ble High Court vide their order dated 16.03.2006 and to arrive at a decision, which was forwarded to the OP No.2 by the Complainant vide his letter dated 03.05.2011. Finally, the OP No.2 vide their letter dated 06.07.2001 repudiated the claim of the Complainant, which is absolutely baseless and unwarranted after the concerned policy was issued by the OP Nos. 1 & 2 on their objective satisfaction of the proposal made. Moreover, the Proforma OP No.3 vide their letter dated 08.07.2009 affirmed that the deceased insured person was their Fieldworker. Accordingly, the case.
3. On the other hand, the case of the OP N
