The Divisional Manager, National Insurance Company Ltd, Vs. Ashutosh Roy and Others - Court Judgment

J. Bag, Ld. Member:

The present appeal is directed against the order of the Ld. District Consumer Disputes Redressal Forum, Uttar Dinajpur , dated 06.03.12 in C.C. Case No. 26/2010 whereby Ld. Forum below allowed the complaint on contest against OPs with cost.

The complaint case, in brief, was as follows:

The Complainant, Ashutosh Roy, who was covered by a Group Janata Personal Accident Policy (No 100300/47/01/9600022/02/96/30414 , valid from 08.03.2003 to 07.03.2015 ) , became the victim of a road traffic accident that occurred on 29.01.2009 when he was on board a bus bearing No. BR-11/D-6613 moving from Kishanganj , Bihar, towards Suryapur (W.B). After the accident he was taken to Kanki BPHC and then to Sub-Divisional Hospital , Islampur , for treatment and thereafter he was further referred to NBMC and Hospital for better treatment. He was treated also at Paramount Hospital (P) Ltd. at Siliguri. During the course of treatment and thereafter, hospital authority found 75% disability in both eyes of the said Ashutosh Ray and on that basis issued him an eyesight disability certificate. The Complainant by filing all relevant documents claimed the insurance money from OP No.1 through OP No.2, 3 and 4, but OP-1 did not pay the claimed amount. Finding no other alternative , the Complainant filed the complaint before the Ld. Forum below for getting proper relief.

OP No. 1 as a single entity and OP Nos. 2 , 3 and 4 jointly filed separate written versions in disputing the case and denying all material allegations against them with the main contention that the case was not maintainable. The reason for non-entertainment of the complaint was that the Complainant did not file any claim form with necessary documents; nor did he intimate about the alleged accident to the insurer / OP-1 within thirty days as per policy condition. Further, it was contended that the policy was issued by the Kishangunj branch office under Bihar State, and as such, there was no jurisdiction on the part of the Ld. Forum below to try the case. The complaint was sought to be rejected with cost.

Ld. Forum below having perused the petition of complaint, W.V.s, documentary evidence on record and after having heard arguments advanced by the Ld. Lawyers of both sides observed that the disability certificate issued by Islampur Sub-Divisional Hospital , Uttar Dinajpur, was not challenged by the OPs. Ld. Forum also found that it was clear that though the policy was colleted from the OP / Golden Multi Services Club , Kishangunj , Bihar, there being a branch of the company situated at Raigung, Uttar Dinajpur and the cause of action arising on 29.01.2009 at Domoria which is situated within the territorial jurisdiction of the Forum below, according to Section 11 of the Consumer Protection Act, the Forum had the territorial jurisdiction to try the complaint. Ld. Forum also observed that except for the facts of non-filing of any document in support of lodging claim and non-reporting of the alleged accident the documents submitted by the Complainant were in order and hence, a decision was arrived at on the basis of those documents allowing the complaint with direction upon the OP -1 to pay a sum of Rs. 1,51,000/- including compensation and cost within one month from the date of passing the order.

Being aggrieved by and dissatisfied with the order of the Ld. Forum below, the Appellant has come up before this Commission with the grounds , inter alia, that the order has been passed without taking into consideration, the fact of violation the terms and conditions of the insurance policy in question as well as the fact of non-submission of claim form along with necessary documents/papers.

We have gone through the Memo. of Appeal together with the final order passed by the Ld. Forum below on 06.03.2012 , the petition of complaint and the written version filed by OP No.1 and also the letter dated 04.01.2010 addressed to the OP/Appellant Divisional Manager, National Insurance Company Ltd. Division –III , the insurance policy , and the dis-ability certificate among other documents / papers annexed to the Memo. of Appeal. Ld. Advocates appearing for all parties have been heard.

Ld. Advocate appearing for the Appellant submitted that the Complainant /Respondent failed to comply with the most important policy condition in so far as no intimation was filed to the insurance company within the period as stipulated in the policy. It was after more than long 11 months that he reported about the accident. Citing the order of Honble National Consumer Disputes Redressal Commission as reported in 2013 (2) CPR 404 (NC) and also the order of the same National Commission as reported in 2011 (3) CPR 148 (NC) , it was submitted that the terms of insurance policy have to be given due importance and failure on the part of the insured to comply with the terms and conditions will not bring the benefits of the insurance policy.The law on this point is well settled and support is drawn from the judgment of the Honble Supreme Court in the case of Surajmal Ram Nivas Oil Mills (P) Ltd, -vs- United India Insurance Company Ltd and Anr. which emphasizes that the words used in the contract of insurance are of ‘paramount importance. Moreover , in view of decision of the Honble National Commission in original Petition Nos.277 and 278 of 1998 decided on 23.04.2013, being reported in 2013 (2) CPR 399 (NC) the claim of the Complainant is premature as the claim was not submitted in proper manner along with necessary documents. The complaint in original should have been dismissed by the Ld. Forum below on such grounds. The appeal does not stand.

Ld. Advocate appearing for the Complainant/ Respondent submitted that the delay was unavoidable on the part of the Complainant as he was under prolonged treatment. The cases cited by the Ld. Advocate for the Appellant do not appear to have any relevance in the present case in so far as , facts of the cases under citation relate to damages caused by fire / theft. Further, Golden Multi Services Club being a franchise of the insurance company can not avoid their responsibility in the matter of settlement of the claim and they should have taken steps for such settlement. In their Written Version submitted by the OPs. no plea of delayed intimation of the alleged accident was raised. Ld. Forum below rightly considered the case and allowed relief in favour of the Complainant and as such the appeal does not have any merit.

Ld. Advocate appearing for Respondent Nos. 2, 3 and 4 submitted that they were in no way responsible for disposal of the claim preferred by the insured. No deficiency in service could be proved against them. On the contrary, they did their best to help the insured by asking him in writing vide letter dated GTFS / claims / GPA / SKB /00 550 to submit 7 specific documents which again the Complainant/ Respondent failed to comply. Hence, there was nothing to allege about against them.

Decision with Reasons

It appears from the order of the Ld. Forum below that the allegations of the OPs about delayed intimation as well as non-submission of claim form were ‘ignorable as the Complainant was seriously injured and remained under treatment for long. With such observation Ld. Forum below accepted the fact that there was non-compliance of some formalities but why such noncompliance would be ignored was not assigned any reason to.

The fact goes that the Complainant did not report about the accident within the stipulated period or within such period as would have appeared justified with reasons. The Complainant/Respondent was quite conversant that for getting the insurance benefit, he would have to comply with the first and foremost condition of reporting about the accident in writing to the insurance company. His submission in the letter dated 04.01.2010 addressed to the OP / Appellant Divisional Manager-III, National Insurance Company Ltd. that he being ‘an illiterate person (Paragraph-vii) failed to make out the terms and conditions of the policy is hardly tenable in so far as his signatures , though in vernacular, put in the petition of complaint as well as in the letter dated 04.01.2010 speak otherwise. The evidence in support of his contention that he was under prolonged treatment and as such could not give intimation about the accident to the insurance company does not have enough force to be reckoned with. Ld. Forums observation that such failure on the part of the Complainant was ‘ignorable has not been justified with any reason. We find no reason to agree with the view taken by the Ld. Forum below. The impugned judgement suffers from material irregularity and illegality. The appeal deserves to be allowed on merit

Hence,

Ordered

that the appeal be and the same is allowed on contest without cost. The complaint stands dismissed.