Can I initiate complaint against the insurance company under Consumer Protection Act, 1986? Who can file Complaint in Consumer Disputes redressal forum?

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Q. Few years back I took an insurance policy. One month before my husband met with an accident and I claimed insurance. But the company denied my application on some unreasonable grounds. Can I initiate complaint against the insurance company under Consumer Protection Act, 1986?  Who has the locus standi to file complaint in consumer redressal forums?

A. The definition of “service” under Section 2 (1)(o) clearly stated that service of any kind which was received by the potential users includes banking, financing, insurance, transport, processing, supply of electrical and other energy, board or lodging or both, housing construction, entertainment, amusement or the purveying of news or other information, but not the service that rendered free of charge or under a contract of personal service.  From the definition of “service” it is clear that services provided by the insurance company come under purview of the Act.  The person who receives the service from the insurance company is a consumer as per the Act.

Section 2(1) (b) of the Act provides us the definition of Complainant.  Usually, an aggrieved person should approach the court for remedy, however, the Act is framed consumer-friendly and hence it allowed few other persons to be a Complainant before Consumer Forums.  As per Section 2(1)(b), a complainant can be a consumer, or any registered voluntary organization, Central or any State Government, or any one or more consumers where there are numerous consumers having the same interest. However, in few circumstances, a legal representative of the deceased consumer can file a complaint as stated in Cosmopolitan Hospital v. Smt. Vasantha P. Nair (1) 1992 CPJ NC 302.   Also, a legal heir of the de­ceased consumer is entitled to file a complaint under the said Act.- Joseph Alias Animon v. Dr. Elizabeth Zachariah (1) 1997 CPJ 96. However, in the personal accident policies of insurance, if the insured is deceased, his dependents can claim and on behalf of minors, their guardians as next friend can file a complaint before Consumer Forum against the Insurance Company. In Punjab National Bank, Bombay v. K.B. Shetty 1991 (2) CPR 633 it was stated that a spouse on behalf of the insured can file a complaint under the Act.

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In your case, since you availed services from the insurance company, and your claim has been denied by the insurance company, you as a consumer can file a complaint before consumer forum.

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By Anitha Gutti