Jharkhand

Bokaro

cc/15/146

Altu Ansari - Complainant(s)

Versus

Baranch Manager, Relince Genaral Insurence Co. Ltd. - Opp.Party(s)

Annu Kumari

29 Jun 2018

ORDER

Complainant Altu Ansari filed this complaint for a claim for Rs. 5,00,000/- with 18% interest from 18-09-2014 along with compensation for Rs. 1,00,000/- with litigation cost of Rs. 25,000/-

2          The case in brief is that complaint is an employee of Bokaro Steel Plant having Staff No. 633273 posted as HM- Elect. Dept. and he is insured under Group Personal Accident policy No. 241034291 for a Sum of Rs. 5,00,000/-

            On 18-09-2014 he was on duty in Night Shift and he met with an accident at 9:50 pm and he was referred to Bokaro General Hospital for better treatment. He was released from hospital on 02-02-2015 and he took medical certificate and joined duty on 03-02-2015. He appeared before medical board and he was found 17% temporary disablement.

            He got Rs. 1,07,671.20/- as compensation payable under Worksman Compensation Act.

            On. 10-11-2014 complainant had submitted his claim form of Reliance General Insurance to Samuhik Bima Durghatna Bima Samiti But on 21-11-2015 Samiti informed that Insurance Company has rejected the claim due to delay of receipt of the claim. This is deficiency in service of the insurance Company and liable to pay the insured amount.

3          Complainant filed the following documents in support:-

            Anx-1- Copy of Staff Identification.

            Anx-2- Copy of Injury on works

            Anx-3 to 3/4 Copies of B.G.H. Admission & Discharge memos

            Anx-4- Copy of Medical Certificate submitted to Insurance Co.

            Anx-5- Copy of Disability Assessment of Medical Board.

            Anx-6- Copy of Office order of compensation under Workman

             Compensation Act.

            Anx-7- Copy of the claim form.

            Anx-8 & 8/1- Copies of information and repudiation letter.

4          O.P. No. 1&2 Reliance General Insurance Co. Ltd. appeared and filed W.S. It is submitted that this case is not maintainable as there is no cause of action since the terms and condition of the policy is violated and there is delay of 386 days in filing the claim form. It is submitted that Durghatna samiti has neither intimated nor send any document within prescribed limit of G.P.A.  policy condition, hence O.P. No.3 is liable for compensation.

            It is submitted that claim has been repudiated only on the ground of late intimation, as accident occurred on 18-09-2014 and intimation is received after 53 days from the date of loss. Therefore O.P. No. 3 is liable. And there is no deficiency on the part of O.P. No. 1&2.

            Anx- A- Copy of term and condition has been filed.

This O.P. also relied on Atam Parkash Vs R.G. In Co. Ltd. reported in 2014 3 PR (N.C.) 679 where claim paper is sent after 14 months delay.

5          O.P. No.3 Samuhik Durghatana Bima Samiti appeared and filed W.S. it is submitted that he is only a bridge and premium of the policy is being paid through this O.P

            It is admitted that complaint is an employee of SAIL and admitted that complainant is covered under G.P.A. policy No. 2410342914000013 for the year 2014 to 2015.

It is admitted that he received intimation of accident by the complainant on 07-11-2014 regarding accident on 18-09-2014 through letter date 04-11-2014 of the complainant.

            This O.P. received claim form on 08-09-2015 submitted by the complainant through office of AGM S/c HM (E) dept. but due to discrepancies returned to AGM on the same day for rectification and rectified claim form was received o 08-10-2015 and sent on the same day to the office of insurance Co. therefore, this O.P. is not liable for any deficiency.

 

F I N D I N G S

6          We perused the record and hold that complainant being beneficiary of the G.P.A. Policy and paid premium to avail services of the insurance Co. is a consumer and the dispute is a consumer dispute.

7          The policy is admitted by O.P.s and also that complainant is covered insured for the period 2014 to 2015. The accident occurred on 18-09-2014 and after treatment he was discharged on 02-02-2015 from the hospital. Accident is also admitted along with temporary disablement up to 17% on the basis of the certificate of the medical board on which complainant, admittedly, received compensation under Worksman compensation Act.

            It is admitted that by letter dt. 04-11-2014 complainant informed the O.P. No.3 about accident, since accident occurred in the plant itself which is within the knowledge of the SAIL department HM (E) where the complainant was posted. It was the duty of the department head to inform the accident to the Insurance Company through Durghatna Samiti. However, it was intimated to O.P. 3 on 07-11-2014 during his treatment at B.G.H. So, complainant is not liable for late intimation regarding accident.

            It is also admitted that on 02-02-2015 the complainant was discharged from the hospital and medical board submitted its report about 17% temporary disablement by certificate dated 24-04-2015 (Anx 5)  and compensation under W.C. Act was given vide office order dt. 30-07-2015.

            Therefore, claim form for insured amount was submitted on 08-09-2015 and rectified form received by O.P. No.3 on 08-10-2015 which was sent to Insurance Co.

8          After examination of the document and admitted position that there was delay in submission of claim form but only on the basis of technical ground of delay, otherwise genuine claim should not had been repudiated by the Insurance Company which is against the principle of natural justice. It is also a fact that O.P. 1&2 admitted that repudiation is on the only ground of delay which is highly technical ground and we cannot accept the ground for repudiation against natural justice and O.P. Insurance Company is liable for deficiency in service and complainant is entitled for the claim.

9          Thus we allow the claim of the complainant and direct O.P. R.G.I Co. Ltd to pay Rs 5,00,000/- (Five Lac) only with interest of 6% P.A. since 08-09-2015 date of deposit of the claim form.

            We further direct to pay compensation of Rs. 5,000/- (Rs. Five thousand) only and litigation cost of Rs. 3000/- (Rs. Three thousand) only to the complainant.

            All the payment must be paid within 60 days of the date of order failing which the rate of interest on main claim shall be enhanced to 10% till realization.