Jharkhand

Bokaro

CC/17/152

Mahabir Pd. Pandey - Complainant(s)

Versus

Claim Manager, Reliance General Insurence - Opp.Party(s)

Sanjay Kapoor

23 Feb 2024

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-16-11-2017

Date of final hearing-23-02-2024

 Date of Order-23-02-2024

Case No. 152/2017

Mahabir Prasad Pandey

R/o Sector-XI/D, Qr. No. 2391, Bokaro Steel City, Distt.- Bokaro

                                      Vrs.

1. The Claim Manager, Reliance General Insurance Co. Ltd.

3^rd Floor, M-5, City Centre, Sector-4, Chandrakali Bhawan,  

 Bokaro Steel City.

 2. The Secretary, The Bokaro Steel Samuhik Durghatna Samiti, Room No.E-45, Purana Prashasnik Bhavan, Bokaro Steel Plant.

B.S.City, District- Bokaro, 827001

 

 

Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-:Order:-

1. Complainant’s case in brief is that he was SAIL/BSL, Bokaro Employee vide Staff No. 758443 Dept. of Fire Services and he was a member of M/S Bokaro Steel Durghatna Bima Samitee sponsored by Reliance General Insurance Co. Ltd. registered office Kolkata. Further case is that during working on 30.09.2015 while he was on B-shift Duty and opened the bonnet of the vehicle the dust particles entered into his right eye causing injury and he became injured who was treated at Bokaro General Hospital ( in short BGH) since 01.10.2015 to 07.10.2015 and he was discharged on 07.10.2015. Further case is that mean while complainant gave information to the O.Ps. who intimated the insurance co. Further case is that on 29.04.2016  complainant was examined by the Medical Board accordingly disablement certificate was issued by the Medical Board and its photo copy was made available to the O.P. showing 25% permanent disability. But claim of the complainant has been rejected on the ground that it was filed with 70 days delay though it was required to be intimated within 45 days from the date of accident. Hence this case has been filed with prayer to direct the O.Ps. to pay Rs. 1,25,000/- as claim  compensation with interest @ 12% per annum, Rs. 25,000/- for compensation related to various type of harassments and Rs. 10,000/- as litigation cost.
2. O.P. No.2 Secretary, Bokaro Steel Samuhik Durghatna Bima Samitee, SAIL/ BSL has filed W.S. admitting most of the facts of the case and has not denied or controverted any of the fact mentioned in complaint petition.
3. O.P. No.1 M/s Reliance General Insurance Co. Ltd. has filed W.S. mentioning therein that case has been filed after prescribed period of limitation and claim has been repudiated on the ground related to delay in intimation regarding accident  and also delay in filing the claim. Further reply is that as per policy claimant is bound to produce the documents within 365 days for compliance of claim who has not produced the documents, hence he violated the terms and conditions of the policy. Further reply is that intimation about accident must be reported to the O.P. within 45 days from the date of accident which was not given after the accident and there is no report to the Police .  Hence it is prayed to dismiss the case.
4. Point for determination is whether complainant is entitled to get relief as prayed ?
5. To prove its case complainant has filed photo copy of Injury on works report (Anneuxre-1), photo copy of prescription issued by BGH (Annexure-2),  photo copy of injury report (Anxure-3-), photo copy of claim form (Annxure-4), photo copy of claim intimation by BSL (Annexure-5), photo copy of letter dt. 18.04.2016 (Annxure-6), photo copy of disability certificate (Annxure-7), photo copy of office order dt. 20.06.2016(Annexure-8), photo copy of letter dt. 23.02.2017 (Annxure-9), photo copy of repudiation letter dt. 14.02.2017 (Annxure-9 A) and photo copy of legal notice dt. 13.09.2017 (Annxure-10).
6. On the other hand no any separate paper or document or evidence has been produced by the O.Ps.
7.  On careful scrutiny of the pleadings of the parties it is very much clear that the fact related to employment of the complainant as claimed in  the complaint petition and the fact related to accident during working are not disputed  facts by the O.P. No.1 and he has not denied  the fact that complainant  was covering with the insurance policy and accordingly his claim was forwarded to the insurance co. for consideration.
8. It is also admitted fact of both the parties that there is delay in transmission of intimation regarding intimation about accident as well as submission of claim form from the date of accident.  But as per complainant he was under treatment during that very period and there was delay in obtaining the disability certificate.  Therefore, it is very much clear and established that complainant sustained injuries due to accident during working and he was under treatment thereafter.
9. On careful perusal of the medical treatment papers it appears that complainant was treated at BGH from 01.10.2015 to 07.10.2015. On careful perusal of Annexure-1,2,3,5,6 and 7 of the complaint petition it is establishing the fact that due to that very accident occurred on 30.09.2015 complainant sustained injuries and suffered with permanent disablement of 25% and disablement certificate was issued on 29.04.2016. It is therefore very much clear that from the issuance of disablement certificate there is no delay on the part of the complainant in filing the claim before the O.Ps.
10.  The sole ground for rejection of the claim is delay in filing of the claim before the competent authority. Ld. Counsel for the complainant has filed photo copy of the circular of INSURNACE REGULATORY AND DEVELOPMENT AUTHORITY dt. 20.09.2011 Ref-IRDA/HLTH/MISC/CIR/216/09/2011 by which “IRDA has advised all insurers to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the Insurers must not repudiate such claim unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time”. On careful perusal of the direction it appears that O.P. No.1 has not followed the directions of his regulator rather he has violated it.
11. Ld. Counsel for the complainant has placed reliance on the Judgment passed by the Hon’ble Jharkhand State Commission in F.A. No. 251/2010 passed on 05.08.2011 in which the ground of rejection of the claim on delay intimation has been considered as wrong ground.
12. On careful perusal of the circular of IRDA, the principle laid down by the Hon’ble State Commission and the facts and circumstance of this case it is very much apparent that here in this case there was reasonable explanation of the complainant for condonation of delay. Therefore, we are of the view that mere on the ground of delay in intimation or submission of the claim it was not justifiable for the O.P. No.1 to repudiate the claim. So far delay in filling this case is concerned it is very much clear that repudiation letter was issued on 14.02.2017 by the O.P. No.1  and this case has been filed on 16.11.2017 in this way it is very much clear that case has been filed very promptly within prescribed period of limitation from the cause of action.  Hence we are of the opinion that complainant is entitled to get relief as claimed. Accordingly this point is being decided in favour of the complainant.
13. As per terms and conditions of the Insurance policy in respect to permanent or partial disablement the amount of the claim will be according to percentage assessed by the BGH Medical Board. It is admitted fact that complainant was working as non executive in the BSL and sum assured for such official was Rs. 5,00,000/- only hence on permanent disablement of 25% only 25% of the sum assured will be payable. Hence claim is liable to be accepted only for Rs. 1,25,000/- i.e. the 25% of Rs. 5,00,000/- in respect to permanent disablement.
14. Hence prayer is being allowed in the following manner:-

O.P. No.1 Reliance General Insurance Co. Ltd. is directed to pay Rs. 1,25,000/- to the complainant on account of his 25% permanent disablement. Said payment must be made within 60 days from receipt/production of copy of this order failing which complainant will be entitled to receive interest on that very amount @ 10% per annum from 16.11.2017 (i.e. the date on which case was filed). Further O.P. No1 is directed to pay compensation of Rs. 10,000/- on account of various type of harassment and also to pay Rs. 5,000/- as litigation cost within above mentioned period.

 

 

(J.P.N. Pandey)

                                                                                   President

 

 

                                                                            

                  

                                                                               (Baby Kumari)

                                                                                       Member