Complainant Sabera Begum the mother of deceased Sk. Hasibur Rahaman by filing this complaint has submitted that her son Sk Hasibur Rahaman was covered by a policy under Group Janata Personal Accident Insurance Policy being Policy No.100300/47/01/9600022/02/96/30245 valid for the period from 23.10.2002 to 22.10.2007.

          Fact remains that on 09.07.2006 at about 10:30 P.M. the insured Sk Hasibur Rahaman met an accident and died on the same date.  Thereafter complainant as nominee of Lt. Sk Hasibur Rahaman the insured sent several reminders to settle up the matter but no response has been received by the complainant from the op.  So, on 03.04.2013 complainant requested the op to release the claim amount.  Though complainant submitted Voter Identity Card of complainant, death certificate of the insured, certified copy of charge sheet, P.M. report etc. and for the breach of the agreement and negligent manner on the part of the op, complainant has suffered loss and damages and for negligent and deficient manner of service the present complaint is filed.

          On the other hand op nos. 1 & 2 by filing written statement submitted that Sk Hasibur Rahaman since deceased obtained Janata Personal Accident Insurance Policy of the op company under the Group Insurance Scheme through Golden Multi Services Club of GTFS and that was for the period from 23.10.2002 to 22.10.2017 for a sum insured of Rs. 2,00,000/- and no doubt Sabera Begum mother and nominee of the deceased. 

          It is further submitted that as per MoU existing between National Insurance Company Ltd. and op no.1 Golden Multi Services Club of GTFS, the said coverage was extended to their members of the Golden Multi Services Club.  But op no.1 has violated the terms and conditions of the MoU and for which for their illegal act op no.2 is solely authorized to consider the prayer of the members of GTFS not other.  It is further submitted a receipt of the letter where op requested the complainant to submit original certificate copy of Sk Hasibur Rahaman along with Voter Identity Card, Ration Card of the insured as well as of the claimant to facilitate the insurer for processing the claim and practically no claim application was submitted and for which the matter could not be disposed of as per norms.

          Moreover the accident took place on 09.07.2006 and the last claim sent by op on 01.04.2009 thereafter complainant was completely kept silent.  Besides that the complainant has mentioned about another letter dated 03.04.2013 but no such copy is filed.  But that letter has not cleared the time limitation.  Fact remains the complaint is not filed within two years from the date of sending communication letter by the op on 01.04.2009.  So the present complaint is barred by limitation.  So the present complaint is not maintainable.

          Further it has been submitted that complainant was under statutory obligation to submit all necessary paper to op no.2.  But necessary paper was not submitted and for which the claim was repudiated and there is no deficiency in service on the part of the op.

          In the result, the complaint should be dismissed.

          On the other hand op no.1 submitted that Golden Multi Services Club of GTFS has no liability in view of the fact that they are not the insurance company.  But only as per MoU in between the op nos. 1 & 2 they purchased that coverage and the documents which are submitted by the complainant are sent to NIC.  But they are not able to say whether complainant submitted claim form etc. or not.

          So, under any circumstances the present complaint is not maintainable in present form against the op no.1 and the present complaint should be dismissed against the op no.1.

Decision with reasons

          After a careful consideration of the complaint and written version and also considering the argument as advanced by the Ld. Lawyers of both the parties and also considering the entire materials including the document it is clear that practically GTFS did not send any claim form along with all documents as required by the op no.2.  From the letter of the NIC to the GTFS prior to that accident dated 17.07.2001 it is found that GTFS was informed that all claim settlement shall be decided by the op no.2 after receipt of required documents.  But in the present case it is clear that complainant has failed to show that she filed any claim application through GTFS and GTFS has failed to prove that complainant is a member of their club.

          But on the contrary it is found that he was an employee of a private security agency.  But after proper study of the entire materials on record, we have gathered that practically the village lady after losing her son went to GTFS, but GTFS did not help her and did not act as per agreement and did not send the same along with a proper document for which the complainant was requested by GTFS to submit all required documents.  But GTFS did not send it after collecting from the complainant and for which practically complainant is being suffered.

          Regarding limitation we have gathered that matter was decided on 24.05.2014 on contest and this Forum came to a conclusion that the present complaint is not barred by limitation and the Forum has jurisdiction and there is no question about jurisdiction.  So that matter had already been decided on 14.05.2014.  So, we are confirmed that this complaint is not barred by limitation and this Forum has jurisdiction to decide and about jurisdiction and its jurisdictional as per order dated 14.05.2014.

          On thorough study of the materials and also relying upon the argument as advanced by the ops, we are confirmed that for the laches of the GTFS, complainant is not getting relief from the op and it is also proved that op has failed to settle the same and in the above situation we find that the rural lady having no knowledge about the entire procedure should be given a chance for filing a fresh claim along with all documents to the op no.2 and in this regard op no.1 shall take all such step to help the lady/complainant so that the proper form of claim including all other required documents as required by the op must be submitted by the complainant through op no.1 to op no.2 and on receipt of the same op no.2 shall decide whether the complainant may get such relief or claim or not.

          Accordingly the complaint is disposed of on contest.

          Hence, it is

ORDERED

          That the complaint be and the same is allowed on contest against the ops with a cost of Rs. 2,000/- and op no.1 shall have to pay the cost to the complainant.

          Op no.1 is directed to collect all the material documents including claim form duly signed and filled up by complainant and same shall be submitted to the op no.2 on proper receipt and on receipt of the same, op no.2 shall have to dispose of the claim of the complainant and in this regard op no.2 shall not anyway raise any question about application of the claim at a belated stage and question of filing the same at belated stage shall not be raised by the op no.2 at the time of decision against application of the claim which will be submitted and shall be treated as valid and there is no question of limitation and op no.2 shall have to dispose of on receipt of the said claim application including other documents which shall be submitted by the op no.1 within two months and shall have to dispose of the same within two months from the receipt of the same and op no.1 shall have to take all such steps for filing the claim application along with other required documents for settlement of claim by the op no. 2 after collecting it from the complainant and if op no.1 is found reluctant in that case op no.1 shall have to pay the entire claim amount to the complainant after lapse of two months from the date of this order and ops shall have to submit report regarding the compliance of the order by the ops.