Delhi

New Delhi

CC/821/2009

Clarion Properties Ltd. - Complainant(s)

Versus

M/.S New Indian Assurance Company Ltd. - Opp.Party(s)

22 Apr 2019

ORDER

 

CONSUMER FISPUTES REDRESSAL FORUM-VI

(DISTRICT NEW DELHI,  M-BLOCK, 1^ST FLOOR,

VIKAS BHAWAN, I.P. ESTATE. NEW DELHI-1100001.

 

C.C.No.821/2009

 

M/s Clarion Properties Ltd.,

34, Babar Lane,

Bangali Market,

New Delhi-01.

                                             …..Complainant

Vs.

 

M/s  New India Assurance Co. Ltd.,
Delhi Regional Office-1,

Jeevan Bharti Building,

124, Connaught Circus,

New Delhi-110001.                                                    

    ….Opposite Party

 

 

NIPUR CHANDNA, MEMBER

 

O R D E R

 

 

The complainant has filed the present complaint against the O.P under section 12 of Consumer Protection Act, 1986. The facts as alleged in the complaint are that the complainant is the policy holder of OP Co. vides policy bearing No.311701/36/07/01/0000001011 named as Workmen Compensation policy on 2.8.2007.  The policy covered 250 skilled/unskilled workers and the worker engaged in the construction activities at site.  The tenure of the policy is from 2.8.2007 to 1.8.2008.  After issuing the temporary cover note, the actual policy was to be issued by the OP within a period of 15 days from the date of issuance of cover note.   Despite repeated requests and follow-up by the official of the complainant’s Co., OP never provided the policy documents. 

2.     On 29.10.2007, complainant Co. informed OP that the policy issued by it covered only 250 workers working at the site endorsement be made include the worker employed by a contractor or sub-contractor or petty contractor working at the site and the same was accepted by  OP vide its letter dt. 30.10.2007. On demanded the details of the contractor/sub contractor was supplied to the OP vide letter dt. 12.11.2007 but OP failed to provide the policy document mentioning the necessary endorsement. 

 

3.     On 13.4.2008, an accident took place, due to which one of the worker named Sh. Amar Nath Sahni died due to falling from 8^th floor of one of the Tower.  On 26.4.2008, the intimation of the same was given to the OP and further request was made to lodge the claim and settle it.  On 9.5.2008, surveyor was appointed by the OP to whom all the required documents were supplied.  However, vide letter dt. 3.7.2008, OP directed that the claim of the complainant be lodged before Workmen Compensation Commissioner and as such the claim was lodged  with Workmen Compensation Commissioner and the intimation of the same was given to the OP vide letter dt. 9.7.2008.   

 

4.     On 4.11.2008, Sh. K.R. Verma, Commissioner under Workmen Compensation Act passed its Award directing that Sh. Amar Nath Sahni, died due to accident and awarded a compensation of Rs.2,80,000/- along with 12% interest p.a.  to be deposited by complainant’s Co. or the OP with whom the deceased was insured.  The complainant‘s Co. approached OP vide letter dt. 8.11.2008 thereby requesting it to comply the order.  The OP Insurance Co. vide letter dt. 29.12.2008 denied its liability for paying the awarded amount on the ground that the deceased was employee of the sub contractor and not of the insured, as per master roll.  The complainant’s Co. paid an amount of Rs.2,80,000/- and Rs.30,000/- to the legal heir of the deceased person.  Legal Notice was sent to the OP demanding the refund of the compensation of Rs.3,10,000/- along with interest @ 24% p.a. from the date of claim but neither the OP replied to the said notice nor had paid the money as demanded.  Complainant, therefore, approached this Forum for redressal of his grievance.

 

5.     Complaint has been contested by OP.  OP filed its written statement in which it denied any deficiency in services on its part in repudiating the claim as the same was not payable as per the terms and conditions of the policy. The insured had taken the policy referred above in respect of his 250 skilled/unskilled workers. During the continuation of the policy, the insured had informed OP that one Sh. Amar Nath who was working at the site under construction at Gurgaon sustained fatal injuries.  The OP appointed its surveyor, after making detailed enquiry, the surveyor submitted its detailed report dt.6.2.2008 stating that Sh. Satya Narain Sahni, sub contractor had employed the deceased.   The deceased was employee of the sub contractor and not of the insured, as per master roll verified by the surveyor.  Consequently, the claim was rightly repudiated, as the policy does not cover the employees of the sub contractor. 

 

6.     Both the parties have filed their evidence by way of affidavit.  

7.     We have heard argument advance at the Bar and have perused the record.

 

8.     It is argued on behalf of complainant that vide letter dt. 29.10.2007 request was made to the OP for making the necessary endorsement in the policy in question for including the workers  employed by a contractor or sub-contractor or petty contractor working at the site, the same is accepted by  OP vide its letter dt. 30.10.2007.  On demand the details of the contractor/sub contractor was supplied to the OP vide letter dt. 12.11.2007 but OP failed to provide the policy document mentioning the endorsement details.   The OP Insurance Co. vide letter dt. 29.12.2008 denied its liability for paying the awarded amount on the ground that the deceased was employee of the sub contractor and not of the insured, as per master roll verified by the surveyor which is arbitrarily and unjustified. 

 

9.     It is argued on behalf of OP that the claim of the complainant was rightly repudiated, since; the deceased was not covered under the policy.

 

10.    The complainant has alleged in its complaint that the OP Insurance Co. only issued cover-note to it. Despite its repeated requests and follow-up, OP Co. never provided the policy documents.  On 20.102007, an application was moved on behalf of complainant’s Co. to OP for making the necessary endorsement in the policy in question for including the workers employed by a contractor or sub-contractor or petty contractor working at the site.  This letter shows that before this the contractor or sub-contractor or petty contractor working at the site were not coverd under the policy in question.  The OP considered the request of endorsement and asked the complainant’s Co. to complete certain formalities.  After submitting the documents, the complainant’s Co. never approached OP for getting the endorsed policy in question nor had raised any objection at any point of time for getting the same.  Mere, writing a letter for getting the endorsement is not sufficient, the complainant should asked for the policy documents alongwith the endorsement from the OP Co.

11.    The OP Insurance Co. along with its written statement had placed on record, the copy of the policy in question which specified that only skilled/unskilled workers were covered under the policy and all the sub contractor were excluded.  The OP Insurance Co. repudiated the claim of the complainant’s Co. on the ground that the deceased was not covered under the policy in question as he was working under the sub-contractor; this fact is proved by mere perusal of the policy document attached with the written statement by the OP, hence in our view repudiation is justified. We find no merits in the present complaint, same is hereby dismissed.

 

This final order be sent to server (www.confonet.nic.in ). A copy each of this order each be sent to both parties free of cost by post.

 

Announced in open Forum on 22/04/2019.

                  

 

                                        (ARUN KUMAR ARYA)

                                                PRESIDENT

       ( NIPUR CHANDNA )                                         ( H.M. VYAS )

              MEMBER                                                         MEMBER