Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 30.05.2018

                    Nisha Nath Ojha

1. In the instant case the Complainant has sought for following reliefs against the Opposite party:-

1. To direct the opposite parties to pay Rs. 2,00,000/- with Rs. 10,000/- cost of the suit and interest @ 18% per annum from the date of filing the claim application.

2. The facts of this case lies in a narrow compass which is as follows:-

The complainant has asserted that after paying of premium of Group Janta personal Accidental Insurance policy Arjun Rajak took the aforesaid policy bearing no. 100300/47/01/9600022/03/96/30025 in the name of his two sons Raj Kumar, as well as Pawan Rajak (Now Deceased) and himself as will appear from annexure – 1. On 14.08.2007 the husband of the complainant namely Arjun Rajak was injured due to fall of old wall in rainy season and after being injured he was brought to Sushil Nursing home Pvt. Ltd. by the complainant for treatment but doctor declared him dead and issued a death certificate as will appear from annexure – 2. This fact was reported in daily news paper Dainik Jagran as well as Aaj as will appear from annexure – 3 series.

It is further case of the complainant that after accidental death of her husband she filed an application before opposite party no. 2 on 07.09.2007 and opposite party no. 2 issued a claim form and directed to deposit the claim form after properly filling the same with relevant papers. The aforesaid application and the claim form duly filled has been marked as annexure – 4 and 4/1. The aforesaid claim form was forwarded to opposite party no. 3 for its processing and final settlement as will appear from annexure – 5. As per order of Chief Minister matter was investigated after lodging Sanha no. 293/08 and after investigation the police came to conclusion that husband of the complainant Arjun Rajak died due to fall of the old wall on 14.08.2007 as will appear from annexure – 6.

It is further case of the complainant that the husband of the complainant has taken another insurance policy with Oriental Insurance Company Ltd., and the complainant has submitted similar documents. Thereafter the Oriental Insurance Company Ltd. has settled the claim after paying Rs. 80,000/- through cheque on the similar documents as appear from annexure – 7 and 7/1. The complainant has already submitted death certificate and other relevant documents before opposite party no. 2 as will appear from annexure – 8, 8/1 and 8/2 who has forwarded the same to insurance company but opposite party insurance company has not settle the claim of the complainant.

On behalf of opposite party no. 1 and 2 a written statement has been filed, in Para – 4 of which following facts have been asserted, “that Mr.Arjun Rajak member of the club obtained a Janta Personal Accidental Insurance coverage from National Insurance Company Ltd., Division – III, under a Group Insurance Policy through the facilitation of Golden Multi Services Club of GTFS. The said Group Janta Personal Accidental Insurance Policy no. 100300/47/01/9600022/03/96/30025 Serial no. being 01772799/103040018699 was issued by National Insurance Company Ltd., Division – III, 8 India Exchange Place, Kolkatta 700001 in favour of Golden Multi services Club of GTFS covering the member Mr. Arjun Rajak for sum insured of Rs. 5,00,000/- and his other two sons for Rs. 2,00,000/- each for the period from 15.04.2003 to 14.04.2018. Mrs. Rinki Devi is the wife and the nominee of the deceased member under the policy.  ”

It has been further asserted that opposite party no. 1 and 2 are only facilitator. Their duty is to extend the insurance coverage to its members under the said Group Janta Personal Accidental Insurance Policy. It has been stated that after accidental death of Arjun Rajak his wife Mrs. Rinki Devi who was a nominee submitted a claim form duly completed along with the original policy certificate attested Photocopy of death certificate including press news to Golden Multi Services Club of GTFS who in term after initial verification and checking submitted the said claim documents to National Insurance Company Ltd., Division – III, Kolkatta vide letter dated 23.10.2007 for early settlement. As it was a case of unnatural death the policy authority should have been inform to arrange for conducting post mortem examination of the person but unfortunately this exercise has not been done. The opposite party no. 1 and 2 have given several reminders to opposite party no. 3 for settling the claim as will appear from annexure – C series.

On behalf of opposite party no. 3 a written statement has been filed stating therein that complainant herself failed to comply the provision of policy and as such there was no option left for insurance company except to treat the claim as no claim. No documents has been filed to establish the death of the person namely Arjun Rajak accidental one.

Apart from it, it has been further stated that the intimation to the GTFS was given after 25 days of limitation and the insurance company was intimated after laps of two months. Which is violation of terms and condition of the policy.

It has been further stated that as per the memorandum of understanding, all disputes between the parties shall be filed within territorial jurisdiction of Kolkatta.

The fact asserted by the parties have been briefly mentioned in the forgoing paragraphs.

So, far the jurisdiction of this forum is concerned the opposite party no. 3 has office in Patna and policy premium has been deposited through Patna and as such this forum has jurisdiction to pass appropriate order in such cases.

The policy document appears to have been admitted in the written statement of opposite party no. 1, 2 and 3.

From bare perusal of para – 4 and 7 of a complaint petition as well as annexure – C series of written statement of opposite party no. 1 and 2 it is crystal clear that all the relevant documents with claim form has been submitted with opposite party no. 3. It appears that there was no post mortem report of the insured but the police has investigated after lodging Sanha and found that the insured died due to fall of old wall on 14.08.2007 ( annexure – 6).

Apart from the post mortem report all the documents necessary to settle the claim such as death certificate, police report etc. have been filed as will appear with the annexures of the complaint petition.

So far delay in filing is concerned if the complainant intimated the GTFS after delay of 25 days then this delay is not excessive as the complainant has to arrange several documents which are necessary for settling the claim and if there is delay on the part of GTFS informing the opposite party no. 3 then the complainant has no rule in such a matter and as such she cannot be punished for conduct of GTFS.

For the reason stated above we find and hold that by not settling the claim the opposite party no. 3 has committed grave deficiency.

For the reason stated above we direct the opposite party no. 3 to pay Rs. 2,00,000/- ( Rs. Two Lacs only ) i.e. insured amount (annexure – 1) to the complainant within the period of two months from the date of receipt of this order or certified copy of this order failing which opposite party no. 3 will pay 10% interest on above said insured amount of Rs. 2,00,000/- ( Rs. Two Lacs only ) till its final payment is made.

Opposite party no. 3 is further directed to pay Rs. 10,000/- ( Rs. Ten Thousand only ) to the complainant by way of compensation and litigation costs within the period of two months.

Accordingly this complaint stands allowed to the extent referred above.

                                   Member                                                        President