Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.) President
(2) Smt. Karishma Mandal,
Member
Date of Order : 30.09.2016
Nisha Nath Ojha
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay the sum insured with compound interest from the date of claim to the final payment to the complainant.
- To direct the opposite parties to pay Rs. 50,000/- ( Rs. Fifty Thousand only ) as compensation.
- To direct the opposite parties to pay Rs. 20,000/- ( Rs. Twenty Thousand only ) as litigation costs.
- The facts of this case lies in a narrow compass which is as follows:-
It has been asserted by the complainant that the nominee of his brother Late Raj Kumar Yadav was insured with opposite party no. 2 for the period 15.06.2003 to 14.06.2018 under Janta Personal Accidental Policy vide annexure – 1. The insured died due to snake bite on 25.08.2004 ( annexure – 2 and 4 series) during the treatment of Dr. Deen Dayal Champa Devi Memorial Hospital, Kund, District – Rewari, Haryana. The information about the aforesaid occurrence was also given to police station and certificate dated 25.11.2004 was issued vide annexure – 2 by the Hospital. On 02.02.2004 the complainant informed the opposite parties vide annexure – 3. The police has filed final form in this regard and the death certificate dated 31.08.2004 had been issued to the claimant vide annexure – 5 by competent authority.
Thereafter, opposite party no. 1 requested the complainant to send the relevant papers for transmitting the same to opposite party no. 2 vide annexure – 6 which is dated 16.11.2004. As per request of opposite party no. 1 the complainant has filed all original documents before competent authority and the same has been received on 24.12.2004 as will appear from annexure – 7. In this connection a certificate was also issued by sarpanch which is annexed as annexure – 8.
The complainant has asserted that despite the aforesaid submission of papers his claim has not been settled by opposite party no. 2. The complainant is own brother of the insurer and in support of the aforesaid fact the complainant has annexed annexure – 9.
It is the case of the complainant that after filing of relevant documents as per requirements of opposite parties, the opposite party no. 1 and 2 never demanded anything from the complainant after 24.12.2004 and hence the complainant is authorized to receive the insured amount under the act.
On behalf of opposite party no. 1 a written statement has been filed stating therein that the work of opposite party no. 1 is only insured facilitator and as such it is not responsible for settlement for claim. Opposite party no. 1 has stated in Para – 8 of written statement that after alleged death of Raj Kumar Yadav his brother Krishna Kumar Yadav ( nominee of the claimant) submitted a claim form “duly completed along with some essential documents” excepting the police report and the G.T.F.S. i.e. opposite party no. 1 after initial verification and checking furnished the said documents to National Insurance Company Ltd. Vide letter dated 18.02.2005 as will appear from annexure – B.
On behalf of opposite party no. 2 a preliminary objection was filed stating therein that the case is barred under limitation as there is no cmmunication after 24.12.2004 and the case has been filed in 2009 after laps of five years.
In counter affidavit filed by opposite party no. 2 it has been asserted that the claim of the complainant has been rejected and the claimant as well as opposite party no. 1 had been informed vide letter no. NIC/2004/5038 dated 29.12.2005 as will appear from annexure – C of opposite party no. 1. From Para – 8 of written statement of opposite party no. 2 it appears that the complainant has filed five documents except police report.
On behalf of the complainant a reply to the preliminary objection filed by opposite party no. 2 has been filed stating therein that he has not received any letter dated 18.02.2005 and as such he has no knowledge of this written statement.
Perused the record.
The facts asserted by the parties in this case have been narrated in forgoing paragraphs.
The very fact of insurance policy have not been denied. The opposite party no. 1 has asserted that opposite party no. 1 after initial verification and checking of the documents filed by the complainant furnished the same to the opposite party no. 2 vide letter dated 18.02.2005 as will appear from annexure – B.
The opposite party no. 2 has asserted that he has rejected the claim of the complainant vide letter dated 29.12.2005 as will appear from annexure – C of opposite party no. 1.
The complainant has denied of receiving the copy of annexure – C.
It is surprising that not a single chit of paper has been annexed by opposite party no. 2 in order to show that its rejection order i.e. issued vide annexure – C of opposite party no. 1 was served on the complainant because the complainant has asserted that he has no knowledge of annexure – C before perusing the written statement of opposite party no. 2.
The complainant in Para – 5 of his reply of preliminary objection of opposite party no. 2 has stated that he has not received any repudiation letter of the opposite party no. 2 as such he has no knowledge of the same.
For the discussion made above we direct opposite party no. 2 ( National Insurance Company Ltd. ) to pay the sum insured amount of Rs. 5,00,000/- ( Rs. Five Lakhs only ) 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. 2( National Insurance Company Ltd. ) will have to pay an interest @ 10% on the sum insured amount i.e. Rs. 5,00,000/- ( Rs. Five Lakhs only ) till its final payment.
Opposite party no. 2 ( National Insurance Company Ltd. ) is further directed to pay Rs. 5,000/- ( Rs. Five Thousand only ) to the complainant by way of compensation and litigation costs within the period of two months.
Accordingly, this complaint petition stands allowed to the extent referred above.
Member President
