Complainant Rita Devi filed this case for a claim of Rs. 5,00,000/- with 12% interest from the date of repudiation 08.07.2015 and Rs. 15000/- for mental harassment and litigation cost of Rs. 25000/-.

2          Case of the complainant is that she is wife of Late Bipin Bihari Singh who was an employee of the SAIL and covered under group insurance plan in the event of death due to accident at work place or anywhere and the dependants would be paid the insured amount.

            On 20.02.2013, late Bipin Bihari Singh was on duty in B’Shift at night and he fell down in Loco Area of Traffic Dept. and he sustained heavy injuries and rushed to Plant Medical Unit for primary treatment and later in Bokaro General Hospital and died on 21.02.2013.

            The Police lodged the case and registered U.D. Case. Complainant claimed the insurance through O.P. No.3, Samuhik Durghatna Bima Samiti with all requisite papers. But insurance company repudiated the claim by letter dt. 08.07.2015, on the ground of delay and O.P. No.3 is responsible for delay.

                        Thus, this is deficiency in service and hence this case is filed.

3          The following documents are filed in support:-

Anx-1 Copy of repudiation letter by Insurance Co.

Anx-2 Copy of information to the complainant for repudiation.

Anx-3 to 3/1 Copies of death certificate.

Anx-4 Copy of personal details of the complainant.

Anx-5 to 5/4 Copies of U.D. Furdbeyan, P.M. Report etc.

Anx-6 Copy of the legal notice.

4          O.P. No.1 and 2 M/s Reliance General Insurance Co. Ltd. appered and filed W.S.

            It is stated that the present case is not maintainable as it is time barred u/s 24(A) of C.P. Act because the accident took place on 20.02.2013 and case has been filed on 25.05.2016 after lapse of two years.

                        It is also stated that the Group Personal Accident Scheme is a contract between insured and the insurer and in case of any breach of terms and conditions, the O.P. is not liable to indemnify the loss of the complainant.

                        However, the policy and premium being paid is admitted. It is submitted that claim was not submitted within time frame and as such O.P. No.3 is liable to pay compensation. There is no deficiency on the part of the insurance company.

                        As such, complaint is liable to be dismissed.

                                                                        F I N D I N G S

5          Perused the record, we hold that complainant is the dependant and beneficiary under the Group Personal Accident policy on paying premium from the salary of the husband who was SAIL employee, therefore, she is a consumer  and dispute is a consumer dispute.

6          The crux of the matter is that the claim of the complainant is repudiated due to delay of 860 days as against 90 days time to file claim.

                        On perusal of the documents filed, it appears that the death of the husband occurred in the factory premises and the same was reported to the insurance company within two three days and O.P. No.3 immediately sent claim forms to be filed duly filled within 90 days but the claim form was received to O.P. No.3 on 19.03.2015. The claim form should have been received till 18.06.2013. The claim form was sent to O.P. Insurance company on 30.06.2015. There is no ground shown for delay submission of the claim form. However, the claim is genuine and delay is only the cause for repudiation of the claim. The repudiation is highly technical and against the natural principle and justice.  The O.P. insurance co. should not have repudiated the claim and this is deficiency in service.

7          So far, time barred question is concerned, it is fact vide Anx-1 of the letter dt. 08.07.2015. The cause of action arose on this date when the claim is repudiated. Therefore, since the case is filed on 25.05.2016, the complainant is within time of two years and the complaint is maintainable.

8          Thus, we allow the main claim of the complainant and we direct O.P. M/s Reliance General Insurance Co. Ltd. to pay Rs. 5,00,000/- (Rs. Five lac) only to the complainant with interest of 8% (eight percent) since 08.07.2015 till realization.

            O.P. Insurance Company is further directed to pay compensation of Rs. 3000/-(Rs. Three thousand) only and litigation cost of Rs. 1000/-(Rs. One thousand) only.

            All he payment must be paid within 60 days failing which rate of interest on main claim shall be enhanced to 12% (Twelve percent) till realization.