Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.) President
(2) Smt. Karishma Mandal,
Member
(3) Anil Kumar Singh
Member
Date of Order : 28.09.2018
Anil Kumar Singh
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay Insurance claim of Rs. 5,00,000/- along with 18% interest.
- To direct the opposite parties to pay Rs. 2,00,000/- for mental agony, physical and economical harassment.
- To direct the opposite parties to pay Rs. 50,000/- as litigation costs.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant has asserted that her husband Manohar Rai (since deceased) took insurance policy from opposite party no. 1 i.e. National Insurance Company Ltd. on 26.03.2003 for a sum of Rs. 5 Lacs on persuasion of the agency of opposite party no. 2 vide policy no. 100300/47/01/9600022/02/96/30442 after payment of Rs. 2,023/- as one time premium and the policy is valid from 31.03.2003 to 30.03.2018 and the complainant has been named as nominee being wife of the insured Mr. Manohar Rai.
The complainant has further asserted that her husband namely Manohar Rai, who was policy holder died on 29.11.2004 in a motor accident at Daudpur (jaitpur) Chhapra, Siwan Road, Saran, while he was returning after attending a marriage ceremony of his brother – in – law. Subsequently death certificate dated 30.11.2004 was issued by the competent authority. After death of her husband complainant had informed about the occurrence on 14.09.2005 to G.T.F.S., Ara and after information opposite party no. 5 has issued a claim form being no. 79/Ara/JPA/05 dated 14.09.2005. After receiving all relevant documents i.e. Death certificate, post mortem report, F.I.R. final investigation report of police and original policy bond along with payment receipt. The same was submitted before the opposite party no. 5 on 22.11.2005. After completion of all these necessary requirement for insurance claim which was received by opposite party no. 5, the complainant was assured by the opposite parties for settlement of claim immediately. After great persuasion the complainant could not succeed but vide letter dated 25.04.2006 was sent by the opposite party no. 1 who is Senior Divisional Manager, national Insurance Co. Ltd., Kolkata to the complainant rejecting her claim on the ground that intimation of claim was submitted after nine months delay from the date of accident. The complainant also sent a request letter on 28.08.2006 to opposite party no. 1 for settling the claim but opposite party no. 1 did not pay any heed towards her request.
The complainant has further asserted that she had no knowledge about the policy in question. The complainant got the knowledge about the policy in question after eight months of her husband’s death. Only after that the complainant informed the opposite parties within 30 days about the incident. A separate affidavit has been filed by the complainant with regard to delay information which is annexed herewith.
The complainant has further asserted that she has earlier moved before the Hon’ble High Court, Patna and after hearing the parties, the Hon’ble High Court granted liberty to the complainant to approach the Consumer Forum or any other appropriate legal remedy available to her. In case such an application along with a petition for condo nation of delay is filed by the complainant within period of three weeks from today then the Consumer Forum/competent authority shall consider the same keeping in view the fact that the complainant has been pursuing her remedies before this court.
On behalf of opposite party no. 1 and 3 a written statement cum notes of argument has been filed stating therein that there is no cause of action against the opposite party no. 1 and 3 because the present opposite parties rightly repudiated the claim of the complainant as per terms and condition of the insurance policy, the complainant in respect of the accident death of the insured Late Manohar Rai is 288 day delay, hence there is no deficiency in service of the opposite party no. 1 and 3.
Opposite party no. 1 and 3 has further stated that the reply and argument on behalf of the opposite party no. 1 and 3, the statement made in all paragraphs of the complaint petition is the matter of record, depends on the complainant to strictly prove all the facts and maximum statement made in paragraph to catch hold of complaint petition.
The opposite party no. 1 and 3 has further stated that the complainant herself admitted the facts that she informed the present opposite parties through opposite party no. 2, 4 and 5 in respect of the death of her husband after passing 288 days on 14.09.2005 from the date of occurrence i.e. 29.11.2004. in Para – 8 to 12 of the claim petition, the answering respondent humbly submitted that the matter concern the policy condition “unless reasonable cause is shown for delay”, it depends on the insurer/opposite party no. 1 and 3, who condone the delay after satisfaction of cause of delay, in present case the insurance company was not satisfied with the cause of delay in respect of information and submission of documents and rightly repudiated the claim of claimant as “NO CLAIM”.
On behalf of complainant written notes of argument has been filed stating the same fact again and again.
Heard the learned counsel for both the parties.
The complainant before approaching this forum filed a CWJC no. 544 of 2007 before the Hon’ble High Court of judicature at Patna wherein the Hon’ble Court vide order dated 25.02.2013 was pleased to order “Dismissed as not maintainable” and granted liberty to the petitioner “to approach the Consumer Forum or any other appropriate legal remedy available to her. In case such an application along with the petition for condonation of delay is filed by the petitioner within a period of three weeks from today then the Consumer Forum/competent authority shall consider the same keeping in view the fact that the petitioner has been pursuing her remedies before this Court.”
The complainant filed an application before District Consumer Forum, Patna on 14.03.2013 and the same was admitted on 18.03.2013. on perusal of the petition along with its annexure it is evident that the insured Late Manhar Raj died as a result of motor accident on 29.11.2004 and an FIR was lodged with Daudpur P.S. bearing no. 122 of 29.11.2004 U/s 279, 357, 338, 304 A of IPC and post mortem report no. 11341 dated 29.11.2004 of Civil Assistant Surgeon, Sadar Hospital, Chhapra was done.
The widow of the deceased/insured lodged her claim before opposite party no. 1 and 2 on 14.09.2005 which was closed as “ NO CLAIM” with the reason that the petitioner had submitted her claim before the insurance company after delay of nine months from the date of accident vide annexure – 4 of the complaint petition.
However, the widow/claimant again approach the insurance company vide her letter dated 28.08.2006 ( annexure – 5 of the complaint) stating therein that the reasons for delay in intimating the insurance company about the death of her husband/insured.
In view of the above, the petitioner moved before the Hon’ble Patna High Court through CWJC no. 844 of 2007 which was dismissed as “as not maintainable” as mentioned above. However, in CWJC no. 11947 of 2005 the Hon’ble High Court Patna pleased to pass order dated 28.11.2006 in which it has been held that “to take this plea at this stage to deny her benefits is not permissible” since, “delay in lodging the claim could not be fetal to the claim.”
Having considered all the facts and circumstances of this case and pleadings of both the parties, it transpires that the incident of motor accident on 29.11.2004 in which the insured person who was the complainant’s husband died is true as the matter was also reported in local news paper and further that the police FIR, final report and post mortem report has not been denied by the opposite parties.
It goes without saying that there is deficiency in service of opposite parties in non – settlement of the claim of the complainant.
For the reason stated above, we direct the opposite parties to pay the claim amount of Rs. 5,00,000/- ( Rs. Five Lac only) ( sum assured under the policy) to the complainant along with 8% interest from the date of filing of this complaint within the period of two months from the date of receipt of this order or certified copy of this order failing which opposite parties will pay 12% interest on the above mentioned claim amount of Rs. 5,00,000/- ( Rs. Five Lac only) ( sum assured under the policy) till its final payment.
Opposite parties are further directed to pay Rs. 25,000/- (Rs. Twenty Five 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 Member(F) President
