In the Court of the Calcutta District Forum, Unit-I
CDF-1/Case no.199/2007
Fatima Begam,
R.N.T Path, Laxmi Ghat, Bara Khatal,
P.O. Titagar, Dist-North 24 Parganas ……. Complainant
vs.
National Insurance Co. Ltd., Division-III,
1, Shakespeare Sarani,
P.S. Park Street, 6th Floor, Kolkata-71 and others …… Opposite parties
Present : Sri A.K. Das, President
Sri L.K. Banerjee, Member
Smt. J, Saha, Member
Order no. 11 dt.15/05/2008
The case being no.199/2007 has been filed u/s 12 of he C.P. act 1986 by Fatima Begam, w/o Late Jabbar Ali, R.N.T Path, Laxmi Ghat, Bara Khatal, P.O. Titagar, Dist-North 24 Parganas against the o.ps. viz (1) National Insurance Co. Ltd., Division-III, 1, Shakespeare Sarani, P.S. Park Street, 6th Floor, Kolkata-71, (2) The Senior Divisional Manager, National Insurance Co. Ltd., Division-III, 1, Shakespeare Sarani, P.S. Park Street, 6th Floor, Kolkata-71 and (3) The Golden Trust Financial Services, 16, R.N. Mukherjee Road, Kolkata-1 before the forum praying for various relief as specified at pages 8-9 of the main petition of complaint.
The facts of the case are in brief as follows :
That Jabbar Ali, the deceased husband of he petitioner took a Group Janata Personal Accident Insurance Policy and the GTFS being the principal insured had only facilitated such insurance coverage to Jabbar Ali since deceased being a member of he said club. The policy holder was a member of Golden Multi Services Club of Golden Trust Financial Services (GTFS). The petitioner is a nominee and beneficiary of he deceased policy holder. The policy number as issued by the o.ps. is vide no.100300/47/01/9600022/01/96/31154, period covered w.e.f. 23.3.02 to 22.3.2014 (midnight) and policy amount insured Rs.4,00,000/-, annex-A1.
That on 7.2.04 the complainant asked the brother and father of her husband to settle the partition of disputed family properly. This proposal made them furious and they attacked the husband of the petitioner with iron rod. Being injured the husband of the petitioner rushed to Balaram Hospital for treatment where he died at night. An FIR was lodged with the Khardah Policy Station being case no.47 dt.7.2.04 u/s 341/324/506/34 IPC dt.7.2.04. The post mortem was conducted on 8.2.04 at Police Civil Morgue, Barrackopur and the report stated that the death was due to the effects of injury, annex-3. The death certificate was issued by Khardah Municipality on 15.4.04, annex-A4.
That he petitioner intimated about the death of her husband to the GTFS on 22.3.04 and as per their advice submitted the claim form along with all documents on 4.9.04 for onward transmission to the o.ps. for settlement of her claim. Thereafter the petitioner was assured that the claim would be settled shortly but on 21.6.05 the o.ps. intimated the petitioner that due to violation of policy condition no.1 her claim was repudiated and treated as ‘no claim’. The petitioner should have intimated the claim with 30 days from the date of accident / death instead she took one month fifteen days time to intimate the news of death of her husband. The petitioner being a widow made representations to he o.ps. to review and modify the decision but it was of no avail. Hence the case is before the forum. The petitioner relied upon the annex marked A-1 to A-8 in support of her claim.
The o.ps. have been contesting the case all along by way of filing w/v denying therein very emphatically the material allegation as alleged by the petitioner.
It appears from the record that the accident resulting death of the policy holder took place on 7.2.04. Thereafter the beneficiary and nominee of the policy holder had to take time to intimate the sad death of the policy holder as she was in distress condition and could not get time to do the needful required for settlement of the claim. Hence the delay of only 15 days for submitting he claim form. The delay in submitting the claim form is not a fundamental breach of policy condition. It is a mere technicality for which a claim cannot be repudiated on the sole ground of delay.
The death was accidental and the petitioner had to ran pillar to post for procuring documents required for settlement of he insured policy. Moreover she was widow and as it appears from the record she had no positive support in this regard.
The fact is that the deceased husband was a policy holder and the petitioner is a nominee and beneficiary of the policy holder and is entitled to get the benefit of the policy.
The o.ps. took more than nine months to repudiate the claim of the petitioner and intimate the decision in spite of having well oiled administrative machinery. This is a deficiency in service and this inaction on the part of the o.ps. amounts to dereliction of duty. Mere technicality and delay of intimating the news of death of the policy holder to the o.ps. cannot be treated as fundamental breach of policy condition and cannot be the sole ground for repudiation of the claim.
The proforma o.p. no.3 has categorically stated in the w/v that it has no role to play in settling the claim of he petitioner. The o.p. nos.1 and 2 have the sole responsibility and liability to settle the claim of the petitioner.
The forum have perused all the documents and submissions made by the parties and come to conclusion that the petitioner’s case is genuine and the petitioner has been able to prove her case o the hilt so as o get he benefit within the ambit of C.P. act 1986. the case succeeds on contest.
Hence,
Ordered,
The o.p. nos.1 and 2 are directed to pay the insured claim amount Rs.4,00,000/- (Rupees four lakhs) only to the petitioner, the beneficiary and nominee of h deceased policy holder and the o.ps. are also directed to pay Rs.2000/- (Rupees two thousand) and Rs.1000/- (Rupees one thousand) respectively as compensation and litigation cost for needless mental agony, harassment to the petitioner through its negligence, inaction and deficiency. The payment should be made to the petitioner within 60 days from the date of this order failing which it will carry interest @ 8% p.a. from this date of the order till realization.
Let copy of this order be supplied to the parties free of cost.
Member Member President
