Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 30.10.2017

                    Nisha Nath Ojha

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

1. To direct the opposite parties to pay the insured amount i.e. Rs. 1,00,000/- along with 18% interest.
2. To direct the opposite parties to pay Rs. 2,00,000/- ( Rs. Two lakh only ) as compensation along with 18% interest.
3. To direct the opposite parties to pay Rs. 15,000/- ( Rs. Fifteen Thousand only ) as litigation costs.

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

It is the case of the complainant that her husband Jagdeo Prasad Singh ( Now deceased) took a group Janta Accident Policy bearing policy no. 100300/42/04/8200012 covering the period from 23.08.2004 to 22.08.2014 for a sum of Rs. 1,00,000/- through GTFS (opposite party no. 3) as will appear from annexure – 1. On 26.05.2006 while the husband of the complainant was repairing the roof of his house, he fell down and became senseless. He was brought to the hospital where he was declared dead. Thereafter, post mortem was done and UD case was also lodged bearing no. Gaurichak P.S. UD Case no. 07/06. Thereafter, death certificate was issued. The aforementioned fact is clear from annexure – 2 series.

It is further case of the complainant that on 24.06.2006 after cremation of her husband, the complainant informed GTFS opposite party no. 3 with an written application along with documents regarding death of the insured as well as claim form and requested the authority to make payment of insured amount. The aforesaid application was filed on 24.06.2006 as will appear from annexure – 3 series. Thereafter the insurance company i.e. opposite party no. 1 and 2 vide letter dated 17.01.2017 repudiated the claim on the basis of late intimation as well as non submission of required documents from the end of the complainant and treated the claim as no claim as will appear from annexure – 4 series.

The complainant has asserted that from the letter of opposite party no. 3 dated 01.07.2006 and 31.08.2006 ( annexure – 5 series ) addressed to opposite party no. 1 it is clear that the information of said occurrence was given within a stipulated time but the claim of the complainant has been repudiated on the ground of delay which is not proper.

On behalf of opposite party no. 1 and 2 a written statement has been filed, in Para – 7 of the written statement following facts have been asserted, “ that it humbly submitted that after perusal of the repudiation letter dated 17.01.2007, it becomes clear that date of accident in question is 26.05.2006 and after 1 month and 7 days ( laps of 30 days) claim intimated to NIC/opposite party no. 1 and 2 on 03.07.2006 and also the claim submitted on 31.08.2006 lack of some essential documents after a gap of 3 months 4 days ( laps of 90 days) without any reasonable explanation in respect of cause of the delay. Lastly on 17.01.2007, awaiting the required documents i.e. FIR and police final report/charge sheet, which are necessary to established the cause of the death of the insured, the opposite party no. 1 and 2 repudiated the claim of the complainant as “NO CLAIM.”

It has been also stated that the complainant has failed to prove the cause of death by authentic documents and also to provide all documents within stipulated time as per terms and conditions.

No any rejoinder appears to have been filed.

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

The very fact that the complainant’s husband was insured with opposite party no. 1 and 2 stands admitted. It is also admitted that the alleged occurrence took place during the covering period of annexure – 1.

It appears from repudiation letter as well as written statement of opposite parties that the claim has been treated as no claim on the ground of delay and submission of the relevant documents such as first information report, charge sheet etc. In Para – 7 of written statement it has been stated that the accident took place on 26.05.2006 and after one month and seven days the claim was intimated to opposite parties on 03.07.2006 and the claim form was submitted on 31.08.2006 after gap of three months and four days which was lacking some important documents. No any reasonable explanation has been given and lastly on 17.01.2017 for want of FIR, charge sheet etc. the claim of the complainant was repudiated and treated as no claim as will appear from annexure – 1 of the written statement of opposite party no. 1 and 2.

So far delay is concerned the complainant has asserted in Para – 6 of complaint petition that after one months of occurrence the information regarding death of the insured was given to opposite party no. 3 with submission of relevant documents, claim form etc.

From bare perusal of annexure – 5 series which is letter dated June 1of opposite party no. 3 addressed to Senior Divisional Manager National Insurance Co. Ltd, Division III being memo no. GTFS/CLAIM/PA/TS/17800 it is crystal clear that the Patna office of GTFS received the claim intimation along with closure on 24.06.2006 but it took time to reach Kolkatta head office on 01.07.2006 which was forwarded to opposite party no. 3 on 03.07.2006.

It goes without saying that death of the husband of the complainant took place on 26.05.2006 and was intimated to opposite party no. 3 on 24.06.2006 which is within 30 days. If the opposite party no. 3 had intimated the opposite party no. 1 and 2 after delay then the complainant cannot be punished because she has intimated opposite party no. 3 in time.

Apart from it, from perusal of annexure – 1 of written statement i.e. letter dated 17.01.2017 of opposite party no. 2 it is crystal clear that the opposite party no. 1 and 2 were asking about FIR, charge sheet etc. while the real fact is that the police has not registered FIR because no faul play was found by police in the death of husband of the complainant and hence only UD case was registered.

As there was no FIR hence there is no question of any charge sheet or final report because the police did not found reason to investigate the matter and hence it was impossible for complainant to submit the copy of FIR and charge sheet with her claim form. The cause of death was established from record of UD case, post mortem report etc.

For the discussion made above we find and hold that by repudiating the claim of the complainant vide annexure – 1 of written statement as well as annexure – 5 series the opposite parties have committed serious deficiency for the reason that the complainant had intimated the opposite party no. 3 in time and opposite party no. 1 and 2 demanded certain papers which was never issued or prepared by competent authority.

Hence, we direct the opposite party no. 1 and 2 to pay the sum insured amount of Rs. 1,00,000/- ( Rs. One Lakh 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. 1 and 2 will pay 10% interest on the above said insured amount of Rs. 1,00,000/- ( Rs. One Lakh only ) till its final payment.

Opposite party no. 1 and 2 are further directed to pay Rs. 5,000/- ( Rs. Five Thousand only ) to the complainant by way of compensation and litigation costs within the stipulated period of two months.

Accordingly this complaint stands allowed to the extent referred above.

                             Member                                                                              President