Present : Sri A.K. Das, President
Sri L.K. Banerjee, Member
Smt. Dipa Sen (Maity), Member
Order no. 11 dt.06.11.2007
The present case being no.338/2006 was filed by Smt. Rekha Rani Maity, W/o. Late Srikrishna Maity, Vill & P.O. Laxmi Janardanpur, P.S. Pathar Protima, Dist. South 24 Parganas against the o.ps. viz (1) National Insurance Co. Ltd., 1, Shakespeare Sarani, 6th Floor, P.S. Park Street, Kol-71 and (2) Golden Trust Financial Services, S.B. Mansion, 16, R.N. Mukherjee Road, Kol-1 before the forum for various reliefs as specified at page 7 of the main petition.
The case was filed u/s 12 of the C.P. act, 1986. The facts are in brief as follows :
That the petitioner along with her late husband is a policy holder with the o.ps. being policy no.100300/47/01/9600022/02/96/30429. The policy was for a period with effect from 23.3.03 to 22.3.08. The sum insured for her late husband was Rs.3,00,000/- and for herself was Rs.2,00,000/-. That it appears from the record that her husband died on 15.2.04 after falling from a tree. The petitioner took the insurance policy through the o.p. no.2 as member of the Golden Trust Financial Services. The o.p. no.2 provides Janata personal Accident Insurance Policy to the members of the o.p. no.2. The complainant submitted the claim form along with relevant documents to the o.p. no.2 on 2.9.04 for onwards transmission to the o.p. no.1 for settlement of her claim which the o.p. no.2 did on 17.12.04. The o.p. no.1 intimated the petitioner through a letter stating that her claim has been closed as “No Claim” by the respondents on the ground of violation of condition no.1 of the insurance policy, annex-C.
The petitioner made correspondence with the o.p. no.1 with a prayer to reconsider evaluate the decision regarding her claim but the petitioner did not get any reply and hence the case is for justice.
The o.p. no.1 neither appeared at the time of hearing nor did they submit any w/v. The o,.p. no.2 contested the case and admitted the claim of the policy holder and also stated that the policy was obtained by the petitioner through them as member of the club but they have no authority to settle the claim, hence their name should be expunged from the petition of complaint. The o.p. no.1 has the exclusive and sole authority to settle the claim of the policy holder.
It is apparent from the fact that the petitioner’s husband - a policy holder died on 15.2.04. The petitioner submitted claim form through the o.p. no.2 on 2.9.04. The petitioner received letter of repudiation from the o.p. no.1 on 17.12.04. The o.p. no.2 recommended the claim for settlement.
The petitioner could not submit the claim in time as per the stipulation of the policy. Merely non submission of form in time could not be the sole ground for repudiation of the claim.
Generally in an accidental claim the details are to be obtained from the agency and various sources on which the claimant or any member of the family has little control. This is the main reason for non submission of claim in time.
Here it is apparent that the o.p. no.1 has not applied its mind while dealing with the case. It is a gross negligence, inaction non application of mind and deficiency on the part of the o.p. no.1.
The forum have perused all the documents available with the record, considered the arguments submission and the w/v of he o.p. no.2 and have come to conclusion that the complainant has been able to prove her case to the hilt so as to get the benefit within the ambit of the C.P. act, 1986. The petitioner relied upon the annex-marked A,B,D in support of her claim. The case succeeds on contest.
Hence,
Ordered,
The o.p. no.1 is directed to pay accidental claim of Rs.3,00,000/- (Rupees three lakhs) only to the petitioner and also as sum of Rs.5000/- (Rupees five thousand) and Rs.1000/- (Rupees one thousand) respectively only as compensation and litigation cost for causing needless mental agony and harassment to the petitioner through its negligence, inaction and deficiency. The o.p. no.1 is also directed to pay to the petitioner simple interest @ 8% p.a. beginning from this day on the aforesaid sums till the full payment of the sums as ordered is made, if the o.p. does not pay such sums within that time as now given.
The payment should be made by the o.p. no.1 as the o.p. no.2 has no liability to settle the claim to the complainant within 60 days from this date of the order.
The office will make available a copy of this order to the concerned parties free of cost as rules.
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Member Member President
