Present         (1)    Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                     President

                    (3)     Smt. Karishma Mandal,

                              Member

Date of Order : 20.11.2015

Nisha Nath Ojha

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

1. To direct the opposite party no. 1 and 2 to pay claim amount of Rs. 3,00, 000/- ( Rs. Three lakh only ) with interest @ 12% per Annum from 28.09.2010 till the date of final payment.
2. To pay Rs. 1,00,000/- ( Rs. One lac ) as Compensation for mental and physical torture.
3. To pay Rs. 20,000/- ( Rs. Twenty thousand only ) as litigation cost.

2. The complainant has asserted following facts in his complaint petition which is being reproduced in toto :-

1. That the proposal for personal accident insurance policy was properly filed without concealing any material facts and information required by the insurer and the same was submitted in the prescribed manner.
2. That the opposite party no. 1 accepted the said proposal and issued the insurance certificate bearing policy no. 100300/47/01/9600022/03/96/30209.
3. That the accident took place on 28.09.2010 when the complainant’s husband (insured) was travelling by tractor bearing registration no. BR 12 5772. The insured died in accident. The first information report was lodged in relation to the aforesaid accident.
4. That the dead body of deceased insured was sent for post mortem. The PM examination was conducted at 8:45 AM on 29.09.2010. After completing the post mortem examination, the conducting medical officer sent the post mortem report bearing PM report no. 32 dated 29.09.2010.
5. That the dead body of the deceased ( insured ) was cremated according to the custom in the presence of his family members.
6. That the complainant being nominee in the said policy, informed the opposite party no. 1 through the proper channel that on 28.09.2010 the insured was travelling in the tractor bearing registration no. BR 12 5772 and the same vehicle was turned turtle and the insured died in such accident.
7. That the complainant was asked to submit the claim form along with the copy of FIR , post mortem report and final police report.
8. That on completion of investigation, the final report bearing final report no. 280/10 was submitted by the police on 30.10.2010.
9. That in pursuance of such direction, the complainant submitted the written application along with claim form, with copy of the F.I.R., death certificate, post mortem report, police final report, insurance certificate and policy copy of F.I.R. in the branch office of Golden Trust Financial Service at Patna.
10. That it is relevant to mention here that on 24.01.2011 the attested copy of first information report, final police report, the post mortem report, death certificate, attested copy of voter identity card of nominee, photo copy of bank pass book and attested copy of residential certificate were submitted in the branch office of Golden Trust Financial Service at Patna, so that the claim be settled without any delay.
11. That after two weeks the complainant visited the office of GTFS, at Patna and requested the concerning authority of GTFS, Patna to take appropriate steps from his own level for settlement of claim. Then he told the complainant that all documents submitted by her were forwarded to the opposite party no. 1 and claim will be settled by the opposite party no. 1 shortly.
12. That the vide letter dated 02.03.2011 issued by the opposite party no. 2, the complainant was requested to submit the documents i.e. attested photo copy of ration card, voter identity card of the deceased person and nominee, final police report/ charge sheet through the Court ( Certified), post mortem report, photo copy of the Bank pass book of the nominee, employee’s salary certificate/ copy of form 16 of IT return / income certificate, local panchayat/ municipal certificate regarding the incident and status of the nominee in the original, original J.P.A. certificate, attested copy of F.I.R., attested photocopy of driving license and attested photocopy of disablement certificate issued from the medical board.
13. That the complainant again visited the office GTFS, Patna, and the letter dated 02.03.2011 issued by the opposite party no. 2 was produced before the incharge/ branch manager of GTFS, Patna. Then he told the complainant that all documents submitted by her has been forwarded to the opposite party no. 1 and further advise the complainant to submit the photocopy of voter identity of deceased and nominee, income certificate, local panchayat certificate regarding the incident and status of the nominee in original, attested photocopy of driving license.
14. That the complainant filed the application along with the attested photocopy of the voter identity cards of deceased and nominee, income certificate, local panchayat certificate regarding the incident and status of nominee in original, attested photocopy of driving license before the opposite party no. 1 though proper channel.
15. That it is duty of insurance company to act without inordinate delay, even then the opposite party no. 1 has not bothered to redress the grievance of the complainant by disposing of her application i.e ( annexure  - 6) and by finalizing the claim made by the complainant till date.
16. That it is well settled that the insurance companies must finalize the insured claim within a period of three months. Any delay beyond that would attract the odium of deficiency in service on the part of insurance company.
17. That it is relevant to mention here that the complainant has discharged all obligations as prescribed under the policy and relevant Act and rules.
18. That the cause of action arose with in jurisdiction of this Hon’ble forum and this Hon’ble forum has territorial and pecuniary jurisdiction to try the present complaint.
19. That the present complain is being filed within the period prescribed under section 24 A of the Act.

3. The Opposite Party no. 1 and 2 in their written statement has submitted as follows :-

1. The present complaint case as framed and filed by complainant Anita Devi, wife of deceased Ajay Kumar who was insured by National Insurance co. Ltd. through G.T.F.S. of Rs. 3,00,000/- for the period of 15.09.2003 to 14.09.2018 vide policy no. 100300/47/01/9600022/03/96/30209 for accidental death, is not maintainable either in law or on facts as claimed.
2. The complainant cum nominee has filed a photo copy of insurance certificate as Annexure – 1 to the memo of complaint petition in which name of insured person is Ajay Kumar hence with regard to the made statement in Para – 1,2 and 3 of complaint petition are matter of record and there is objection by the present answering opposite parties no. 1 and 2.
3. With regard to the content of annexure – 2, 3 and 4 in the Paragraph no. 4, 5 and 6 F.I.R., post-mortem report and death certificate respectively are matter of record and it is onus on the complainant to prove about death as accidental.
4. This answering opposite party no. 1 and 2 are unable to pay the compensation according to terms and condition of the policy as printed in back of insurance certificate for which this opposite party no. 1 and 2 have right to raise defence on this point.
5. In present case opposite party no. 3 as a facilitator of its member has failed, because intimation as well relevant document were not submitted within time to the insurance co. for this act wholly opposite party no. 3 is responsible to pay insured amount it allowed.
6. There was clear cut violence of term and condition with regard to MoU executed between the insurance company and GTFS but certificate of policy of Rs. 3,00,000/- was issued by GTFS in collusion with insured without inquiring above income of insured to grab public money.
7. There was clear cut violence of term and condition with regard to certificate of policy, because the intimation period is one month only while intimation was given on 22.12.2010 after lapse of two months.
8. In the light of a decision of Apex Court, United India Insurance Co. Vrs. Harchand Rai Chandan Lal reported in 2004 (4) PLJR 185 SC, the Supreme Court had already settled the law that “ the insurance policy is a contract between the parties and both are bound by the term of the contract ”, the complainant miserably failed to intimate.
9. The present answering opposite party no. 1 and 2 are entitled for protection U/s 64 VB of the insurance Act, 1938 because the insurance policy on which the complaint is relying upon is yet to be verified from the office record and if the certificate of insurance after verification from the office record is found to be fake or not valid/ effective at the material date and time of accident/ occurrence, in that case the present opposite parties will  not be liable either to pay compensation to the complainant or to indemnify the insured.
10. The present answering opposite party no. 1 and 2 do not admit of the alleged facts as mentioned in the present complaint petition, which has not been specifically admitted in the present written statement.
11. What so ever are not specifically admitted in the present written statement are deemed to have been denied by the present answering opposite party no. 1 and 2.
12. Under the facts and the circumstances as stated above the present petition filed by the complaint is not maintainable either in law or on facts and as such it is fit to be dismissed in limine.
13. Under the facts and the circumstances as stated above the complainant has got no valid cause of action in the present case against the present answering opposite party no. 1 and 2.
14. The present complaint petition also suffers from Miss-joinder and Non – joinder of necessary parties.
15. The complaint case is also not maintainable because of the facts it is barred by the law of limitation as well as on the basis of the principles of estoppels, waiver and acquiescence.
16. the present answering opposite party no. 1 and 2 reserve right to file any additional written statement in future if so directed or of so required or if so advised in the present case.

The fact of the case as narrated by the parties have been narrated in the forgoing Paragraphs. However at the cost of repetition certain facts are being mentioned to enable us to record our findings.

The husband of the complainant was insured Vide Annexure – 1. He died in an accident while he was travelling by tractor on 28.09.2010 and thereafter F.I.R. was instituted Vide Annexure – 2. After the death, post mortem was conducted which has been annexed as Annexure – 3. Thereafter the body was cremated as will appear from Annexure – 4. The complainant being nominee had applied with all relevant papers through GTFS as will appear from Annexure – 6 and 7. Thereafter certain documents were asked for as will appear from Annexure – 8 and the complainant has submitted all the documents, the Photocopy of which have been annexed as Annexure – 9 Series with this complaint petition. It is curious to note that none of the aforesaid facts as well as documents asserted and annexed in complaint petition by the complainant has been denied in the Written Statement. However in Para – 5 and 6 of the Written statement it is mentioned that opposite party no. 3 has not submitted all the documents with in time and opposite party no. 3 has not convinced its member i.e. complainant etc. about terms and conditions of the Insurance policy and the said policy i.e. Annexure – 1 was issued against the MoU signed between the Insurance Company and GTFS ( opposite party no. 3 ).

It is needless to say that GTFS has been made opposite party no. 3 of this petition. For the sake of clarity, we think it proper to narrate the facts asserted by opposite party no. 1 and 2 i.e. Insurance company in Para – 7 of written statement which is as follows: - “ There was clear cut violence of term and condition with regard to certificate of policy, intimation period is under one month only and all documents for three months while intimation was given on 22.12.2010 after lapse of two months ”.

For the sake of originality we have simply quoted the fact mentioned in Para – 7 of the written statement without any correction and modification.

In Para – 10 of the written statement it has been asserted that documents submitted on behalf of complainant “ is yet to be verified from the from the office record and if the certificate of Insurance after verification from the office record is found to be fake or not valid/effective at the material date and time of accident/occurrence, in that case the present opposite parties will not be liable either to pay compensation to the complainant or to indemnify the insured ”.

On behalf of the opposite party no. 3 no written statement has been filed but learned counsel for opposite party no. 3 have supported the claim of the complainant.

We are pained to note that as per F.I.R. the husband of the complainant died on 28.09.2010 and as per Para – 7 of the written statement the opposite party no. 1 and 2 received the intimation on 22.12.2010 and this written statement have been affidavited on 05.01.2015. thus it is clear that between 22.12.2010 and 05.01.2015 the documents etc. submitted by the complainant has not been verified by opposite party no. 1 and 2. This shows the apathy and insensitivity on the part of Insurance company i.e. opposite party no. 1 and 2 towards the widow who has lost her husband. The lame excuse of opposite party no. 2 that the documents etc. were sent by opposite party no. 3 to opposite party no. 1 and 2 after delay of two months or some time is also not acceptable because the complainant has no hand in it and if there was some delay on the part of complainant then it was duty of opposite parties to process it with sensitivity and sympathy which is the crux of the Insurance policy.

We have no option but to allow this complaint because we find deficiency on the part of opposite parties who have not even considered or process and claim of the complainant after laps of even 4 years.

We hope that higher authorities of Insurance Company will investigate the matter of such delay and take appropriate steps so that in future no person suffers due to such delay. In the facts and circumstances of this case, instead of directing to process the claim of the complainant in time frame we think it proper to pass final order in this regard.

In view of the aforesaid fact, the complaint petition is allowed and the opposite party no. 1 and 2 are jointly and severally directed to pay the claim amount of Rs. 3,00,000/- ( Rs. Three Lacs only ) to the complainant within the aforesaid period of three months from the date of receipt of this order or certified copy of this order failing which the opposite parties have to pay an interest @ 12% per annum to the complainant till the aforesaid amount is finally paid.

Further the opposite parties are jointly and severally directed to pay Rs. 25,000/- ( Rs. Twenty five Thousand only ) to the complainant by way of compensation and litigation costs within the aforesaid period of three months.

Accordingly, this complaint petition stands allowed to the extent indicated above.

 Member                                                       President