Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 31.10.2016

                    Nisha Nath Ojha

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

1. To direct the opposite parties to pay the insured amount of Rs. 5,00,000/- ( Rs. Five Lakh only ).
2. To direct the opposite parties to pay Rs. 15,000/- ( Rs. Fifteen Thousand only ) as compensation and litigation costs.

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

The complainant has asserted that he is only child of late Baidnath Singh who was covered with group janta personal accident insurance policy from 25.12.2002 to 14.12.2017. The insurance was done through G.T.F.S. ( opposite party no. 2 ) and the insured amount was Rs. 5,00,000/-. In the aforesaid insurance policy the complainant was nominee as will appear from annexure – 1. The insured Baidnath Singh died on 02.08.2003 as will appear from annexure – 6 and the claim to opposite party no. 1 through opposite party no. 2 was submitted by complainant in month of may 2004.

It is further case of the complainant that after filing the claim to opposite party no. 1 through opposite party no. 2 the complainant visited opposite party no. 2 several times who informed him that his claim has been forwarded to opposite party no. 1 for payment and his claim has been registered with opposite party no. 1 being claim no. 4720049600618 dated 24.05.2005. The photocopy of the claim form submitted by the complainant has been annexed as annexure – 2.

It is the grievance of the complainant that despite submission of the claim petition to opposite party no. 1 no positive action has been taken regarding the payment of the claim of the complainant.

On behalf of opposite party no. 2 a written statement has been filed stating therein that after prima facie scrutiny the documents along with the claim form is sent to insurance company who is empowered to process the claim petition in accordance with law. From Para – 14 of the written statement it appeares that the complainant submitted the claim form duly completed with other supporting documents to National Insurance Company Ltd. through G.T.F.S. ( opposite party no. 2 ) on 10.12.2004 and thereafter a reminder was also given to insurance company ( opposite party no. 1 ) on 01.08.2006 enclosing a copy of representation dated 07.07.2006 of the complainant whereby the insurance company was requested to expedite the claim. Another reminder dated 21.04.2007 was also given to insurance company by opposite party no. 2. All these letters have been annexed by opposite no. 2 as annexure – C series.

On behalf of opposite no. 1, 3 and 4 a written statement has been filed. In Para – 8 of written statement it has been asserted that the claimant had submitted the claim beyond statutory period of 30 days and claimant failed to provide post mortem report and charge sheet of Late Baidnath Singh.

On behalf of complainant a rejoinder ( reply ) to the written statement filed by opposite party no. 1, 3 and 4 has been filed. In Para – 7 and 8 of the aforesaid reply it has been mentioned that the claim was filed on 26.08.2003 and thereafter proper claim was filed when charge sheet was submitted in the court. The assertion of the opposite party no. 1, 3 and 4 in written statement in Para – 9 has been refuted by the complainant in Para – 8 of the reply stating therein is as follows, “The statement made in Para – 9 of the written statement is wrong hence denied. Fact is that the petitioner filed his claim through opposite party no. 2 and same was registered as claim no. 4720049600618 dated 24.05.2005 with the National Insurance Company petitioner filed all the relevant documents. This is fully covered under the Janta Personal Accident Insurance.” The complainant has also annexed the copy of post mortem report, charge sheet etc. with this reply.

It is the case of the complainant that after death of his father he has submitted claim to opposite party no. 1 through opposite party no. 2 in the month of May 2004 and when he came to the office of opposite party no. 2 he was informed that his claim has been registered vide claim 4720049600618. It is also grievance of the complainant that despite submission of required documents no action has been taken on his claim petition. Opposite party no. 2 in Para – 14 of written statement has clearly admitted that complainant submitted the claim form duly completed and other supporting documents to opposite party no. 1 on 10.12.2004 and a reminder was also given on 01.08.2006 after enclosing a copy of representation dated 07.07.2006 and again reminder was given on 21.04.2007. All these documents have been annexed by opposite party no. 2 as annexure – C series from perusal of which it appears that the complainant has submitted 10 documents which was forwarded by opposite party no. 2 to opposite party no. 1 as will appear from letter dated 09.12.2004. From perusing the letter dated 01.08.2006 and 21.04.2007 ( annexure – C series ) it is crystal clear that all the relevant documents were forwarded to opposite party no. 1 by opposite party no. 2 but despite that the opposite party no. 1, 3 and 4 in their written statement have stated that the claimant has not filed post mortem report and charge sheet. Opposite party no. 1, 3 and 4 in their written statement have not denied the existence of annexure – C series as well as the fact mentioned by opposite party no. 2 in Para – 14 of written statement. All these facts shows that either the documents forwarded by opposite party no. 2 to opposite party no. 1 vide annexure – C series appears to have been lost or misplaced because the aforesaid facts have been stated by complainant in his reply of written statement filed on behalf of opposite party no. 1, 3 and 4.

In our opinion by not passing appropriate order despite receiving of the documents from opposite party no. 2 vide annexure – C series the opposite party no. 1, 3 and 4 have committed gross deficiency.

In view of the aforesaid fact and circumstances we direct the opposite party no. 1, 3 and 4 to pay Rs. 5,00,000/- ( Rs. Five Lakh only ) which is the insured amount vide annexure – 1 within the period of two months from the date of receipt of this order or certified copy of this order failing which the opposite party no. 1, 3 and 4 will have to pay an interest @ 12% on the amount of Rs. 5,00,000/- ( Rs. Five Lakh only ) till its final payment.

Opposite party no. 1, 3 and 4 are further directed to pay Rs. 20,000/- ( Rs. Twenty Thousand only ) to the complainant by way of compensation and litigation costs within the period of two months.

Accordingly this complaint petition stands allowed to the extent referred above.

                             Member                                                                              President