Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.) President
(2) Smt. Karishma Mandal,
Member
Date of Order : 30.06.2017
Nisha Nath Ojha
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay the insured amount of Rs. 3,00,000/- along with 12% interest.
- To direct the opposite parties to pay Rs. 1,80,000/- ( Rs. One Lack Eighty Thousand only ) as Compensation.
- To direct the opposite parties to pay Rs. 10,000/- ( Rs. Ten Thousand only ) as Litigation costs.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant Urmila devi is the wife of Late Subhash Chandra Sinha who had purchased an accidental insurance policy of the opposite parties after persuasion of agent of opposite party no. 4. The husband of the complainant paid the amount of premium of Rs. 1,231/- towards his accidental insurance policy on 07.04.2004 and insurance certificate on 08.04.2004 which have been annexed as annexure – 1 and 2.
It is further case of the complainant that on 18.05.2004 while her husband was returning to home from Patna Masaurhi via Punpun road he was killed by someone and thereafter a FIR was lodged by the son of the insured being Dhanarua P.S. Case no. 83/04 as will appear from annexure – 3 and 4.
After the Shradh ceremony of insured was over in the month of July 2004, the son of the complainant was advised by opposite parties to submit all his required documents which was submitted to opposite party on 21.03.2007 and thereafter his claim number is registered vide claim no. 4720079600183 dated 02.04.2008 as will appear from annexure – 5.
Thereafter when the claim of the complainant was not decided then the complainant sent a legal notice vide annexure – 6.
It appears that the case of the complainant was forwarded to opposite party no. 2 by opposite party no. 3 as will appear from annexure – 7. The complainant thereafter knocked the door of the opposite parties several times but the claim has not been settled for the reason best known to opposite parties.
On behalf of opposite party no. 3 and 4 i.e. (G.T.F.S.) a written statement have been filed admitting the issuance of Janta accidental policy through them in favour of complainant’s husband.
It has been further stated by opposite party no. 3 and 4 that their function and status is to extend the insurance coverage to its member under the said group Janta personal Accidental insurance policy but the settlement is to be done by opposite party no. 1 and 2 because the opposite party no. 1 and 2 are insurer.
In Para – 8 of the written statement of the written statement of opposite party no. 3 and 4 it is been admitted that the complainant had submitted claim forum duly completed along with other supporting documents to them who interen after initial verification and checking furnished “ the said claim documents to National Insurance Company Ltd., Division – III on 02.04.2007 for early settlement of the claim.”
It has been further stated that subsequently a copy of the proposal form has also been made available to the insurance company followed by two reminders letters dated 31.03.2008 and 17.01.2009 issued by Golden Multi Services Club of G.T.F.S. to National Insurance Company Ltd. Division – III for the benefit of the distressed claimant as will appear from annexure – C.
On behalf of opposite party no. 1 and 2 a written statement has been filed stating therein that the complainant failed to provide the mandatory documents i.e. post mortem report and investigation report of the investigating officer which are essential to settle any claim of the any claimant/insured.
On behalf of complainant rejoinder to the written statement submitted by opposite party no. 1 and 2 have been filed. in the second part of the Para – 6 of rejoinder following facts have been asserted by the complainant, “the opposite party no. 1 and 2 appointed an investigator by letter dated 18.12.2009 and also assured the complainant to settle her claim by letter dated 21.12.2009. The complainant submitted all the relevant documents as required by the opposite party no. 1 and 2 but not a single paisa has been paid to the complainant till date and her insurance claim is still unsettled.”
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It is the case of the complainant that after death of her husband she has submitted all the relevant documents with the authorities. From perusal of annexure – C of opposite party no. 3 and 4 it is crystal clear that the claim form with documents have been forwarded to opposite party no. 1 and 2 on 02.04.2007 but no action has been taken by opposite party no. 1 and 2.
The complainant has asserted that she had submitted all the documents on 21.03.2007 as will appear from annexure – 5. From annexure – C series of opposite party no. 3 and 4 it is crystal clear that the aforesaid documents and claim form were forwarded to opposite party no. 1 and 2 on 02.04.2007. Thus it is crystal clear that the complainant has played her role by filing claim petition in prescribed form through opposite party no. 3 and 4 who had interen forwarded the same to opposite party no. 1 and 2 on 02.04.2007 through annexure – C series. These facts have not been denied by opposite party no. 1 and 2.
Apart from it, if any documents was lacking it was duty of the surveyor or the representative of opposite party no. 1 and 2 to take steps for collecting the same through opposite party no. 3 and 4 or directly from the complainant as opposite parties are public institution aiming to serve the society by ameloriating the regour of mishappening in which they have failed.
For the discussion made above we find and hold that opposite party no. 1 and 2 have committed deficiency by not deciding the claim of the complainant who is a widow.
Hence we direct the opposite party no. 1 and 2 to pay the sum assured of accidental benefit i.e. Rs. 3,00,000/- ( Rs. Three Lacks 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 the opposite party no. 1 and 2 will pay 10% interest on the above said amount of Rs. 3,00,000/- ( Rs. Three Lacks only ) till its final payment.
Opposite party no. 1 and 2 are further directed to pay Rs. 10,000/- ( Rs. Ten Thousand only ) to the complainant by way of compensation and litigation costs within the period of two months.
Accordingly this complaint stands allowed to the extent referred above.
Member President
