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 full insured amount of Rs. 50,000/- along with 12% interest.
2. To direct the opposite parties to pay Rs. 25,000/- ( Rs. Twenty Five Thousand only ) as compensation.
3. To direct the opposite parties to pay Rs. 10,000/- ( Rs. Ten Thousand only ) as litigation costs.

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

The complainant has asserted that his father in his lifetime was a Kisan Credit Card holder vide annexure – 1 which was insured by National Insurance Company Ltd. (opposite party no. 1) under personal accident insurance. According to master policy on personal accident, insurance claim, the death claim is based on personal accident only in the case of Credit Card holder.

It is further case of the complainant that his father (Late) Janmejay Singh died on 01.09.2006 due to snake bite at his house under the period of said Kisan credit card. Thereafter, one Sri K.D. Narayan issued a certificate to effect that Sri Janmejay Singh died due to snake bite on 01.09.2006 as will appear from annexure – 2. Thereafter, a death certificate was issued from competent authority of State Government as will appear from annexure – 2A. After the death of his father, complainant approached the Branch Manager of Punjab national Bank at Parsa Bazar ( opposite party no. 2) and submitted his claim in prescribed form with necessary documents relating to death of his father. The bank ( opposite party no. 2) accepted the claim of the complainant on 06.11.2006 and forwarded the same to opposite party no. 1 for settlement of insurance claim which was accepted by opposite party no. 1 on 07.11.2006 as will appear from annexure – 3. The complainant also submitted the certificate of Mukhiya and application to opposite party no. 2 containing the endorsement of Deputy Mukhiya and member District Parishad as well as several villagers in connection with death of his father as will appear from annexure – 4. Thereafter the complainant personally visited the office of opposite party no. 1 and got reply that his claim is under process. When there was delay the complainant sent a letter to opposite party no. 1 requesting to settle his claim as will appear from annexure – 5 but no action has been taken.

It has been stated that after death of father of the complainant all liabilities came to the shoulder of complainant who as well as his younger brother are not doing and facing hardship.

On behalf of opposite party no. 1 a written statement cum notes of argument has been filed. In Para – 7 and 8 the following facts have been asserted, “that, after perusal of entire documents and as per the annexure – 2 of the complaint petition i.e. a certificate of private nursing home, it is clear that the complainant did not lodged any information before police regarding death of his father and also not admitted in Government Hospital, where post mortem would have been done, hence without any police investigation report and post mortem report the cause of death i.e. snake bit, could not be established.”

“that, it is pertinent to mention here that as per the personal accident policy terms and condition “any claim occurring under the policy has to be reported within 30 days of occurrence of incident and the necessary claim papers in original /notarized are required to be submitted to National Insurance Company within 90 days of the occurrence of incident. Claim papers received late will not be entertained”, and in the present complaint case the opposite party no. 1/ National Insurance Company had received information along with some documents lack of essential documents after 60 days from the date of occurrence, it becomes clear that “the complainant violated the terms and conditions of the Insurance policy”, so that opposite party no. 1/ National Insurance company is not liable to pay any compensation as per the policy terms and conditions.”

On behalf of complainant a rejoinder has been filed stating therein that opposite party no. 1 has kept the claim pending for much time and no reason has been communicated by the opposite party no. 1 for keeping claim pending.

It has been further stated that as per regulation 2002 ( protection of policy holder interest) framed by IRDA it is mandatory duty of insurance company to conclude and dispose of the claim of the insured nominee within three months from the date of the claim but opposite party no. 1 has not complied this provision.

It has been further stated that the complainant informed the opposite party no. 2 within reasonable time about the death of his father which was forwarded by opposite party no. 2 to opposite party no. 1.

It has been further stated that opposite party no. 1 has not produced any documents to prove that FIR and post mortem report are necessary documents in respect of death claim.

The fact asserted by both the sides have been narrated in the forgoing paragraphs.

It is the case of the complainant that his father was a kisan credit card holder who died due to snake bite on 01.09.2006. In support of aforesaid fact the complainant has annexed annexure – 1 from bare perusal of annexure – 2, it is crystal clear that the father of the complainant died due to snake bite on 01.09.2006. This certificate has been granted by Sri D.K. Narayan belonging to Narayan Health Care, Simra. From bare perusal of annexure – 2 A which is death certificate dated 21.09.2006 it is crystal clear that Janmejay Singh died on 01.09.2006 at Simra. Annexure – 3 is a letter of opposite party no. 2 to opposite party no. 1 forwarding the claim of the complainant with seven documents mentioned in the annexure itself. Annexure – 4 is an application to opposite party no. 2 on which Deputy Mukhiya, member District Parishad as well as 52 villagers had put their signature in support of the fact that kisan credit card holder Late Janmejay Singh died on 01.09.2006 but from bare perusal of annexure – 6, 7 and 8 of written statement of opposite party no. 1 it transpires that the claim of the complainant has been rejected on the ground that complainant has not submitted FIR as well as post mortem report of his father to prove that his father died due to snake bit.

It has been further stated by opposite party no. 1 that instead of 30 days the claim form has been received by opposite party no. 1 after delay of 60 days which is violation of terms and conditions of the policy. No copy of the policy or any documents has been annexed by opposite party no. 1 in support of his aforesaid assertion.

In our opinion from bare perusal of annexure – 1, 2, 2A, 3 and 4 referred above it is crystal clear that the father of the complainant has died due to snake bite.

In our opinion that there are sufficient evidence in support of the claim of the complainant.

So far delay in receiving the claim form is concerned it must be born in mind that complainant is a simple villager who has submitted claim form to opposite party no. 2 and opposite party no. 2 has forwarded the same to opposite party no. 1 and as such some delay may occur which must be Condoned as opposite party no. 1 is for welfare of the society.

It is surprising that the opposite party no. 1 has not annexed the copy of repudiation letter in written statement cum written argument and hence we are unable to peruse the same but from perusal of Para – 6, 7 and 8 of written statement it appears that the claim of the complainant has not find favour with opposite party no. 1.

For the reason stated above we find and hold that by not paying the insurance amount to the complainant the opposite party no. 1 has committed deficiency in service.

Hence, we direct the opposite party no. 1 to pay the full insured amount of Rs. 50,000/- ( Rs. Fifty Thousand only ) to the complainant which is admissible under the aforesaid scheme 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 opposite party no. 1 will pay 10% interest on the above mentioned insured amount of Rs. 50,000/- ( Rs. Fifty Thousand only ) till its final payment.

Opposite party no. 1 is further directed to pay Rs. 5,000/- ( Rs. Five Thousand only ) to the complainant by way of compensation and litigation costs within the above mentioned period.

Accordingly this complaint stands allowed to the extent referred above.

                             Member                                                                              President