This is a petition filed by the complainant, Monoranjan Roy praying an award of Rs. 10,00,000/- together with compensation of Rs. 2,00,000/- and litigation cost of Rs.10,000/-  against the O.P./ the Oriental Insurance Company Limited. Fact in short is that the complainant is an employee of Boarder Roads Organization and he was sent to Afganistan in the year 2007. Prior his departure for Afganistan he got an insurance with the OP/ insurer against group personal accident policy with sum insured of Rs 10, 00,000/- being under high risk and the policy number was 215502/48/2007/2196 for a period of 24-11-2006 to 23-11-2007.  During his stay an accident was occurred due to bomb blast at Zaranj on 23-07-2007 and he lost vision of his left eye permanently. Due to lack of vision and traumatic stress, the complainant did not file claim papers before the OP earlier. The complainant made several communications with OP for settlement of his claim but OP did not bother to make payment. Hence this case, for appropriate relief.

On the other hand opposite parties/ Insurers by filing a written version has contested this case denying inter alia, all the material allegations against them contending that the case is not maintainable as the instant case was not informed timely to the O.P. Insurance Co. , so, the case be dismissed on contest.

To establish the case, complainant filed following documents:

i)Xerox & original Letter from OP/ Insurer dated 13.07.2011; ii) Letter of Complainant dated 18-01011; iii) Insurance Policy & Schedule; iv) Copy of Report of delay; v) Copy of FIR in English and Official language of Afganistan; vi) Copy of letter by Nimroz Province Police H.Q.; vii) Prescription of Dr. Sanjib Gupta, AIIMS, Delhi; viii) Medical Certificate by Dr. N. Mittal; ix) Certificate of disability; x) Copy of endorsement schedule of Insurance policy; xi) Forwarding letter/ settlement of claim of Late Ganga Ram and xii) Judgement in MFA no. 60 of 2006 dated 8.03.2011

Decision with reason

On careful consideration of the materials on record it reveals that the complainant filed this case before this Forum on 08.09.11. From the letter dated 13.07.11 of OP it reveals that they will send proper reply from the policy issuing office but till date the complainant did not get any communication from the end of the OPs about the fate of the claim. It is admitted fact that complainant could not submit claim papers or any intimation to the OP earlier. But the documents like copy of FIR , letter from concerned police H.Q., Medical certificate and after all Persons with Disabilities (PWD) certificate from the appropriate authority support the case of the complainant about  40% permanent  visual impairment in relation to his left eye which was duly insured with the O.P./insurer. When investigation was made by appropriate Authority i.e., a medical board consisting three doctors there is no need to disbelieve it.

We find that the complainant informed OP almost three and half years after occurrence of accident though he took all relevant steps for his survival within the appropriate time of occurrence of accident. The complainant has also defined the cause of delay of submission of claim papers elaborately to the OP. We go through the delay report supported by documents. The complainant got the PWD certificate on 28.10.2010 and informed the OP on 22.12.10. It is an important document to ascertain the actual loss by the OP for disburses the claim. So, we do find that the cause of delay is sufficient to justify. We do not find any documents from the end of opposite parties other than a letter dated 13.07.11 ; which shows that they have taken some sorts of measures to mitigate claim properly even they do not sent any intimation regarding the fate of the claim whether it is repudiated or closed. Further all the documents support the case of the complainant about loss of 40% permanent visual impairment of his left eye.  Moreover, we go through the Endorsement Schedule as designed by the OP/ insurer and according to this endorsement the complainant is fit for getting benefit under benefit no 3 as described ‘ loss of one limb or one eye’- amount payable 50% of CSI.

          We know "Person with disability" means a person suffering from not less than forty per cent of any disability as certified by a medical authority as defined in the PWD Act, 1995. And "Disability" means  (I) Blindness;(ii) Low vision;(iii) Leprosy-cured;(iv) Hearing impairment;(v) Loco motor disability;(vi) Mental retardation;(vii) Mental illness. All PWD certified persons are eligible for enjoying benefits as provided under the law and in the same time it is irrelevant whether that very person is suffering from 40% disability or 100% disability.  

Under this facts and circumstances, when the complainant was insured under the risk of group personal accident policy as per Table 1(A) with the OP no.1 they cannot avoid their payment on the plea of receiving delay intimation of claim.  

It is the settled principle of law the public uses to make insurance policy for the safety and security of their life and belongings and if the Insurance Company did not take proper steps for effecting settlement without making any further delay the public can not have faith upon them. The Opposite party should duly intimate about the fate of the claim to its customer and should give proper emphasis/ care to each and every case. 

Therefore, considering the circumstances, when the OP did not settle the claim shortly after receiving letter of intimation dated 22.12.10 and the instant case has been instituted on 08.09.11 long after the intimation this Forum is of the view that there was delay and causing mental pain and harassment and it amounts to deficiency of service as defined under Section 2(1)(g) & (o) of the C.P. Act, 1986.   

 So, the complainant is entitled to get an order as prayed for.

So, it is ordered that the CC case No. 49/2011 is allowed on contest against Oriental Insurance Company Limited, i.e., both the opposite parties. The complainant is entitled to get the sum of `5, 00,000/- from the O.Ps/ insurer. Moreover, the complainant is also entitled to get compensation of `2000/- for his harassment and mental agony. We also award him `1000/- in the account of litigation cost.  

The Insurance company is directed to pay the aforesaid amount within 45 days from the date of this order; in default, an interest @ 9% p.a. shall be levied till full satisfaction from the date of filing this case, i.e., 08-09-11.

Fees paid are correct.

Furnish the true photocopies of this Final order to the parties free of cost.