No. 5/17.09.2010

HON’BLE JUSTICE SRI PRABIR KUMAR SAMANTA, PRESIDENT.

Appellant through Mr. P. Banerjee, the Ld. Advocate, Respondent No. 1 through Mr. B. Mondal, the Ld. Advocate and Respondent No. 2 through Mr. Abhik K. Dutt, the Ld. Advocate are present.  Respondent No. 2 files BNA.

This appeal is by the Insurer against judgement and order dated 01.07.2008 passed in C.F. Case No. NAD/16/O/2007.  It is not in dispute that the Complainant was covered by an Insurance Policy issued by the Insurer under Certificate No. 01101Z040/103040844890.  Such Policy was taken under Group Janata Personal Accident Insurance Policy Scheme through the Golden Multi Services Club.  The said Policy covers accidental death/loss of limbs/permanent total disablement and offers maximum benefit of Rs.5,00,000/- in either case.   The validity period of the said Policy is from 23.01.2004 till 22.01.2019.

It has not been disputed that the Complainant met with an accident during the validity period of such insurance cover and thereby suffered a permanent disablement to the extent of 60 per cent.  It has also been established from the materials on record that the Complainant submitted his claim along with the policy papers, other relevant documents and the Discharge Certificate issued by the District Sadar Hospital showing his permanent disability is to the extent of 60 per cent.  Such claim had been received by the Divisional Manager of the Insurer on 25.10.2005.  In spite of receipt of such claim the Insurer having failed to respond to such claim the aforesaid complaint was filed before the Forum which has been disposed of by the aforesaid impugned judgemnt and order by directing the Insurer to pay to the Complainant a sum of Rs.3,00,000/- by way of insurance claim and Rs.20,000/- by way of compensation for the harassment meted out to the Complainant and mental agony suffered by him.

At the hearing of this appeal it has only been urged on behalf of the Insurer that the Insurance Policy taken by the Complainant is a Group Insurance Policy taken under Group Janata Personal Accident Insurance Policy Scheme through O.P. No. 1 and since such claim of the Complainant had not been forwarded to the Insurer through the said Golden Multi Services Club, the Agent of the Insurer, the claim so made by the Complainant was not properly raised and as such the benefit of such insurance could not be provided to the Complainant.

It is too late in the day to make such submission.  Admittedly the Complainant was covered by the Insurance Policy issued by the Insurer although such Policy was issued under Group Insurance Scheme through the O.P. No. 1.  It has also not been disputed that the claim had been received by the Insurer on 25.10.2005.  The Insurer did never ask the Complainant to make such claim by observing the formalities of making claim through the aforesaid Group Insurance Agent namely O.P. No. 1.  Such plea had also not been taken before the lower Forum.

The Insurance cover of the Complainant has not at all been disputed by the Insurance Company.   Since the claim that was raised by the Complainant had also been received by the Insurer and the Insurer did not dispute such claim on any ground whatsoever, we are not inclined to interfere with the impugned order only for the purpose of observing mere technical formalities of preferring such claim through the O.P. No. 1 as contended in this appeal.

Furthermore the Insurer in this appeal has also not contended that the claim as raised by the Complainant was either excessive or not tenable as per the insurance cover of the Complainant.  In such circumstances there is no justification to interfere with the impugned order only for the purpose of observing a technical formalities of preferring a claim through the O.P. No. 1 particularly when the said O.P. being a party to the complaint case did not raise any objection against the claim as made by the Complainant. 

For all the reasons as aforesaid we do not find any merit in this appeal.  The same is accordingly dismissed.  We further direct that the amount as awarded by the lower Forum be paid to the Complainant within 30 days from this date, in default of which the aforesaid awarded amount will carry an interest @ 18% per annum from the date of the order of the lower Forum.