Jharkhand

Bokaro

CC/17/76

Brajandra Kumar - Complainant(s)

Versus

Secretary, Bokaro Steel Samuhik Durghatna Bima Samittee - Opp.Party(s)

Sanjay Kumar Mishra

08 May 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-05-05-2017

Date of final hearing-08-05-2023

 Date of Order-08-05-2023

Case No. 76/2017

Sri Brajendra Kumar

R/o- Sector-9/D, Qr.No. 1329, Street-38,

Bokaro Steel City, 827009

                                      Vrs.

1. The Secretary, The Bokaro Steel Samuhik Durghatna Samiti,

   Purana Prashasnik Bhavan, Bokaro Steel Plant.

B.S.City, District- Bokaro, 827001

2.  Branch, Manager, Reliance General Insurance Co. Pvt.  Ltd.

        R. Care Personal Accident Team, Office-Hyderabad

3. The Branch Manager, Reliance General Insurance Co. Ltd.

3^rd Floor, M-5, City Centre, Sector-4, Bokaro Steel City.

 

Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

 

PER- J.P.N Pandey, President

-:Order:-

1. Complainant’s case in brief is that he was SAIL/BSL, Bokaro Employee vide Staff No. 491506 and he was a member of M/S Bokaro Steel Durghatna Bima Samitee sponsored by Reliance General Insurance Co. Ltd. registered office Kolkata. Further case is that during working on 23.05.2015  the complainant met with an accident and became injured who was treated at Bokaro General Hospital ( in short BGH) since 23.05.2015 to 30.05.2015 and on his request he was discharged on 01.06.2015 and went to Cuttack Ashwini Hospital where he was admitted on 02.06.2015 and discharged on 16.06.2015 with direction to take complete bed rest under supervision of doctor. Further case is that mean while complainant gave information to the O.Ps. who gave information through  letter No. 488 dt. 19.09.2015 to the O.P. who was directed vide letter dt. 01.04.2016 to deposit the paper related to disablement till 16.05.2016 accordingly he deposited the letter on 15.04.2016 which was forwarded to the O.P. Further case is that on 24.06.2016 disablement certificate was issued by the Medical Board and its photo copy was made available to the O.P. vide letter No. 454 dt. 03.08.2016 but claim of the complainant has been rejected on the ground that it was filed with 121 days delay though it was required to be intimated within 45 days from the date of accident. Hence this case has been filed with prayer to direct the O.Ps. to pay Rs. 1,50,000/- as claim  compensation, Rs. 1,00,000/- for compensation related to various type of harassments and Rs. 20,000/- as litigation cost.
2. O.P. No.1 Secretary, Bokaro Steel Samuhik Durghatna Bima Samitee, SAIL/ BSL has not filed W.S. inspite of appearance on 06.10.2017 hence vide order dt. 29.08.2018 he has been debarred from filing W.S.
3. O.P. No.2 & 3 M/s Reliance General Insurance Co. Ltd. have filed W.S. mentioning therein that case has been filed after prescribed period of limitation and claim has been repudiated on the ground related to delay in intimation regarding accident  and also delay in filing the claim. Further reply is that as per policy claimant is bound to produce the documents within 365 days for compliance of claim who has not procured the documents hence he violated the terms and conditions of the policy. Further reply is that intimation about accident must be reported to the O.P. within one calendar month which was not given after the accident and there is no report to the Police .  Hence it is prayed to dismiss the case.
4. Point for consideration is whether complainant is entitled to get relief as prayed ?
5. To prove its case complainant has filed photo copy of Injury on works report (running page No.-8), photo copy of discharge ticket issued by BGH (running page No.-9), photo copy of discharge ticket and other papers issued by Ashwini Hospital, Cuttack (running page No.-10 to 13), photo copy of letter No. 618 dt. 01.04.2016 of Bokaro Steel Samuhik Durghatna Bima Samiti (running page No.-14), photo copy of letter written by the complainant to the officials of O.P. No.1  (running page No.-15), photo copy of claim form  (running page No.-16), photo copy of Medical Certificate (running page No.-17), photo copy of disability certificate issued by BGH (running page No.-18), photo copy of Legal Notice dt. 16.03.2017 and 23.02.2017  (running page No.-19 to 26), photo copy of Fitness Certificate  issued by Ashwinin Hospital, Cuttak (running page No.-27), photo copy of Fitness Certificate  issued by BGH (running page No.-28), photo copy of enter departmental letter dt. 13.10.2016  (running page No.-29), photo copy of  letter No. 1173 dt. 14.10.2016 by which intimation regarding repudiation of claim has been given by the Dept. concerned (running page No.-30) and photo copy of repudiation letter dt. 28.09.2016 (running page No.-31), photo copy of letter dt. 05.11.2016 written to O.P. No.2 & 3  (Running page No. 32), photo copy of intimation letter dt. 30.01.2017 given by the Dept. concerned to the complainant and claim repudiation letter dt. 13.01.2017 (Running page No. 33 and 34).
6.  On careful scrutiny of the pleadings of the parties it is very much clear that the fact related to employment of the complainant as claimed in  the complaint petition and the fact related to accident during working are not disputed  facts by the O.P. No.2 & 3 and they have not denied  the fact that complainant  was covering with the insurance policy and accordingly his claim was forwarded to the insurance co. for consideration.
7. It is also admitted fact of both the parties that there is delay in transmission of intimation regarding intimation about accident as well as submission of claim form from the date of accident.  But as per complainant he was under treatment during that very period and was advised to take complete bed rest under supervision of the doctor.  Therefore, it is very much clear and established that complainant sustained injuries  due to accident during working and he was under treatment till 29.10.2015.
8. On careful perusal of running page No. 9 to 13, 27 & 28 it is being established that since 23.05.2015 till 29.10.2015 complainant was under treatment for the injuries suffered during accident. On careful perusal of running page No. 17 & 18 of the complaint petition it is establishing the fact that due to that very accident occurred on 23.05.2015 complainant sustained injuries and suffered with permanent disablement of 25% and disablement certificate was issued on 24.06.2016. It is therefore very much clear that from the issuance of disablement certificate there is no delay on the part of the complainant in filing the claim before the O.Ps. On perusal of running page No. 14 it appears that it is copy of letter No.  618 dt. 01.04.2016 issued by Secretary, Bokaro Steel Samuhik Durghatna Bima Samitee, Bokaro by which complainant was directed to deposit all papers till 16.05.2016. This letter also shows that complainant has complied it within time.
9.  The sole ground for rejection of the claim is delay in filing of the claim before the competent authority. Ld. Counsel for the complainant has filed photo copy of  the circular of INSURNACE REGULATORY AND DEVELOPMENT AUTHORITY dt. 20.09.2011 Ref-IRDA/HLTH/MISC/CIR/216/09/2011 by which “IRDA has advised all insurers to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the Insurers must not repudiate such claim unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time”. On careful perusal of the direction it appears that O.P. No.2 & 3  have not followed the directions of his regulator rather he has violated it.
10. On careful perusal of the circular of IRDA and the facts and circumstance of this case it is very much apparent that here in this case there was reasonable explanation of the complainant for condonation of delay. Therefore, we are of the view that mere on the ground of delay in intimation or submission of the claim it was not justifiable for the O.P. No.2 & 3  to repudiate the claim. So far delay in filling this case is concerned it is very much clear that last repudiation letter was issued on 13.01.2017 by the O.P. No.2 & 3  and this case has been filed on 05.05.2017 in this way it is very much clear that case has been filed very promptly within prescribed period of limitation from the cause of action.  Hence we are of the opinion that complainant is entitled to get relief as claimed to the some extent. Accordingly this point is being decided in favour of the complainant.
11. As per terms and conditions of the Insurance policy in respect to permanent or partial disablement including due to fracture, the amount of the claim will be according to percentage assessed by the BGH Medical Board. It is admitted fact that complainant was working as non executive in the BSL and sum assured for such official was Rs. 5,00,000/- only hence on permanent disablement of 25% only 25% of the sum assured will be payable. Hence claim is liable to be accepted only for Rs. 1,25,000/- i.e. the 25% of Rs. 5,00,000/- in respect to permanent disablement.
12. Hence prayer is being allowed in the following manner:-

O.P. No.2 & 3 Reliance General Insurance Co. Ltd. are directed to pay Rs. 1,25,000/- to the complainant on account of his 25% permanent disablement. Said payment must be made within 60 days from receipt/production of copy of this order failing which complainant will be entitled to receive interest on that very amount @ 10% per annum from 05.05.2017 (i.e. the date on which case was filed). Further O.P. No.2 & 3 are directed to pay compensation of Rs. 10,000/- on account of various type of harassment and also to pay Rs. 5,000/- as litigation cost within above mentioned period.

 

 

(J.P.N. Pandey)

                                                                                      President

 

 

                                                                            

                  

                                                                               (Baby Kumari)

                                                                                       Member