STATE CONSUMER DISPUTE REDRESSAL COMMISSION
BIHAR, PATNA
Appeal No. 384 of 2016
1. Managing Director, Star Health and allied Insurance Company Ltd. Nangambakkam, Chennai-600034
2. The Regional Manager, Star Health and allied Insurance Co. Ltd. Agarkhan Chowk, Andheri East Bombay- 400069, through its authorized signatory, Senior Branch Manager, Star Health and allied Insurance Co. Ltd, 3rd Floor, Grand Plaza, Dak Bunglow Chauraha, Fraser Road, Patna
.… Appellants
Versus
Sharadha Devi, W/o- Late Mangal Prasad, R/o- Village- Haraiya, PO- Sakhekhas, PS- Uchakagaon, District- Gopalganj (Bihar)
…. Respondent
Counsel for the Appellant: Adv. Lal Chandra Lal Das
Counsel for the Respondent: Adv. Chandra Kant & Adv. Navin Kumar
Before,
Hon’ble Mr. Justice Sanjay Kumar, President
Mr. Ram Prawesh Das, Member
Dated 16.02.2023
As per Sanjay Kumar, President.
O r d e r
Present appeal has been filed on behalf of appellants/Opposite parties Star Health and Allied Insurance Company Ltd. for setting aside the judgment and order dated 30.04.2016 passed in Complaint Case no. 97 of 2013 passed by Ld. District Consumer Forum, Gopalganj whereby and whereunder the complaint case filed on behalf of complainant has been allowed and the appellants have been directed to pay sum assured amount of Rs. 10,00,000/- (Ten lacs) with interest @9% p.a. from the date of filing of the complaint case with further direction to pay compensation of Rs. 50,000/- (fifty thousand) for mental and physical harassment and Rs. 10,000/- (ten thousand) as cost of litigation within two months from the date of order failing which interest @9% per annum shall become payable.
Briefly stated the facts of the case is that son of complainant Ajay Kumar aged about 26 years had taken insurance policy during his lifetime under Pravasi Bhartiye Bima Yojna policy 2006 for sum assured amount of Rs. 10,00,000/- and same was valid for two years from 21.12.2009 to 20.012.2011. Complainant who is mother of insured is nominee in the insurance policy. As per terms & conditions of policy in the event of accidental death of the insured during period of validity the nominee will get sum assured of Rs. 10,00,000/- from the insurance company.
Insured Ajay Kumar went to Muscat on 23.12.2009 and was employed at Saltanat of Oman and working as a carpenter under M/s Aday Oman W.L.L. He had an Indian passport. The insured Ajay Kumar died on 23.11.2011 at Muscat in an accident within the period of validity of insurance policy. Death certificate was issued dated 10.12.2011 under the seal and signature of Director of Royal Oman police. After observing the required formalities, the dead body of the insured was transported to India through one of his co-villager at the instance of Embassy of India, Muscat. A certificate was also issued regarding absence of any infectious disease at the time of death. The dead body was received on 19.12.2011 by family members and co-villagers and last rites of deceased was performed according to Hindu rites and customs on 20.11.2011 at his village and Shradh ceremony was also performed in the village.
Complainant being mother and nominee under the insurance policy claimed sum assured amount of Rs. 10,00,000/- from the insurance company by sending claim form through registered post enclosing all the relevant documents for early settlement of her claim. No steps were taken by the insurance company to settle the claim even after sending reminders to the insurance company, the complainant filed complaint case before the District Consumer Forum, for payment of sum assured amount as well as compensation for physical and mental harassment and cost of litigation.
Notices were issued to the opposite parties and they appeared and filed their written statement stating therein that the complaint is premature as complainant never submitted her claim form for settlement alongwith necessary documents before the opposite parties. Opposite parties also denied regarding any intimation of death of insured. However, they admitted insurance of the deceased and claimant to be nominee in said insurance policy and expressed their willingness to settle her claim if relevant documents is provided by the claimant i.e Claim form duly filled, FIR, Postmortem report, Legal heir certificate, place, time and date of accident and cause of accident, English translation of all certificate issued by the Kingdom of Saudi Arabia, original insurance policy, letter from employee furnishing the details of accident, copy of passport.
In support of her claim case complainant has filed evidence on affidavit and all witnesses have supported the claim of complainant. Apart from evidence on affidavit complainant has filed documentary evidence in support of her claim case which are: Exibit-1 (insurance Policy schedule which demonstrate that insurance policy was valid from 21.12.2009 to 20.12.2011), Exhibit-2 (Passport of insured), Exhibit- 3 (Air ticket receipt), Exhibit-4 (VISA), Exhibit-5 (Death certificate), Exhibit-7 (Certificate issued by Embassy of India at Muscat), Exhibit- 8 (certificate regarding absence of any infectious disease), Exhibit-9 (contents of coffin and sealing issued by Royal Oman Police), Exhibit-9 (Cause of death as multiple injuries), Exhibit-10 (Embalming and sealing certificate issued by Royal Oman Police), Exhibit-11 (Airway bill), Exhibit-12 (Airway bill with name of consignee as Munna Kumar Singh), Exhibit-13 (Certificate issued by Mukhiya), Exhibit-14 (Certificate of receiving dead body of insured and cremation of dead body), Exhibit-15 (Taxi receipt), Exhibit-15 (Dead body brought to Hararaiya, Gopalganj from Patna), Exhibit-16 (Legal heir certificate), Exhibit-17 (handing over of dead body of insured to the complainant), Exhibit-18/A (Reminder letter with postal receipt), Exhibit-18/B (Second reminder letter with postal receipt), Exhibit-18C (Third reminder letter with postal receipt).
The District Consumer Forum after hearing the parties and considering the materials available on record held that the appellant insurance company had received the claim form along with all relevant documents required for settlement of the claim but did not settle the claim even after two years as a result of which complainant was compelled to approach the District Consumer Forum for payment of sum assured amount which reflects deficiency in service of the appellant-insurance company. The District Consumer Forum found the claim of claimant genuine and all supportive documents to support her claim has been place before the Consumer Forum for settlement of claim and accordingly directed the appellant-insurance company to pay the sum assured amount to the complainant with interest @9% p.a from the date of filing of complaint case and further directed to pay Rs. 50,000/- as compensation for physical and mental harassment and Rs. 10,000/- as cost of litigation.
Aggrieved by judgment and order dated 30.04.2016 passed by District Consumer Forum, Gopalganj, appellant insurance company has preferred this appeal.
Counsel for the appellants submitted that there were disputed question of fact which could not be decided in summary procedure before Consumer Forum. It has been further argued that the claim of claimant has not been repudiated by the insurance company as such the complaint case was premature.
Heard counsel for the parties.
The District Consumer Forum has properly assessed and appreciated the oral as well as documentary evidence placed before it and has arrived at the conclusion that all relevant papers as well as claim form was sent to insurance company and in support of which postal receipts were exhibited and there is presumption that documents send by registered post reaches its destination unless contrary is established. Appellants nowhere have doubted the authenticity and genuinity of the documents exhibited before the District Consumer Forum on basis of which claim of complainant has been allowed.
On the basis of evidences placed before the District Consumer Forum, complainant has been successful in establishing her case as made out in her complaint petition. There were ample evidence on the record to demonstrate that deceased son had taken Pravasi Bhartiye Bima Yojna policy 2006 for sum assured amount of Rs. 10,00,000/- and validity of policy of insurance was for the period from 21.12.2009 to 20.012.2011 and during said period insured Ajay Kumar met an accidental death on 23.11.2011 in Muscat and thereafter his dead body was transported to his native village where he was cremated and complainant being nominee in the insurance policy was entitled to get the sum assured amount of Rs. 10,00,000/- which was denied by the appellant-insurance company on one pretext or other and did not settle her claim for more than two years on the ground that they have not received the claim form and required documents although, several registered postal receipts evidencing sending of claim form along with required documents were placed before the District Consumer Forum. District Consumer Forum has rightly disbelieved the stand of the appellant-insurance company that no document and claim form was received by them to settle the claim and allowed the claim case.
There is no such disputed facts in this case which cannot be decided in summary procedure and District Consumer Forum has rightly decided the complaint case. Once the District Consumer Forum has decided the claim after hearing and considering the rival contention of parties and appreciating evidences placed on record nothing remain to be decided by the insurance company and they are bound to comply the judicial order.
There is no merit in this appeal and is accordingly, dismissed.
(Ram Prawesh Das) (Sanjay Kumar,J)
Member President
Md. Fariduzzama
