Present (1) Nisha Nath Ojha,
District & Sessions Judge (Retd.)
(2) Smt. Karishma Mandal,
Member
Date of Order : 27.02.2018
Nisha Nath Ojha
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the opposite parties to pay the claim amount of Rs. 2,00,000/- ( Rs. Two Lakh only ) along with 18% interest.
- To direct the opposite parties to pay Rs. 50,000/- ( Rs. Fifty Thousand only ) as compensation.
- To direct the opposite parties to pay Rs. 20,000/- ( Rs. Twenty Thousand only ) as Litigation costs.
- To direct the opposite parties to pay Rs. 15,000/- ( Rs. Fifteen Thousand only ) as convenience Charge & other expenses.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant has asserted that her husband was insured under Janta Personal Accidental Insurance Policy of National Insurance Co. Ltd. through GTFS Club ( opposite party no. 4) vide annexure -1. Her husband was sheet seller who was hit by a red Colour Ten Wheeler on 14.11.2005 due to which he died on the spot leading to institution of FIR (annexure – 2) being Barh P.S. case no. 365/05. After death of her husband a death certificate was issued by competent authority which in the record. After investigation the police has found the occurrence true but clueless and submitted final report. The photocopy of final report has been annexed as annexure - 4.
It has been further stated that relevant papers have been submitted to opposite party no. 4 on 30.01.2016 i.e. annexure – 5 and thereafter vide annexure – 6 the claim of the complainant who is the nominee of her late husband stands rejected on the ground that the claim was filed after delay of one month and 121 days from the date of the accident of complaint petition. It has been asserted by the complainant that no member of the family was aware of insurance policy of her husband and after completion of Shradh Karm etc. the aforesaid insurance policy was found and due to which there has been delay in filing the claim.
On behalf of opposite party no. 4 a written statement has been filed written statement stating therein that as per memorandum of understanding and subsequent letter dated 17.07.2001 ( annexure – A and A/1) opposite party no. 4 is only insured facilitator and not as authorized agent or corporate agent and as such it has no liability about settlement of the claim.
In Para – 8 of written statement following facts has stated which is as follows, “that after said alleged accidental death of Mr. Ram Balak Modi his wife Mrs. Lalita Devi as a nominee claimant submitted a claim form duly completed along with the other supporting documents towards substantiation of the claim to Golden Multi services Club of G.T.F.S. who in truth after initial verification and checking furnished the said claim documents to said National Insurance Company Ltd. vide their letter dated 22.03.2006 towards settlement of the claim at an early date.”
Opposite party no. 4 in support of his assertion has annexed annexure – B with written statement from which it appears that it has forwarded the claim of the complainant to opposite party no. 2 and 3 on 22.03.2006 with several relevant documents mentioned in this annexure.
Opposite party no. 2 and 3 i.e. insurance company has also filed a written statement stating therein that in annexure – 1 of the complaint the name of insured has been written as Ram Balak Modi while in the FIR i.e. annexure – 2 his name has been mentioned as Ram Balak Prasad Barnwal which is serious discrepancy.
It has been further stated that there is no documents to show that Ram Balak Prasad Barnwal and Ram Balak Modi are the same person. In Para – 11of written statement the opposite party no. 2 and 3 had made following facts, “that the complainant has not filed any papers of intimation which shows that information was delivered to this opposite party / N.I.C. Co. Ltd. only a claim form was annexed with complaint petition, which shows same was received by G.T.F.S. on 30.01.2006 but no any receiving paper had been produced by the complainant, hence it is clear that this opposite party/N.I.C. Ltd., has no knowledge regarding the claim of the complainant and as well as it is also automatically cleared that information was not made within prescribed time, i.e. one month as per the rule/Act of the Insurance Policy.”
We have narrated the fact asserted by the respective parties in the forgoing paragraphs.
So far insurance policy annexure – 1 is concerned it has not been disputed by any of opposite parties.
It has been stated by opposite party no. 2 and 3 that in insurance policy i.e. annexure – A the name of the deceased has been mentioned as Ram Balak Modi while in FIR i.e. annexure – 2 his name has been mentioned as Ram Balak Prasad Barnwal and there is no documents to show that both are same persons.
It goes in without saying that competent authority has issued death certificate in which the name of deceased Ram Balak Modi.
Apart from it even the employee of opposite party no. 2 and 3 would have verified this fact after instituting enquiry in this regard or they would have directed the complainant to get this fact verified from the concerned Police Station.
In our opinion this ground is nothing but vague pertext of not allowing claim by opposite party no. 2 and 3.
It has been further stated by the complainant that as no member of the family of deceased was in the knowledge of insurance policy of deceased which was later on found when the Shradh ceremony etc. was over and due to this there has been delay.
In our opinion this explanation is sufficient to condon the delay because complainant and deceased belong to lower state of the society having no knowledge of law etc.
The complainant has stated that she had submitted duly filled personal accident claim form before opposite party no. 3 through opposite party no. 4 which has been annexed as annexure – 5. Annexure – 5 bears the date of 05.01.2006. Opposite party no. 4 has asserted that after initial verification and checking the claim form was forwarded to opposite party no. 2 and 3 vide letter dated 22.03.2006 which has been annexed as annexure – B.
From bare perusal of annexure – B it is crystal clear that claim form was forwarded with seven documents mentioned in this annexure.
The opposite party no. 2 and 3 have stated that complainant has not filed any papers of intimation rather a claim form was annexed with complaint petition which appears to be have been received by GTFS on 30.01.2006 but no any receiving paper has been produced by complainant.
It is surprising that from bare perusal of annexure – B dated 22.03.2006 of GTFS, it is clear that seven papers were sent to opposite party no. 2 and 3 because on this annexure there is a stamp of National Insurance Co. Ltd. dated 23.03.2006. from which it transpires that annexure – B with seven documents mentioned in it have been received by National Insurance Co. Ltd. apart from it the existence of annexure – B has not been denied by opposite party no. 2 and 3.
Hence we feel that authority of opposite party no. 2 and 3 must investigate the very fact that letter dated 22.03.2006 i.e. annexure – B containing seven documents were received by whom because the stamp of the opposite party no. 2 and 3 over annexure – B bears the signature of the employee concerned who has received this and look into the matter with sympathy.
The complainant is also at liberty to file appropriate representation before opposite party no. 2 and 3 for reddressal of her grievance which must be considered by opposite party no. 2 and 3 in the light of aforementioned discussion and finding and taking into consideration that they are welfare institution and as such they are bound to consider the application of complainant with sympathy.
We further direct the opposite party no. 2 and 3 that all the exercises by the officials of opposite party no. 2 and 3 with regard to enquiry or disposal of the representation of the complainant if filed, must be concluded within the period of three months from the date of receipt of this order or certified copy of this order.
Accordingly, this case stands disposed off with aforementioned direction.
Member President
