The complainant Smt. Anita Devi alias Nitu Devi has filed this complaint petition against Reliance General Insurance Company Limited, Jawaharlal Nehru Road Kolkata and two others (o.ps) for realization of Rs. 1 lacs/- as sum assured, Rs.15000/- as compensation for harassment, inconvenience, frustration and mental agony with 12 % p.a. interest against insured amount since 30-09-2010 till payment and cost of the case.
The brief facts, of the case is that the husband of the complainant namely Devendra Kr. Alias Denvendra Rai alias Devendra Prasad since ( deceased, ) was insured with o.p no.-1 Reliance General Insurance Company Limited, under caption Group Personal Accident policy vide policy No.- 150330291400018 for the period of from 16-04-2010 to 15-04-2011 through o.p No.- 1 & 2 for sum of Rs. 1 lacs/-. The further case is that the complainant is nominee in the aforesaid policy. The further case is that on 25-09-2010 at about 3 P.M., husband of the complainant namely Devendra Kr was coming to Minapur, Muzaffarpur by a motor cycle, when he reached at Ali Neura bridge, a tractor bearing registration No. BR06-5285 dashed to his moter cycle and resulting of which Devendra Kr alias Devendra Rai alias Devendra Prasad got serious injury and he died on spot. After death of her husband, the complainant submitted claim form with required documents to o.p no.-2 for settlement of claim of complainant vide letter no.-06275 dated 20-10-2010. The further case is that o.p no.-1 repudiated the claim of the complainant vide letter no.- 06-12-2010 on the ground that the intimation was received to him after 45 days after the reported death and as per policy the name of deceased was Devendra Kr. Whereas papers / documents submitted in the name of Devendra Rai/ or Devendra Pd.
The complainant has filed the following documents with the complaint petition- Photocopy of Personal Accident Insurance Claim Form -annexure-1-, photocopy of Id. Card of GTFS Multi Services Ltd. annexure-2, photocopy of FIR of Minapur P.S. Case no.-258/2010 –annexure-3, photocopy of P.M. Report annexure-4, photocopy of Death Certificate –annexure-5, photocopy of letters send by o.p no.- 2 to o.p no. 1 – annexure- 6 & 7.
On issuance of notices, o.p no.1 appeared on 26-11-2012 but he didn’t file his w.s., so he was debarred from filing w.s vide order dated 11-06-2013.
O.P. No. 2 & 3 appeared and filed their w.s. on 02-06-2012 with prayer to expunge/struck down their names from the complaint petition. Receiving of Personal Accident Insurance Coverage from Reliance General Insurance Company Limited, through the facilitation of G.T.F.S Multi Services Ltd. is an admitted fact. It is also an admitted fact that the period of policy was from 16-04-2010 to 15-04-2011 with sum insured of Rs. 1 lacs/- and Anita Devi is the nominee in the same. It has been further mentioned in the w.s. that as per tie-up of arrangement between Reliance General Insurance Company Ltd. Himalaya house 5th floor 38 B, Jawaharlal Nehru Road Kolkata, and answering o.ps G.T.F.S Multi Services Ltd., the Insurance Coverage was extended by G.T.F.S Multi services Ltd. to its Member Mr. Devendra Kumar under the said Group Personal Accident Insurance Policy and Reliance General Insurance Company Ltd. have an exclusive right and authority to entertain, process and settle such claims . It has been further mentioned that G.T.F.S Multi Services Ltd. have no role to play in this regard or any authority being vested to them in so for as claim settlement/payment of insurance claim/ delayed settlement of claim/ rejection of the same is concerned. Hence there is no deficiency in service on his part. It has been further mentioned that he had received death intimation with respect to Devendra Kumar from Mrs. Anita Devi and he had submitted the same to Reliance General Insurance Company Ltd., Kolkata on 06-10-2010. It has been further mentioned that o.p no.-2 had also requested Anita Devi to submit the attested copy of I.D. Card, Death Certificate, FIR, Postmortem Report, Bank passbook, etc. in support of the Accidental claim. They have annexed the copy of letter dated 06-10-2010 as annexure-I. It has been further mentioned that on 20-10-2010, after receiving of the required documents from nominee he had submitted all those documents to Reliance General Insurance Company Ltd. with copy to Anita Devi. It has been further mentioned that Reliance General Insurance Company, repudiated the claim of the complainant on the ground with they have received the death intimation after 45 days after the reported death of loss which is a gross violation of the maximum prescribed time limit as set out for the policy as 20 days. He has also annexed copy of letter dated 20-10-2010 as annexure-II. They have further mentioned in the w.s. that G.T.F.S Multi services Ltd vide letter dated 04-03-2011, in turn had intimated Reliance General Insurance Company that the claimant submitted the death intimation on 08-10-10 within time limit of 20 days and requested them to proceed with the settlement of death claim at the earliest. The copy of letter dated 04-03-2011. has been annexed as annexure-III.
On issuance of policy in the name of Devendra Kr. (under a Group caption scheme by o.p no.-1 through o.p no.-2) is an admitted fact. It is also an admitted fact that Anita Devi is nominee in the aforesaid policy. The complainant has annexed the repudiation letter of o.p no.-1 as annexure-7. The Reliance General Insurance Company, Jawaharlal Nehru Kolkata has repudiated the claim of the complainant on two grounds i.e the intimation was received by him 45 days after the reported date of loss which is grossly violated the maximum time limit specified in the policy for intimation of loss annexure-. The nominee of deceased as per policy was Devendra Kr. Whereas papers / documents supported are in the name of Devendra Rai or Devendra Pd.
As regards ground for repudiation no.-1 ie. Receiving of intimation after 45 days from the reported date of loss, the o.p nos.- 2 & 3 have mentioned at page-3 of their w.s. that he had received intimation letter regarding death of insured on 06-10-2010 and he had submitted the same to Reliance General Insurance Company. O.p nos.- 2 & 3 have annexed the letter dated 06-10-2010 as annexure-I which supports the version of o.p no.- 2 & 3. O.p no.- 2 & 3 has annexed the o.p nos.- 2 & 3 have also mentioned on the same page of his w.s. that they had also requested to Anita Devi to submit the attested copy of I.D. Card, death certificate, FIR postmortem report and bank pass book, etc. in support of accidental death and she had filed the above document on 21-10-2010 and he had also forwarded the same to the Reliance General Insurance Company vide his letter dated 20-10-2010. A copy of the aforesaid letter has also been annexed by the o.p no.- 2 & 3 as annexure-II. The o.p No. 2 & 3 has also mentioned at the same page of their w.s. that after repudiation of the claim of Anita Devi, he had also intimated to o.p nos.- 2 & 3 that the intimation of death was received to them within prescribed period of 20 days and for this they have also annexed the letter dated 04-03-2011 as annexure-III, also support the version of o.p no.- 2 & 3, as mentioned in their w.s. On the other hand o.p no.-1 has not filed any w.s. nor he has adduced any evidence in support of his contention that he received the intimation of death after 45 days. So, it transpires that the version of o.p. no.-1 mentioned in repudiation letter with regards to late receiving of death claim is baseless and without any cogent evidence.
As regards second plea for repudiation of the claim, Anita Devi is nominee in the policy and this has been admitted by o.ps no.- 2 & 3. They have not raised any objection regarding the death claim filed by Anita Devi. The claimant has been mentioned the alias name of Devendra Kr., & Devendra Rai alias Devendra Pd. In the complaint petition and she has supported the same by affidavit.
No evidence has adduced on behalf of o.p no.- 1 nor he has filed their any w.s. to support the above facts of repudiation so this ground is also hopeless and having no leg to stand.
On the basis of above discussions we are of the considered opinion that there is deficiency on the part of o.p no.-1 for repudiation of claim of the complainant. O.p no.- 2 & 3 has discharged their duties in the proper manner, so they are not responsible to pay the claimed amount.
Accordingly, the complaint petition is allowed and the o.p no.-1 is directed to pay Rs. 1 lacs/- as sum assured, with 7 % p.a. interest from the death of filing of claim petition i.e 28-03-2012, Rs.15,000/- as physical and mental harassment, and Rs. 5000/- as litigation cost within two months from the date of order/, on failure they shall be responsible to pay the above amount with 8 % p.a. interest till realization. Let a copy of this order to be furnished to both the parties as per rule.
