Date of Order : 25.02.2017
- In the instant case the Complainant has sought for following reliefs against the Opposite party:-
- To direct the National Insurance Co. Ltd. Opposite party no. 1 to pay the sum assured amount of Rs. 2,00,000/- ( Rs. Two Lack only ).
- To direct the opposite party no. 1 to pay Rs. 50,000/- ( Rs. Fifty thousand only ) as compensation.
- To direct the opposite party no. 1 to pay Rs. 10,000/- ( Rs. Ten Thousand only ) as litigation costs.
- The facts of this case lies in a narrow compass which is as follows:-
The complainant has asserted that her husband Krishna Prasad took a Janta Personal Accident Policy through opposite party no. 3. Opposite party no. 3 after verifying all the relevant documents in accordance with law issued insurance policy vide annexure – 1. The aforesaid policy covers the risk of Rs. 2,00,000/- and was effective from 31.03.2003 to 30.03.2018. The premium etc. was deposited by her husband and being the wife of the policy holder she was also nominee of policy.
The further case of the complainant is that on 31.03.2004 while her husband was returning from his office on his scooter suddenly his scooter sliped and he fell into canal and died after drowning in the water. Thereafter F.I.R. was lodged before Alamganj Police on 01.04.2004 giving rise to Alamganj P.S. Case no. 3/04 dated 01.04.2004 as will appear from annexure – 2 and 2/1.
The complainant thereafter filed an application to opposite party no. 3 on 06.04.2004 on which opposite party no. 3 i.e. G.T.F.S. issued claim form to the complainant and thereafter complainant submitted the claim form along with documents available with her to opposite party no. 3 on 17.05.2004. The opposite party no. 3 then vide letter dated 26.07.2004 directed the complainant to submit some requisite documents which has been submitted as per availability with the complainant on 11.07.2005 and thereafter opposite party no. 3 granted receipt which has been annexed as annexure – 3. The opposite party no. 1 vide letter dated 20.01.2008 directed to submit viscera report vide annexure – 4 the complainant could not procure the aforesaid report which is the part of postmortem which ought to be send by Doctors on the request of police. The complainant could not procure viscera report of her husband because she could not interfere with the Government agency. This fact she had informed the opposite party no. 1 orally and she met insurance officials at Kolkatta. Thereafter she got a letter dated 13.02.2009 vide annexure – 5 from opposite party no. 1 stating therein that if she could not produce the above mentioned report within 20 days then they will close the file as no claim as will appear from annexure – 5.
She had further asserted that the opposite party no. 1 had appointed one Navneet Ranjan as investigator of the complainant as will appears from annexure – 6 and thereafter opposite party no. 1 is sitting tight over the matter from last five years.
On behalf of opposite party no. 3 a written statement has been filed admitting the issuance of insurance policy on behalf by opposite party no. 1. It has been asserted by opposite party no. 3 that no liability for the payment is attached to the opposite party no. 3 because opposite party no. 3 is simply insured facilitator. In Para – 9 and 10 of the written statement opposite party no. 3 admitted the case of the complainant and stated that the complainant as nominee of the claimant submitted a claim form duly completed along with other supporting documents towards substantiation of the claim and thereafter the opposite party no. 3 after initial verification and checking “Furnish the said claim documents to National Insurance Company Ltd., Division – III vide letter dated 09.09.2005 to enable then to process the settlement of the claim at an early date vide annexure – B.”
In Para – 11 of the written statement the opposite party no. 3 has asserted as follows, “that National Insurance Company Limited Division issued a letter dated 03.11.2006 i.e. after a laps of 14 months to Mr. Navnit Ranjan, insurance claim investigator, Patna seeking clarification of the accidental death of the insured person. More than 2 -3 years have already been elapsed in the meantime, the insurance company, as it appears has not yet been able to settle the claim despite receipt of the final police report and post mortem report which are said to be the most authentic documents towards settlement of a claim.”
In Para – 7 of written statement the opposite party no. 1 and 2 asserted as follows, “that as far as concern about the cause of death of the insured, in question, insured died by drowning in the deep canal only for that view the present opposite party no. 1 and 2 raised their investigator ( Mr. Nishant Ranjan)”. The canal was for drainage. What the deceased was doing there, why he had gone and how the accident had occurred.”(this letter of opposite party no. 1 and 2 has already been annexed as annexure – 5 with the complaint petition.”
In Para – 13 of the written statement the opposite party no. 1 and 2 asserted as follows, “that the present answering opposite parties are entitled for protection 64 VB of the insurance Act, because the insurance policy of the insured is yet to be verified from the office record for its genuineness.”
We have narrated the fact of the case briefly in the foregoing paragraphs.
Heard the learned counsel for the parties.
Opposite party no. 1 and 2 has not stated that annexure – 1 is not genuine rather it has been stated that they have to verify annexure – 1. It is surprising that after passing several years the opposite party no. 1 and 2 have not taken pain to verify the insurance policy contained in annexure – 1.
From bare perusal of annexure – B of written statement of opposite party no. 3 it is crystal clear that on 09.09.2005 the opposite party no. 3 has forwarded eleven documents to opposite party no. 1 for deciding the claim of the complainant.
It is most unfortunate that despite appointing an investigator by opposite party no. 1 and 2 namely Navneet Ranjan (vide Para – 7 of written statement of opposite party no. 1 and 2), the opposite party no. 1 and 2 have not taken pain to verify the entire documents submitted by the complainant which was forwarded by opposite party no. 3 vide annexure - B to the opposite party no. 1 and 2 as back 09 September 2005 rather instead of making verification of the documents containing annexure – B the opposite party no. 1 and 2 were asking the complainant to provide viscera report of her husband which she could not procure rather it was duty of Government agency to provide to the opposite party no. 1 and 2.
It goes without saying that complainant is a house wife belonging to lower class family and as such she was not capable of proving viscera report from the concerned agency.
In our opinion it is the duty of investigator or opposite party no. 1 and 2 to procure the aforesaid relevant documents i.e. viscera report etc. from the concerned agency and decide the claim of the complainant after verifying the relevant documents submitted by opposite party no. 3 to opposite party no. 1 and 2 vide annexure – B of the written statement of the opposite party no. 3.
It is most unfortunate that instead of passing final order after proper verification of the documents submitted by the complainant the opposite party no. 1 and 2 had chosen to sit idle on the pretext of non receipt of viscera report etc.
The conduct of opposite party no. 1 and 2 reflects their callous attitude and bureaucratic style which is not expected from them as they have to serve to society by allaying the suffering of people by paying the insurance amount in accordance with law.
For the discussion made above we direct opposite party no. 1 and 2 to pay Rs. 2,00,000/- ( Rs. Two Lacks only ) to the complainant within the period of two months from the date of receipt of this order or certified copy of this order failing which opposite party no. 1 and 2 will have to pay 10% interest on the above said amount of Rs. 2,00,000/- ( Rs. Two Lacks only ) till its final payment.
Opposite party no. 1 and 2 are further directed to pay Rs. 25,000/- ( Rs. Twenty Five Thousand only ) to the complainant by way of compensation and litigation costs within the period of two months.
Accordingly this complaint stands allowed the extent referred above.
Member President
