FINAL ORDER

Smt. S. S. Ali

            The complainant herein is the widow of late Subrata kumar Bera of village-Jasadambur, P.O –Naikuri, P.S- Tamluk District- Purba Medinipur. She filed the instant case seeking a direction upon the opposite parties. The New India Assurance Co.Ltd, for payment of the death claim amount for the accidental death of her husband who was covered under the Group Janata Personal Accident Insurance Policy, being no. 4751040203915 from 29/04/1999 to 28/04/2014.

            The husband of the complainant died of a road accident he met with accident  on 10/08/2007 and he succumbed to his injuries on 31/08/2007. By a letter dated 17/03/2008 the complainant informed the op’s about the occurrence of the said accident, the complainant filed all necessary documents enclosed the same with the duly filled up policy claim form but no reply was received from the op’s, thereafter the complainant sent a letter dated 19/12/2009 to the insurance ombudsmen for non-settlement of the accident claim, the op in the meantime sent a letter dated05/01/2010  to the complainant, the complainant also sent a reply dated 09/03/2010 and another letter dated 12/07/2010to the op’s after duly submitting their representations but the op’s did not make any payment. The ops’ by letters dated 19/09/2011 and 19/10/2011 stated therein their inability to make payment to the complainant hence this case.

The op entered appearance and filed their WV and WNA and all documents. The op in their WV and WNA stated that the case is bad for non-joinder and /or miss-joinder of parties and stated that the complainant has already received a sum of RS 12,00,000/- along with interest @9% in MACC case no 55/08awarde by the Motor Accident Claim Tribunal and as such for the same accident the complainant is not entitled to any compensation in this present case.

Now the points in issue are as follows :-

1. Whether there is any deficiency in service in settling the  claim of the complainant?

2.  Whether the complainant is entitled to any compensation as claimed for from the opposite parties?

Decision  with reasons

Point nos. 1&2:

Both these points are taken up together for the sake of convenience of discussion.

The fact of the case as stated by the complainant it is appears that the husband of the complainant died on 10/08/2007 to prove  her case she filed the discharge certificate of Ekbalpore nursing home, Death certificate of Subrata k. Bera, Letters & correspondences  with the opposite parties. Ongoing through the case and the documents filed we find that the complainant informed the op’s about the death her husband by letter dated 17/3/08 but the op’s herein by their letters dated 19/9/11 and 19/10/11 informed the complainant of their inability to make payment of the death claim to the heirs of the complainant i.e after a lapse 3years 6months and after 1year 9months after seeking for representation by letter dated 5/01/10. Moreover it’s the op no 1& 2 who issued certificate to the insurer which is covered under the said policy under the definition of Group Janata personal Accident Insurance Policy issued in the name of P.M System &Financial Services Pvt Ltd.

            In case of third party insurance the insured in no manner should suffer from  any hardship in getting back his insured sum if he presented all relevant documents along with the claim form. In the instant case the complainant informed the op about the incident on 17/3/08 and the op replied to the same on 19/09/11 stating their inability after a lapse of 3years 6 months which is in itself a deficiency in service towards the complainant, and the argument made on behalf of the op that the complainant is not entitled claim any compensation from the insurance company as she has already received a compensation in MACC case 55/08 which is not tenable in the eye of law as because the tribunal awarded the  compensation in MACC case from the insurance company of the offending vehicle as a penalty which has no connection with this case as such with the claim made herein by  the same is from the insurance under whom the deceased was insured by paying premium and his heirs i.e the complainant is legally entitled to the same after his demise. We therefore decide both the issues in favor of the complainant. The complainant is entitled to get back the sum assured i.e RS 100000/- to be payable by the ops also Rs 10000/- as compensation for the their inordinate delay and RS 2000/- litigation cost within 40 days from the date of this order in default interest @9% on the total sum from the date of filling of the case till realization.

The complainant shall be at liberty to execute the above order after the said time period.

                         Hence it is,

Ordered

the complainant is entitled to get back the sum assured i.e Rs 100000/- to be payable by the OPs, also Rs 10000/- as compensation for the their inordinate delay and RS 2000/- litigation cost within 40 days from the date of this order; in default interest @9% on the total sum from the date of filling of the case till realization is payable by the OPs to the complainant.