Jharkhand

Bokaro

CC/18/68

Sabitri Devi - Complainant(s)

Versus

The Secretary, Bokaro Steel Samuhik Durghatna Bima Samittee - Opp.Party(s)

Nimai Gope

21 Apr 2023

ORDER

                District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-12-06-2018

Date of final hearing-21-04-2023

 Date of Order-21-04-2023

Case No. 68/2018

Sabitri Devi W/o Late Santosh Mahto,

R/o Sector-2/C, Qr.No-2-354, District- Bokaro, Jharkhand

Vs.

1. The Secretary,

M/s Bokaro Steel Samuhik Durghatna Bima Samitee,

Room-45, Old Adm. Building, District- Bokaro, Jharkhand

2.The Managing Director (Health & P.A. Claim East),

Reliance General Insuarnace Co. Ltd., Himalaya House,

8.  

 

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-:Order:-

1. Complainant’s case in brief is that her husband late Santosh Mahto was BSL, Bokaro Employee vide Staff No. 635899 posted at SMS I Deptt. and he was a member of M/S Bokaro Steel Durghatna Bima Samitee sponsored by Reliance General Insurance Co. Ltd. registered office Kolkata. Further case is that during working in the plant on 11.05.2017 the husband of the complainant met with an accident and died on spot for which case was lodged. Further case is that inspite of filing of death claim for payment it has been refused on the ground related to late intimation. Further ground is that on account of death of the husband complainant was suffering with shock and anxiety however she has submitted a petition to the Department for her sufferings. Hence it is prayed to direct the O.P. to pay Rs. 5,00,000/- as compensation and Rs. 50,000/- compensation for harassment and litigation cost.
2. O.P. No.1 Secretary, Bokaro Steel Samuhik Durghatna Bima Samitee, SAIL/ BSL has filed W.S. admitting the fact that deceased Santosh Mahto died on 11.05.2017 at 06:30 A.M. during working at work place who was being covered by the Durghatna Bima Policy. Further reply is that intimation about his death was received on 11.12.2017 with delay of 214 days from the date of accident and claim form was received on 16.02.2018 which was send to the Insurance Co. on 17.02.2018 but Insurance Co. has repudiated the claim for the reason related to delay of 214 days in intimation and 282 days in submission of claim form. However, this O.P. is only coordinator and not liable to pay the claim.
3. O.P. No.2 M/s Reliance General Insurance Co. Ltd. has filed W.S. mentioning  therein that case has been filed after prescribed period of limitation and claim has been repudiated on the ground related to 7 months delay in intimation regarding death and also delay in filing the claim. This O.P. has denied that the deceased Santosh Mahto was insured with this O.P.
4. Point for consideration is whether complainant is entitled to get relief as prayed ?
5. To prove its case complainant has filed photo copy of her Adhar Card (Annexure-1), photo copy of application dt. 27.05.2017 addressed to DGM, BSL (Annexure-2), photo copy of her Medical book (Annexure-3), photo copy of death intimation application  which was received in the office of concerned authority on 04.12.2017 (Annexure-4), photo copy of her Adhar Card of the deceased Santosh Mahto (Annexure-5), photo copy of her death certificate issued from BSL, as well as State Authority (Annexure-6), photo copy of separation order showing family members of the deceased dt. 15.05.2017 (Annexure-7), photo copy of papers related to UD Case No. 03/2017 including photo copy of order sheet, FIR, Final Report, Fardbayan, inquest report (Annexure-8 series), photo copy of post mortem report  (Annexure-9), photo copy of intimation letter dt. 11.12.2017 with photo copy of claim form, medical certificate, inter department correspondence  (Annexure-10 & 11) have been filed.
6. On the  other hand no any document has been filed by the O.Ps.
7. On careful scrutiny of the pleadings of the parties it is very much clear that the fact related to employment of the deceased Santosh Mahto as claimed in  the complaint petition and the fact related to his death on 11.05.2017 due to accident during working at work place are admitted facts by the O.P. No.1 who is competent to say it. Therefore, on this score other O.P. cannot say anything contrary.
8. O.P. No.1 has admitted the fact that deceased was covering with the insurance policy and accordingly his claim was forwarded to the insurance co. for consideration. Hence this fact also cannot be denied by O.P. No.2 specially when the employer of the employee is not denying it.

 

 

9. It is also admitted fact of both the parties that there is delay in transmission of intimation regarding death as well as submission of claim form, the date of accident but as per complainant she was shocked due of death of her husband and was suffering with several ailments hence due to such reasons there was delay. As per post mortem report death is due to head injury found on the body of the deceased. Therefore, it is very much clear and established that deceased died due to accident on the work place.
10.  The sole ground for rejection of the claim is delay in filing of the claim before the competent authority. In support of its argument on the point of condonation of delay Ld. Counsel for the complainant has placed reliance on the principles laid down by the Hon’ble High Court, Jharkhand at Ranchi in LPA No. 347/2013 decided on 21.04.2014 in the case of Central Coal Fields Ltd. Vrs. Oriental Insurance Co. & Sri Mati Yashoda Devi and also placed reliance on the principles laid down by the Hon’ble High Court of Jharkhand at Ranch in W.P. No. 3350/2009 decided on 19.02.2016.
11. We would like to refer the circular of INSURNACE REGULATORY AND DEVELOPMENT AUTHORITY dt. 20.09.2011 Ref-IRDA/HLTH/MISC/CIR/216/09/2011 by which “IRDA has advised all insurers to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the Insurers must not repudiate such claim unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time”. On careful perusal of the direction it appears that O.P. No.2 has not followed the direction of his regulator rather he has violated it.

 

12. On careful perusal of the principles laid down by the Hon’ble High Court in above noted cases  as well as the circular of IRDA and the facts and circumstance of this case it is very much apparent that here in this case there was reasonable explanation of the complainant for condonation of delay who has lost her husband at prime age. Therefore, we are of the view that mere on the ground of delay in intimation or submission of the claim it was not justifiable for the O.P. No.2 to refuse the claim. Hence we are of the opinion that complainant is entitled to get relief as claimed accordingly this point is being decided in favour of the complainant.
13. Hence prayer is being allowed in the following manner:-

O.P. No.2 Reliance General Insurance Co. Ltd. is directed to pay Rs. 5,00,000/- to the complainant as death claim of her husband on account of his death on work place. Said payment must be made within 60 days from receipt/production of copy of this order failing which complainant will be entitled to receive interest on that very amount @ 10% per annum from 12.06.2018 (i.e. the date on which case was filed). Further O.P. No.2 is directed to pay compensation of Rs. 20,000/- on account of verious type of harassment and also to pay Rs. 10,000/- as litigation cost within above mentioned period.

(J.P.N. Pandey)

                                                                                      President

                                     

                                                                               (Baby Kumari)

                                                                                       Member