Present         (1)     Nisha Nath Ojha,   

                              District & Sessions Judge (Retd.)                                                                                         President

                    (2)     Smt. Karishma Mandal,

                              Member

Date of Order : 04.09.2015

                    Nisha Nath Ojha

1. In the instant case the Complainant has sought for following reliefs against the Opposite party:-

1. To pay the sum insured Rs.1,00,000/-(One lac only) along with interest @ 12% from the date of final payment to the complainant.
2. To pay Rs. 50,000/-(Fifty thousand only) to the complainant as compensation.
3. To pay Rs. 20,000/-(Twenty thousand only) as litigation costs.

2. Brief facts of the case which led to the filing of complaint are as follows:-

1. The above mentioned complainant is a nominee of the deceased insured. The complainant’s claim has not been settled by the insurer i.e. the opposite parties no. 1 to 3 as yet. The complainant has properly informed to the opposite parties in proper time with prescribed manner. Reasonable time has already passed but claim has not been settled by the opposite parties. Hence the complainant has no alternative remedy but to file the complaint case against the opposite parties no. 1 to 3. The opposite parties are responsible for loss, mental agony and physical harassment of the complainant. The opposite parties no. 1 and 2 have ignored I.R.D.A. ( Regulation 2002 ) and Hon’ble Supreme Court of India Judgment with respect to claim settlement time. Therefore the opposite parties no. 1 and 2 have to compensate the actual loss of the complainant under the Consumer Protection Act, 1986.
2. The opposite parties no. 1 to 3 have not accepted the claim of the complainant nor rejected the claim of the complainant as yet, inspite of knowledge, therefore the cause of action is running till today from the date of accident because of the opposite party have not replied against the claim of the complainant as yet from the date of knowledge. There is no need of file a petition for condoning the delay under the law.
3. The facts of the case are in short as follows :

1. Mr. Sanjay Kumar Singh was insured by the opposite party no. 1 for the sum of Rs. 1,00,000/- for the period of 15.03.2003 to 14.03.2004 vide Policy no. 100300/47/01/9600022/02/96/30416. ( Vide Annexure – 1 )
2. The opposite party no. 2 is a Regional Manager of the opposite party no. 1 under the law. The opposite party no. 3 has acted as a role of an agent of the opposite party no. 1 and 2 under the contract. The opposite party no. 3 has authority to receive and to supply any documents with respect to insurance claim on behalf of the opposite party no. 1 and 2 under the M.O.U. under the agreement the opposite party no. 3 has received all the documents on behalf of the opposite party no. 1 from the complainant and the same has been forwarded to the insurance company for settling the insurance claim of the claimant as soon as possible. Time to time the opposite party no. 3 has issued reminder letters to the party as well as insurance company for necessary action. The opposite party no. 1 has not considered the reminder letters issued by the opposite party no. 3 due to malafide ill motive. ( Vide Annexure – 2 )
3. The deceased insured died in road accident on 23.01.2004 within period of insurance policy. Proper information has been given to the local police station and road accident case has been registered vide F.I.R. no. 9/2004 dated 23.01.2004 Post Mortem report has been completed by the competent doctor of Sub – Divisional Hospital, Danapur, Patna.
4. From the post mortem report it appears that the cause of death was Haemorrhage shock due to road accident. ( Vide Annexure – 3 )
5. Investigating officer submitted final form before the competent authority for approval. From perusal of the F.I.R. and police final report dated 09.09.2004 it appear that case is true. ( Vide Annexure – 4 )
6. The opposite party no. 3 has issued several letters to the Sr. Divisional Manager, national Insurance Co. Ltd. for early settlement. Lastly on 12.12.2007 the opposite party no. 3 issued a letter in which it has been mentioned that claim of the claimant must be settled without further loss of time. ( Vide Annexure – 5 )
7. The opposite party no. 1 has not raised any dispute with respect to documents of the claimant. The opposite party no. 1 has not raised any dispute with insurance policy. So the claim of the claimant is undisputed. Inspite of all possible efforts the claim has not been settled by the insurer as yet. Hence the complainant has no option but to file the complaint case before this forum under the law. The Patna District Consumer Forum has power to remove the deficiency in service and negligence under the C. P. Act.

4. From perusal of the annexures it appears that the insurance company is responsible for deficiency in service and negligence. It is undisputed that the insurance claim must be settled under the I.R.D.A. regulation 2002 rules 08. This regulation is mandatory. The opposite party no. 1 can not ignored I.R.D.A. regulation 2002 rule 08 without reason.
5. I.R.D.A. regulation 2002 rule 08 sub clause  (3) says  that life insurance policy shall be paid or be disputed giving all the relevant reason within 30 days from the date of receipt of all relevant papers and clarification required. The opposite party no. 1 has not followed the rule 8 of the I.R.D.A. 2002. It is a case of deficiency in service and negligence under the law.
6. I.R.D.A. regulation 2002 rule 8 sub rule (5) says that where there is a delay on the part of the insurer the life insurance company shall pay interest on the claim amount at a rate which is 2% above the bank rate. It is humbly submitted that ‘shall’ word is used in rule 8 sub rule (5). It means that it is mandatory under the law. It is humbly submitted that the present bank interest rate is fixed 10% on fixed amount by the Govt. of India and R.B.I.
7. The opposite party no. 1 and 2 are most negligent in their duties. They have not performed their duties under the I.R.D.A. regulation 2002 in reasonable time, therefore, the complainant is suffering loss and mental agony because of negligence of the opposite party no. 1.

3. The Opposite Party no. 1 and 2 in their written statement have asserted following facts which is being mentioned in toto :-

The opposite party no. 1 and 2 have filed written statement stating therein that claimant cum nominee has filed a photocopy of Insurance certificate ( Annexure – 1 ) in which name of the Insured person is Sanjay Kumar Singh and hence the statement made by the complainant in Para – 3 (a) is a matter of record.

It has been further asserted that the complainant has filed a photocopy of the letter dated 17.04.2006 issued by GTFS to National Insurance Company which supplied a same copy to the complainant but concealed the date of intimation and reason of delay.

It has been asserted that opposite party no. 2 is as a facilitator of its member has failed because it received intimation on 17.04.2006 and submitted the same on 18.09.2006 to Insurance Company. Hence any responsibility for late supply of the aforesaid documents rest on opposite party no. 2.

It has been further asserted that in the post mortem report (Annexure – 3) and death certificate the name of the deceased is Sanjay Ray while the name of the Insured person is Sanjay Kumar Singh.

It has been submitted that there is no deficiency on part of the opposite party no. 1 and 2 since the complainant failed to made available the mandatory documents which was necessary to file for disposal of the claim of the complainant.

It is stated that in the absence of required documents such as final Police report, post mortem report it is difficult to reply.

It has been further submitted that opposite party Insurance Company is entitled U/s 64 – VB of the Insurance Act 1938 because the Insurance Policy is yet to be verified.

Opposite party no. 3 has also filed written statement stating therein that Sanjay Kumar Singh since deceased obtained a Janta Personal Accident Insurance Policy of National Insurance Company under a group Insurance Scheme through facilitator of opposite party no. 3. The said policy was issued by National Insurance Company Ltd. in favour of Golden Multi Service Club of GTFS covering the member who is Sanjay Kumar Singh for period 15.03.2003 to 14.03.2004 for sum insured of Rs. 1,00,000/- (One Lakh only). Mr. Dharmdeo Kumar is brother (Complainant) and nominee of the deceased.

In Para – 7 of the written statement the opposite party no. 3 has stated as follows :-

“ After the said accidental death of Mr. Sanjay Kumar Singh, his brother Mr. Dharmdev Kumar as a nominee claimant submitted a claim form duly completed along with other supporting documents towards substantiation of claim to Golden Multi Service Club of G.T.F.S who in turn after initial verification and checking furnished the said claim documents to National Insurance Company Ltd., Division III, on 20.04.06 for early settlement of the claim. Subsequently, few more documents could have been made available to the Insurance Company with a representation letter of the claimant vide G.T.F.S letter dated 12.12.07 requesting for immediate settle of the claim on merits for the benefit of the distressed claimant. ”

We have narrated the facts asserted by parties briefly in forgoing Paragraphs and examine the record of the case.

During the pendency of this case a report was called for from the Officer-In-Charge, Maner Police Station to certify as to whether Sanjay Kumar Singh and Sanjay Ray was the same person after indicating the parentage and address of the complainant Dharmdeo Kumar and deceased and the Officer-In-Charge sent a report vide his letter no. DR 2348/13 dated 07.09.2013 wherein it has been reported that during enquiry it has come to the conclusion that son of Shiv Nath Ray @ Shiv Nath Prasad is Sanjay Kumar and Sanjay Kumar Singh and name of both are same person.

It has been further reported that it has been intimated by Harendra Ray S/o Ram Niwas Ray and Jay Prakash, Member Punchayat Samittee that deceased has taken a policy and in that policy Dharmdeo Kumar, S/o Late Amir Lal Singh, Vill-Brahmchari, P.S. Maner, District – Patna was nominee in this policy and he has filed a case for claiming the policy amount of the deceased as he is brother (Gotiya) of the deceased.

Whereas family members of deceased now desire that claim amount of policy be given to them.

In the concluding line of the report it has been suggested that in the circumstances it would be advisable to settle the claim after hearing the dependent of the deceased.

We have heard the parties and have gone through the records.

The claim of the complainant has not been settled by the Insurance Company on the only technical ground that name of the policy holder in policy document is mentioned as Sanjay Kumar Singh whereas in the death certificate the name appears as Sanjay Ray. The police after due verification has reported that both Sanjay Kumar Singh and Sanjay Ray are the same person.

The suggestion of the police for settling the claim after hearing the dependent of the deceased, perhaps, calls for no action as in the policy the deceased Sanjay Kumar Singh @ Sanjay Ray has nominated the complainant Dharmdeo Kumar as a nominee for claiming the amount in case of any eventuality.

The opposite party no. 3 has also asserted that it is the opposite party no. 1 and 2 ( Insurance Company ) has made delay.

It is needless to say that after the accident when the papers were received by the Company it was duty of the company to get the matter investigated and decide the claim of the complainant which has not being done leading to filling of this case.

Thus from the above discussion We are of the firm opinion that the opposite party cannot sit over the matter for such a long period on the pretext of difference in the name of the original policy holder.

Now the police after due verification have concluded that both the name of the deceased policy holder as mentioned in policy certificate as well as in death certificate are the same and hence the complainant is entitled for getting the claim as per terms and conditions mentioned in the policy.

Therefore We hold opposite party no. 1 and 2 responsible for deficiency in service

Therefore We direct the opposite party no. 1 and 2, jointly and severally, to pay to the complainant Rs. 1,00,000/- (One lac only ) along with interest @ 9% ( Nine ) per annum from the date of receipt of police report i.e. 07.09.2013 and the amount so calculated must be paid to the complainant within a period of three months from the date of the receipt of this order failing which the interest rate @ 12% ( Twelve ) will be paid to the complainant by the aforesaid opposite party no. 1 and 2 till final payment.

Aforesaid opposite party no. 1 and 2 are further directed to pay Rs. 10,000/- (Ten thousand only ) to the complainant as composite charge for compensation and litigation within the aforesaid period of three months.

Accordingly, this case stands allowed to the extent indicated above.

                                        Member                                                         President