Jharkhand

Bokaro

CC/112/2019

Goutom Kumar Majee - Complainant(s)

Versus

The Branch Manager, National Insurance Co. Ltd. - Opp.Party(s)

Binod Kumar Singh

03 Mar 2023

ORDER

District Consumer Disputes Redressal Commission, Bokaro

Date of Filing-25-06-2019

Date of final hearing-03-03-2023

 Date of Order-03-03-2023

Case No. 112/2019

Goutom Kumar Majee S/o Late Ajoy Chandra Majee

R/o Village- Mohal, P.S. Chandankiyari, District- Bokaro

Vs.

1. The Branch Manager, National Insurance Company Limited

bye Pass Road, Chas, Bokaro

2. The Manager, Golden Trust Financial Services,

16, R.N. Mukherjee Road, Kolkata-700001

 Present:-

                             Shri Jai Prakash Narayan Pandey, President

Shri Bhawani Prasad Lal Das, Member

                  Smt. Baby Kumari, Member

PER- J.P.N Pandey, President

-Order-

1. Complainant has filed this case with prayer for direction to O.Ps. to pay him Rs. 5,00,000/- with 18% interest as sum assured by the insurance policy on account of death of his father (insured)  and compensation of Rs. 50,000/- and legal expense Rs. 25,000/-.

2.   Complainant’s case in brief is that his father late Ajay Chandra         Majee has obtained Janta Personal Accident Insurance Policy vide policy No. 100300/47/01/9600022/03/96/30209 dt. 15.09.2003 valid for the period from 15.09.2003 to 14.09.2018 for sum of Rs. 5,00,000/- but he met with motor vehicular accident on 05.06.2004 and died during treatment  for which Chandankiyari P.S. Case No. 69/2004 was registered and investigated. Complainant being nominee of the policy applied for payment of the claim vide claim No. 4720049600573 on 24.08.2004 which was investigated and verified by the investigator but matter was not settled  rather letter dt. 17.06.2010 was received by which complainant was directed to furnish documents mentioned in the letter which was complied, inspite of it matter was not settled. Motor Accident Claim Case No. 73/2004 was filed which was decided in favour of the complainant on 18.12.2008 thereafter, P.L. Case No. 18/2011 was filed which has been disposed off on 30.01.2017 hence this case has been filed before this Commission with above mentioned prayer.

3.   O.P. No. 1 National Insurance Co. Ltd. has filed W.S. mentioning therein that the case is not disclosing cause of action which is file with distorted facts. Further reply is that it is true that complainant has taken said policy and it was valid as mentioned in the complaint petition but policy is very old hence it could not been verified at present as many record keeping system had changed.  Further reply is that claimant had failed to inform the insurance co. in time about the accident and no claim has been lodged with this O.P. Further reply is that alleged date of accident is 05.06.2004 and case has been filed with more delay hence it is time barred. Therefore, it is prayed to dismiss the case.

4.   O.P. No. 2 is the TPA Golden Trust Financial Services engaged by the O.P. No.1 and O.P. No. 2 has filed W.S admitting the claim of complainant in which most of the facts of the complaint petition have been admitted by the TPA, at para 3 (VIII) of the W.S. this O.P. has admitted the fact that it is engaged to process the claim. At para 5.2 it has been admitted by this O.P. that this O.P. has intimated the O.P. No.1 Insurance Co. for earlier disbursement of the claim of the claimant hence there is no deficiency on the part of this O.P. and claim is pending with the O.P. No.1.

5.   Now, point for consideration is whether complainant is entitled to get relief as prayed ?

6.   On perusal of pleadings of the parties it is very much clear that issuance of the insurance policy as mentioned in the complaint petition for Rs. 5,00,000/- is not in dispute. The fact related to enforcement of the policy during the period as mentioned in the complaint petition , accidental death of the insured and capacity of the complainant as nominee of the policy is also not in dispute in this case. O.P. TPA which was engaged by the insurance co. has processed the claim much earlier and has recommended for payment has also been admitted by that very O.P. and it has not been controverted by the O.P. No.1 Insurance co. Therefore, it is very clear that still claim of the complainant has not been denied by the O.P. No.1 and as per reply of O.P. No.2 claim is pending at the level of O.P. No.1 with positive recommendation of O.P. No.2.

7.   So for point related to limitation is concerned it is very much clear that till date O.Ps. have not repudiated the claim hence it will be treated that there is unreasonable delay on the part of O.P. No.1 in taking decision on the recommendation of O.P. No.2 for which O.P. No.1 is liable and it cannot be said that complaint is time barred.

8.   In light of above discussion as well as facts admitted by both the parties we are of the view that the genuine claim of the complainant related to Rs. 5,00,000/- has not been settled by the O.P. No.1  for about more than seventeen years  which shows gross deficiency on the part of O.P. No.1.  and the complainant is entitled to get relief as claimed accordingly this point is being decided in favour of the complainant.

9.   Accordingly prayer of the complainant is being allowed in the following manner:-

         O.P. No. 1  National Insurance  Co. Ltd. is directed to pay Rs. 5,00,000/- to the complainant within 60 days from receipt/production of the copy of this order, failing which this O.P. will pay interest @ 10% per annum  on that very amount from 25.06.2019 (i.e. the date on which case was filed). Further O.P. No.1 is directed to pay compensation of Rs. 15,000/- for various types of harassment caused to the complainant for his genuine claim and also to pay Rs. 7000/- as litigation cost within above mentioned period.

 

(J.P.N. Pandey)

                                                                                      President

                            

                             (B.P.L Das)

   Sr. Member

                                                                  

 

                  

                                                                               (Baby Kumari)

                                                                                                    Member