Bajaj Allianz v KaDistrict Consumer Forum, Bokaro
Consumer Case No.-66/2009
Karu Mandal s/o late Chakradhar Mandal
R/o Sector-IX/A, Road, Qr.- 932, Bokaro Steel City Dist.-
Bokaro. (Jharkhand)
Vs.
1. Sri Sanjay Mohalkar s/o Unknown,
Claims Head India Office, Poona, Bajaj Allianz General Insurance Co Ltd, G.F. Plaza, Air Port Road, Yerawada, Poona-411006
2. Secretary, Bokaro Steel Group Accident Insurance Ltd, Bokaro Steel City-827001, P.S.- B.S.City. Dist.- Bokaro( Jharkhand)
Present-
S.M. Alam, President
Sri Vijay Bahadur Singh, Member
Shabnam Praveen, Member
Date of Judgment-19/12/2009
Date of Case filing-26/08/2009
-: Judgment:-
The complainant has filed the present case against the opposite parties to pay Rs. 55000/- on account of accidental claim.
2 Brief fact of the case is that the complainant was appointed on the post Operator in BSL on 27.12.1971 and retired on14.01.2009. The complainant while in service was provided Group Accident Insurance Committee of BSL and accordingly premium was detected from the salary of the complainant to be paid to the insurance co., vide No. OGO7-2401-9902-00000032 and claim No. OC-082401-9902-00000031 by the B.S.L. Bokaro having calibration with Bajaj Allianz General Insurance Co. Ltd. The complainant met with an accident on 13.04.2007 while he was going his duty by cycle and sustained injury in the left thigh and got permanent disability in that part. The complainant was also admitted in BGH from 13.04.2007 to 26.09.2007 and due to accident 17% of the body got effected and stopped functioned. The complainant informed his Department and the Group Accident Committee about the accident and claim for partial disability of the body. The complainant sent several letters to Bokaro Steel Group Accident Committee/ Bajaj Allianz General Insurance Co. as per agreement for the payment of the said claim of the complainant. The Bokaro Group Accident Committee asked the Bajaj Allianz General Insurance Co. to pay the complainant Rs. 55000/- as compensation on the basis of 17% disablement as per the medical report. The complainant also served a legal notice upon the opposite parties but no reply was received from them. The complainant is suffering from physical and mental harassment as no compensation has been paid by the opposite parties. Thus there is apparently deficiency on the part of the opposite parties for which the complainant is entitled to get relief as sought against them.
3 Upon issuance of notices, the opposite party No.2 appeared and field its written statement, in which it has been admitted that Bokaro Steel Group Accident Committee constituted by SAIL , Bokaro Steel Plant and BSL acts as link between the insured employee of the Company and the insurer in as much as it facilitated insurance of its employee under Group Personal Accident Insurance Policy and pursues the claims with the insurer for settlement in case of accidental death or disability of the insured. The opposite party no.2 further admits that the complainant was an employee of SAIL, Bokaro Steel Plant vide Staff No. 138273, met with an accident on 13.04.2007 while he was in way of his duty place. The necessary information of the said accident was given to the concerned Authority by the concerned department of the opposite party no.2. Accordingly on received of information from the department the opposite party no.2 sent a intimation to the opposite party no.1 on 03.05.2007. The complainant also submitted an application on 06.02.2008 to opposite party no.2 to the effect that he would raise a formal claim with all relevant documents after assessment of the disability suffered by him due to injuries received in the said accident which was also forwarded to the opposite party No.1 on 08.02.2008. On 16.02.2008 the claim form and other relevant papers submitted by the complainant was handed over to the opposite party no.1. But the opposite party no.1 repudiated the claim of the complainant vide its letter dated 08.07.2009. It appears that the claim of the complainant has been repudiated on flimsy ground vide its letter dated 23.07.2009. The opposite party no.2 was requested to reconsider the claim in that connection also informed its attention to the outstanding reached between them on 08.04.2009 that the entire pending claim relating to disability would be settled by 30.04.2009. An intimation in this regard was also given to the complainant vide its letter dated 24.07.2009. The opposite party no.1 did not reconsider the matter necessitating the filing of the present complaint by the complainant. However liability of payment of compensation to the complainant is that of opposite party no.1 and not opposite party no.2. Since the opposite party no.2 is merely work like bridge between the insured and insurer which has been done by the opposite party no.2, as such there is no deficiency on the part of the opposite party no.2 and the name of opposite party no.2 be sponged from this Consumer Complaint.
4 However the opposite party no.1 neither appeared nor file any written statement in this case, hence proceeding against the opposite party no.1 proceeded Ex-parte.
5 We heard the complainant and the opposite party no.2. The opposite Party No.1 has failed to argue the case. On perusal of the entire case records and documents filed by the parties it is observed that the complainant was declared 17% disabled by the proper authority due to his accident on 13.04.2007 while he was going to attend his duty at 13.50 hours. Though the medical certificate declaring the complainant as 17% disabled was signed on 29.01.2008 by the concerned Doctor, the disableness as above is concluded to be occurred on 13.04.2007.
6 In view of the above the repudiation of the claimants claim by the opposite party no.1 on the ground that the disability did not fall under 12 months from the date of injury, is held to be an act of negligence and deficiency in service. We, therefore, hold the opposite party no.1 liable to pay 17% of the insured amount of Rs. 250000/-(Rs. 42500/-) to the complainant besides other reliefs.
7 Under the facts and circumstances of the case, the opposite party No.1 Sri Sanjay Mohalkar s/o Unknown, Claims Head India Office, Poona, Bajaj Allianz General Insurance Co Ltd, G.F. Plaza, Air Port Road, Yerawada, Poona-411006 is directed to pay Rs. 42500/- (Rs. Forty two thousand five hundred) only to the complainant within 30 days from the date of this order. The above opposite party is further directed to pay compensation of Rs. 500/- (five hundred) only to the complainant within 30 days from the date of this order.
Member (lady) Member President
ro Mandal
Tags: Bajaj Allianz