District Consumer Forum, Bokaro.
Consumer Case No.100 of 2008
Smt. Sujata Prakash, w/o late Om Prakash
R/o Plot No.- KF-15, City Centre, Sector-IV, P.S.- Sector-4, Bokaro Steel City, Dist.- Bokaro.
Versus
1. Bajaj Allianz General Insurance Co. Ltd.
Poddar court Gate No.-18, 7th Floor, Rabindra Sarani, Kolkata-700001 (W.B.)
2. The Secretary,
Bokaro Steel Group Accident Insurance Committee, Room No.-82, Old Ispat Building, Bokaro Steel Plant, Bokaro Steel City, Dist.-Bokaro
Before-
S.M.Alam, President
Vijay Bahadur Singh, Member
Shabnam Praveen, Member
Date of Judgment-: 31 July, 2009
Date of case filing 26 December, 2008
-: Judgment:-
The complainant has filed this case against the
opposite parties for payment of Rs. 252500/- together with interest 18% beside Rs. 25000/- towards compensation and Rs. 5000/- as litigation cost.
2 Brief fact of the case is that Late Om Prakash was a permanent employee of BSL/ SAIL vide staff no. 182311 and the complainant is widow and nominee of late Om Prakash. As per policy of SAIL, Bokaro Steel Plant the risk of life of the deceased Om Prakash was covered under Group Personal Accident Policy vide Policy No.-OG-07-2401-9902-00000032 with the opposite party No.1 with the help of opposite party No.2 and the sum assured was Rs. 252500/-. The said Om Prakash met with an accident due to sudden fell down in his bathroom on 07.05.2007 at 6:30 P.M. and as result of which Om Prakash sustained severe head injury, hence he was brought to B.G.H. where the attending doctor declared him dead. The Fardbyan of the complainant was recorded on 09.05.2007 at 9:30 hours by Sector-IV Police Station on the basis of said Fardbyan a U.D. case NO.12/2007 was registered. The Postmortem on the dead body was conducted by the doctors of Sadar Hospital, Chas. The Police submitted final form stating therein that the Om Prakash died due to fell down in the Bathroom.
3 The opposite party No.2 submitted claim on behalf of the complainant before the opposite party No.1, the opposite party No.1 vide its letter requested the opposite party No.2 to provide certified copy of FRT and complete medical history for finalizing the claim and subsequently all the relevant papers were submitted to the opposite party No.1 through opposite party No.2. The opposite party No.1 and 2 knowing well about the accident set over the matter for long time, and ultimately the opposite party No.1 rejected the claim vide letter dated 28.06.2008 on the ground that the complainant was enable to produce/clarify the reason for delayed intimation to Police and delayed registration of U.D. Case was not justified. Inquest Report not submitted. The complainant shocked to receive the letter because the opposite party No.1 repudiated her husband death claim on false and fabricated ground. It is important to mention here that the LIC of India Bokar Branch had already settled the death claim of the husband of the complainant on the ground of accidental death. Thus from the fact and circumstances of the case, it transpired that repudiation of death claim of complainant is unlawful and illegal and as such the opposite party No.1 is deficient in providing service to the complainant, due to which the complainant has suffered in term of physical as well as mental agony, economic loss for that opposite party No.1 is liable to compensate the complainant under establish provision of law.
4 Upon issuance of notices, both opposite parties appeared and filed their written statement separately.
5 It is submitted on behalf of the opposite party No.1 that there was no accident on 07.05.2007 at 6:30 P.M. as alleged in the complaint petition and it is also denied by the opposite party No.1 that death of Om Prakash was due to sudden fell down in the Bathroom. It is further submitted that the statement of the claimant reveals that the death of the deceased was on 07.05.2007 at about 6:30 P.M. but the complainant recorded the Fradbay on 09.05.2007 at about 9:30 hours is an after though measure, just only to lay claim before, the insurance co. for compensation. It is submitted that had the accident actually been occurred, the complainant definitely would have informed the police regarding the alleged accident. It is further submitted that when medical report of the deceased was sought by the opposite party No.1, the complainant and opposite party No.2 submitted only some papers of medical test to cover up the reason behind the alleged accident. The Police submitted Final Form about the accident death of deceased Om Prakash due to fell down in Bathroom, but the Police deliberately did not produced any sketch map of the place of occurrence as well as size of the Bathroom so as to ascertain whether in the Bathroom alleged fall can occurred or not. It is matter of fact and it cannot be decided in summary proceeding. The delay in filing information before local Police has not been explained by the complainant and this casts reasonable doubt of the alleged accident of the deceased. The complete medical history for finalizing the claim was not sent to the opposite party No.1 and in absence of documents the claim of the claimant can not be settled by the opposite party No.1 and in absence of such documents the claim of the complainant was rejected by opposite party No.1. it is submitted that the opposite party No.1 did not repudiate the death claim of deceased Om Prakash on false and fabricated and unlawful ground rather it was repudiated on genuine grounds as because the complainant did not satisfied the opposite party regarding the accidental death of the deceased Om Prakash and in absence of any accident of deceased Om Prakash, the claim has rightly been repudiated by the opposite party No.1.
6 under the above facts and circumstances it is crystal clear that the opposite party No.1 is not deficient in providing service to the complainant, and hence the complainant is not entitled to get the relief from the opposite party No.1.
7 The opposite party No.2 has stated in its written statement that opposite party no.1 is a bridge between the claimant and opposite party No.1 (Insurance Co.) in respect of settlement of claim of deceased Om Prakash. The opposite party No.1 further submits that the liability to pay compensation is on the insurer ie opposite party No.1 and not this opposite party No.2, so the claim of the complainant is fit to be dismissed against this opposite party No.2 who has been unnecessarily made party in this case.
8 Both parties were heard. The entire case records and document filed by the parties have been perused. It is observed that the complainant’s claim was repudiated by the opposite party No.1 on the ground of delayed FIR and delay in registering UD Case and non submission of Inquest Report. The deceased insured had died on 07.05.2007 after his fall in his bathroom at 6:30 P.M. on that day sustaining serious head injury resulting in his death. The complainant had recorded her Fardyan on 09.05.2007 at 09:30 hours before ASI concerned of Sector IV Police Station and subsequently a UD Case No. 12/2007 was registered. Postmortem of the dead body was conducted at Sub-Divisional Hospital, Chas. It is found that the FRT and PMR both support the accidental death of the deceased insured. There is nothing on record to establish that the death was non accidental as contended by the insurance co.
9 It is further observed that all the necessary documents were forwarded by the complainant to opposite party No.1 through opposite party No.2 as an when such documents were made available to the complainant. We do not agree with the contention of the opposite party No.1 that there was intentional and inordinate delay in lodging the FIR by the complainant besides delayed registration of UD case.
10 In view of the above and after considering all the material facts placed before us by the parties, it is concluded that repudiation of the complainant’s claim under the Group Personal Accident Policy in question by the opposite party No.1 was not justified at all. We, therefore, hold that the opposite party No.1 Bajaj Allianz General Insurance Co. Ltd. has been negligent and deficient in its action of repudiation of the complainant’s claim. The opposite party No.1 is hence held liable to pay the claim to the complainant. The opposite party No.2 was only a facilitator in the Bokaro Steel Group Personal Accident Policy Scheme and did not receive any service charge or commission from either of the parties. As such no liability is fixed on the opposite party No.2, Secretary, Bokaro Steel Group Personal Accident Policy Scheme.
11 Under the facts and circumstances of the case, the opposite party No.1 Bajaj Allianz General Insurance Co. Ltd. , Poddar court Gate No.-3, 7th floor, 18 Rabindra Sarani, Kolkata-700001 (W.B.) is directed to pay Rs. 252500/- (Rupees two lacs fifty two thousand five hundred) only along with interest thereon @ 9% per annum from 26.12.2008 till payment to the complainant within 30 days from the date of this order. The above opposite party is also directed to pay compensation of Rs. 2000/- (Rupees two thousand) only to the complainant within 30 days from the date of this order.
Member (lady) Member President
Tags: Bajaj Allianz