United India Insurance Co. Ltd. vs GANESH BARWAL

THIS appeal arises from order dated 19.2.2002 rendered by the learned Consumer Disputes Redressal Forum, Valsad in Consumer Protection Case No. 173 of 2000 directing the opponent Insurance Company to pay to the complainants Rs. 65,750/- with interest at the rate of 12 per cent from 15.9.1997, compensation in the sum of Rs. 5,000/- and cost in the sum of Rs. 1,000/- on the ground that complainant No. 2 held insurance policy from the opponent Insurance Company for its workers including complainant No. 1 Ganesh Barwal who met with accident on 11.9.1997. 1st complainant sustained serious injuries requiring him to be confined to bed for a period of around 8 months. Personnel Manager of complainant No. 2 company immediately informed the opponent Insurance Company by letter dated 15.9.1997. Upon the complainant resuming duty on 16.9.1998, all the required documents for claiming compensation were submitted to the opponent Insurance Company. Opponent Insurance Company informed the complainants that necessary documents which were submitted to the Insurance Company were not traceable and hence called for another letter from the complainants. The complainants, therefore, issued another letter dated 5.11.1998. Since there was delay in sanctioning the claim, the complainants frequently communicated with the opponent''s concerned officers, but of no consequence. Alleging unfair trade practice as well as deficiency in service, the complainants approached the learned Forum for compensation as per the prayer in the complaint.

THE opponents resisted the complaint inter alia on the ground that the complainants intimated the opponent Insurance Company after a long period, that the insurance of the complainant No. 1 was covered from 7.10.1997 and, therefore, the risk that attached to the complainant No. 1 prior to that was not covered under the insurance and that the complainants would not be entitled to the amount of insurance under the Group Personal Accident Insurance Policy for the workers of complainant No. 2 company. After considering the facts and circumstances of the case and the evidence placed on record, the learned Forum came to the conclusion that the complainants have made out their case with regard to the employment of complainant No. 1 in complainant No. 2 company with effect from July 1997, about the intimation having been given to the opponent Insurance Company about said employment well in time, about the premium amount having been paid so as to cover the risk of complainant well in time and about the claim preferred in the complaint insofar as the indemnity amount is concerned. THE learned Forum, however, did not accept the claim for compensation prayed for by the complainants on the head of mental agony and hardship but proceeded to award only Rs. 5,000/- against the prayer of Rs. 50,000/-. It is this order which has been subjected to challenge by the opponent Insurance Company in this appeal. We have heard the learned Advocate for the opponent Insurance Company-now appellant and the Law Officer of complainant No. 2 company. We have examined the relevant documents. In our considered opinion, the suggestion of the opponent Insurance Company that the first intimation with regard to employment of 1st complainant was submitted to the Insurance Company only on 7.10.1997 and not prior to that cannot be accepted as the list of the employees along with the amount of premium payable for the employees was being submitted month to month and we have also been shown copy of such list as also copy of inward register of opponent Insurance Company which was placed on the record of the complaint before the learned Forum. In that view of the matter, repudiation of the claim on that ground is prima facie not tenable. Fact that the worker met with serious accident on 11.9.1997 is not in dispute and cannot be disputed. In fact, the repudiation is not on that ground. If that is so, it was for the opponent Insurance Company to process the claim and award appropriate claim of indemnity under the group insurance policy in question. It has been submitted that the claim was preferred after a lapse of 13 months. Here also, the opponent Insurance Company has not come out with true facts. The complainants did present before the learned Forum material to indicate that due intimation was forthwith given to the opponent Insurance Company with regard to the accident that occurred to the complainant No. 1-complainant No. 2''s workman. It has come on the record of the case that the complainant No. 1 was seriously injured and was confined to bed for around 8 months. It was, therefore, quite natural and obvious for complainant No. 2 Insurance Company to submit the claim papers setting out what amount of expenses was incurred by the 1st complainant and what was the disability he sustained. In that view of the matter, it cannot be said that intimation was given to the Insurance Company after a lapse of a very long period of 13 months. Complainants have presented before the learned Forum below how the communications of the complainant-complainant No. 2 in particular - have been attended to by opponent Insurance Company through its concerned officers. In our considered opinion, upon appropriate appreciation of the facts and circumstances of the case and the evidence placed on record, the learned Forum has rightly come to the conclusion that there was neither delay nor any lapse on the part of the complainant No. 2 in respect of intimating the opponent Insurance Company with regard to the accident in question.

It has finally been submitted on behalf of the opponent Insurance Company that complainant No. 1 did not sign the complaint and, therefore, no claim can be awarded in the complaint filed by the complainants and signed only by the complainant No. 2''s authorised signatory. This argument cannot be accepted, for, complainant No. 1 is shown as party to the complaint in the title of the complaint and complaint has been filed on behalf of the 1st complainant by the company in which he was serving. It is not in dispute that group insurance policy has been obtained by complainant No. 2 company for its workers. Therefore, it is a part of the contract of insurance. The cause of action has certainly ensued in favour of the complainants out of whom complainant No. 1 is a beneficiary of the insurance. The officer who is present on behalf of the complainant No. 2 company frankly submits that the payment of the insurance amount is to be made to complainant No. 1 and is not to be retained by complainant No. 2 company. He also frankly submits that the amount might be deposited in this Commission for being paid over to complainant No. 1 workman. In that view of the matter, we do not see any fatal defect in the pleading as has been sought to be submitted on behalf of the opponent Insurance Company.

IN view of the aforesaid facts and circumstances of the case, we pass following order: ORDER Impugned order is hereby maintained. However, the amount of compensation shall be payable to the complainants in the following manner: The amount of Rs. 50,000/- deposited by the opponent Insurance Company in this appeal shall be paid over to the complainant upon joint application being made by the complainants before this Commission. Balance amount shall be deposited by the opponent Insurance Company in this Commission within six weeks from today. Upon such deposit, payment also shall be made to the complainants upon joint application as started above. Appropriate orders will be passed regarding mode of payment as and when such application is made before this Commission. This appeal is accordingly disposed of, with no further order as to costs. Appeal disposed of.