Case Law Details
Rajendra Prasad Rai Vs United India Insurance Co. Ltd. (NCDRC)
Conclusion: In present facts of the case, it was held that the Consumer was entitled to get his claim covered under the sub clause of the Insurance Policy which provides him a higher benefit.
Facts: In present facts of the case, the Revision Petition has been filed by the Petitioner against Respondents under section 21 (b) of Consumer Protection Act 1986, against the order dated 26.03.2018 of the State Consumer Disputes Redressal Commission Bihar.
The Petitioner has taken Personal Accident Policy in the year 1991-92 for insured amount of Rs.2,00,000/-. As per terms of the policy, if a premium was paid within time every year, Rs.10,000/- was to be added in sum assured every year. On 25.05.2005, i.e. during the subsistence of the insurance policy, the complainant met with an accident and was admitted in the hospital. The said information was brought to the notice of the Respondent on 26.05.2005 and FIR was also lodged. The Petitioner vide his letter dated 25.08.2005 submitted the claim with the Insurance Company. The complainant alleged that even though all the papers along with the claim were submitted for action, the Insurance Company closed the case of the Petitioner as ‘no claim’. He again resubmitted his papers and after sending reminders, legal notice, the Insurance Company sent a settlement intimation voucher asking him to receive Rs. 1,50,000/- as full and final payment. The Petitioner protested this and on being protested, the Respondent informed him that since he had opted for Table-III of the policy, therefore, he is not entitled for an amount more than Rs.1,50,000/-. It was alleged that he had opted for Table-IV of the policy and been paying the annual premium regarding the same. The Petitioner asked for other documents under RTI but the same were not supplied. He sent legal notice on 13.05.2009 and Respondent replied on 16.06.2009 stating that his claim is not maintainable and sent intimation voucher.
Petitioner approached the District Forum, wherein Complaint was partially allowed and directed the Respondents to pay Rs.1,50,000/- within 45 days from the receipt of the order failing which the Respondent would be liable to pay additional 10% annual interest on the principal amount of Rs.1,50,000/- from the date of judgment till date of payment to the Complainant. Aggrieved by the said Order dated 17.01.2017 of District Forum, Petitioners appealed in State Commission and the State Commission vide order dated 26.03.2018 in FA No. 54 of 2017 partly allowed the Appeal of Complainant and directed the Respondent to pay compensation and litigation cost and interest and allowed benefit amount of Rs.1,50,000/- with 9% p.a. from the date of filing complaint i.e. 04.12.2014, compensation of Rs.10,000/- and litigation cost of Rs.5000/-.
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