Silpi Majumder, Member - (1.) THIS appeal has been directed against the judgment passed by the learned District Forum, Birbhum, on 2.1.2009, in its Case No.30/2008, wherein the Forum below allowing the complaint in part on contest against the OP and directed the OP to pay a sum of Rs. 2,40,000 towards personal accident claim, Rs. 30,582 towards medical treatment cost, Rs. 1,000 as compensation due to harassment and litigation cost of Rs. 500 to the Complainant within 30 days from the date of passing the judgment, failing which the above -mentioned total amount would carry interest @12% p.a. for the default period.
(2.) THE brief facts of the case of the Complainant before the Forum below were that the husband of the Complainant since deceased obtained a Nagarik Suraksha Policy for Rs. 3,00,000 covering the period from 9.12.2005 to 8.12.2007 with personal accident benefit. The husband of the Complainant while returning from Burdwan on 2.2.2006 by train (No. 3011 UP Howrah -Malda Intercity Express) near Sainthia Railway Station fell down from the train and sustained severe injury. The police of Sainthia GRPS with the assistance of the Station Manager removed him to Sainthia BPHC for medical aid and from there he was taken to Suri Sadar Hospital and lastly to SSKM Hospital, Kolkata, where his left leg and left hand were amputed. For the said injuries and treatment the husband of the Complainant submitted application for accidental benefit before the OP, but to no effect. The insured expired on 23.4.2007 and the Complainant being his wife and legal nominee of the said policy requested the OP to settle the claim, but without any result. Thereafter finding no other alternative the Complainant filed the complaint before the District Forum with some prayers.
(3.) BEING aggrieved by the above -mentioned judgment the OP -Appellant has preferred this appeal stating that the Forum below has erred to consider that the Complainant -Respondent did not satisfy the Surveyor about their queries as mentioned in the letter dated 21.3.2007 and thus the Appellant has rightly repudiated the claim. The learned Counsel for the Appellant has submitted that the Forum below ought to dismiss the complaint but without doing the same the Forum has allowed the prayers of the Complainant erroneously. For this reason the judgment is defective and is liable to be set aside and the Appellant has prayed for allowing the appeal. During hearing the Appellant was present through the learned Advocate and the Respondent through her authorized representative (son). The Appellant has submitted that the Complainant -Respondent has failed to provide sufficient papers and to answer the questions made by the Surveyor and thus the Appellant has repudiated the claim due to non -submission of papers by the Respondent. On careful perusal of the record it is seen by us that there is no doubt that the husband of the Respondent since deceased purchased a policy where the present Respondent is the nominee. It is an admitted fact that the policyholder preferred a claim for personal accident for which the Appellant appointed a Surveyor. The said Surveyor put some questions to the policyholder regarding the accident caused to the policyholder. In this connection we have noticed a certificate issued by the Sainthia GRPS is very clear regarding the accident caused to the policyholder. It clearly speaks the injuries sustained by the policyholder, the train in which the accident took place and the place of the accident as well. It has been disclosed in the said certificate that after the accident a GDE was entered in that police station. Therefore it is not clear to us what prevented the Surveyor to contact the said GRPS to know about the accident whether it has been occurred or not. On perusal of several medical documents the Forum has concluded about the injuries sustained, treatment done and percentage of disablement of the policyholder. The Appellant could not produce anything contrary to those papers to prove their case. In our opinion in spite of production and submission of these documents some irrelevant questions were made and on the basis thereof the claim was repudiated. Such action proves the gross negligence in duty and deficiency in service on the part of the Appellant -Company. The claimant has proved his case by producing all the documents, but nowhere the Appellant -Respondent has contradicted those papers and the Appellant in support of their repudiation has filed nothing. Therefore we are also of the view with the Forum below that repudiation was not correct.;