State Consumer Disputes Redressal Commission
The National Insurance Co Ltd, Through ... vs Shivaji Dhondiba Dhondiram on 29 August, 2022
1 FA/252/2018
Date of filing :05.07.2018
Date of order :29.08.2022
MAHARASHTRA STATE CONSUMER DISPUTE
REDRESSAL COMMISSION,MUMBAI, BENCH AT
AURANGABAD.
FIRST APPEAL NO. : 252 OF 2018
IN COMPLAINT CASE NO.: 57 OF 2017
DISTRICT CONSUMER FORUM : LATUR.
The National Insurance Company Ltd,.
Through its Manager, Aurangabad.
Through its Divisional Office, Hazari Chembers, Padampura,
Railway Station road, Aurangabad. APPELLANT
VERSUS
1. Bhivaji s/o Dhondiba @ Dhondiram Dhondi Garad,
R/o Khandala Shirala, Tq. & Dist.Latur.
2. The Manager,
Bajaj Capital Insurance Broker, Office No.4,
Apollo House, Ground floor 8284, Samarchar Marg,
Fort, Mumbai 400001
3. The Taluka Agriculture Officer,
Taluka Agriculture Office, Latur.
4. The District Agriculture Officer,
Krushi Karyalay, Administrative Building, RESPONDENT No.1 to 4.
Latur.
CORAM :Smt.S.T.Barne, Hon'ble Presiding Judicial Member.
Mr.K.M.Lawande, Hon'ble Member.
Present : Adv.S.V.Kulkarni for appellant,
Adv.A.K.Jawalkar for respondent No.1.
Adv.T.M.Tandale for respondent No.2.
2 FA/252/2018
JUDGMENT
(Delivered on 29/08/2022) Per Mr.K.M.Lawande, Hon'ble Member.
1) Being aggrieved by the judgment and order of District Consumer Commission, Latur in C.C.No.57/2017 dated 31.5.2018, the appellant has filed this appeal.
2) The appellant is the opponent in the consumer complaint and respondent no.1 is the complainant and respondent No.2,3,&4 are the opponents. The parties all hereinafter referred as per their status in the consumer complaint. The District Consumer Commission is referred as District Forum for the sake of convenience.
3) It is the case of complainant that, his father Dhondiba @ Dhondiram Garad was resident of village Khandala Shirala, in Latur Tahasil of Latur district. He was agriculturist and was holding land in Gut No.158. He died in railway accident on 6.7.2016. He had left the house on 6.7.2016 to visit his daughter at Niwali. His dead body was found on railway track at gate No.47 near village Niwali. The deceased died in railway accident. After getting information of death of deceased the complainant obtained custody of dead body of deceased and performed the last rituals. It is the contention of complainant that the deceased was entitled for the benefit of insurance under "Gopinath Mundhe Farmers Accident Insurance Scheme". Hence the complainant filed insurance claim before the opponent Insurance Company along with necessary documents including 7/12 extract, 8-A, mutation entries, form no.6(C)(D), Aadhar 3 FA/252/2018 card, residence certificate etc. However, the opponent insurance company wrongly repudiated the complainant's claim on 24.1.2017. Hence this complaint.
4) The opponent Insurance Company appeared before the District Consumer Commission and filed w.s. and denied the rival allegations. The opponent denied the narrations in the complaint for want of knowledge. It is denied that, the deceased met with an accident. It is not pleaded by the complainant that, how the accident occurred. The insurance company rightly repudiated the claim.
5) The District Consumer Commission has partly allowed the complaint and directed the opponent insurance company to pay Rs.2 Lakhs within 30 days from receipt of order. It is also directed to pay interest @9 % p.a. if the order is not complied within period directed. The amount of Rs. 5,000/- towards mental and physical agony and Rs. 3,000/- towards cost of litigation is also awarded.
6) Being aggrieved by said order of District Consumer Commission the opponent insurance company has filed this appeal on the following grounds.
That, the District Consumer Commission failed to consider that, the insurance scheme is provided for the farmers of age 10 to 75 only the age of deceased was over and above the stipulated age of 75 years. The District Consumer Commission wrongly interpreted the facts of the case. The District Consumer Commission failed to appreciate the spot panchanama properly. The document is clearly mentioning that, the deceased has committed suicide. As per the 4 FA/252/2018 terms and conditions of the policy, the suicidal death is not covered under the policy, it is fully under exclusion Clause of the policy. The District Consumer Commission has not applied their mind judiciously and passed the incorrect and erroneous order.
7) Adv. V.S.Kulkarni appeared for opponent/appellant, Adv.A.K.Jawalkar for complainant. After having submission of parties following points arise for our consideration.
8)
Sr.No. Points. Findings.
1 Whether, the complainant proved No.
deficiency in service on the part of
opponents?
2 Whether, there requires interference in the Yes.
judgment and order of District Consumer
Commission?
3 What order? As per final order.
REASONING
Point Nos. 1&2 :-
9) The ld. Adv. Shri. V.S.Kulkarni argued for the appellant that ,
the District Consumer Commission failed to consider that, the deceased was above 75 years of age when died. There is Adhar card and election card stating the age of deceased of appeal compilation and the election card is stating age of deceased as 55 years on 1.1.94. Even election card is considered, the age of deceased is more than 77 years at the time of death.
The ld. Adv. further argued that, the District Consumer Commission failed to consider that it is a case of suicide as evidence from spot panchanama. Therefore, opponent is justified in 5 FA/252/2018 repudiating the complainant's claim. The District Forum failed to appreciate the facts in proper perspective. Complainant himself submitted properly evidence for age of deceased.
The ld. Adv. for appellant Shri. V.S.Kulkarni further argued for the appellant that, the District Forum failed to consider that, the deceased was above 75 years of age when died. From Aadhar card at page No.42 and election card at page No.43 of appeal compilation, it can be inferred that the deceased was above 75 years at the time of death. These cards are provided by the complainant himself. He was rather 77 or 78 years old as per the Adhar and elections card. Therefore, the complainant is not entitled to get the benefit of the insurance scheme when the deceased was not within the stipulated age limit. Also the District Forum erringly held that, this is case of accident. When the evidence i.e. spot panchanama made by the police is stating that, it is a case of suicide. The complainant has not established who has dashed the deceased, reason behind the accident.
10) The ld. Adv. Mr.Jawalkar argued that the District Forum has properly appreciated the evidence on the record and decided the complaint in allowing. This is a case of accident. The deceased died in railway accident only. The record made by the police is not reliable to accept. The District Forum rightly observed that the opponent has not adduced evidence to prove the case of suicide. To support his contention the ld. Advocate relied on the judgment of Hon' National Commission in New India Assurance Company Ltd,. vs. M.S.venkatesh Babu, RP/2575/2007 decided on 12.08.2011 wherein the Hon'ble National Commission upheld the judgment of Hon'ble State 6 FA/252/2018 Commission and refused to rely upon the FIR and statement recorded by police and relied on the affidavits filed before the District Forum. The learned advocate further argued that the date of birth on Aadhar card and Election card are recorded approximately. Those are not authentic dates.
11) It reveals from the policy that there are certain conditions to be satisfied for claiming the insurance amount. The one of the condition is age. The stipulated age of the father died in the accident is stated as 10 to 75 years. In the case in hand as per Adhar Card the age of the deceased comes to 78 years 5 months at the time of death. And as per election card, the age comes to 77 years and 6 months. Though ld. Adv. of opponent argued that, the age was recorded approximately in these cards. However, both the card showing the age of deceased above 75 years. Therefore, it is not justified to discard both the cards for consideration of age of deceased, which appearing under use for longer period. Therefore, it reveals that, the District Forum failed to consider the age of deceased while allowing the complaint. Besides these two documents viz. Aadhar Card & Election Card , there is no other authenticated documents to infer the age of deceased is below 75 years. Though there is certificate of provisional cause of death on record showing age of deceased as 70 years. However no post- mortem report is brought on record so as to infer the age on the basis of structure or built of deceased and other aspects mentioned in the post-mortem notes.
7 FA/252/2018 Also there is other dispute as to cause of death of deceased. The complainant is contending that the deceased died in accident whereas the opponent has taken defence that it is a case of suicide. We would not like to go for discussion on whether it is a case of accident or suicide as already the deceased is not found entitled for the benefit on the ground of his age above 75 years. Even other wise if it is discussed and for the sake of discussion if it reveals that, it is a case of accident. Even then, it will not be possible to upheld the judgment of District Forum as the deceased crossed 75 years of age when died.
In view of aforesaid discussion appeal deserves to be allowed. There requires interference in the order of District Forum. Hence, the order.
ORDER
1. Appeal is allowed.
2. The judgment and order of District Forum, Latur in C.C.No.57/2017 dated 31/05/2018 is quashed and set aside.
3. The C.C.No.57/2017 is hereby dismissed.
4. No order as to costs in appeal.
Sd/- Sd/- Mr.K.M.Lawande Smt.S.T.Barne, Member Presiding Judicial Member UNK