National Consumer Disputes Redressal
M/S. Reliance G.I.C. Ltd. vs Mms Maritime India Pvt. Ltd. & 2 Ors. on 30 April, 2024
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 273 OF 2019 (Against the Order dated 30/11/2018 in Complaint No. 179/2014 of the State Commission Maharashtra) 1. M/S. RELIANCE G.I.C. LTD. H - BLOCK, 1 FLOOR, BHIRUBHAI AMBANI KNOWLEDGE CITY NAVI MUMBAI 400 710 ...........Appellant(s) Versus 1. MMS MARITIME INDIA PVT. LTD. & 2 ORS. 401, RAHEJA PLAZA, 15/B, SHH INDUSTRIAL ESTATE OFF. ANDHERI LINK ROAD, ANDHERI (W) MUMBAI 400 053 2. MMS CO LTD SURFEEL NAKAMEGURO BUILDING 1-18/12, KAMIMEGURO , MEGURO-KU TOKYO JAPAN 3. SUREKHA SURESHRAO WADWALKAR R/O. GURURAO GALLI, KANDHAR, NANDED MAHARASHTRA ...........Respondent(s)
BEFORE: HON'BLE AVM J. RAJENDRA, AVSM VSM (Retd.),PRESIDING MEMBER
FOR THE APPELLANT : FOR THE APPELLANT : MR. S. SURENDER, ADVOCATE
MR. ANUJ CHAUHAN, ADVOCATE FOR THE RESPONDENT : FOR THE RESPONDENTS : MR. RAHAT BANSAL, ADVOCATE
MR. AMIT A. PAI, ADVOCATE
MR. KUSHAL DUBE, ADVOCATE
Dated : 30 April 2024 ORDER
1. The present First Appeal has been filed under Section 19 of the Consumer Protection Act, 1986 ("the Act") against the Order dated 30.11.2018 passed by the State Consumer Disputes Redressal Commission, Maharashtra ("the State Commission"), in Consumer Complaint No. CC 179 of 2019, wherein the Complaint filed by the Complainants (Respondents herein) was allowed.
2. There was 15 days delay in filing the present First Appeal. For the reason stated in IA No. 2859/2019 seeking condonation of delay, vide order dated 18.10.2019, the same is condoned.
3. For clarity and consistency, the parties involved in this Appeal will be referred to as per the Complaint filed before the learned State Commission. The Complainant No. 1/Respondent No. 1, "MMS Maritime India Pvt. Ltd.," is a company incorporated under the Companies Act, 1956. Complainant No. 2/Respondent No. 2, "MMS Co Ltd.," is a company incorporated under the laws of Japan. Both these Complainants are part of Melji Shipping Group (Japan). Complainant No. 1 provides various services, including manpower services, and maintains a dedicated pool of seafarers for tanker operations to fulfill the manpower requirements of Complainant No. 2 and the Melji Shipping Group (Japan). Complainant No. 3 is the dependent mother of the deceased Shri Saurabh Sureshrao Wadwalkar, who was an insured covered by the policy issued by the Appellant/OP-1. The OP-1/Appellant is an insurance company that issued the policy in question to the Complainants. The OP-2 is an insurance agent who negotiated the insurance policy in question.
4. Brief facts of the case, as per the Complainants, are that MMS Maritime India Pvt. Ltd. (Complainant No. 1) maintains a dedicated pool of seafarers for tanker operations to address the manpower requirements of MMS Co. Ltd. (Complainant No. 2) and the Melji Shipping Group (Japan). Complainant No. 1 also provides necessary training and conducts workshops and seminars for Indian seafarers. While the Indian seafarers are covered by appropriate insurance through Protection and Indemnity Clubs (P & I Clubs) during vessel operations, they are not covered while on shore in India.
5. In July 2012, the Complainants sought to obtain an accident and health insurance cover for Indian seafarers while on shore. An MOU was entered into between Complainant No. 1 and OP-2 to facilitate this process. A meeting was held on 12.07.2012 between the parties to deliberate the scope and terms for accident insurance for Indian seafarers. The arrangement between the Complainants and Indian seafarers was explained to OPs, who assured that Indian seafarers would be adequately covered by the insurance policy. Relying on this, the Complainants decided to avail a Group Accident Policy and Group Health Insurance Policy for the Indian Seafarers, their spouses and children from OP-1. On 21.09.2012 Complainant No.1 paid a premium of Rs.5,85,613.99 towards Accident Insurance Policy. Complainant No.1 also paid Rs.23,21,507/- towards Health Insurance Cover to OP-1. Complainant no.1 paid Rs.2,90,712/- to OP-2 as consideration for services. On 12.10.2012, the OP-1 issued a Group Accident Insurance Policy No.1109322914000001 valid from 01.10.2012 to 30.09.2013, received on 18.10.2012. However, upon receiving the policy, Complainant No. 1 realized that the terms were not as agreed between the parties. Despite informing OP-2 of the discrepancy, it was merely assured that Indian seafarers were adequately covered.
6. On 06.10.2012, Saurabh Sureshrao Wadwalkar was involved in a fatal road accident in Khadki, Taluka Daund, District - Pune. He was on shore pursuant to the agreement and undergoing training as preparatory for rejoining the vessel of the Complainants. Later, on 26.10.2012, Complainant No. 1 filed a claim with OP-1 under the policy along with all requisite documents. OP-1 deputed its authorized agent to the site to conduct a thorough investigation. However, to the utter shock and dismay of the Complainants, on 19.02.2013, OP-1 repudiated the claim, citing that the deceased was a contractual employee and thus not covered under the policy. Despite diligent follow-ups and correspondence, OP-1 failed to honor the claim.
7. Being aggrieved by the repudiation of claim and deficiency in service on the part of OPs, the Complainant filed Consumer Complaint No. CC 179 of 2014 seeking Rs.50,00,000/- under the policy to the Complainants or dependents of the deceased with interest @18% per annum from the date of repudiation. The Complainants have also claimed amount of Rs.10,00,000/- towards mental agony and Rs.5,00,000/- for deficiency in service and Rs.1,00,000/- towards litigation costs.
8. In reply, the OP-1/Insurer refuted all adverse allegations and raised preliminary objections, arguing that the Consumer Forum is not the appropriate venue for the Complaint's relief. The claim was thoroughly investigated and rejected. Such disputes are better suited for a regular civil suit in the Civil Court due to complexity. Moreover, OP-1 asserted that the claim exceeded the Consumer Forum's pecuniary jurisdiction, making it not maintainable. On the merits, OP-1 acknowledged that OP-2, as one of its official agents, facilitated a meeting between the parties to discuss obtaining accident and health insurance for Indian seafarers. Consequently, OP-1 issued the said Group Personal Accident Insurance Policy dated 12.10.2012 to cover Indian seafarers while on shore, as agreed upon. Following the tragic death of Mr. Saurabh Wadwalkar in a fatal road accident in Pune, a claim was filed on 26.10.2012. OP-1 repudiated the claim as it was beyond terms and conditions of the policy. The insurance was obtained by the Complainants solely to safeguard the interests of Indian seafarers while on shore. The insurance policy was specifically intended to cover permanent employees of MMS Maritime (India) Pvt Ltd. Upon verification and review of documents, it was found that the deceased was a contractual worker and not a permanent staff, as stipulated by Clause 11 of the Policy Schedule. For contractual staff, neither the dependents nor the deceased himself are entitled to claim any benefits. OP-1 asserted that the repudiation of the claim was justified and sought the complaint to be dismissed with costs.
9. In reply, OP-2 contested the complaint to be false, vexatious and aimed at tarnishing its reputation. No negligence or deficiency in the services provided. OP-2 clarified that it offers insurance related services to various clients. It interacted with the Complainants and provided numerous insurance quotes to fit the need of Complainant No. 1 and Complainant No. 1 selected OP-1 from the options. OP-2 facilitated a meeting between the parties, during which the terms, conditions, and clauses were discussed and negotiated. OP-2 clarified that Complainant No. 1, MMS Maritime of India Pvt. Ltd., acted as the principal agent of Meikai Marine Services (Tokyo) Co. Ltd, handling the welfare of seafarers and office staff. Policies were issued in the name of Meikai Marine Services through MMS Maritime (India) Pvt Ltd. In August/September 2012, the Complainant No. 1 had approached OP-2 for Group Accident Policy & Group Mediclaim Insurance for office staff and onshore seafarers. Four cheques for premiums were handed to OP-1 on 25.09.2012. Upon the death of Mr. Saurabh Wadwalkar, OP-2 informed OP-1 and assisted in collecting necessary documents for the claim. The repudiation letter was shocking, as policies were understood to cover contractual seafarers. OP-2 previously settled numerous claims for Complainant No. 1. OP-2 denied any deficiency in service or unfair trade practice and sought dismissal of the complaint.
10. The learned State Commission held OP-1 liable for wrongfully repudiating a genuine claim but absolved OP-2 of any deficiency in service and partly allowed with the following order: -
"ORDER
(i) Consumer complaint is partly allowed against opponent no.1.
(ii) It is hereby declared that opponent no.1 is guilty of deficiency in service.
(iii) Opponent no.1 is directed to pay amount of Rs.50,00,000/- to the complainant no.3 under Group Accident Insurance Policy with interest @9% per annum from the date of repudiation of claim i.e. since 19th February, 2013 till realization of the entire amount.
(iv) The opponent no.1 to pay to the complainantno.3 amount of Rs.1,00,000/- towards compensation for mental pain and agony and amount of Rs.1,00,000/- as compensation on account of deficiency in service.
(v) The opponent no.1 to pay an amount of Rs.50,000/- to the complainant no.3 towards costs of litigation and shall bear its own costs.
(vi) Consumer complaint stands dismissed against opponent no.2
(vii) Copies of this order be furnished to the parties."
11. Being aggrieved by the impugned order dated 30.11.2018, the OP-1 / Appellant filed this Appeal No. 273 of 2019 seeking to:
"a. set aside the Judgment & the order dated 30.11.2018 passed by the Hon'ble State Commission, in the CC No.179 of 2018 and titled as MMS MARITIME INDIA PVT. LTD AND ORS. VS. RELIANCE G.I.C. LTD. AND ANR. and b. Stay the execution proceedings, if any, in respect of Order dated 30.11.2018 passed by the Hon'ble State Commission in CC NO.179 OF 2014.
12. In the Appeal, the Appellant/OP-1 raised mainly the following issues:
The State Commission overlooked that the Respondents/ Complainants were aware of the policy terms and conditions since they submitted the policy and its annexures, and they never objected to the scope of coverage.
The State Commission failed to note that the Group Personal Accident quotation was based on the understanding that only permanent employees of MMS Maritime India Pvt. Ltd. onshore would be covered. It was issued with explicit conditions specifying coverage for permanent employees and excluding offshore risks.
The State Commission erred in not recognizing that Clause 11 of the policy's General Conditions clearly stated coverage for permanent employees only, and no evidence was provided by the Respondents/Complainants to prove otherwise.
The State Commission neglected to consider that the claim was rightfully denied due to the deceased being a contractual employee, which was a material non-disclosure by Respondents/ Complainants during the insurance proposal, thus misleading the issuance of the policy.
The State Commission failed to acknowledge the nature of the insurance contract as one of utmost good faith, wherein the Respondents/Complainants were obligated to adhere to the policy's terms and conditions.
13. Upon the notice on the memo of Appeal, the Respondents/ Complainant have made written submissions appreciating the Impugned Order passed by the learned State Commission.
14. The learned Counsel for the Appellant/OP-1 reiterated the facts of the case and grounds of Appeal and emphasized that the policy in question was explicitly intended to cover permanent employees of MMS Maritime (India) Private Ltd., as stated in the policy's general conditions. It was argued that the deceased was a contractual worker based on verification and documents provided. Additionally, Clause 11 of the policy specified coverage only for permanent employees or seafarers. Therefore, the Appellant/OP No. 1 rightfully rejected the claim. The counsel further alleged that the Respondents violated Condition 10 of the policy terms and conditions by filing the claim fraudulently. The learned counsel for the Appellant has relied on the following judgments to support the arguments: -
a. United India Insurance Co. Ltd. vs. Harchand Rai Chandan, Civil Appeal No. 6277 of 2004.
b. Suraj Al Ram Niwas Oil Mils Vs. M/s. United India Insurance Co. Ltd., Civil Appeal 1375 of 2003.
c. Jaspreet Singh Vs. ICICI Home Finance Co. Ltd. and ICICI Home Finance Co. Ltd., Mumbai, R.P. No. 113 of 2013.
15. The learned counsel for the Respondents reiterated the facts of the case and strongly argued that the deceased was covered under the Group Insurance policy, emphasizing the Appellant's deficiency in service. It was asserted that the specific requirements of the policy were communicated and agreed upon by both parties. The Appellant failed to ensure compliance with these terms. He highlighted the discrepancies between Appellant's contentions and the documented agreements, asserting that the Appellant's stance contradicted prior understandings. The Appellant was deficient in service and unfair trade practices. To support these arguments, he cited the Hon'ble Supreme Court's decision in Texco Marketing Private Limited Vs Tata AIG General Insurance Company Ltd., (2023) 1 SCC 428.Top of Form
16. I have gone through the pleadings placed on record and the and written submissions filed by both the parties. Heard the learned Counsels for both the Parties and rendered careful consideration to the issues raised in the arguments advanced.
17. The primary issue in this case revolves around whether the deceased individual was covered under the subject group insurance policy? Specifically, it concerns the discrepancy between the terms agreed upon by both parties and the Appellant's contention that the deceased was not covered under the policy. This raises questions of terms of contract, duty of the insurer to provide coverage as agreed upon, and alleged deficiency in the services provided by the insurer.
18. It is admitted position that the Respondent No. 1 considered that the temporary Indian Seafarers while on shore are not covered life insurance and sought to obtain a Group Accidental Insurance cover from OP-1 through OP-2. On being explained the requirement, OP-2 facilitated a meeting between the parties, the intention and scope were deliberated on 12.07.2012. At the meeting amongst the Complainant No.1, the OP-1 and OP-2 the requirement of insurance for Indian Seafarers was deliberated and clarified to OP-1. Copy of the agreement between Complainant No.1 and 2, qua the Indian Seafarers was immediately forwarded to OP-2 on 25.07.2012. The agreement copy was also forwarded to OP-1. OP-1 acknowledged the receipt and confirmed that the insurance policy proposed to be availed would cover the seafarers while on shore. These facts are not challenged by the Opposite Parties. Complainant No.1 and 2 obtained a Group Accident Policy and Group Health Insurance Policy for Indian Seafarers, their spouses and children with similar terms and conditions. The Group Accident Policy covered permanent partial/total disability, and death. The sum insured would not exceed 24 times monthly gainful employment of any person and subject to maximum of Rs.50,00,000 per insured life.
19. Indian Seafarer Saurabh Sureshrao Wadwalkar had met with a fatal accident 06.10.2012 in Khardi, Taluka and District Pune. A claim was filed with OP-1 on 26.10.2012 which was rejected. The rejection was mainly on the ground that deceased was contractual employee of the Complainant No.1 and the policy covers only permanent employees. Admittedly, as on the date when the fatal accident happened on 06.10.2013, the Complainants were yet to receive the Insurance Policy. When they received the same a few days later and noticed certain discrepancies in the terms and conditions with respect the cover to seafarers on shore, they reflected the same forthwith to the OPs including the repudiation of the claim.
20. It is also uncontested that OP-1 had allowed Mediclaim policy with respect to seafarers without any restriction, including the status of any individual as a temporary employee. Very pertinently, the terms and conditions of Mediclaim policy and Group Accident Policy are one and the same. The temporary employee issue was raised only when claim of the deceased Saurabh Wadwalkar was filed under Group Accident Policy. Manifestly, the terms and conditions were not issued as agreed in the meeting between the parties. On receipt of the same, the discrepancy was observed by the Complainants and OP-1 was approached. If the policy issued by OP-1 was as per the terms agreed upon between the parties, OP-1 was to repudiate the claims under Mediclaim policy was well. Admittedly, the claim under Mediclaim policy of the deceased was allowed and the same under Group Accident Policy was repudiated. Also, OP-2 also expressed disbelief to note the reason for rejection of the claim and corroborated that OP-1 was well aware of the mandate that the policies were taken for seafarers on shore and OP-1 was regularly providing insurance for seafarers who are on contractual basis.
21. It is uncontested fact that the Complainants and Respondents have entered into an agreement and obtained a Group Accidental Insurance policy No. 11009322914000001 dated 12.10.2012 for providing life cover to Indian seafarers. Perusal of the policy reveals that, the total number of employees covered are 190 and, therefore, the total numbers of lives covered are also 190. In pursuance of the same, the Complainant had paid Rs.5,85,613.99/- as premium. Along with the policy, the Appellant/Insurer issued a schedule of the names of individuals approved to be covered under the policy. It is manifest from the schedule of the individuals approved to be insured by OP-1 that the name of the deceased Shri Saurabh Sureshrao Wadwalkar is listed at Sl. No. 188 and insured for Rs.50,00,000/-. Therefore, the intent of the Complainants as well as the OP-1 with respect to facilitating life insurance of the staff including the deceased i.e. Shri Saurabh Sureshrao Wadwalkar is explicit.
22. Notwithstanding the same, after the unfortunate death of Shri Saurabh Sureshrao Wadwalkar and the claim was submitted, the insurer repudiated the claim citing clause No.11 of the general conditions citing that the policy is for permanent employees of MMS Maritime India and that the deceased Shri Saurabh Wadwalkar is not a permanent employee. Such stand of the Appellant / Insurer is untenable with due regard to issue of policy was obtained for total of 190 employees, including the deceased. This has been specifically stated in the policy and schedule approved and issued by the insurer. Even for the sake of discussion, if the deceased Shri Wadwalker is considered not eligible for insurance cover, the total lives proposed to be insured would fall short of 190, while OP-1 had collected premium for 190 individuals, including Shri Saurabh Wadwalker as approved by the OP-1 in the Schedule to the Insurance Policy.
23. In addition to the above, it is undisputed that one more insurance contract for providing medical insurance was entered into between the parties with similar terms and conditions and OP-1 had accepted the claims of Shri Saurabh Sureshrao Wadwalkar and paid the claims. In any case, it is also an established position that, in the event of any ambiguity with respect to the terms and conditions of contract, the same shall be interpreted in the favour of the insured.
24. In view of the above discussion, I am of the considered view that the Order of the State Commission does not suffer from any illegality or irregularity that warrants interference of this Commission. The FA No. 273 of 2019 is accordingly dismissed.
25. In the given circumstances, there shall be no order as to costs. All pending Applications, if any, also stand disposed of accordingly.
26. The Registry is directed to release the Statutory deposit amount, if any due, in favour of the Appellant after compliance of the order of the learned State Commission, as per law.
................................................................................... AVM J. RAJENDRA, AVSM VSM (Retd.) PRESIDING MEMBER