State Consumer Disputes Redressal Commission
Rekha Ravindra Jadhav vs Branch Manager, The Oriental Insurance ... on 5 January, 2022
1 A/532/2020
Date of filing :15.12.2020
Date of order :05.01.2022
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION,MUMBAI, BENCH AT AURANGABAD.
FIRST APPEAL NO. : 532 OF 2020
IN COMPLAINT CASE NO.: 357 OF 2019
DISTRICT CONSUMER FORUM : JALNA.
1. Rekha W/o Ravindra Jadhav,
R/o Churmapuri, Tq.Ambad,
Dist.Jalna.
2. Pawan Ravindra Jadhav,
R/o as above.
3. Harshwardhan Ravindra Jadhav,
R/o as above.
Appellant Nos. 2 & 3 minor U/g
Appellant No.1) ...APPELLANTS
VERSUS
1. Branch Manager ,
The Oriental Insurance Co.Ltd.
Ostwal Bandhu Building, J.M.Road,
In front of hotel Loves, Pune-411042.
2. Taluka Agricultural Officer,
Taluka Krishi Office,
In front of Tehsil Ambad, Dist.Jalna. ...RESPONDENTS
CORAM : Smt.S.T.Barne, Hon'ble Presiding Judicial
Member.
Mr.K.M.Lawande, Hon'ble Member.
Present : Adv.Sanjay Laghane for appellants,
Adv. P.M.Hiwale for respondent No.1.
JUDGMENT
(Delivered on 05/01/2022) Per Mr.K.M.Lawande, Hon'ble Member.
(1)Being aggrieved by the judgement and order of District Forum Jalna in consumer complaint 537/2019 dated 11/03/ 2020, the appellants have filed this appeal.
2 A/532/2020 (2) The appellants are the complainants and the respondent No.1 is the opponent in the consumer complaint. The respondent No.2 is the opponent No.2 in the consumer complaint . The parties in the appeal are hereinafter referred to as complainant/s and opponent as per their status in the consumer complaint. The District Consumer Dispute Redressal Forum is referred to as District Forum for the sake of convenience.
(3)(i) It is the case of complainants that they are resident of village Churmapuri , Tahsil Ambad, District Jalna. The complainant No.1 Rekha and her husband were engaged in agriculture . The family possesses agricultural land ,gut number 216 ,area 0-80 (H-R) at village Mahakala, Tahsil Ambad in the name of complainant. On 26/10/2018 at 5.30 p.m., when her husband Ravindra was travelling on his motorcycle from Churarmapuri to Aurangabad . The unknown vehicle gave dash to his motorcycle .In the said Accident, he sustained with grievous injuries and died on the spot. The police have registered crime number 335/ 2018. Post mortem on the body was done and body was handed over to the relatives for last rituals.
(ii)The Government of Maharashtra has already declared Group Insurance Scheme under the name "Gopinath Munde Farmers Accident Scheme ", to extend protection to the farmers and their families in case of accident of the farmer. The complainant submitted her Insurance claim along with the necessary documents to opponent number 2 Taluka Agricultural Officer who later forwarded the claim proposal through brokerage company to the opponent No.1 Insurance Company. However, the opponent Insurance Company has not settled her claim . The complainant therefore filed the consumer complaint before the District Forum Jalna seeking directions to opponent insurance company to pay the amount of Insurance of Rs 2 lacs with 15% interest.
3 A/532/2020 (4) The opponent Insurance Company filed written statement before the District Forum and submitted that as per terms and conditions of the policy there requires agricultural land in the name of deceased. In the case in hand the deceased Ravindra is not having agricultural land in his name. The complainant Rekha has purchased the land on 20/06/2007 and it is in her name vide mutation entry 2261.Complainant's claim is repudiated on the ground of not having agricultural land in the name of deceased.
(5) The District Forum dismissed the Consumer Complaint Observing that as per terms and conditions of the policy there requires of having agricultural land in the name of deceased and there are no documents showing the deceased was having agricultural land in his name.
(6) The complainant filed appeal on the ground that the District Forum failed to appreciate the provisions in the GR dt.01/12/2018 and failed to decide the consumer complaint in proper perspective.
(7) Heard Advocate Shri Laghane for the complainant and Advocate Shri Hiwale for the opponent.
(8) From the submissions of parties, following points arise for our consideration. We have noted them along with findings against it for the reasons to follow.
Points Answers
(i) Whether the complainant established
deficiency in service on the part of opponent
opponent insurance company? ..In affirmative.
(ii) Whether there requires interference in
the judgement and Order of the Dist.
Forum? ..In affirmative
4 A/532/2020
(iii) What order? - As per final order
REASONING
Points (i)(ii)(iii)
(9) The ld.advocate Shri Laghane argued for the complainant that the
Insurance Company has repudiated the complainant's claim without proper appreciation of documents on technical grounds and not considered that her deceased husband was agriculturist as the family possessed the land though in the name of wife .In the complaint before the District Forum , the Forum failed to appreciate the facts and law in proper prospective. The preamble of the scheme explains the true spirit of the scheme which is not looked into by the District Forum. The District Forum wrongly interpreted the terms and conditions observing requirement of agricultural land in the name of deceased .The District Forum failed to consider that family possessed agricultural land in the name of wife complainant Rekha .The G.R. dated 01.12.2018 has also clarified that the insurance company has to abide by terms and conditions provided in future. The circular is also issued by Agriculture Commissioner on 02.06.2020 stating that the insurance benefit is extended to the any one member of the agriculturist's family. The Insurance Scheme is a social legislation. The Insurance Company has repudiated the complainant's claim without proper appreciation of scheme and repudiated the claim on technical grounds. It is not considered that deceased husband was an agriculturist as the family possessed the land though in the name of wife. The ld.Advocate concluded the arguments with prayer that appeal to be allowed.
(10) It is argued by the ld.Advocate of the opponent Shri Hiwale that the complainant did not submit evidence as to agricultural land in the name of deceased .The land is in the name of complainant. The terms and conditions of the policy prescribe the condition of having land in the name of deceased/insured person as registered farmer on the day of inception of the 5 A/532/2020 policy period. The District Forum has rightly dismissed the complaint in view of the provisions of the policy .
(11) (i)After hearing both the parties, the issue before us is whether there is necessity of agricultural land in the name of deceased insured and whether the land in the name of other family member/s will entitle the complainant for the benefit of insurance claim towards the death of deceased husband and whether the District Forum is justified in holding that the Insurance Company rightly repudiated the claim .
(11)(ii)We have perused the policy ,it states the definition of 'farmer' as registered farmer, having land in his name on the day of inception of policy. We have also referred the GR dt. GR 01/12/ 2018 ,from the preamble of the said GR , it is sufficiently clear that the scheme is for protecting the farmer/farmers and their families in case of accidents of various types. Thus ,the scheme is basically benevolent in nature. It is to be read with the circular of Commissioner dt.2.6.2020.
(11)(iii) The deceased died in an accident on 26.08.2018 is not disputed.
The post-mortem report of the body is on record. Admittedly, there is no land in the name of deceased.However,there is land Gut No.216 at Mahakala Tq. Ambad in the name of complainant Rekhbai. There is mutation entry dt.
20/06/2007 on record, which shows the complainant has purchased the land in the year 2007 which shows that complainant is agriculturist. It appears that the complainant has filed insurance claim claiming herself to be wife of deceased along with son Pawan & Harshwardhan. It is not disputed by opponent that complainants are not heirs of the deceased. It appears that the District Forum has perused the documents showing land in the name of complainant.However,District Forum observed that there is 6 A/532/2020 requirement of land in the name of deceased as per tripartite agreement.
Observing no land in the name of deceased, the District Forum has dismissed the complaint. The complainant has produced the circular No. case No.5/13573/20 dated 2.6.2020 issued by Commissioner, Agriculture, it states that the benefits is extended to one of the family members of the deceased registered farmer. It appears that the said circular was not before the District Forum. From the perusal of circular it appears that it is made applicable for the year 2019-2020 onwards. The learned advocate for the complainant has already brought G.R. dt. 01/12/2018 to our notice. The said G.R. in clause No.14 which is in Marathi states as below.
Clause. 14 गोपीनाथमुढ ं े शेतकरी अपघात िवमा संबंधी शासनाचे वतीने आयु त,कृ षी तसेच िनयु त कर यांत येणारी िवमा स लागार कं पनी व िवमा कं पनी यांचम े ये तुत शासन िनणयातील अटी/शत व मा यतेनुसार सामंज य करार (MOU) व ि प ीय करार (Tripartite Agreement) क न यानुसार योजना अंमलात आणली जाईल.
शासनव िवमा कं पनीम ये झाले या पॉिलसी करारातील तरतूदी, उपरो त दनांक िडसबर 2009 या शासन िनणया ारे व उपरो त द. 5 माच 2011 या शासन िनणय शु दीप का वये िविहत के ले या अटी व शत , तसेच, भिव यात लागू कर यांत येणा-या अटी व शत , तसेच, मागदशक सुचनांनस ु ार िवमा दावे मंजरू करणे, तसेच, िवमा तावांसद ं भातील कायप दती, सादर करावया या आव यक कागदप ांबाबतचा तपिशल व नमुने इ.बाबी िवमा कं पनीवर बंधनकारक राहतील.
Thus, it appears from the said G.R. that terms and conditions made applicable in future are made applicable. Therefore , the circular issued by Commissioner, Agriculture can be relied upon to consider that deceased husband of the complainant is covered for the benefit of insurance, as the deceased is family member of the registered agriculturist i.e. complainant.
7 A/532/2020
11.(iv) Thus there appears deficiency in service on the part of opponent towards the complainant by repudiating the claim of Insurance on technical ground. Therefore we answer point No.1 in affirmative.
(12) The District Forum dismissed the Consumer Complaint Observing that as per terms and conditions of the policy there requires of having agricultural land in the name of deceased as registered farmer. However, the complainant has submitted the G.R. dt. 01/12/2018 and circular of Commissioner dt. 02.06.2020 in appeal and reliance on the said G.R. and circular is required in the interest of justice. Therefore, there requires interference in the order of District Forum.
In view of aforesaid discussion, we answer the points accordingly and pass the following order.
ORDER
(1) Appeal is allowed
(2) The judgement and order of District Forum, Jalna in consumer
complaint No. 357/2019 decided on 11.03.2020 is quashed and set aside.
(3) The consumer complaint No.357/2019 is allowed.
(4) The opponent No.1, Insurance Company is directed to pay Rs. 2 lacs to the complainant with interest at rate of 7% p.a. from the date of complaint within three months.
Sd/- Sd/- Mr.K.M.Lawande Smt.S.T.Barne, Member Presiding Judicial Member MBM