State Consumer Disputes Redressal Commission
Oriental Insu.Co. vs Smt. Panchwati Kevat on 1 August, 2016
M.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION
PLOT NO. 76, ARERA HILLS, BHOPAL (M.P.)
Appeal No. 1497/2011
The Oriental Insurance Co. Ltd.
Through Divisional Manager,
Near Normal School, in front of Rajeev Plaza.
Bilaspur ... Appellant
Vs.
1. Smt. Panchvati Kevat
W/o late Shri Tulsi Kevat,
R/o Mines Colony, Qr. No. M/490,
Police Station Bijuri
District Anooppur
2. Commercial Manager,
SECL Ltd., Bijuri,
District Anooppur ... Respondents
BEFORE;
HON'BLE SHRI JUSTICE RAKESH SAKSENA, PRESIDENT
HON'BLE SMT. NEERJA SINGH, MEMBER
COUNSEL FOR PARTIES:
SHRI MOHAN CHOUKSEY, LEARNED COUSNEL FOR APPELLANT.
NONE FOR RESPONDENT NO.1 (PRESUMED).
SHRI AJAY NAMDEO,, LEARNED COUNSEL FOR RESPONDENT NO.2.
ORDER
( PASSED ON 01.08.2016) The following order of the Bench was delivered by Smt. Neerja Singh, Member.
This appeal is by the opposite party, the Oriental Insurance Co Ltd., (hereinafter referred to as the Insurance Company), aggrieved by the order dated 13.7.11 passed by : 2 : District Consumer Disputes Redressal Forum, Anooppur in CC No. 11/2010.
2. The facts, in brief, are that the respondent- complainant's husband, (hereinafter referred to as the insured), was covered under the Janta Personal Accident Policy, taken by his employer, the South Eastern Coalfields Ltd, (SECL) for the period 16.10.99 to 15.10.09. The insured died on 6.10.07, when he was run over by a train. The employer was informed and a police report was made. As the respondent-complainant could not locate the certificate of insurance at home, she requested the employer for the certificate, which they provided on 10.3.09. She contacted the appellant-Insurance Company on 10.4.09, but they did not settle her claim. She then filed a complaint before the District Forum, No 21/09, in which the Forum vide order dated 18.2.10, directed the respondent- complainant to provide all the necessary papers to the appellant who were directed to decide the claim. She gave all the necessary documents on 25.2.10. On 26.2.10, the appellant sent her a letter repudiating her claim on the ground of delayed intimation.
3. The appellant have denied that the respondent- complainant is the wife of the insured or that he died in a train : 3 : accident. They deny that any employee of the SECL was covered under the policy. They aver that the policy has been cancelled by them and out of spite the employer is issuing false certificates. They further contend that as a Writ petition is pending in the Hon'ble High Court, Bilaspur, the matter is subjudice and cannot be entertained by the Forum.
4. After denying all the facts, the appellant then state that since the insured died while crossing the railway track, it is a case of suicide which is not covered under the policy. They aver that there is no evidence that the insured was covered under the policy as no certificate has been filed. No claim was filed with them. On the directions of the District Forum, the respondent- complainant filed the claim form and necessary documents on 25.2.10, and they repudiated the claim on 26.2.10 as it was filed beyond the prescribed period of 15 days.
5. The District Forum held that the delay has already been dealt with in the previous order given in complaint No. 21/09 and since the appellant did not file any appeal, the point is no longer in dispute. The appellant were directed to pay the sum insured, Rs.5,00,000/- with 9% interest from 21.4.10 and costs of Rs.1000/-.
6. Heard.
: 4 :
7. The contention of the appellant that the insured was not covered under the policy is without any merit. The respondent-complainant has filed the pay slip of the insured showing that deduction were made from his salary towards the insurance. A certificate of the employer is also filed to the effect that the premium for the policy was deducted from the insured's salary.
8. As regards the cancellation of the policy, it is now well settled that the Insurance Company cannot unilaterally cancel a policy. The Hon'ble Bombay High Court in the case of Western Coalfields Ltd. & Ors. vs New India Assurance Co. Ltd. (2006 (I) Mh.L.J. 244) has held that this unilateral cancellation of the policy was illegal. This judgment has been upheld by the Hon'ble Supreme Court in SLP No 1733/2006, vide order dated 23.01.07. This Commission also, in a number of judgments, has followed the view taken by the Bombay High Court, and held that the cancellation was invalid.
9. The police report mentions that the insured died in an accident while crossing the railway track. There is no evidence on record to show that the insured committed suicide. Merely because he was hit by a train while crossing the tracks would not amount to suicide. The onus was on the Insurance Company to : 5 : substantiate their allegation which they have failed to do. Nor is this their ground of repudiation.
10. The Insurance Company has repudiated the claim on the ground of delayed intimation. They state that they were not informed of the incident in the period prescribed in the policy. However, the learned counsel for the appellant was not able to show us any condition prescribing the period in which a claim could be made. In fact, no policy has been filed on record.
11. Learned counsel for respondent No. 2 showed us the Memorandum of Understanding between the appellant and the SECL. It only states that - "in the event of claim, the same shall be settled within one month's time on submission of the required documents".
12. In the absence of any condition making it mandatory for the claim to be filed within a specific period, we do not find any illegality in the order of the District Forum in awarding Rs.5,00,000/- to the respondent-complainant. However, the interest of 9% is on the higher side and is reduced to 6%, applicable from the date of this order.
13. In the result, the appeal is partly allowed and the order of the District Forum is modified. The appellant are directed to pay a sum of Rs.5,00,000/- with 6% interest to the respondent- : 6 : complainant from the date of this order. The cost awarded by the Forum is maintained. No order as to the cost of this appeal.
(JUSTICE RAKESH SAKSENA) (SMT. NEERJA SINGH)
PRESIDENT MEMBER