State Consumer Disputes Redressal Commission
The Divisional Manager, vs 1. Shobhabai Prakash More on 19 March, 2014
1 F.A. No. 580-08
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION, MUMBAI, CIRCUIT BENCH
AT AURANGABAD
Date of filing: 05.04.2008
Date of Order:19.03.2014
FIRST APPEAL NO.: 580 OF 2008
IN COMPLAINT CASE NO. 250 OF 2007
DISTRICT CONSUMER FORUM: JALGAON.
The Divisional Manager,
National Insurance Company Ltd.,
586, Sadashiv Peth,
Laxmi Road, Pune,
Tq. & Dist. Pune. ... Appellant
VERSUS
1. Shobhabai Prakash More
R/o. Sant Gadgebaba Nagar,
Tq. Pachora, Dist. Jalgaon.
2. Executive Engineer,
Pachora, Tq. Pachora,
Dist. Jalgaon. ... Respondents
Coram : Shri. S.M. Shembole, Hon`ble Presiding Judicial Member.
Mrs. Uma S.Bora, Hon`ble Member.
Present: Adv. Shri. P.V. Soman for appellant.
Adv. Shri. Ujwal Patil for respondent No.1.
Adv. Shri. P.B. Paithankar for respondent No.2.
- :: ORAL JUDGMENT:: -
(Delivered on 19th March, 2014) Per Mrs. Uma S. Bora, Hon`ble Member
1. Divisional Manager, National Insurance Company Limited, Pune challenges in this appeal the judgment and order passed by District Forum, Jalna on 04.03.2008 while deciding consumer complaint No.250/2007.
2. Facts in nutshell are as under:2
Complainant Shobhabai Mote resident of Pachora District Jalgaon is wife of deceased Prakash More. Deceased Prakash More was working with respondent No.2 MSEDCL at Pachora District Jalgaon. Respondent No.2 had obtained "Group Insurance Policy" for their employees in the year 1998. Said policy was bearing No.270200/47/61/158/1998. During the pendency of said policy on 28.02.2000 deceased Prakash while walking on the wall of Dam died due to drowning. Accordingly inquest panchanama and P.M. report was received by the complainant. The complainant, wife of Prakash More was not aware about the present policy. She was orally informed by the respondents that there is insurance policy of her husband. Therefore on 08.02.2007 she supplied all the required documents with opponent no.2 and opponent No.2 forwarded all the documents with claim form to present appellant on 19.02.2007. Present appellant repudiated the claim of the complainant on the ground of delayed intimation about the accident and the death of the policy holder, therefore complainant approached to Forum.
3. Appellant appeared before Forum and denied the claim mainly on the ground that after the death of policy holder claim was not preferred to the insurance company within a month and hence claim is rejected on the ground of delayed intimation. It is further submitted by appellant that claim in respect of another policy was settled in the year 2006 and therefore complainant is not entitled for claim of similar policy again.
4. Opponent No.2 appeared before Forum and submitted that they had regularly deposited the premium of policies in respect of deceased. They have already supplied all the required documents with claim form with the appellant therefore there is no deficiency on their part.
5. After hearing both the parties District Forum held that guideline about intimation regarding the accident is directory and not mandatory and allowed the complaint. Forum directed opponent Nos. 1 & 2 to pay Rs.2,00,000/- as a insurance amount and Rs.5000/- for mental agony and Rs.1000/- for cost of the complaint. Said amount was directed to be paid on or before 04.04.2008 or said amount will carry 18% interest from 04.03.2008.3 F.A. No. 580-08
6. Being aggrieved by the said judgment and order opponent no.1 came in appeal. Adv. Shri. D.V. Soman appeared for appellant. Adv. Shri. Ujwal Patil appeared for respondent No.1. Adv. Shri. P.B. Paithankar appeared for respondent No.2. It is submitted by Adv. Soman that husband of complainant died in the year 2000 and intimation regarding his death was given by complainant with claim form on 19.02.2007. Therefore there is abnormal delay in preferring the claim. As per the terms and conditions of the policy intimation regarding accidental death is required to be given immediately at the most within one month after the incident but in the present case complainant preferred the claim near about seven years. Therefore his claim was rightly repudiated on the ground of delayed intimation. It is further submitted by Adv. Soman that husband of the complainant had also obtained another same policy. Claim of said policy was sanctioned and accordingly complainant received the claim amount. Therefore she is not entitled to claim the amount of another policy in respect of death of her husband.
7. Adv. Ujawal Patil appeared for respondent No.1 submitted that complainant is an illiterate lady. Therefore she was not aware of the policies obtained by her husband. The terms and conditions of policy never supplied by the appellant to the husband of complainant, therefore she was not aware about any terms and conditions of the policy. It is further submitted by Adv.
Ujwal Patil that in the year 2007 somebody from respondent No.2 office orally intimated to the complainant about the policy of her husband. Therefore she immediately supplied all the required documents with the opponent No.2 and accordingly opponent No.2 forwarded her claim to National Insurance Company. It is further submitted by Adv. Patil that District Forum has rightly appreciated the facts and evidence while allowing the complaint. Hence appeal be dismissed by allowing the complaint. Adv. Shri. Patil, relied on M/s. Toorent Securities Pvt. Ltd. Vs. National Insurance Company, 2007 (1) CPR 299 (NC). It is held by Hon'ble National Commission that, when at the time of commencement of insurance, the insurance company chose to give only policy schedule and very late thereafter gave 4 details of policy terms and conditions and that too after accident had taken place, those terms and conditions could not be said binding on insured. Adv. Patil also relied on Mangalbai Sahebrao Nirmal Vs. National Insurance Co. Ltd., and ii) Smt. Indumati Chandrabhan Satpute Vs. National Insurance Co. Ltd. The judgment and order given by State Commission, Aurangabad in Appeal No.281/2007 and 282/2008, and State Commission relied on New India Assurance Co. Ltd. Vs. Nanasaheb Hanumant Jadhav & Ors, reported in 2005 (2) CPR 24. It is held by State Commission that the condition regarding intimation of accident immediately is directory one and not mandatory. Therefore repudiation of claim by the insurance company is not legal and proper.
8. Adv. Paithankar appeared for respondent No.2 submitted that respondent No.2 obtained the "Group Insurance Policy" for its employees. After getting the required documents for submitting the claim with insurance company by the complainant claim was forwarded by respondent No.2 to the insurance company. It is further submitted by Adv. Paithankar that it is not proper on the part of insurance company to repudiate the claim on mere technicalities.
9. We thus heard all the counsel and perused the record. It is an admitted fact that husband of complainant had obtained "Group Insurance Policy" in the year 1998. It is an admitted fact while the policy was in force husband of complainant died due to drowning. It is seen from the record that complainant is a illiterate lady and only person who is to look after the family, she get the claim of his policy in the year 2006 and thereby she got oral information from respondent No.2 office about the second policy of the deceased husband of complainant. Immediately after getting the knowledge about second policy she submitted all the required documents and claim form with the respondent No.2, and respondent No.2 forwarded the same to appellant, claim was repudiated on only ground that intimation of death of Prakash was given by causing delay. In our view said term is directory only and with view that if insurance company got the claim form within 5 F.A. No. 580-08 reasonable time they can enquire into the matter. That is not mandatory condition or no fundamental breach caused by violation of said condition. While allowing the complaint District Forum rightly appreciated the facts and evidence. We do not want to disturb the reasoning recorded by the Forum. Hence the following order.
ORDER
1. The appeal is dismissed.
2. No order as to cost.
(Mrs. Uma S. Bora) (S.M. Shembole)
Member Presiding Judicial Member
Kalyankar