State Consumer Disputes Redressal Commission
Reliance General Insurance Company ... vs 1. Sarita Devi Wife Of Kuldeep Son Of Shri ... on 24 September, 2012
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, HARYANA, PANCHKULA First Appeal No.1327 of 2011 Date of Institution: 21.09.2011 Date of Decision: 24.09.2012 Reliance General Insurance Company Ltd., through its authorised signatory, Krishna Kant, Legal Manager, IInd Floor, SCO No.135-136, Sector 9-C, Chandigarh. Appellant (OP) Versus 1. Sarita Devi wife of Kuldeep son of Shri Shamsher Singh, resident of Village Sheria, Tehsil Jhajjar, District Jhajjar. Respondent (complainant) 2. District Social Welfare Officer, Jhajjar. 3. S.D.O. (Civil), Beri, district Jhajjar. Respondents (Ops No.2 & 3) BEFORE: Honble Mr. Justice R.S. Madan, President. Mr. B.M. Bedi, Judicial Member. For the Parties: Shri T.K. Joshi, Advocate for appellant. Shri Pardeep Chahar, Advocate for respondent No.1. None for respondents No.2 and 3. O R D E R
Justice R.S. Madan, President:
This appeal has been preferred against the order dated 02.06.2011 passed by District Consumer Forum, Jhajjar whereby complaint filed by complainant (respondent No.1 herein) against the appellant-opposite parties was accepted and following direction was issued:-
We, therefore, direct the respondent No.1 to pay a sum of Rs.1,00,000/- to the complainant under the scheme of Rajeev Gandhi Parivar Bima Yojna. The complaint is disposed of accordingly.
The brief facts of the present case as emerged from the record are that Kuldeep son of Shamsher Singh - husband of the complainant (respondent No.1 herein) expired on 3.6.2008 due to biting of poisoned insect/heart attack at Civil Hospital, Jhajjar. The postmortem of the deceased was conducted vide P.M.R. No.GCH/10/08 dated 4.6.2008. DDR No.28 dated 4.6.2008 was registered. The complainant submitted claim with the appellant-opposite parties under the scheme Rajeev Gandhi Parivar Bima Yojna but her claim was rejected on the ground that the complainant had not submitted her claim within the prescribed period of six months as per the terms and conditions of the Insurance Policy. Challenging the repudiation of her claim, the complainant invoked the jurisdiction of the District Forum by filing complaint.
Upon notice, the opposite parties appeared and contested the complaint. It was stated by the appellant-opposite party No.1 in its written statement that complainants claim was rightly rejected as per the terms and conditions of the policy as the complainant had not submitted her claim within the prescribed period of six months and rather filed claim after more than 2 years.
Opposite Party No.2 in his written statement stated that the claim file of the complainant for claiming the benefit of death of her husband was received on 15.12.2009 and the same was recorded in the register at Sr. No.157. The opposite party No.2 had intimated the opposite party No.3 vide letter No.7082 dated 21.7.2010. Thus, it was prayed that the complaint merited dismissal.
On appraisal of the pleadings of the parties and the evidence adduced on the record, District Forum accepted complaint and issued direction to the opposite party No.1 as noticed in the opening para of this order.
Aggrieved against the order of the District Forum, the opposite party No.1 has come up in appeal.
There is a delay of 61 days in filing of the present appeal the condonation of which has been sought by the appellant by moving an application alongwith the appeal which is supported with an affidavit of Krishna Kant, Legal Manager, Power of attorney holder of M/s Reliance General Insurance Company Ltd.
While dealing with the application for condonation of delay, it is not disputed that the delay cannot be condoned on the ground of equity and generosity, but at the same time it is to be taken into consideration that in case of any legal infirmity is committed by the District Consumer Forum while passing the impugned order which is apparent on record, the same cannot be allowed to continue as it would amount to no order in the eyes of law. Reference is made to the observation made by the Honble Supreme wherein it has been held that when the substantial justice and technical approach are pitted against each other, the former has to be performed. It has further been held that the words Sufficient Cause have to be interpreted to advance the cause of justice. The Honble Apex Court in case cited as State of Nagaland Vs. Lipok A.O. and others, 2005(3) SCC 752 has held as under:-
11.What constitutes sufficient cause cannot be held down by hard and fast rules. In New India Assurance Co. Ltd. Vs. Shanti Misra (1975)(2) SCC (840) this Court held that discretion given by Section 5 should not be defined or crystallized so as to convert a discretionary matter into a rigid rule of law. The expression sufficient cause should receive a liberal construction. In Brij Inder Singh Vs. Kanshi Ram (ILR) (1918) 45 Cal. 94 (PC) it was observed that true guide for a court to exercise the discretion under Section 5 is whether the appellant acted with reasonable diligence in prosecuting the appeal. In Shakuntala Devi Jain Vs. Kuntal Kumari (AIR 1969 SC 575) a Bench of three-Judges had held that unless want of bona fides of such inaction or negligence as would deprive a party of the protection of Section 5 is proved, the application must not be thrown out or any delay cannot be refused to be condoned.
In the instant case the District Consumer Forum has passed the impugned order without appreciating the facts of the case and therefore, we think it a fit case to condone the delay. Hence, the delay of 61 days in filing of the present appeal is condoned.
Arguments heard. File perused.
On behalf of the appellant it is contended that the opposite party No.2 had received the claim file of the complainant on 15.12.2009 which was recorded in the register at Sr.no.157. However, as per the scheme of Rajeev Gandhi Parivar Bima Yojna, the claim of benefit of the said scheme was to be entertained within a period of six months from the date of death/injury and therefore complainants claim was rightly rejected in view of the terms and conditions of the Insurance Policy. In support of his argument, learned counsel for the appellant has referred to MoU (Annexure A-3), the relevant para 11(iii) of which is reproduced as under:-
(iii) General It is further agreed between the parties that both the parties shall ensure strict adherence to the terms and conditions contained in the policy and that any benefit claimed outside the terms and conditions of this Memorandum of Understanding/Policy shall be disallowed by the insurer.
As per the policy condition No.1, a written notice was required to be given to the appellant within one month of the occurrence of the event but in the instant case, no intimation was received from the complainant. Relevant condition No.1 of the insurance policy is reproduced as under:-
Condition No.1.
Upon the happening of any event which may give rise to a claim under this policy, written notice with full particulars must be given to the company immediately. Unless reasonable cause is shown, the insured persons/nominee should within one calendar month after the event which may give rise to a claim under the policy give written notice to the company with full particulars of the claim.
Learned counsel for the appellant has further drawn out attention towards the Notification No.2188-SW(4)2009 dated 19.11.2009 (Annexure A-4) published by Haryana Government with respect to Rajeev Gandhi Parivar Bima Yojna, the relevant part of which is reproduced as under:-
No claim will be entertained, if lodged after six months of the death/accident. It will be applicable to all claims that may be filed in future and also to the cases in which death/accident has occurred and claim not filed so far.
Admittedly, the claim of the complainant was received by the opposite party No.2 on 15.12.2009 and therefore the aforesaid notification which is dated 19.11.2009 is applicable to the instant case. It has come on the record that the deceased Kuldeep husband of the complainant had expired on 3.6.2008 and complainants claim was received on 15.12.2009 i.e. after about one and half year. Thus, in view of the terms and conditions of the Insurance Policy, complainants claim was not entertainable.
By now it is well settled principle of law that the terms and conditions of the Insurance Policy have to be construed strictly and no relief can be given to any of the parties beyond those terms and conditions. District Consumer Forum has failed to appreciate the above stated facts of the case in its true perspective, hence, the impugned order is not sustainable in the eyes of law.
For the reasons recorded above, this appeal is accepted, impugned order is set aside and the complaint is dismissed.
The statutory amount of Rs.25,000/-
deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules, after the expiry of period of appeal and revision, if any filed in this case.
Announced: Justice R.S. Madan 24.09.2012 President B.M. Bedi Judicial Member