State Consumer Disputes Redressal Commission
Branch Manager, National Insurance Co. ... vs Smt. Sumitra Ramchandra Mohite+1 on 26 March, 2014
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, MAHARASHTRA
STATE CONSUMER
DISPUTES REDRESSAL COMMISSION, MAHARASHTRA
CIRCUIT BENCH
AT NAGPUR
5 TH FLOOR,
ADMINISTRATIVE BUILDING NO. 1
CIVIL LINES,
NAGPUR-440 001
First Appeal
No. A/10/786
(Arisen out
of Order Dated 13/10/2010 in Case No.CC/09/318 of District Consumer Forum, Yavatmal.)
Branch
Manager, National Insurance Co. Ltd.,
Sterling
Cinema Bld., IInd floor, 65, Marzaban
Road,
D.O. 14, Fort Mumbai-400 001, through
The
Regional Manager, Nagpur Regional Office,
Mangalam
Arcade, IInd floor, Dharampenth Ext.,
North
Bazar Road, Nagpur.
.... ...Appellant(s).
Versus
1. Smt. Sumitra Ramchandra Mohite,
R/o.
Post Echori, Tq. & Distt. Yavatmal.
2. Tahasildar, Tahasil Office Yavatmal,
Tq.
& Distt. Yavatmal. .... ...Respondent(s)
BEFORE:
HON'ABLE SMT.JAYSHREE YENGAL PRESIDING MEMBER
HON'BLE MR.
S.B. SAWARKAR, MEMBER
PRESENT:
Adv. Mr. Kukde .....For the Appellant
None
.....For the Respondent.
ORDER
(Delivered on 26/03/2014) Per Smt. Jayshree Yengal, Hon'ble Presiding Member.
1. This appeal challenges the order dated 13/10/2010 passed by the District Consumer Forum, Yavatmal partly allowing the consumer complaint bearing No. 318/2009 and directing the insurance company appellant herein to pay the complainant sum of Rs. 1.00.000/- with 6% interest from 09/12/2009, Rs.2000/- and Rs.1000/- as compensation and cost of the proceeding respectively.
Appellant- National Insurance Company Ltd. to be referred as Opposite Party No.1 and Respondent No.1- Smt. Sumitra Ramchandra Mohite to be referred as complainant and Respondent No.2 Tahasildar, Tahsil Office, Yavatmal to be referred as O.P. No.2 for the sake of brevity.
2. Brief facts giving rise to this appeal are that the complainant Smt. Sumitra Ramchandra Mohite is the widow of the deceased Ramchandra Panduji Mohite who was an agriculturist. Deceased Ramchandra met with an accident on 17/03/2007 and he died on 18/03/2007. The complainant was not having any knowledge about the any agreement of insurance between the insured- Commissioner Agriculture, Government of Maharashtra, Kabal insurance services Pvt. Ltd. and M/s. National Insurance Co. Ltd., and that by virtue of this agreement as many as 68,00,000 farmers were covered under Group Janta Personal Accident Insurance Policy for sum insured of Rs. 1,00,000/- for a farmer.
3. It is the contention of the complainant that even the Talathi of the Mouza where the complainant was residing ever gave any information about the said insurance scheme.
4. The complainant came to know about this insurance scheme only in August 2009 when one Shobha Kale who had availed benefit of that insurance scheme told about it to the complainant. The complainant immediately contacted opposite party No.2- Tahsildar and submitted the insurance claim with necessary documents. The opposite party No.2 on receipt of the claim forwarded the papers to Kabal Insurance Services Pvt. Ltd. on 18/08/2009 who immediately forwarded the papers to opposite party No.1.
5. Opposite party No.1 by letter dated 15/09/2009 repudiated the claim on the ground that the same was submitted after two years of death of the farmer i.e. the insured died on 17/03/2007 and Kabal Insurance Services Pvt. Ltd. had submitted the claim on 27/08/2009 which was in breach to the policy condition and therefore the insurance claim was rejected.
6. Being aggrieved and alleging deficiency in service she filed a consumer complaint claiming insurance claim of Rs. 100000/- under the Group Janta Personal Accident Insurance Policy with interest to be imposed from the date of repudiation, 10,000/- as compensation for mental and physical harassment and Rs.5000/- more towards cost of the proceeding.
7. The opposite parties resisted the complaint by filing their written version. Opposite party No.1- National Insurance Company by its written version denied all the adverse allegations of the complainant and specifically submitted that it had not rendered any deficiency in service as it had rightly repudiated the claim as it was preferred after a delay of more than two years. It submitted that the deceased husband of the complainant died on 18/03/2007 and the insurance claim was forwarded by Kabal Insurance Services Pvt. Ltd. on 27/08/2009 which is directly in breach of policy condition. The clause (viii) of the agreement, prescribes limitation period as "Intimation for claim or the documents should be submitted to the insurance company within the policy period. However, subsequent to the expiration of the policy, claims will be received only for a period of 90 days from the last date of the expiration of the policy. The insurance company will condone the delay if sufficient cause for the delay is given."
8. Opposite party No.2 Tahsildar submitted by its written version that the complainant is not his consumer and he has immediately forwarded the insurance claim to Kabal Insurance Services Pvt. Ltd. and the liability is of opposite party No.1 to pay the insurance claim therefore the complaint deserves to be dismissed against him as not tenable.
9. The Forum after hearing both the parties and perusing the documents filed on record by both the parties partly allowed the complaint as aforesaid. The Forum has observed that the Govt. of Maharashtra has floated insurance scheme for benefit of the farmers in the event of a farmer dying due to an accident. The Govt. by the said G.R. has further imposed the responsibility on opposite party No.2 to scrutinize the documents in respect of the insurance claim and to forward the same after due scrutiny to Kabal Insurance Services Pvt. Ltd. The said G.R. further mentions that the insurance claim should not be repudiated on technical reasons and steps be taken to see that the insurance claim is given to the beneficiary at the earliest. The Forum has further observed that repudiating the claim as time barred would mean repudiating it on technical ground. Therefore, holding accordingly the Forum partly allowed the complaint as aforesaid.
10. Being aggrieved by the impugned order opposite party No.1- Insurance Company has filed this appeal. The opposite party No.1 challenges the impugned order on three grounds, which are as under.
i.
i. The date of accrual of cause of action is the date on which the deceased died i.e. 18/03/2007 and the consumer complaint was filed on 09/12/2009. Therefore, undisputedly there is delay of more than two years in filing the complaint and in absence of any delay condonation application complaint is liable to be dismissed.
ii.
The Forum exonerating opposite party No.2 after holding that he failed to give proper advice to the complainant cannot sustain in law.
iii.
The insured under the policy is Commissioner of Agriculture and the deceased farmer is only the beneficiary therefore the insured Commissioner of Agriculture is a necessary party. The complaint cannot be entertained in absence of necessary party.
The counsel for the appellant has placed its reliance in the judgment of the Apex Court reported in II (2009) CPJ 29 (SC) in the case of State Bank of India. Vs. B.S. Agricultural Industries Ltd.
11. We heard counsel for the appellant. Appeal is proceeded exparte against respondent as none for the respondent appeared though served. We also perused the copies of the complaint, written version, insurance documents, agreement and other documents filed on record.
12. The facts about Group Janta Personal Accident Insurance Policy covering risk for 6800000 farmers for a period from 15/07/2006 to 14/07/2007, date of death of farmer i.e. 18/03/2007, insurance claim submitted on 27/08/2009, date of repudiation as 15/09/2009 are not disputed. The only issue that survives for our consideration is whether the insurance company has rightly repudiated the claim by relying on the condition of the agreement.
13. As per the condition clause No. (viii) of the agreement the limitation period prescribed as "Intimation for claim or the documents should be submitted to the insurance company within the policy period. However, subsequent to the expiration of the policy, claims will be received only for a period of 90 days from the last date of the expiration of the policy. The insurance company will condone the delay if sufficient cause for the delay is given."
14. The aforesaid condition reflects that sufficient opportunity be given to the beneficiary to submit the claim. This can be inferred from the very fact that vide this condition of the agreement the Govt. not only gives an additional period of 90 days to the beneficiary but in case there is further lapse of time it imposes the duty on the insurance company to condone the delay if sufficient cause for the delay is given. In our opinion the complainants claiming that theyhad no knowledge of the insurance scheme and had submitted the insurance claim as soon as they got the knowledge. This can be said to be a sufficient cause for condoning the delay. The condition also nowhere mentions that insurance claim submitted after delay would not be granted or would fall within the scope of breach of policy condition. The authority on which the appellant relies on the point of limitation is not applicable to the present case as it deals with limitation prescribed under section 24 A of Consumer Protection Act, 1986. In this case the claim was repudiated on 15/09/2009 and complaint was filed on 09/12/2009.
15. As regards the other grounds of appeal in respect of O.P. No.2 being exonerated, the complainant has not brought on record any evidence to show that O.P. No.2-Tahsildar was rendered any deficiency in service, on the contrary it is not disputed that the complainant got knowledge of the insurance scheme in August-2009 and the claim papers were immediately forwarded to Kabal Insurance Services in August-2009 itself.
16. Under the insurance scheme the farmer being the insured the complaint is rightly filed by the insured. The Commissioner of Agriculture though being party in the tripartite agreement he is only a representative of the farmers and therefore he cannot be said to be a necessary party in the common complaint.
17. For the foregoing reasons we find no glaring illegality or irregularity in the impugned order and the appeal fails being devoid of any merits. Hence we proceed to pass following order.
ORDER i. Appeal is dismissed ii. No order as to cost in appeal.
iii. Copy of order be furnished to both parties free of cost.
Dated:- 26/03/2014.
[HON'ABLE SMT.JAYSHREE YENGAL] PRESIDING MEMBER [ HON'BLE MR.
S.B. SAWARKAR,] MEMBER ay