State Consumer Disputes Redressal Commission
New India Assu vs Smt. Rekha Bai on 8 June, 2022
Daily Order M. P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PLOT NO.76, ARERA HILLS, BHOPAL FIRST APPEAL NO. 62 OF 2013 (Arising out of order dated 09.11.2012 passed in C. C. No.45/2011 by District Commission, Chhindwara) THE NEW INDIA ASSURANCE CO.LTD. THROUGH BRANCH MANAGER, BRANCH OFFICE-1602002, GANESH CHAMBERS, LAKSHMI NAGAR CHOWK, NAGPUR (MS) ... APPELLANT. Versus 1. SMT. REKHA BAI W/O LATE SHRI SANTOSH TEKAM, R/O TANSI, POST-RAMPURBHAY, TEHSIL-JUNNARDEV, DISTRICT-CHHINDWARA (M.P.) 2. MANAGER, TANSI PARIYOJNA, WESTERN COAL FIELDS LIMITED, KANHAAN KSHETRA, POST-RAMPURBHAY, TEHSIL-JUNNARDEV, DISTRICT-CHHINDWARA (M.P.) ... RESPONDENTS. BEFORE : HON'BLE DR (MRS) MONIKA MALIK : PRESIDING MEMBER
HON'BLE DR. SRIKANT PANDEY : MEMBER HON'BLE SHRI D. K. SHRIVASTAVA : MEMBER COUNSEL FOR PARTIES : Ms. Preetima Shrivastava, learned counsel for the appellant. Ms. Mona Paliwal, learned counsel for the respondent no.1. None for the respondent no. 2. O R D E R (Passed on 08.06.2022)
The following order of the Commission was delivered by Dr.(Mrs) Monika Malik, Member:
This appeal by the opposite party no.1/appellant is directed against the order dated 09.11.2012 passed by the District Consumer Disputes Redressal Commission, Chhindwara (for short the 'District Commission') in C. C. No. 45/2011 whereby the District Commission has -2- partly allowed the complaint filed by the complainant and has directed the opposite party no.1/appellant-insurance company to pay the insurance claim with respect to 'Janta Personal Accident Policy' to the complainant.
2. Briefly put, facts of the case are that the complainant's husband Late Santosh Tekaam (hereinafter referred to as 'deceased') was insured under the group insurance policy namely 'Janta Personal Accident Policy'. Requisite premium in aforesaid regard was deducted from the salary of the deceased and subsequently group insurance policy was issued by the appellant insurance company. The deceased died in an accident and therefore the claim form accompanied with requisite papers was sent via opposite party no.2 to opposite party no.1. It is alleged that the opposite parties have been deficient in service in denying the insurance claim. Therefore, alleging deficiency in service on part of the opposite parties, the complainant filed a complaint before the District Commission seeking relief.
3. The complainant had earlier filed a complaint case (No. 105/2008) before the District Commission, Chhindwara which was partly allowed by the District Commission vide order dated 17.04.2009, whereby the opposite party no.1-insurance company was directed to decide the complainant's claim in accordance with insurance certificate no. 484, after obtaining requisite documents from the opposite party no.2. In addition compensation of Rs.3,000/- with costs of Rs.1,000/- was also awarded.
-3-4. The opposite party no.1 /appellant-insurance company resisted the complaint filed by the complainant stating that neither complainant nor the opposite party no.2 had submitted certificate of insurance or certificate no.484 with the opposite party no.1. Record of insurance certificate no.484 is not available with the opposite party no.1.
5. The opposite party no.2 submitted that they had forwarded the requisite information along with the claim form and accompanied documents to opposite party no.1 and they have no liability in the instant matter.
6. The District Commission allowed the complaint filed by the complainant and directed the opposite party no.1/appellant i.e. the New India Assurance Company Limited to pay sum assured of Rs.5,00,000/- with interest @ 10% p.a. from 09.11.2009, till realization. In addition Rs.10,000/-, as compensation with another sum of Rs.1,000/- as costs has also been awarded. Hence this appeal.
7. Heard. Perused the record.
8. Learned counsel for the opposite party no.1/appellant argued that in compliance of earlier order of the District Commission dated 17.04.2009, the complainant had only submitted an affidavit stating that the certificate of insurance is lost. It is also mentioned in the said affidavit that certificate of insurance is no. 484, but it is not found in the record of the appellant-insurance company. Instead said certificate no.484 is available in -4- the name of some another person. Since the complainant could not provide the certificate of insurance, she is not entitled for claim of her deceased husband. It is not proved that the deceased was insured with the appellant-insurance company. Therefore, the impugned order directing the appellant-insurance company to pay sum assured under the group insurance policy is not sustainable and deserves to be set-aside.
9. Learned counsel for the complainant/respondent no.1 argued that the complainant had stated that certificate of insurance was lost and an affidavit in aforesaid regard was submitted by her, which is available in the record. The opposite party no.2/respondent no.2 had acknowledged this fact and had forwarded the copy of the affidavit to the appellant-insurance company. The respondent no.2 had provided list of employees, from whose salary the premium amount was deducted towards group insurance policy. Name of the deceased is there in the said list. She further argued that name of the deceased is also included in the list issued by the opposite party no.2/respondent no.2, whose proposal form was forwarded to the insurance company in order to obtain the group insurance policy. Merely because name of the deceased is not available on a specific number, it does not indicate that the deceased was not insured and the complainant is not entitled for claim of the deceased, who had paid insurance premium in order -5- to obtain the group insurance policy. She argued that this appeal deserves to be dismissed.
10. On careful perusal of evidence available in the record, we find that the appellant-insurance company has denied the complainant's claim on the basis that the complainant has not been able to provide certificate of insurance. While pursuing the matter on the basis of earlier order of the District Commission dated 17.04.2009, the appellant-insurance company submitted that the insurance certificate no. 484 does not bear name of the deceased. We find that the complainant/respondent no.1 had submitted an affidavit to the effect that the certificate of insurance has been lost. The aforesaid fact is acknowledged by the opposite party no.2/respondent no.2. An affidavit of M. M. Ansari, Manager, Tandsi-mine, WCL, Kanhan Area, acknowledging this fact, is there in the record. Shri M. M. Ansari has admitted in the said affidavit of deducting Rs.526/- from the salary of the deceased towards the group insurance policy which was forwarded to the appellant insurance company. List of employees, from whose salary premium for group insurance policy is deducted is available in the record of the District Commission, and it contains name of the deceased.
11. Letters dated 29.07.2000 & 28.03.2001 from respondent no.2 addressing the appellant-insurance company indicate that they had conveyed the final figure of the employees, who had opted for group -6- insurance policy, and no employee is left from whose salary, the premium is not deducted.
12. On the above basis, we infer that merely because name of the deceased is not mentioned in the specific certificate number, it does not conclusively indicate that the deceased was not insured under the group insurance policy issued by the appellant insurance company when various other documents including the premium deduction list demonstrate that the insurance premium was collected from him.
13. It is noteworthy that the District Commission vide order dated 17.04.2009 had directed the insurance company to decide the complainant's claim. The aforesaid order is binding on both parties, since none of the parties had preferred an appeal against the said order.
14. In view of the aforesaid discussion, we reach a conclusion that the District Commission has rightly passed the impugned order upon due consideration of evidence available in the record. The impugned order does not suffer from any illegality or irregularity and is therefore affirmed.
15. This appeal, which is devoid of any merit deserves to be and is hereby dismissed. However, no order as to costs.
(Dr. Monika Malik) (Dr.Srikant Pandey) (D. K. Shrivastava) Presiding Member Member Member