State Consumer Disputes Redressal Commission
Vaishnavi Annasaheb Sanjay Ninale vs The Branch Manager, National Insurance ... on 22 March, 2022
1 A/754/2019
Date of filing :08.04.2019
Date of order :22.03.2022
MAHARASHTRA STATE CONSUMER DISPUTE REDRESSAL
COMMISSION,MUMBAI, BENCH AT AURANGABAD.
FIRST APPEAL NO. : 754 OF 2019
IN COMPLAINT CASE NO.: 303 OF 2017
DISTRICT CONSUMER FORUM : BEED
1. Vaishnavi Wd/o Annasaheb @ Sanjay Ninale,
2. Swamini Annasaheb Ninale,
3. Indu Wd/o Popat Ninale,
All R/o Chausala, Tq. & Dist.Beed. ...APPELLANTS
VERSUS
1. The Branch Manager,
National Insurance Co.Ltd. ,
Near of J Tower, Railway Station Road,
Aurangabad.
2. Taluka Agricultural Officer,
Taluka Agriculture Office, Beed,
Tq. Beed, Dist.Beed.
3. Bajaj Capital Insurance Broking Ltd.
Bajaj House 97, Neharu Palace,
New Delhi-110019. ...RESPONDENTS
CORAM : Smt.S.T.Barne, Hon'ble Presiding Judicial
Member.
Mr.K.M.Lawande, Hon'ble Member.
Present : Adv.A.S.Pavse for appellants,
Adv.S.V.Kulkarni for respondent No.1.
2 A/754/2019
JUDGMENT
(Delivered on 22/03/2022) Per Mr.K.M.Lawande, Hon'ble Member.
1. Being aggrieved by the judgment and order dated 12.12.2019 passed by District Forum, Beed in C.C.No.303/2017, the appellant has preferred this appeal.
2. The appellants are the complainants and the respondents 1 & 2 are the opponents in complaint No.303/2017 before District Consumer Dispute Redressal Forum. The appellant and respondent are hereinafter referred to as 'complainants' and 'opponent' as per their status in the complaint and District Consumer Disputes Redressal Forum is referred to as 'District Forum' for the sake of convenience.
3. It is the case of complainants that the deceased Annasaheb alias Sanjay Nanale died in the road accident on 11.01.2016.He was the husband of complainant No.1. Complainant No.2 is the minor daughter of deceased. Complainant No.3 is the mother of the deceased. The complainants 1,2,3 are the legal heirs of the deceased. The deceased had agriculture land in Gut No.47/05 in village Chousala and he was agriculturist by occupation. After the said accident, the FIR 08/2016 is registered at police station. The Government of Maharashtra has already launched the group insurance scheme for protecting the farmers in case of injuries out of accident and accidental death. The Government has also paid the premium to insurance 3 A/754/2019 company. Therefore, the complainants are consumers of opponents. The complainant submitted the proposal for getting compensation under the said scheme by submitting required documents through opponent No.3 to opponent No.1 insurance company. However, the opponent insurance company has not approved the claim. Alleging deficiency in service , the complainants have filed consumer complaint and prayed for directions to opponent insurance company to pay Rs.2 lacs with 18% interest, Rs.20,000/- towards cost.
4. The opponent insurance company filed its written statement before the District Forum and denied the rival allegations. It was contended that the complainant has not produced the documents in respect of deceased Sanjay including inquest panchanama, driving license of deceased, form 6C. It is the contention of opponent that name of the deceased on the documents 7/12, 8A, mutation entry, school leaving certificate, Bank pass book, Aadhar card are not tallying with the name mentioned in FIR, spot panchanama, post-mortem report. The complainant has also not produced driving license of the deceased. The license produced on record is not legible and may be false and fraudulent. There is no documentary proof that the deceased Sanjay and Annasaheb are one and same. The complainant's claim is doubtful.
5. Opponent No.2 filed written statement stating that it is working as agent for collection and verification of documents and not concerned with the settlement of insurance claim.
4 A/754/2019
6. Opponent No.3 has filed written statement and submitted that the insurance claim in respect of death of Annasaheb/Annabhau was received by them on 30.06.2016. After completion of anomalies( ुटी), they forwarded the claim on 11.07.2016 to opponent No.2. It is contention of opponent No.2 that there is no deficiency in service on the part of.
7. The District Forum dismissed the complaint vide impugned judgment and order dt. 12.02.2019. Being aggrieved by the said judgment and order , the complainant has filed this appeal on the following grounds.
That the District Forum dismissed the complaint on hyper technical ground. The District Forum failed to consider that the complainant fulfilled the conditions of the agreement that the deceased was the farmer and that death occurred due to accident. The District Forum failed to consider that the complainant has submitted FIR, inquest panchanama, post-mortem report concerned with the death of deceased to opponent insurance company and opponent insurance company failed to consider these documents and did not settle the claim. The District Forum failed to consider that the deceased Sanjay and Annasaheb @ Annabhau are the names of one and same person. On 7/12 record, the name appearing as Annasaheb Popatrao Ninale and on police papers name is Sanjay Popat Ninale). The complainant had also clarified this by filing an affidavit. The deceased was also having driving license at the time of accident. The District Forum failed to appreciate the documents in proper perspective.
5 A/754/2019
8. Heard Adv.Pavse appeared for the complainant/appellant and Adv.S.V.Kulkarni appeared for the opponent No.1 insurance company.
9. From the submissions of parties, following points arise for our consideration. We have noted them along with findings against it for the reasons to follow.
Points Answers
(i) Whether the complainant established deficiency in service on the part of opponents ? -..In affirmative.
(ii) Whether there requires interference in the judgement and Order of the Dist.
Forum? ..In affirmative (iii) What order? - As per final order REASONING
10. Adv.A.S.Pavse for the appellant argued that District Forum dismissed the complaint on hyper technical ground. The District Forum failed to consider that the complainant fulfilled the conditions of the agreement that the deceased was the farmer and that death occurred due to accident. The District Forum failed to consider that the complainant has submitted FIR, inquest panchanama, post-mortem report concerned with the death of deceased to opponent insurance company and opponent insurance company failed to consider these documents and did not settle the claim. The District Forum failed to consider that the deceased Sanjay and Annasaheb @ Annabhau are the names of one and same person. On 7/12 record, the name appearing as Annasaheb Popatrao Ninale and on police papers name 6 A/754/2019 is Sanjay Ninale). The complainant had also clarified this by filing an affidavit. The deceased was also having driving license at the time of accident. The District Forum failed to appreciate the documents in proper perspective.
11. Adv.S.V.Kulkarni argued for the insurance company that name of the deceased was not tallying in police record and 7/12, 8A documents. Also the deceased was not having valid motor driving license at the time of accident. The District Forum rightly appreciated the record while dismissing the complaint.
12. Question arose, whether insurance company is justified in not sanctioning the claim of the complainant. The opponent insurance company has raised objection that the name of the deceased on the police record and revenue record(7/12, 8A) are not tallying with. The complainant has filed affidavit that Sanjay and Annasaheb @Annabhau are names of deceased only. It appears that the insurance company has not considered the affidavit and held that the claim is doubtful. It appears that the District Forum also did not appreciate the affidavit. It reveals that on 11.01.2016 in road accident,two persons died,which is revealed from information report/khabar jabab of one Sudhakar Jogdand who stated that his cousin Mahesh @ Baburao Babanrao Jogdand and Sanjay Popat Ninale died in the accident. The other police papers FIR, spot panchanama and post-mortem report also stated that name of the deceased is Sanjay Popat Ninale. It is therefore certain that one person who was the son of Popat Ninale of the village 7 A/754/2019 Chousala died in the accident. It needs to be appreciated that the complainant wife of the deceased submitted the documents as 7/12, 8A, school living certificate, death certificate showing that the name of deceased is Annasaheb @ Annabhau Popat Ninale. She has also submitted in her affidavit that the deceased was referred with three names as Sanjay, Annasaheb @ Annabhau . From the death certificate, it cannot be denied that Annasaheb @ Annabhau Popat Ninale died on 11.01.2016. The police papers are showing that the accident occurred on dt.11.01.2016 and in the death certificate also date is mentioned same. For the sake of clarity complainant has submitted her affidavit that the names mentioned in police papers and the death certificates and revenue record are of one and same person and that death of her husband occurred in the accident who is agriculturist. However, insurance company has taken a contrary stand that the claim is doubtful on the ground that name of the deceased person is not tallying in two types of records. It is to be noted that Sudhakar Jogdand has given the intimation to police informing death of his cousin and deceased Sanjay. It is not the information given by the close relatives of the deceased. Also it is not the case that police authorities verified the name of the deceased from any documents. It appears that the police record is based on the oral information on names of person in the village. It is but sure that in an accident person died is the son of Popat Ninale. The complainant submitted documents as to names of the deceased in Annasaheb @ Annabhau. The complainant has also submitted the affidavit stating that deceased was referred with three different names and all the three names referred are of one and same person. The opponent insurance company has 8 A/754/2019 not settled the claim on the ground of variation in names. However, the opponent insurance company has a investigation agency to verify the facts. It was the duty of opponent insurance company to made investigation, or to adduce evidence that Annabhau alias Annasaheb and Sanjay are the different persons in the village and complainant has filed a false claim and that Sanjay and Annasaheb @ Annabhau are two different persons. In our opinion, the insurance company adopted hyper technical approach and not settled the claim. Also the District Forum supported the opponent's contention without verifying the genuineness of the case of the complainant. In our opinion the District Forum failed to appreciate the documents in proper perspectives. It reveals that the District Forum have not come to the conclusion in the judgment with appropriate and sufficient discussion that the deceased Sanjay and deceased Annasaheb are two different persons and complainant filed false claim. Therefore we answer point No.(i) in affirmative.
13. The opponent also raised objection that the deceased was not having the valid driving license . The opponent has contended in written statement that the extract of the driving license is not legible. We have also seen the copy/extract of said driving license which is at page 58 of appeal compilation. It is not legible. However , the opponent insurance company and District Forum could have asked the complainant to ask for the legible copy of motor driving license of deceased. Also, it was possible for the opponent insurance company to verify from RTO record as to whether the 9 A/754/2019 deceased was having valid driving license or not. It appears that the opponent insurance company have failed to do so.
14. Secondly , the case need to be appreciated with different angle. Even if the deceased was not having the license , whether the opponent insurance company is justified to repudiate the complainant's claim and whether there is necessity of submission of valid and effective driving licence of the deceased while filing of the insurance claim under the Gopinath Munde Farmers Accident Insurance claim.
15(i) We would like to discuss the provisions in the GR dated 04/12/2009. It stated the guidelines and instructions to various agencies involved in implementation of the scheme in details. The condition of necessity of valid driving licence is also discussed in the said GR. Amongst the clause/instruction No. 21 in the said GR states the necessity of having valid and effective and valid driving licence of the person who is dead , if he was driving the vehicle. However, the clause No. 6 of the Part E in the GR states that in case of accidents , all the farmers should be held eligible except the driver who is at fault . In the case in hand, from the documents on record it can be safely interpreted that, in case of accident occurred not because of fault of the driver, such driver cannot be deprived from the benefit of the scheme.
(ii) Also ,there is one annexure/ prapatra D, which prescribes for the submission of documents to be submitted for insurance claim which include 10 A/754/2019 FIR, spot panchnama, PM report. It does not include valid and effective driving licence of the deceased driver.
(iii) There is also an exclusion clause , provided in part C in the GR dt.04/09/2012, which is also not stating the provision for rejection/dismissal of the Insurance claim on the ground of non submission of valid and effective licence of the driver in the road / railway accident cases .
(iv) Also, from the GR dated 04/12/2009, it is sufficiently clear that the scheme is for protecting the farmer/farmers and their families in case of accidents. Thus ,the scheme is basically benevolent in nature.
(v) To support our discussion in aforesaid para, we have to rely upon the judgements cited by Advocate of the appellant in following cases.
(i) The Hon. High Court, Bombay Bench at Aurangbad in
Bhagyashri Dhage -Vs- State of Maharashtra & Ors.
W.P.No.9650/2014 wherein it is held that, prima facie, clause 21 contained in the Government Resolution cannot be considered to be mandatory and the benefits of the scheme framed for social advancement cannot be denied to the heirs of the deceased.
(ii) In Shakuntala W/o Dhonddiram Mundhe -Vs- State of Maharashtra [2010(2)Mh.L.J] wherein it is held that "Personal accident insurance policy for benefit of farmers-said scheme is social welfare scheme and is beneficial to the family members of farmers 11 A/754/2019 who expire in accidental death-Farmer having died in accident, Insurance company declined to grant the claim for compensation on ground that deceased was not registered farmer-Insurance company adopted obstructive attitude and deprived the petitioner from the claim of compensation-Government Resolution dated 5-1-2005 & 31- 3-2005, from where the said scheme of personal accident insurance emanates, nowhere whispers about the term, "registered farmer".
16. In view of aforesaid discussion , there reveals deficiency on the part of insurance company towards the complainant in repudiating the Insurance claim. Hence we answer point No.(ii) in affirmative and pass the following order.
O R D E R
1. Appeal is allowed
2. The order of District Consumer Commission in C.C.No.303/2017 is set aside and this consumer complaint is hereby partly allowed as follows.
The opponent insurance company is directed to pay the amount of Rs.2 lakhs towards the insurance claim and further to pay interest " 9% p.a. from 29.06.2016 ( i.e. filing of insurance claim). The opponent insurance company is further directed to pay Rs.3,000/- towards mental and physical agony and Rs.2000/ towards costs.
Sd/- Sd/-
Mr.K.M.Lawande Smt.S.T.Barne,
Member Presiding Judicial Member
MBM