PER MR.B.S.WASEKAR, HON’BLE PRESIDENT

1)                The present complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986. According to the complainant, her husband Shri Kisan Dasharath Khalate was an agriculturist holding Gut No.1793 at village Kalus, Taluka-Khed, District-Pune. He died accidentally on 26^th December, 2011 in motor vehicle accident.  She submitted insurance claim under the Government Scheme of Shetkari Apghat Vima Yojana.  Her claim was not satisfied therefore she has filed this complaint for insurance claim of Rs.1 Lakh with interest.

2)                The opponent appeared and filed written statement. It is submitted that the claim was rejected vide letter dated 31^st August, 2012 as the Post Mortem Report of the deceased and complete set of documents was not submitted within time as per Tripartite Agreement therefore, she can not file claim before this Forum. There is no deficiency in service on the part of the opponent therefore the complaint is liable to be dismissed with cost.

3)                After hearing both the parties and after going through the record, following points arise for our consideration.

POINTS

REASONS

4) As to Point No.1 & 2 :- The complainant has produced revenue record showing that her husband was holding agricultural land and he was farmer. The complainant also produced copies of Police Complaint, Spot Panchanama, Certificate issued by Lokmanya Hospital, Chinchwad Discharge Summary, Death Certificate and Driving License and information received under the Right to Information Act showing that claim was submitted.  On going through all these papers, it is clear that the husband of the complainant died in the motor vehicle accident.  According to the opponent, complete set of documents was not submitted. On perusal of the documents produced by the complainant, it is complete set as per requirement under the Agreement. Under the Government Resolution, the beneficiary has to submit the claim to the concern agricultural department and the concern agricultural department has to comply all the formalities i.e. necessary documents and submit it to the opponent. Liability is fixed on the government agricultural department. The beneficiary should not be suffered due to lack of the compliance within time by the government machinery. According to the complainant, the claim was submitted to the opponent government office within time. The opponent has produced copy of repudiation letter dated 31^st August, 2012.  If, according to the opponent, complete set of documents was not submitted within time, it was necessary to inform the complainant accordingly.  There is nothing on record to show that the complainant was informed to submit the complete set of documents.  On the other hand, the complainant has obtained information under the Right to Information Act showing that the claim was submitted and the same was forwarded to the opponent. Therefore, the defence taken by the opponent can not be accepted. The complainant has produced all the required documents under the Agreement therefore her claim can not be rejected.  

5)                According to the opponent, Post Mortem Report was not submitted therefore the claim was repudiated.  It is also not produced before this Forum.  It is true that the complainant has not produced copy of Post Mortem Report but she has produced Discharge Summary and Medical Case Papers showing that the deceased was admitted in the hospital for accidental injuries and he died due to those injuries. The evidence on record is sufficient to show that the deceased died due to accidental injuries.  Therefore, merely because the complainant failed to produce the Post Mortem Report, her claim can not be repudiated. 

6)                The learned advocate for the Opponent has placed reliance on the judgment of Hon’ble National Commission reported in 1994(1) CPR 108 in the case of Jewellers Narandas & Sons –Versus- The Oriental Insurance Company Limited, decided on 16^th December, 1993. In para 5 of the judgment, the Hon’ble National Commission has laid down as under :

Annexure R-V is a communication that gives detailed reasons in support of the decision taken by the insurer to repudiate the claim and it cannot be said that the said decision was taken arbitrarily and without due application of mind of the relevant facts and circumstances or otherwise than in good faith.  Such being the position, we have no hesitation to hold that there was no deficiency in service on the part of the Insurance Company so as to entitle the complainant to seek relief under the Consumer Protection Act.  In case the complainant feels aggrieved by the action of the Insurance Company in repudiating its claim, the remedy of the complainant to approach the ordinary Civil Court for appropriate relief.

In that judgment detailed reasons were given for repudiating the claim.  In the instant complaint before us, there is nothing on record to show that the complainant was informed to submit the required documents. In fact, as per Government Resolution, it is the liability of the government office to submit all the necessary documents. On their failure, the complainant who is the beneficiary should not be suffered.  Therefore, the abovecited judgment is not applicable in this case. Similar view is taken in other judgment of the Hon’ble National Commission reported in 1986-96 National Commission and SC page 3060 in the case of B.L.Agarwal –Versus- National Insurance Company Limited decided on 21^st October, 1993.

7)                The learned advocate for the complainant has placed reliance on the judgment of our State Commission reported in 2008(2) All MR (Journal) 13 in the case of ICICI Lombard General Insurance Company Limited –Versus- Smt.Sindhubai Khanderao Khairnar, decided on 7^th January, 2008. In para 9 of the judgment, the Hon’ble State Commission has observed as under :

The Government declares various benevolent schemes for Agriculturists and person coming from lower strata of society. For effective implementation of the claim, Govt. prescribed simple procedure. Taking into consideration, the illiteracy in the rural areas, the liability is imposed on the Village Revenue Officer and Tahsildar for purpose of collection of necessary documents and submission of the claim to the insurance company. The success of benevolent scheme depends as to how and in what manner such schemes are implemented. Unfortunately, because of lukewarm and obstructive attitude of insurance company, genuine and honest claim of widow is defeated for no fault of her.

In the instant complaint before us also, claim form was immediately submitted to the government office. Therefore, the claim of the complainant can not be repudiated. 

8)                It is submitted by the learned advocate for the opponent that the deceased had no valid driving license therefore insurance claim can not be admitted.  The complainant has produced copy of driving license of the deceased which was valid on the day of accident.  Therefore, the submission made by the learned advocate for the opponent can not be accepted. 

9)                Thus, there is sufficient evidence on record to show that the deceased was the farmer holding agricultural land. He died accidentally in the motor vehicle accident.  The complainant is a widow therefore, as per the Agreement, the opponent is liable to satisfy the claim of the complainant. The complainant has complied all the formalities as required under the Agreement and the Government Resolution. 

         As discussed above, the complainant is entitled for the relief as prayed. Hence, we proceed to pass the following order.

ORDER

1. Complaint is allowed.
2. The O.P./Insurance Company is directed to pay Rs.1,00,000/- (Rs.One Lakh Only) to the complainant with interest at the rate of 12% per annum from the date of death of the insured i.e. 26^th December, 2011 till its realization.
3. The O.P./Insurance Company is further directed to pay Rs.3,000/- (Rs.Three Thousand Only) to the complainant as cost of this proceeding.
4. The above order shall be complied with within a period of one month from today.
5. Copies of this order be sent to the parties free of cost.

Pronounced on 23^rd February, 2015