Maharashtra

Central Mumbai

CC/14/81

SMT. DOLCY STALYN KOYLO - Complainant(s)

Versus

FUTURE GENERALI INDIA INSURANCE CO. LTD. THROUGH ITS MANAGER - Opp.Party(s)

SHRI. ANKUSH NAVGHARE

13 Feb 2015

ORDER

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CENTRAL MUMBAI
Puravatha Bhavan, 2nd Floor, General Nagesh Marg, Near Mahatma Gandhi Hospital
Parel, Mumbai-400 012
 
Complaint Case No. CC/14/81
 
1. SMT. DOLCY STALYN KOYLO
R/O PAPDI, TAL VASAI, DIST. THANE
THANE
MASHARASHTRA
...........Complainant(s)
Versus
1. FUTURE GENERALI INDIA INSURANCE CO. LTD. THROUGH ITS MANAGER
DGP HOUSE, 1ST FLOOR, 88C, OLD PRABHADEVI ROAD, NEAR BENGAL CHEMICAL, PRABHADEVI, MUMBAI 400 025.
MUMBAI
MAHARASHTRA
2. CABAL INSURANCE COMPANY LTD. THROUGH ITS MANAGAR
MITTAL TOWERS, 118, B WING, 11TH FLOOR, NARIMAN POINT, MUMBAI 400 021
MUMBAI
MAHARASHTRA
3. GOVERNMENT OF MAHARASHTRA THROUGH DISTRICT AGRICULTURAL OFFICER, THANE
THANE DIST THANE
THANE
MAHARASHTRA
............Opp.Party(s)
 
BEFORE: 
 HON'BLE MR. B.S.WASEKAR PRESIDENT
 HON'BLE MR. H.K.BHAISE MEMBER
 
For the Complainant:
For the Opp. Party:
ORDER

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 Stalyn Francis Koylo was an agriculturist holding Gut No.277 at village Sandore, Taluka-Vasai, District-Thane. He died accidentally on 17th February, 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 O.P.No.1 appeared and filed written statement. It is submitted that 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)                The O.P.No.2 appeared and filed written statement and submitted that claim was received through District Agricultural Officer, Thane and the same was forwarded to the O.P.No.1 and the O.P.No.1 repudiated the claim vide letter dated 29th February, 2012.

4)                The O.P.No.3 failed to appear before this Forum.

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

POINTS

Sr.No.

Points

Findings

1)

Whether there is deficiency in service ? 

Yes

2)

Whether the complainant is entitled for the relief as claimed ? 

Yes

3)

What Order ? 

As per final order

REASONS

6) 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 F.I.R., Spot Panchanama, Inquest Panchanama, Post Mortem Report, 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 opponents, 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 opponents.  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 opponents had produced copy of repudiation letter dated 29th February, 2012. If, according to the opponents, 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.  Therefore, the defence taken by the opponents can not be accepted. The complainant has produced all the required documents under the Agreement therefore her claim can not be rejected.  

7)                The O.P.No.2 has placed reliance on the judgment of our State Commission in First Appeal No.1114 of 2008 dated 16th March, 2009.  In that judgment, Tahsildar failed to produce the documents in spite of service of notices for several times.  In the instant complaint before us, there is no evidence to show that the complainant was intimated to produce the documents.  In the absence of such evidence, it can not be said that the complainant failed to produce the required documents. Therefore, the abovecited judgment is not applicable to this complaint.

8)                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 16th 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 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 21st October, 1993.

9)                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 7th 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. 

10)              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.No.1/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. 17th February, 2011 till its realization.
  3. The O.P.No.1/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 13th February, 2015  

 
 
[HON'BLE MR. B.S.WASEKAR]
PRESIDENT
 
[HON'BLE MR. H.K.BHAISE]
MEMBER

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