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, he is an agriculturist holding Gut No.525, Shindewadi, Taluka-Junnar, District-Pune. He was injured accidentally on 23^rd May, 2012 in motor vehicle accident.  He submitted insurance claim under the Government Scheme of Shetkari Apghat Vima Yojana.  His claim was not satisfied therefore he 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, he 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. It is submitted that the claim of the complainant was received through District Agricultural Officer, Pune and the same was forwarded by this O.P. to O.P.No.1. The O.P.No.1 repudiated the claim vide letter dated 31^st December, 2012. There is no deficiency in service therefore the complainant is not entitled for the relief as prayed.

4)                The O.P.No.3 appeared and filed written statement. It is submitted that claim form was received by this office and the same was forwarded onwards.  The O.P.No.1 repudiated the claim vide letter dated 31^st December, 2012 as there was no permanent disability.

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

POINTS

REASONS

6) As to Point No.1 & 2 :- The complainant has produced revenue record, showing that he is holding agricultural land and he is farmer. The complainant also produced copies of Complaint, Crime Details Forum and Disability Certificate issued by Sasoon Geneeral Hospital, Pune showing amputation of right leg having 70% disability.  On going through all these papers, it is clear that the complainant injured in 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 claim to the concern agricultural department and the concern agricultural department has to comply all the formalities i.e. necessary documents and submit 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.

7)                According to the opponents, the claim was repudiated by the O.P.No.1 vide letter dated 31^st December, 2012.  Copy of the said letter is produced on record.  As per this letter, claim was repudiated on the ground that all the limbs including both hands and legs were not disabled and therefore claim can not be accepted.  The reason given by the opponent is against the Government Resolution as well as Tripartite Agreement.  On perusal of Government Resolution and Tripartite Agreement, the insured is entitled for 50% of claim if anyone limb is disabled.  In this case, the complainant has produced disability Certificate issued by Sasoon General Hospital, Pune showing amputation of right leg and 70% disability therefore as per Tripartite Agreement, the complainant is entitled for the 50% of the claim i.e. Rs.50,000/-.  Thus, the claim was wrongly repudiated. 

8)                The learned advocate for the O.P.No.1 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, the claim was wrongly repudiated 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.

9)                Thus, there is sufficient evidence on record to show that the complainant is the farmer holding agricultural land. He was injured and disabled in motor vehicle accident. He has produced Disability Certificate showing amputation of right leg and 70% disability. Therefore, as per the Tripartite 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 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 partly allowed.
2. The O.P.No.1/Insurance Company is directed to pay Rs.50,000/- (Rs.Fifty Thousand Only) to the complainant with interest at the rate of 12% per annum from the date of filing of the complaint i.e. 10^th January, 2014 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 10^th October, 2014