PER SHRI. S.S. PATIL - HON’BLE MEMBER :
1) This is the complaint regarding, deficiency in service of the Opposite Party by repudiating the insurance claim of the deceased husband of the Complainant.
2) The deceased husband of the Complainant Shri.Ramchandra Redkar had purchased splender motor cycle no.GJ-15-FF-3870. This motor cycle was comprehensively insured with Opposite Party. In the said policy the deceased had also paid additional premium of Rs.50/- to cover compulsory P.A. of owner-cum-driver for the sum of Rs.1 Lakh vide Policy No.231000/31/05/01/0006299 valid from 21/01/2006 to 20/01/2007.
3) On 16/06/2006 the deceased Ramchandra met with a motor accident while riding his above said motor cycle and died in that accident. An offence was registered by Daman Police Station against the rider of another vehicle for causing the death of Ramchandra Redkar by driving his vehicle rashly and negligently vide C.R.No.129/06 U/s.279, 338 and 304(A) of I.P.C. on 17/06/2006.
4) The Complainant further stated that after the above incident, she approached the Opposite Party at Vapi and submitted the relevant documents pertaining to the insurance claim, to the Opposite Party at Vapi for the reimbursement of the claim of Rs.1 Lakh against the death of her husband. However, there was no response from the Opposite Party.
5) The Complainant further stated that she waited for the reply of the Opposite Party but since there was no response, she again approached the Opposite Party at Vapi where she was told in the Opposite Party’s office that the papers relating to her insurance claim were not traceable and further Opposite Party advised her to submit fresh claim form. Accordingly she submitted a fresh claim form on 11/07/2007. However, Opposite Party repudiated the insurance claim as no claim on the folloiwng ground –
“As per the terms and conditions of the policy, claim to be intimated within 6 calendar months of such accident/injury. Whereas you have intimated the claim after one year. Hence, claim is not payable. We hereby reject our liability.”
6) The Complainant further stated that the Insurance Policy document (Policy No.231000/31/05/01/0006299) consists of only two pages having no terms and conditions attached to this document. The genuine claim of the Complainant cannot be repudiated for the above said ground and this is the deficiency in service on the part of the Opposite Party.
7) The Complainant also submitted that the repudiation of the claim caused great hardships, mental agony, inconvenience to her hence, she is entitled for the compensation. Therefore, she prayed for the reimbursement of the insured sum i.e. Rs.1 Lakh plus compensation of Rs.50,000/- and cost of this complaint Rs.5,000/-.
The Complainant submitted the xerox copies of the following documents alongwith her complaint –
a) Insurance Policy No.231000/31/5/01/0006299.
b) FIR dtd.17/06/2006.
c) Memorandom of Autopsy, dtd.17/06/2006.
d) Certificate in Gujrathi script.
e) English version of FIR dtd.17/06/2006.
f) English version of Punchanama, dtd.17/06/2006.
g) Claim form submitted by the Complainant on 11/07/2007.
h) Letter of Opposite Party to Complainant, dtd.02/08/2007 repudiating the insurance claim.
The complaint was admitted and Opposite Party was served with the notice. The Opposite Party appeared through its advocate and submitted its written statement wherein it denied that the deficiency in service etc. However, it is admitted that the vehicle of the deceased was insured under the Policy No.23100/31/05/01/0006299 and further this policy was issued by them for the period from 21/01/2006 to 20/01/2007 insured for the sum of Rs.1 Lakh with additional premium of Rs.50/- against personal accident benefit and the decease had met with an accident on 16/06/2006 but specifically averred that the Complainant had submitted her claim on 11/07/2007 for the first time. She did not approach the Opposite Party before 11/07/2007. As she did not approach within 6 months of the incident of death of the insured, the office of the Opposite Party has rightly rejected her insurance claim. As per the terms and conditions of the insurance contract, the Complainant should lodged her claim within 6 months of the incident of death. Therefore, it is a breach of terms and conditions of the insurance contract and it (Opposite Party) is not liable to pay the insured sum.
8) The Opposite Party further clarified that it always supplies the booklet containing the terms and conditions of the policy alongwith the original policy to their clients and in this case also it supplied these documents to the husband of the Complainant (insured).
9) The Opposite Party finally prayed for dismissal of the complaint.
10) The Complainant filed an affidavit of rejoinder and written argument wherein she reiterated the facts mentioned in the complaint and categorically stated that the claim and the relevant documents pertaining to the claim were submitted to the Opposite Party within 6 months after the incident of death of her husband. At the same time it was stated that the terms and conditions of the policy were never furnished to the Complainant by Opposite Party.
11) The Opposite Party did not file written argument. We heard the Ld.Advocate for the Complainant. The Opposite Party and the Ld.Advocate for the Opposite Party did not remain present at the time of hearing. We perused all the papers submitted by the Complainant and the written statement of the Opposite Party and our findings are as follows -
12) The husband of the Complainant had purchased the motor cycle No.GJ-15-FF-3870 and had taken Insurance Policy NO.231000/31/05/01/0006299 from the Opposite Party for the period from 21/01/2006 to 20/01/2007 and paid additional premium of Rs.50/- to cover the personal accident of the owner /rider for the sum of Rs.1 Lakh. During the validity of this policy, the insured Shri.Ramchandra Redkar, the husband of the Complainant while riding on the above motor cycle met with an accident with other vehicle in the jurisdiction of Daman Police Station and died in the hospital. An offence of negligent driving and causing death of Shri.Ramchandra Redkar had been registered against the rider of the other vehicle which knocked down the deceased. Therefore, there was no fault of an insured Shri.Ramchandra Redkar, in the said motor accident.
13) The only point of dispute raised by the Opposite Party is that the Complainant did not file her claim within the stipulated time of 6 months from the date of incident of death as per the terms and conditions of the policy. However, the Opposite Party has not produced the terms and conditions of the policy having provision that an insurance claim be submitted within the period of 6 months from the date of incident. The Complainant vehemently denied of providing the terms and conditions of the policy in the complaint, rejoinder and written argument. On the contrary the Opposite Party has failed to produce the same even during pleading of this case.The Ld.Advocate for the Complainant has relied upon the Hon’ble National Commission Judgement reported in 2007 CTJ 384 (CP) (NCDRC) in the mater of Toorent Securities Pvt.Ltd. V/s. National Insurance Co. Ltd. wherein the Hon’ble National Commission has observed as follows –
“Vehicle allegedly stopped by some extremists and set on fire. Claim repudiated on the ground that intimation of incident given after 13 ½ months. Dist. Forum held that the terms and conditions of the policy be read down to advance the main purpose of the contract of insuring the loss caused to the vehicle. Accordingly insurance company was directed to pay the insured amount with interest. However, State Commission reversed the Forum’s order – Revision Petition by the Insured – Initially, at the time of commencement of Insurance, the company only gave the policy schedule indicating the Name of the Insured, registration no., policy no., premium amount but detailed policy with terms and conditions was issued only after insured made this claim – Policy conditions in circumstances, not binding on the insured – Revision allowed. Order passed by the State Commission is set aside. Insurance Company was directed to pay the insured amount with cost.”
14) In the above case, the terms and conditions were at least given after the Complainant filed the complaint but in the complaint in hand the Opposite Party has not produced the terms and conditions till this date. Therefore, we do not hesitate to say that these terms and conditions are not binding on the Complainant. The Opposite Party has not proved that these documents or booklets containing the terms and conditions were provided to the Complainant. By repudiating the claim on the ground of late submission of the claim, the Opposite Party is ignoring the spirit of the insurance itself. In the case in hand, the insured had met with an accident in which he succumbed to the injuries sustained by him in the motor accident. The Complainant is the beneficiary of the insured and as such, she is entitled to the claim of sum insured in the policy. Therefore, we find that there is a deficiency in service of the Opposite Party as it repudiated the genuine claim of the Complainant on the ground of late submission of the claim to the Opposite Party. We therefore pass the following order -
O R D E R
i. Complaint No.261/2007 is hereby allowed.
ii. Opposite Party is directed to pay a sum of Rs.1,00,000/- (Rs.One Lakh Only) to the Complainant as sum
insured in the policy alongwith interest @ 9 % p.a. on aforesaid amount from 02/08/2007 till realization
of the entire amount.
iii. Opposite Party is also directed to pay an amount of Rs.5,000/-(Rs.Five Thousand Only) to the Complainant
towards compensation for mental agony and harassment caused to the Complainant.
iv. Opposite Party is directed to pay an amount of Rs.3,000/- (Rs.Three Thousand Only) to the Complainant
towards the cost of this complaint.
v. Opposite Party is directed to comply with the above order within 30 days from the date of receipt of this
order.
vi.Certified copies of this order be furnished to the parties.
