Haryana

StateCommission

A/385/2016

ORIENTAL INSURANCE CO. - Complainant(s)

Versus

RAMPATI - Opp.Party(s)

RECEIVED FROM NCDRC,NEW DELHI

28 Oct 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

Remand Appeal No:   385 of 2016

First Appeal No:        1107 of 2012

Date of Institution:        24.09.2012

Date of Decision :         28.10.2016

 

1.     The Oriental Insurance Company Limited, through its Regional Manager, Regional Office, LIC Building, Jagadhri Road, Ambala Cantt.

2.     Oriental Insurance Company Limited, Regional Office, Managing Director, The Oriental Insurance Company Limited, Oriental House Asaf Ali Road, New Delhi-110002.

                                      Appellants-Opposite Parties

Versus

 

Rampatti wife of late Raja Ram s/o Sh. Ram Richha, Resident of Village Rajound, Tehsil and District Kaithal.

                                      Respondent-Complainant

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Mr. B.M. Bedi, Judicial Member.

                                                                                                         

Present:               Shri A.S. Khara, Advocate for appellants.

                             Shri Sandeep Goyal, Advocate for respondent.

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

         This Opposite Parties’ appeal is directed against the order dated August 3^rd, 2012 passed by District Consumer Disputes Redressal Forum, Kaithal (for short ‘the District Forum’) in Complaint No.303 of 2009.

2.                Raja Ram (since deceased)- husband of Rampati-complainant/respondent, purchased Nagrik Suraksha Insurance Policy (Exhibit C-1) for Rs.5.00 lacs, covering period from 19^th June, 2003 to 18^th March, 2007. Raja Ram (hereinafter referred to as ‘the insured’) died on 19^th December, 2006. The complainant-respondent filed claim with the Insurance Company. The Insurance Company repudiated the claim vide letter dated 27^th October, 2009 (Exhibit C-8). Hence, complaint under Section 12 of the Consumer Protection Act, 1986 was filed before the District Forum.

3.                The Insurance Company-Opposite Party, contested the complaint raising plea that the complainant violated the terms and conditions of the policy. It was stated that the policy had coverage of Rs.1.00 lac for hospitalization expanses and Rs.4.00 lacs for personal accident benefits. Immediate intimation was required to be given about any mis-happening which has not been done, so the claim of the complainant was rightly repudiated.

4.                On appraisal of the pleadings and evidence of the parties, the District Forum allowed complaint granting relief as under:-

“I.      To treat the letter (R-2) dated 27/10/09 as cancelled vide which the Op refused to process the claim of the complainant.

II.       To settle the claim of the complainant without raising any objection of delayed intimation as set out in letter dated 27/20/09.

III.      In the case the complainant is found entitled for the claim under the policy, pay the same to her/her legal heirs as the case may be along with interest at the rate of 8% per annum thereon w.e.f. the date of filing of the complaint till its actual payment.

IV.     Further to pay a sum of Rs.3,000/- (three thousand) to the complainant towards lump sum compensation on account of mental agony, harassment and cost of litigation.”

5.                First Appeal No.1107 of 2012 filed before this Commission was allowed vide order dated 19^th November, 2012 and the complaint was dismissed being barred by limitation as provided in Section 24A of the Consumer Protection Act, 1986. Hon’ble National Commission in Revision Petition No.1300 of 2013 set aside the order of this Commission and remanded the case for deciding it afresh.

6.                Arguments heard. File perused.

7.                The only argument raised by the learned counsel for appellants-Insurance Company is that complainant failed to give intimation of death of the insured within the stipulated period as prescribed under the terms and conditions and thus violated the terms of the policy.

8.                Undisputedly, the complainant is an illiterate lady. A perusal of the file shows that the complainant had thumb marked the Power of Attorney (Vakalatnama), affidavit as well as the complaint. She has specifically pleaded in her complaint that she was not aware about her husband having purchased the policy and she learnt about it only on 25^th July, 2009, whereupon she immediately lodged the claim. The Insurance Company in paragraph No.2 of its written version has not denied this fact specifically.

9.                Question of violation of the terms and conditions of the policy would have arisen only if the complainant was aware about the purchase of the policy. The complainant has sufficiently explained the delay, if any, for not giving intimation within the stipulated period of seven days. The explanation given not only appears to be genuine but even the Insurance Company also did not specifically deny this fact. In view of this, the impugned order does not call for any interference.

10.              Hence, the appeal is dismissed being devoid of merits.

 

Announced: 28.10.2016

(B.M. Bedi) Judicial Member

(Nawab Singh) President

 

CL