PER SHRI. S.M. RATNAKAR – HON’BLE  PRESIDENT

1)        By this complaint the Complainant has prayed to pay policy claim of Rs.5 Lacs and compensation of Rs.2 Lacs and cost of Rs.25,000/- towards this complaint.

2)        According to the Complainant, she is widow of deceased Eqbal Ahmed. Rethihalli who was the holder of Pravasi Bhartiya Yojana Insurance Policy issued by the Opposite Party bearing No.P2007101580034.  The said policy was in the name of the deceased husband of the Complainant and it was for the period of 3 years from 30/11/2007 to 14/10/2010.  The deceased was working with M/s. Arabian Bemco Contracting Company in Makkah, Saudi Arabia.  It is submitted that as per the terms of the contract the Opposite Party undertook to indemnify the deceased husband of the Complainant who was insured by the Opposite Party for the period of 3 years i.e. policy period upto Rs.5 Lacs. It is submitted that the deceased husband of the Complainant died in Saudi Arabia on 10/03/2009.  The copy of the death certificate is marked as Exh.‘A’.  According to the Complainant, initially the Complainant and brother of deceased had taken due search to find out the insurance policy papers of the deceased Iqubal, however, after making their best efforts to search the insurance papers they could not find out but one of the colleagues of the Complainant’s deceased husband had informed about the said insurance policy belongs to the Opposite Party. The Complainant and her brother-in-law thereafter contacted Customer Service Unit of the Opposite Party and enquired the details of insurance policy of the deceased through e-mail and the Customer Service of the Opposite Party had forwarded the details of the said insurance policy. Copy of the e-mail dtd.25/04/2009 is marked as Exh.‘B’. 

3)        According to the Complainant, the let husband of the Complainant was holding valid policy issued by the Opposite Party and was serving abroad i.e. Makkah, Saudi Arabia and he died in the said country on 10/03/2009.  It is submitted that as a result of death of Complainant’s husband, the policy referred above automatically came into operation.  It is the case of the Complainant that the Customer Service Unit of the Opposite Party had given the details of the policy obtained from the Opposite Party. The Opposite Party had also requested to register the insurance claim with “Claim Department” of the Opposite Party. The Complainant accordingly registered the claim with the said department at Ballard Estate, Mumbai bearing Claim No.21010493 on 16/10/2009.  The copy of the said claim form is at Exh.‘C’.  It is submitted that the officer of the Opposite Party had given assurance to the Complainant that the appropriate steps will be taken in that regard. The Complainant believing on the representation made by the officer of the Opposite Party waited nearly of 1 year.  It is submitted that however, no action was taken by the Opposite Party on the claim lodged by the Complainant and avoided to give reply in that regard to the Complainant.  The Complainant due to the behaviour of the Opposite Party had suffered a mental torture and mental agony. It is submitted that the Complainant has to take care of her two small kids and the old aged mother-in-law.  It is submitted that after waiting for a long period as the Opposite Party did not give any response the Complainant had issued notice through Advocate on 21/08/2010 for the payment of insurance amount and compensation.  The said notice was received by the Opposite Party on 23/08/2010.  The copy of the said notice and acknowledgment of the notice is marked as Exh.‘E’.  It is submitted that due to the defective and improper service given by the Opposite Party, the Opposite Party is guilty of deficiency in service and is liable to pay the claim made in the complaint as mentioned in para 1 of this order.

4)        The Opposite Party filed written statement and contested the claim.  It is submitted that this complaint has been filed by the Complainant with a view to extort money from the Opposite Party.  It is submitted that the present complaint is barred by limitation as the same has not been filed within the requisite time as provided under the Consumer Protection Act, 1986 (hereinafter referred to as the Act).  The Opposite Party has denied the claim of Rs.7 Lacs made by the Complainant.  It is contended that as per the terms and conditions of the subject policy the intimation in the case of death of the deceased, it shall be made within 1 month from the date of death.  According to the Opposite Party, the intimation regarding the death of the deceased was given after the laps of more than 3 months from the date of death and the claim was lodged after laps of 7 months after the date of death of the deceased. It is contended that the Complainant has failed to show any valid reason for the cause of the said delay in intimation and also lodging the claim.  It is contended that as per the terms and conditions of the subject policy the claimant shall provide necessary supporting documents to prove the loss occurred i.e. the death of her husband in the subject claim.  According to the Opposite Party, none of the condition was complied by any valid documentary evidence.  It is contended that the cause of death of the deceased as mentioned in the certificate is not at all covered under the subject policy.  It is contended that the present complaint lacks of merits and the same deserves to be dismissed with cost.  The Opposite Party has denied all the parawise allegations made in the complaint and prayed for dismissal of the complaint with exemplary cost.

5)        The Complainant has filed her affidavit of evidence and the Opposite Party has filed affidavit of Mr. Ganesh Jadhav, Dy. Manager, of the Opposite Party.  Both the parties have filed their written arguments. We heard the oral argument of the Advocate for the Complainant – Shri. Sachin Borhade. The Advocate for the Opposite Party Shri. Ankush Navghare remained absent at the time of oral argument. 

6)        The Opposite Party has contended that the cause of death of deceased as mentioned in the certificate is not at all covered under the subject policy and therefore, the Complainant has failed to prove her contentions with regards to the subject claim.  While considering these aspects the Opposite Party has relied the copy of the terms and conditions of Reliance Pravasi Bhartiya Yojana Policy.  In the said policy there is specific mention in general condition as follows –

            “Reliance Pravasi Bhartiya Yojana Policy is designed for citizen of India to obtained immigration clearance as required under the Immigration Act, 1983 (31 of 1983) i.e. for all Indian citizens (between the group of 18 to 60 years) whilst on stay abroad on a valid visa for purposes of employment only.  The policy, however, shall not apply in the event of war or internal conflict in the county to which the citizen of India holding the said policy has proceeded with immigrant clearance.”

            In the said conditions it is also mentioned as follows –

           “Upon the happening of any event which may give rise to claim under this policy, the insured person/nominee(s)/legal representative(s), as the case may be shall forthwith give notice thereof to the Company in writing.”

            In Clause ‘C‘ it is also mentioned that –

            “If the Insured person shall die, notice of death shall be given by the nominee(s) /legal representative(s) forthwith”.              

            Considering the aforesaid conditions laid down in the policy document which is submitted by the Opposite Party we are of the view that the contention raised by the Opposite Party that the cause of death of deceased is not at all covered under the subject policy cannot be accepted.  In the said policy document there is no specific exclusion that if the Insured who obtained Reliance Pravasi Bhartiya Yojana Policy dies naturally whilst his stay at abroad, such Insured person is not covered and his legal representatives would not be entitled for the benefit under the policy obtained by the Insured.      

7)        In this case it is undisputed that Deceased Iqbal Ahmed i.e. husband of the Complainant had obtained Policy No.P2007101580034 in his name and it was valid from 30/11/2007 to 14/10/2010.  It is also not disputed by the Opposite Party that in the said policy the Opposite Party assured to pay an amount of Rs.5 Lacs in respect of any of the perils insured against during the period of policy as stated therein.  Considering these facts as the husband of the Complainant and the Insured Iqbal Ahmed, aged 35 years died at Holly Makkah on 10/03/2009 due to large Acute Cardiac Coagulation and as diagnosed by Dr. Aktaruddin Mohmed. Sayyed Reheman due to pressure arrest alongwith Acute Pulmonary Congestion we hold that as the deceased Insured died whilst his stay at abroad it also caused be said natural death.  Thus, the legal representatives of him as per the terms and conditions of the aforesaid policy are entitled to the claim of Rs.5 Lacs from the Opposite Party.  Furthermore, the contention raised by the Opposite Party that the Complainant did not fulfill the requirement of submission of claim within 1 month of the occurrence of event and on that count the Complainant is not entitled for the amount as claimed also cannot be said legal and proper in view of the observations of the Hon’ble National Commission in the case of Reliance General Insurance Co. Ltd. V/s. Sri. AVVN Ganesh, in Revision Petition No.3572 of 2011 decided on 29/11/2011 wherein it is held that the delay in intimation was not prejudicial to the Insurance Company in that it was not prevented, because of the delay.  The Complainant in the complaint by producing the copies of e-mail has specifically alleged that she was not having knowledge of the policy obtained by her husband from the Opposite Party. She has also mentioned that the information regarding it came to know from one of the colleagues of her deceased husband and thereafter, the Complainant contacted to the Customer Service Unit of the Opposite Party and enquired the details of insurance policy of the deceased through e-mail and Customer Service Unit of Opposite Party has forwarded the details of insurance policy as the per the copy of e-mail at Exh.‘D’ dtd.25/04/2009.  We therefore, hold that considering the inability of the Complainant to give intimation immediately to the Opposite Party regarding the death of her husband till submission of her claim dtd.16/10/2009 cannot be said ground to reject the claim made in this complaint.  It is also pertinent to note that after receiving the claim lodged by the Complainant till filing of the complaint the Opposite Party did not reject the claim or communicated anything about any non compliance of the requirements of the Opposite Party for grant of claim in favour of the Complainant.  The Opposite Party did not reject the claim lodged by the Complainant on the ground that the same cannot be allowed in view of the terms and conditions of the policy. Considering all these facts and circumstances of the case, we hold that the claim lodged by the Complainant to pay an amount of Rs.5 Lacs towards the insured amount of late Iqbal Ahmed is required to be paid by the Opposite Party to the Complainant. The Complainant has claimed compensation of Rs.2 Lacs for the mental agony and hardship caused to her by the Opposite Party but we are of the view of that an amount of Rs.10,000/- and cost of Rs.5,000/- towards this complaint would be just and proper. In the result the following order is passed -

O R D E R

                     i.        Complaint No.333/2010 is partly allowed against the Opposite Party.

            ii.        The Opposite Party is directed to pay Rs.5,00,000/- (Rs. Five Lacs Only) and Rs.10,000/- (Rs. Ten Thousand Only)

                       towards compensation for mental agony and hardship and Rs.5,000/- (Rs. Five Thousand Only) towards this complaint to

                       the Complainant.

          iii.        The Opposite Party is directed to comply with the aforesaid order within one month from the date of service of this order

                      and failure to comply the Opposite Party will be liable to pay interest @ 9% p.a. thereafter till its realization on the amount

                      mentioned in para no. ii of this order to the Complainant. 

          iv.        Certified copies of this order be furnished to the parties.