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 Ramesh Vishwanath Rathod was an agriculturist holding Gut No.1 at village Anandnagar, Taluka-Pathri, District-Parbhani. He died accidentally on 1^st January, 2009 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 Opponent appeared and filed written statement.  It is submitted that no intimation was received by this opponent from the complainant 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)                After hearing all the parties and after going through the record, following points arise for our consideration.

POINTS

REASONS

4) 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, Post Mortem Report, Death Certificate, School Leaving Certificate. On going through all these papers, it is clear that the husband of the complainant died in the motor vehicle accident.  According to the opponent, no intimation was received by this opponent from the complainant.  This defence of the opponent is falsified by the information received by the complainant under the Right to Information Act, 2005.  As per information received under the Right to Information Act, 2005, claim of the complainant was repudiated by the opponent vide letter dated 21^st June, 2010 as driving license and other required documents were not produced.  This information shows that the defence taken by the opponent is not correct.  The claim was already received by the opponent but the same was repudiated on the ground of want of required documents. Under the Government Resolution and Tripartite Agreement, 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. According to the complainant, the claim was submitted to the opponent government officer within time. There is no evidence on record to show that the opponent informed the complainant to produce the documents.   Therefore, the defence taken by the opponent can not be accepted. The complainant has produced all the required documents under Government Resolution and Tripartite Agreement therefore her claim can not be rejected. 

5)                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 7^th 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 officer. Therefore, the claim of the complainant can not be repudiated.

6)                It is submitted by the learned advocate for the opponent, the complainant can not produce the documents at the stage of argument. The complainant has already produced the required documents along with complaint and also before filing of affidavit of evidence.   She is not filing the document at the time of argument.  Therefore, the submission made by the learned  advocate for the opponent is not relevant.  It is further submitted by the learned advocate for the opponent that the deceased was smelling alcohol as per post mortem report. The deceased was alcoholic therefore the complainant is not entitled for the benefit under the scheme.  On perusal of post mortem report, there was alcoholic smell but the cause of death is due to head injury and multiple injuries.  The death was not caused due to influence of liquor.  The learned advocate for the complainant has placed reliance on the judgment of our State Commission in First Appeal No.A/13/107 in the case of smt.Sunita Ananda Bhole –Versus- New India Assurance Company Limited, dated 3^rd June, 2014.  In para 5 of the judgment, the Hon’ble State Commission has held as under :

Though in post mortem alcohol is detected, however, the cause of death is head injury. The deceased has not contributed to the accident.  On the contrary, vehicle of a third person has dashed to the deceased.  Learned counsel further pointed out that after careful scrutiny of the papers, panchanama, medical record, it is seen that the accident was not occurred because the deceased was under the influence of alcohol and presence of the alcohol in blood cannot be treated as a conclusive proof and, specific clinical picture of alcohol, intoxication also depends on other factors such as quantity and frequency of the consumption.

Identical facts are before us.  Therefore, the submission made by the learned advocate for the opponent can not be accepted.

7)                The learned advocate for the opponent has submitted that the terms of the contract has to be strictly followed by the parties.  For this purpose, she has placed reliance on the judgment of Hon’ble Supreme Court in the case of United India Insurance Company Limited –Versus- Harchand Rai Chandan Lal, decided on 24^th September, 2004.  In view of this judgment, the terms of the contract are to be strictly followed.  This fact is not disputed by the complainant. 

8)                It is submitted by the learned advocate for opponent that the deceased was not having valid driving license therefore he is not entitled for the benefit of this scheme.  The learned advocate for the complainant has submitted that there was no fault of deceased in the accident therefore, driving license is not required.  For this purpose, he has placed reliance on the judgment of our State Commission in the case of ICICI Lombard General Insurance Company Limited –Versus- Smt.Sindhubai Khanderao Khairnar in First Appeal No.1009/2007 dated 7^th January, 2008 reported in 2008(2) All MR (Journal) 13.  In para 8 of the judgment, the Hon’ble State Commission has held as under :

The Insurance Company insisted for driving license.  In fact, driving license is not necessary. From the perusal of the F.I.R., it is revealed that one Hundai car gave dash to the motor cycle from behind, which was being driven by the deceased.  In the said accident Shri Khanderao Krishna Khairnar sustained serious head injury and ultimately succumbed to the head injury in civil hospital on 7^th June, 2005. He was not at the fault.  He did not attribute for the commission of an accident. Therefore, driving license is not at all necessary to settle the insurance claim. In case of an accident on the road, information report, spot panchanama, inquiry report and post-mortem report are required as per the scheme.  In fact, these documents were submitted to the Insurance Company.  There is nothing on record to show that the deceased was under influence of any intoxication. Shri Khanderao Krishna Khairnar died because of head injury sustained in the road accident. Therefore, as per the scheme, widow of the deceased was one of the complainants. Widow stands at Serial No.1 in the list of claimants. 

In the instant complaint before us also, as per police investigation papers, accident took place due to the fault of the driver of the unknown vehicle and not of the deceased. Therefore, the submission of the learned advocate for the opponent can not be accepted.

9)                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 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 Opponent/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. 1^st January, 2009  till its realization.
3. The Opponent/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 18^th October, 2014