Rajasthan

StateCommission

A/81/2015

National Insurance Company Ltd. - Complainant(s)

Versus

Santosh W/o Late Sukhlal Mali - Opp.Party(s)

Vizzy Agarwal

08 May 2015

ORDER

BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,RAJASTHAN,JAIPUR BENCH NO.1

 

FIRST APPEAL NO: 81/2015

 

 

National Insurance Co.Ltd. DO-4 Jeevan Bhawan Phase 1,43 Hazratganj, Lucknow through authorised signatory Jaipur regional office “Jeevan Nidhi” 2^nd floor, Bhawani Singh Road, Jaipur.

Vs.

Santosh w/o late Sukhlal Mali r/o Nasirda, Tehsil Deoli,Distt. Tonk & ors.

 

Date of Order 8.5.2015

 

Before:

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Mrs.Sunita Ranka -Member

Mr.Kailash Soyal- Member

 

Mr. Vizzy Agarwal counsel for the appellant

Complainant respondent present in-person

Mr. Aalok Fatehpuria counsel for the respondents Sahara India

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BY THE STATE COMMISSION

 

This appeal has been filed against the judgment of learned DCF Tonk dated 8.10.2014 by which it allowed the complaint against the insurance company directing it to pay the death claim with regard to personal accident of the husband of the complainant.

 

Brief facts giving rise to this dispute are that the husband of the complainant had invested a sum of Rs.10,000/- on 31.10.2003 under Silver Year Labh Yojna of respondent no.1 & 2 ( Sahara India ). Under this scheme in case investor died in accident, his heirs were to get personal accident claim for which the respondent no.1 & 2 had taken a Group Insurance Policy from the appellant National Insurance Company. The husband of the complainant died on 29.10.2005 in a road accident and respondent no.1 & 2 were informed of the incident. As the record shows the respondent no.1 & 2 conducted an investigation of the incident and two reports dated 26.8.2006 and 9.10.2007 are on record by which Suresh Kumar Jain who was executive worker of respondent no.1 & 2 submitted his report affirming the death of the complainant's husband in an accident. However, as per the terms of the scheme initial death help of Rs.10,000/- was paid to

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the complainant but claim regarding personal accident insurance was not paid. The complainant was informed by the company on 15.3.2008 that since the claim has not been lodged within time, the personal accident death claim has been repudiated by the insurance company against which this complaint was filed. Perusing the reply of respondent no. 1 & 2 and the insurance company, it seems to be a interpleader suit in so much as both the respondents has held each other responsible for payment of the claim. The insurance company has repudiated the claim on the ground of delay in intimation while respondent no.1 & 2 have placed the responsibility on the insurance company to make the payment to the complainant. The learned DCF found the insurance company responsible for the claim.

 

The insurance company has filed this appeal on the ground that the claim has been filed with inordinate delay and insurance company cannot be held responsible for deficiency of service. The learned counsel for the appellant has further argued that the complaint itself was filed beyond limitation as the limitation would start from the date of death i.e. 29.10.2005 and not from the date of repudiation of the claim as the complainant should not wait for submitting his claim after expiry of the limitation

 

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period.He further submits that in case of accidental death written notice with full particulars should be given to the company. On the point of limitation he has relied on (2009) 7 SCC 768 ( Kandimalla Raghavaiah & Co. Vs. National Insurance Co. Ltd.). He has further submitted that the learned DCF has awarded Rs. 50,000/- while the insured amount was only Rs.25,000/- and the rate of interest on the amount is grossly excessive and cannot exceeds 6% p.a.

 

The learned counsel for the Sahara India has submitted that claim cannot be repudiated merely on the ground of delay. He has placed before us a circular dated 29.9.2011 of Insurance Regulatory & Development Authority in which it was held that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time.

 

We have heard both the counsels and have considered the arguments advanced before us.

 

The respondent no. 1 & 2 (Sahara India) can claim the

 

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benefit of the circular issued by IRDA only in case they explain the reasons for delay in intimating the insurance company while they were informed of the incident in the year 2006 and it processed the death help claim of the complainant's husband.

 

Under the scheme of respondent no.1 & 2, the investors were given the facility of death help in case of sudden death of the investor and if the death occurs by personal accident within two years of the investment, a sum of Rs.50,000/- as personal accident claim was to be paid. For this the respondent no.1 & 2 had taken group insurance policy from the appellant insurance company. In this case the fact shows that incident has been reported to the company though no specific date has been placed on record but two reports prepared by executive member dated 26.8.2006 and 9.10.2007 it is evident that respondent no.1 & 2 had been informed of the incident otherwise first survey report dated 26.8.2006 could not have been prepared. The death maturity claim itself was paid to the complainant on 26.8.2006 which further proves that respondent no.1 & 2 were aware of the incident before the death help was paid to the complainant. It was incumbent upon respondent no.1 & 2 to intimate the insurance company of the incident as we are of the view that the first

 

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liability was of the respondent no.1 & 2 (Sahara India) to make the payment as promised to the investors under the scheme. If respondent no.1 & 2 had taken any group insurance/ indemnification policy for this purpose, they should lodge the timely claim with the insurance company. The complainant cannot be expected to inform the insurance company of the incident as no separate policy has been issued to the individual investors. The individual investors were not informed that in case of any eventuality of this kind they should report the matter to the insurance company. Even we are not sure whether investors were informed that any group insurance policy has been taken from the insurance company.

 

In view of this we find that first liability to make payment devolves on respondent no.1 & 2 (Sahara India) and they can further file a claim for indemnification from the insurance company. In this case consumer cannot be allowed to suffer because respondent no.1 & 2 did not inform the insurance company of the incident and did not lodge a claim with them as per terms of the policy.

 

We,therefore, allow this appeal and modify the order of

 

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the learned DCF to the extent that respondent no.1 & 2 shall pay the personal accidental death claim of Rs.50,000/- to the complainant and then they may claim this amount from the insurance company in case it is within terms and conditions of the policy. Now, when the insurance company has repudiated the claim on the ground of delay the respondent no. 1 & 2 are liable for payment. Appeal allowed.

 

 

Member Member Presiding Member

 

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