ORAL ORDER
Per Shri S.R. Khanzode – Hon’ble Presiding Judicial Member:
(1) This appeal takes an exception to an order dated 5th November, 2003 passed in Consumer Complaint No.499/2001, Shri Ranjankumar Namdeo Chipkar V/s. Branch Manager, Chief Registrar, Bhartiya Jeevan Bima Nigam & Ors., by the District Consumer Disputes Redressal Forum, Thane.
(2) Undisputed facts are that, Respondent/Complainant (hereinafter referred to as ‘the Complainant’) is the Insurance Policy holder for 25 years of Money Back policy with profits (non-medical). When said policy was alive for his illness the Complainant was admitted in Railway Hospital at Byculla. However, subsequently, because of disablement to the extent of 50% noticed he was removed from the service. Consequently, he made the claim, claiming benefits under the additional cover for expenses. The Insurance Company repudiated the said claim on the ground that, disability of the Complainant has no nexus with the accident but as a result of his illness and therefore, the cover for additional benefits is not available to him. Feeling aggrieved by such repudiation he filed consumer complaint.
(3) The Forum partly allowed the consumer complaint accepting the contention of the Insurance Company to hold that the repudiation of the insurance claim is delayed by about 30 months and awarded compensation of `25,000/- and directed the Insurance Company to give disability benefit to the Complainant and also awarded further compensation of `5,000/-.
(4) In the circumstances, looking to the policy document and particularly, its exclusion clause 10.4, since disability of the Complainant has no nexus with the accident but as a result of his illness, the insurance Company rightly repudiated the claim on that count.
(5) The repudiation of the insurance claim was communicated to the Complainant as per Insurance Company’s letter dated 14.07.2000. Complainant tried to submit that he has not received any such letter. We need not to give any importance to it since relief to be granted on the basis of belated repudiation and the mental agony which the Complainant had suffered by such late communication. Therefore, in absence of any evidence, the assessment by awarding compensation of `5,000/- as per impugned order could not be faulted with and, as such, impugned order to that extent needs to be maintained.
(6) As far as direction given to give disability benefit to the Complainant, we find that it is an instance exhibiting exceeding the jurisdiction vested with the Forum, particularly, such direction cannot be given in view of Section 14 of the Consumer Protection Act, 1986 and in the second instance, once finding is given, upholding the repudiation of claim by the Insurance Company on the ground that benefits under the disablement clause are not available to the Complainant, asking Insurance Company to grant such benefits would be improper. We hold accordingly and pass the following order:
O R D E R
(i) Appeal is partly allowed.
(ii) Direction given in paragraph no.2 of the operative part of the impugned order to the extent that Insurance Company or the Opponent Nos.1 to 3 ordered to be given disable benefits to the Complainant is set aside. Impugned order stands modified to that extent and except for this modification rest of the order stands confirmed.
(iii) In the given circumstances, both parties to bear their own costs.
Pronounced on 30th July, 2012.
