Rajasthan

StateCommission

A/808/2015

Sahara India Commercial Carporation - Complainant(s)

Versus

Smt. Chandrika Sharma w/o Lat. Suresh Chand Sharma - Opp.Party(s)

Alok Fathapuria

07 Sep 2016

ORDER

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

 

 

FIRST APPEAL NO: 753/2015

 

National Insurance Co. Ltd., Divisional office (IV) 43, Jeevan Bhawan, Hajratganj, Lucknow through Regional Manager Regional Office “Jeevan Nidhi” building,Ambedkar Circle, Jaipur & ors.

Vs.

Smt.Hukam Bai Meena w/o Late Mithalal Meena r/o Gram Raipura, Post Kalyanpura, Tehsil and Distt. Dausa.

 

APPEAL NO: 808 /2015

 

Sahara India Commercial Corporation, Command Office, Sahara India Bhawan, 1, Kapoorthala Complex, Lucknow & ors.

Vs.

Smt. Chandrika Sharma w/o Late Suresh Chand Sharma r/o Dakwala Sadan, Purviya Mohalla, Dausa & ors.

 

 

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FIRST APPEAL NO: 809/2015

 

Sahara India Commercial Corporation, Command Office, Sahara India Bhawan, 1, Kapoorthala Complex, Lucknow & ors.

 

Vs.

 

Smt.Hukam Bai Meena w/o Late Mithalal Meena r/o Gram Raipura, Post Kalyanpura, Tehsil and Distt. Dausa & ors.

 

 

Date of Order 7.9.2016

 

Before:

Hon'ble Mr.Vinay Kumar Chawla-Presiding Member

Hon'ble Mrs. Sunita Ranka- Member

 

 

Mr. Alok Fatehpuria counsel for Sahara India

Mr.Manish Tiwari counsel for the complainants

Mr.Vinod Tyagi counsel for the Insurance Company

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BY THE STATE COMMISSION

 

All these appeals have been filed against the judgment dated 22.5.2015 passed by the District Forum, Dausa.

 

Brief facts giving rise of these appeals are that Sahara India Commercial Corporation had taken a personal accident insurance cover for its depositors under Silver Year Labh Yojna. The husband of Smt. Hukam Bai ( Appeal No. 809/2015) had deposited Rs. 10,000/- in the scheme in the year 2003. Similarly husband of Smt.Chandrika Sharma (Appeal No. 808/2015) had deposited Rs. 10,000/- in the year 2003. At the time of deposits the depositors were told that in the event of death of a depositor Rs. 2 lakh is payable. The Sahara India Commercial Corporation had taken a policy from the National Insurance Company for this purpose. The husband of Hukam Bai and Chandrika Sharma unfortunately died in the year 2008 i.e.after five years from the commencement of the scheme. They lodged a death claim which was repudiated by the insurance company first on the ground that the claim was delayed. As per terms and conditions the claim should have been filed within one month from the date of death.

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Secondly, they repudiated the claim on the ground that only Rs. 50,000/- was payable under the policy.

 

The complainants filed separate complaints before the learned DCF Dausa who after hearing both the parties came to the conclusion that though the depositors were promised Rs. 2 lakhs in the event of death yet the liability of the insurance company was limited to Rs. 50,000/- only. The learned DCF based its conclusion on a letter dated 7.3.2005. In this letter the insurance company had informed the Sahara India Commercial Corporation that in case of death within one year, the liability is limited as provided in the Table I of the policy and in case death occurs after more than one year the Table II will not be applicable. The learned DCF found that insurance company had not agreed to liability under Table II of the policy. The DCF found that the liability of the insurance company was limited to Rs.50,000/- only and rest of Rs. 1,50,000/- shall be paid by the Sahara India Commercial Corporation which had been promised by them to the depositors.

 

The Sahara India Commercial Corporation have filed two separate appeals against this order and Appeal No.

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753/2015 has been filed by the Insurance Company.

 

The learned counsel for Sahara India Commercial Corporation has referred the judgment passed by this Commission in Appeal No. 742/2015 in which facts are identical. In view of the letter dated 27.9.2005 of the insurance company the company was held to be liable to pay Rs. 2 lakhs. The learned counsel also submitted copy of the policy no. 451500/42/09/8200000063 and has drawn our attention to the special condition mentioned in this policy which states Coverage- As per Table II ( death, permanent partial disablement and permanent total disablement). A copy of Table II has also been enclosed with this policy which bears stamp of the Insurance Company Lucknow office Code No. 451500. As per this table Rs. 2 lakhs were payable in event of death.

 

The learned counsel for the insurance company has contended that table produced by the counsel for Sahara India Commercial Corporation is not which was enclosed with the policy and that was a different table but despite giving adequate opportunity the learned counsel was not able to produce any different Table II. He has also not challenged the

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table submitted by the Sahara India Commercial Corporation on the ground of any forgery. This table bears the stamp of National Insurance Company and code number is also entered in it. The learned counsel for the insurance company has not been able to deny it and has submitted no other Table II. The letter dated 27.9.2005 was not produced before the learned DCF and therefore, the learned DCF came to the conclusion that company's liability was limited to Rs. 50,000/-. Similar controversy was decided by this Commission in Appeal No. 742/2015.

 

The learned DCF has also concluded that the complainants are entitled for claim on non-standard on account of delay in submitting the claim. However, we do not agree with the findings of the learned DCF on this point also. The Insurance Regulatory and Development Authority in its circular dated 20.9.2011 has directed that insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained and recorded and insurers should satisfy themselves that delayed claims would have otherwise been rejected even if reported in time. There is nothing on record to show that insurance company has enquired into the

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causes of delay. The present complaints were filed by the widows of the deceased who were illiterate persons and we are of the view that complainants were knowing all these provisions of insurance in the event of death of their husband is not certain. We are of the view that in case of death claims no non-standard claim can be passed on the ground of delay in submission of the claims.

 

In view of the letter dated 27.9.2005 and the special condition mentioned in the policy document, we are of the view that the insurance company is liable to pay Rs. 2 lakhs in the event of death of the depositor. The appeals of Sahara India Commercial Corporation are allowed and the judgment of the learned DCF to that extent is set aside. The appeal of the insurance company is dismissed. The company shall settle the claim within one month of this order. Rest of the order is maintained.

 

 

(Sunita Ranka) (Vinay Kumar Chawla)

Member Presiding Member

 

 

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