Per Mr B A Shaikh, Hon’ble Presiding Member

1.      This appeal is filed by the original opposite party No.1 – Insurance Company against the order dtd.26.11.2014, passed by District Consumer Forum, Gondia, in consumer complaint No.21/2014, by which the following directions have been given.

i.The opposite party No.1 shall pay sum assured of Rs.1.00 Lacs to the original complainant / respondent No.1 herein towards accidental death of her husband, with interest @ 9% p.a. from 16.04.2014 till its realization by her.

ii.The opposite party No.1 shall also pay compensation of Rs.10,000/- for physical & mental harassment to the original complainant.

iii.The opposite party No.1 shall also pay litigation cost of Rs.5,000/-.

2.      We have heard today advocate Mr W G Paunikar and advocate Mr U Kshiragar.  The respondent No.2 forwarded his reply by post alongwith documents.

3.      The main submission of the appellant as made before the Forum below was that the claim under Janata Personal Accident Policy was not received from the original complainant by the appellant and therefore there was no question of considering the same and settlement of the same.   Moreover, the Forum below held that as death of the deceased husband of respondent No.1 was covered under the policy issued by the appellant herein and as no repudiation letter was received, the cause of action for filing complaint was continuous and the complainant / respondent No.1 herein is entitled to the sum assured under the policy with compensation and litigation cost as above.

4.      The learned advocate of the appellant during the course of argument made aforesaid submission and also submitted that as per policy / scheme the claim ought to have been submitted within 90 days from the date of death of insured and as the claim was not filed, the Forum below erred in partly allowing the complaint.

5.      On the other hand, the learned advocate of the respondent No.1 supported the impugned order and relied on the decision in the following cases.

          i.        Praveen Sheikh Vs. LIC & Anr.,  I(2006) CPJ 53.

ii.Laxmibai & Ors. Vs. ICICI Lombard General Insurance Co. Ltd., III(2011) CPJ 507 (NC).

iii.      Bhagabai Vs. ICICI Lombard General Insurance Co. Ltd., I(2013) CPJ 115 (MAH)

iv.      Sadhana Salunke Vs. State of Maharashtra (MAH), III (2011) CPJ 285.

v.       ICICI Lombard Vs. Dhondiba Bhogulkar in FA/10/1254, passed by State Consumer Disputes Redressal Commission, Maharashtra on 11.06.2013.

vi.      ICICI Lombard Vs. Anita Patil in FA/10/1105, passed by State Consumer Disputes Redressal Commission, Maharashtra on 14.01.2013. 

          The learned advocate of the respondent No.1 submitted that as there is no merit in appeal, it may be dismissed.

6.      It is seen that as per policy, claim was required to be submitted through Taluka Krishi Adhikari (respondent No.2) to the Insurance Company. The said respondent No.2 failed to appear before the Forum, but he filed reply in appeal and in that reply he admitted that the claim received from respondent No.1 was forwarded to the District Agriculture Officer. Moreover, the documents filed on record, also revealed that the claim was submitted by respondent No.1 to respondent No.2 for forwarding the same to the Insurance Company.  We, therefore, find that when respondent No.1 complied with requirements of submission of the claim to respondent No.2, it was the responsibility of respondent No.2 to forward the same to the Insurance Company through District Agriculture Officer.  We, therefore, hold that as the respondent No.1 duly forwarded the claim alongwith documents to respondent No.2 (Taluka Krishi Adhikari), it was the responsibility of the said officer to forward the same to the appellant through District Agriculture Officer. We find that for the failure of the nodal officer in submission of the claim to the appellant, the original complainant cannot be blamed.

7.      We also find from the documents filed on record that deceased husband of respondent No.1 was a farmer and he was covered under the policy and his accidental death was occurred during the period of policy.  Therefore, without going into any technical aspect of the case, we hold that the death of deceased husband was covered under the policy issued by the appellant, it is obligatory on the part of the appellant to pay sum assured to the respondent complainant / respondent No.1

8.      We find that as it is the case of the appellant that claim was not received by it, the compensation of Rs.10,000/- and litigation cost of Rs.5,000/- awarded by the Forum below needs to be set aside.  Accordingly, following order is passed.

ORDER

i.        The appeal is partly allowed.

ii.       Direction given by the Forum below under the impugned order to the appellant to pay assured amount of Rs.1.00 Lac to the original complainant / respondent No.1 herein with interest @ 9% p.a. from 16.04.2014 till its realization is maintained.

iii.      Rest of the directions under impugned order to the appellant to pay compensation of Rs.10,000/- and litigation cost of Rs.5,000/-, are herby set aside.

v.       No order as to costs in this appeal.

vi.      Copy of the order be furnished to both parties free of cost.