BEFORE THE SOUTH MUMBAI DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
Puravatha Bhavan, 1st Floor, General Nagesh Marg, Near Mahatma Gandhi Hospital, Opp. M.D. College, Parel, Mumbai – 400 012.
O.No.
Complaint No.SMF/MUM/CC/2013/223
Date of filing : 30/08/2013
Date of Order: 23/11/2017
Mr. Chhotelal Bhavanisevak Yadav,
R/at : 21/19, Balgovindas Road,
Bhosle Chawl, Dadar,
Mumbai – 400 028. ….. Complainant.
V/s.
1.The Oriental Insurance Company Ltd.,
Claims service Centor, Makar Bhuvan No.1,
5th floor, New Marin Line,
Mumbai – 400 020.
2. PAN CARD CLUBS LIMITED,
111/113, Kaliandas Udyog Bhavan,
Near century Bazar, Prabhadevi,
Mumbai – 400 025. ….. Opposite Party
Coram:
Shri. G.K. Rathod : Hon’ble President
Shri. S.R. Sanap : Hon’ble Member
Appearance : For Complainant - Adv. Shri.Umesh V. Jadhav
For Opponent No. 1 - Adv. Smt. Sapna Bhuptany
For Opponent No. 2 - Adv. Shri. Pramod Kulkarni /
Adv. Shri. Anant Singh
// JUDGMENT //
PER SHRI. G.K. RATHOD – HON’BLE PRESIDENT
The facts giving rise to the present complaint are as follows :-
The Complainant has filed the present complaint that he is a husband of Smt. Laltidevi Yadav and she was a member of the Opponent No. 2 and admitted to their membership on payment of offer price of Rs.900/- and on the payment of Rs. 20,700/-, certificate was issued by Branch Kalyan and the Opponent No. 2 has also gave insurance coverage for personal accident death insurance of Rs.1,00,000/-. The Complainant’s wife Mrs. Laltidevi expired on 27/2/2012 due to accident which she sustained as Buffalo whom she had taken to graze at open space. All of sudden the said Buffalo became violent / aggressive and dragged her with the rope she was holding with the Buffalo and carried she fled on the graved and was pulled fast without stop resulting her death on the spot. Police report panchanama and death certificate also filed on record and therefore, he has filed a claim of Rs. 1,00,000/-. He has filed documents Insurance Coverage Certificate, Mediclaim, Panchanama, Death Certificate, Communication dtd. 27/11/2012, Ration Card, Election Card of the Complainant and copy of the Bank Pass Book.
(2) After receipt of the notice, the Opponent No. 1 appeared and filed its written version and denied all the contents of the complaint in toto. It is contended that the complaint is frivolous, misconceived and without merits and the same liable for dismissed. It is further submitted that there is no document on record to show that the cause of the death to be accidental.
(3) The Opponent No. 2 also filed written version and taken same stand. It is submitted that there is no fault on the part of the Opponent No.2 which is evident from the documents attached with the complaint and the complaint is liable to be dismissed. The Opponent No.2 in this case was involved without any reason and wholly misconceived. The Opponent No. 2 do not provide any other service as its business to its Applicants. It is further submitted that the Party No. 2 procures personal accident death insurance for its applicants from a third party i.e. an Insurance Company which in the present case is the Opponent No.1 and the Opponent No.2 does not charge any amount as a premium from its applicants for the insurance coverage from them. Thus, the opponent No. 2 does not provide service for insurance to the Applicant.
(4) We have heard the oral arguments of the parties.
(5) From the above facts, the following points arose for consideration :
Sr.No. | Points | Findings |
1. | Whether there is deficiency in service and unfair trade practice on the part of the Opponent | Yes. |
2. | Whether the Complainant is entitled for the relief as claimed? | Yes. |
3. | What order? | As per final order. |
REASONING :
(5) We have gone through a the contents of the complaint, affidavit, evidence, documents, as also, written versions, affidavits and written arguments of the parties. As per the letter dtd. 27/11/2012, the claim was repudiated by the Opponent No.1, as the Complainant submitted his claim after 90 days, as per terms and conditions, same shall submitted within 70 days, and therefore, they have not entertained the claim and as such, closed the claim as “No Claim”. On the contrary, the Complainant has submitted the documents police papers, Panchanama, Mediclaim policy, Insurance Coverage Certificate, Ration Card, Election Card of the Complainant and copy of the Pass Book. The insurance policy was admitted, however, only after the limit of 10-20 days, the claim was filed it was rejected or repudiated for that reason the Insurance Company can not repudiated the claim. Considering the facts and circumstances of the claim, and as the Insurance Policy admitted by the Opponent, we found that there is a deficiency in service and unfair trade practice on the part of the Opponent No. 1 and we have also found that there is no case as against the Opponent No. 2.
(6) With the aforesaid discussion and observations, we proceed to pass the following order :
// O R D E R //
(i) The complaint is partly allowed.
(ii) The Opponent No. 1 shall pay Rs. 1,00,000/- (Rs. One Lacs. Only) @ 9% p.a. from date of filing of the complaint i.e. from 30/08/2013 till its realization to the Complainant.
(iii) The Opponent No. 1 shall also pay Rs. 2,000/- towards cost of the proceedings and Rs. 5,000/- for mental agony to the Complainant.
(iv) The Opponent No. 1 to comply the aforesaid order within a period of (30) days from the date of receipt of this order.
(v) No order as against the Opponent No.2.
(vi) Certified copy of this order be supplied to both the parties free of
costs.
sd/-xxx sd/-xxx
(Shri. S.R. Sanap) (Shri.G.K. Rathod)
Hon’ble Member Hon’ble President
Note:- As the pleadings, affidavit, documents of the parties are in English, the order in the proceeding is passed for the better knowledge of the parties in English.
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