Exh. 15
BEFORE THE DISTRICT CONSUMER DISPUTES REDFESSAL FORUM, SANGLI
Hon’ble President – Mr.A.V. Deshpande
Hon’ble Member - Mr. K.D. Kubal
CONSUMER COMPLAINT NO. 266/2011
Date of Filing : 19/09/2011
Date of Admission : 18/10/2011
Date of Judgment : 01/04/2013
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Smt.Sulbha Nemgonda Patil
Age 30 years, Occup.- Agriculturist & Housework
R/o Vasagade, Tal.Palus, Dist.Sangli ……. COMPLAINANT
Versus
1. The Oriental Insurance Co.Ltd.,
Division Office No.2, 8, Hindusthan Colony,
Nr.Ajani Chowk, Wardha Road, Nagpur – 440 015
Through Manager, Shri.Arunabh Bardhan
Sr.Regional Manager, Sangli
2. Kabal Insurance Services Pvt.Ltd.,
101, Shivaji Nagar, 3r Floor,
Nr.Mangala Theatre, Pune – 411 005.
Through Manager, Smt.Sucheta Pradhan,
3. Dist.Agriculture Suptd.,
Office of Dist.Agriculture Suptd.,
Miraj Road, Sangli. ……. OPPPONENT
Advocate on behalf of complainant – Mr.M.N.Shetye
Advocate on behalf of Opponent No.1 - Mr. A.B.Khemlapure
Opponent No.2 & 3 - Ex-parte
J U D G M E N T
Delivered by Hon’ble Mr. A.V. Deshpande, President
1. This is the complaint filed u/s 12 of the Consumer Protection Act alleging the deficiency in service on the part of the Respondents and claiming the amount of Rs.1,00,000/- on account of compensation for the accidental death of the deceased farmer by name Nemgonda Adgonda Patil; along with the interest thereon @ 18% p.a. from the date of the accident till realization and further amount of Rs.50,000/- being the damages for unlawful repudiation of the claim, Rs.40,000/- on account of physical and mental torture, and Rs.3,000/- being the cost of the litigation.
2. This claim is filed by the widow of the deceased Nemgonda Adgonda Patil, under the scheme of the Farmers Package Policy of the agriculturist in the State of Maharashtra, floated by the State Government.
3. Shortly stated the case of the Complainant is that the deceased was having a field Gat No.707 admeasuring 0 H. 17 R.at Mauje Vasagade, Tal.Palus, Dist.Sangli. On 30/10/2009 he was as a pillion on a motor cycle riding towards village Vasagade. At about 12 noon, in the area of village Nandre, the said motor cycle dashed against Tonga. In that accident the deceased sustained serious injuries and he died on 06/11/2009 as a result of thos injuries.
4. Being the widow of the deceased the Complainant informed the Talathi of Mauje Vasagade about the accidental death of deceased; somewhere in the month of December, 2009. On 17/01/2011, the claim proposal was submitted to the Agricultural Officer of Palus. The District Agricultural Superintendant, forwarded the said claim proposal to the Respondent No.2 along with the necessary recommendations and all the necessary papers. Ultimately the said claim proposal was forwarded to Respondent No.1 Insurance Company by the Opponent No.2. Opponent No.1, Insurance Company has repudiated the said claim by its letter dated 04/07/2011, on false grounds. Cause of action for this complaint, as stated; has arisen on 06/11/2009 when the deceased Nemgonda Adgonda Patil died. The cause of action arose again when the Complainant had informed the Talathi in the month of December, 2009 about the accident. It further arose on 17/01/2011 when the claim proposal was submitted to the Agricultural Superintendant, Palus and thereafter when the claim was forwarded to Opponent No.1 and ultimately on 04/07/2011 when the said claim was repudiated on false grounds. On such contentions the complainant prays for the reliefs as stated above.
5. The Respondent No.1 Insurance Company has filed its written statement at Exh.12 and has denied entire allegations against it. All the adverse allegations leveled by the Complainant are specifically denied. It is denied that it has wrongfully repudiated the claim of the Complainant and committed any deficiency in service as alleged. The main contention of the Opponent No.1 is that the Complainant has belatedly submitted the claim proposal after a period of more than two years. It was incumbent on the Complainant to claim the benefit of compensation during the currency of the said policy i.e.till the policy was effective. It is denied that the claim was wrongfully repudiated.
6. Other Respondents have not appeared and have not filed their written statement.
7. The Complainant has filed her affidavit in support of her contentions at Exh.2 and has filed 8 documents along with list of documents at Exh.4. The Respondent No.1 Insurance Company has not filed any document.
8. The Complainant and the Respondent No.1 both have filed their written notes of arguments at Exh.13 & 14 respectively and we have also heard their oral arguments.
9. The points those arise for our determination are as follows.
Points Findings
1) Whether the complainant has proved a deficiency
in service on the part of the Respondent No.1 as alleged ? No.
2) What order ? As per final order.
The reasons for our findings above are as follows.
REASONS
Point No.1
10. From the defence taken by the Respondent No.1 Insurance Company it is clear that it is not disputing almost all the facts in this case. It has repudiated the claim of the Complainant namely on the ground of the delay in submitting the claim proposal. The letter; vide which the Respondent No.1 has repudiated the claim; is filed by the Complainant herself along with list at Exh.4 at Serial No.8. The said letter is dated 04/07/2011. It is a letter addressed by the Respondent No.1 Insurance Company to the Respondent No.2, Kabal Insurance Services Pvt.Ltd., who was appointed as an Insurance Advisor; by virtue of tri-party agreement between the Respondents No.1,2 & 3. In the said letter the Respondent No.1 Insurance Company has informed the broker that in the instant case claim is submitted to Taluka Agricultural Officer on 03/03/2011 and by the said claim the compensation for the accidental death of an agriculturist by name Nemgonda Adgonda Patil , dated 30/10/2009 was claimed. In the said letter the Insurance Company has mentioned that such claims have to be submitted within the period of 90 days prior to the closer of the said insurance scheme, which came to an end on 14/08/2010. The Insurance Company has informed the Respondent No.2 that Respondent No.2 is expected to scrutinize all the claims and ensure that those claims comply with the terms and conditions of the said insurance policy. The Insurance Company has very categorically mentioned there in; that the claim submitted to it was submitted after 90 days from the closer of the said scheme on 14/10/2010 and therefore, the said claim is not admissible and hence it is repudiated. There are no disputes with regard to the terms and conditions of the said Farmers Package Policy. The said insurance policy commenced from 15/08/2009 and it came to an end on 14/08/2010. The accident had taken place on 30/10/2009 and the death of the said farmer appears to have taken place on 06/11/2009. Still the claim appears to have been submitted on 03/03/2011 by the Complainant which is much after the said Farmers Package Policy was over. The Complainant herself has pleaded in her complaint that she had informed Talathi of said village about the accident somewhere around month of December, 2009 and on 17/01/2011 she had submitted the claim to the Taluka Agricultural Officer. The day on which this claim was submitted to Taluka Agricultural Officer, the said scheme of Farmers Package Policy was already over. Therefore, there was neither the insurance policy existing nor the Complainant had followed the time limits for submitting the claim. On this background the Insurance Company was well justified in repudiating the claim. There is absolutely no evidence; except an interested word of the Complainant that she had informed the Talathi of her village about the accident somewhere in the month of December, 2009. No independent evidence is laid by the the Complainant to prove this fact. Thus, when the initial submission of claim proposal was after the expiry of the scheme, it cannot be said that the Insurance Company has committed any deficiency in service in repudiating the claim. Therefore, we hold accordingly and hence we have answered the Point No.1 in negative.
Point No.1
11. The moment it is held that the Insurance Company has not committed any deficiency in service in repudiating the claim of the Complainant, it follows that the Complainant is not entitled to any of her claim made in this complaint. Her complaint will have to be dismissed. Knowing that there is an unsubstantiated delay in submitting the claim proposal, that too after the expiry of the said Farmers Package Policy, which come to an end on 14/08/2010, the Complainant filed claim proposal and this must be simply with a view to extract some money taking disadvantage of the accidental death of her husband and therefore, certain pinch by way of cost has to be saddled on the Complainant. Therefore, we are of the view that the following order would meet the ends of justice.
O R D E R
1. The complaint is dismissed with the cost.
2. The Complainant should pay the cost of Rs.500/- to the Respondent No.1 within 45 days from the date of this order.
SANGLI
Dated : 01/04/2013
( K.D. Kubal ) ( A.V. Deshpande )
Member President
