Order no. 19         dated 27/01/2009

In this consumer complaint the complainant is the widow of the deceased insured person who died on 20.9.04 and prays for a direction to be given upon the o.ps. to settle the legitimate insurance claim of Rs.1,0,000/- along with entrust and compensation of Rs.2000/- for the harassment and mental agony.

The husband since deceased, Birendra Shaw of the present complainant, Smt. Manju Shaw took a Group Janata Personal Accident Insurance Policy no.100300/47/01/9600022/02/96/30352 cover8ing the period from 15.1.03 to 14.1.18 for a capital sum insured of Rs.1,00,000/- from o.p. no.1 through o.p. no.3. And sometime in the month of September 2004, B8irendra Shaw, since deceased met with an accident and he died on 20.9.04 leaving behind his wife, Smt. Manju Shaw, the present complainant, as the nominee of the insurance claim which is evident from the annexure-I of written objection filed by o.p. no.3.

Since the complainant is simple house wife belonging to a typical Indian village, became very much helpless and was busy to manage her family specially regarding the financial problems. Moreover, she was totally in the dark about her husband’s insurance policy. And when she faced an acute financial problem and sought for the advices of her deceased husband’s colleagues and started taking the help of the neighbours, she came to know about this insurance policy question taken by her  husband. By that time, it got delayed and ultimately she could file the claim on 12.1.06 as it is stated in the paragraph no.5 of complaint. Denying the interalia material fact o.p. no.1 has stated that it was filed on 6.3.06 in the w/v filed on 3.3.08. and o.p. no.1 repudiated the claim on the ground of delay. No repudiation letter has been filed by any of he parties. But o.p. no.1 in this w/v has acknowledged that they have repudiated the claim for delay in providing intimation to o.p. no.1 as it falls under the policy condition scheduled as 5.3 and 5.4. Hence they are not deficient in service. O.p. no.3 has argued in their w/v as well as in the affidavit of evidence that they are only the facilitator of the said insurance policy as they have annexed the MOU and a subsequent letter dt.17.7.01 as annexure-II within w/o and affidavit on evidence. And every right is reserved by the o.p. no.1 in respect of the settlement of the claim. And they have prayed that they should not be held responsible.

On hearing the arguments of both the parties, we are of the candid opinion that the present complainant being a poor village lady, the delay in filing he claim to the o.ps. should not be a ground for repudiation. And there are ample examples of  judgments passed by Hon’ble State Commission and Hon’ble National Commission in this respect. And from the w/v filed by the o.p. no.1, we came to know that o.p. no.1 has repudiated the claim. And when o.p. no.1 has repudiated the claim that means they have admitted the claim. And u/s 58 of Indian Evidence Act, the admitted fact need not be proved. And denial must not be evasive but it must be specific. And o.p. no.3 also filed the policy document wherefrom it is evident that the deceased husband of the complainant was a member of the group insurance accident policy in question. Hence, the complaint filed by the complainant succeeds. Fee paid is cored.

Hence,

            Ordered,

O.p. no.1 is directed to pay the insured amount of Rs.1,00,000/- (Rupees one lakh) only to the wife of the deceased insured person, Smt. Manju Shaw, the complainant and Rs.2000/- (Rupees two thousand) only as compensation and Rs.500/- (Rupees five hundred) only as litigation cost within one month from the date of delivery of this judgment, in default, it will carry an interest @ 10% p.a. till the full recovery of the decretal amount.

Let copy of this order be supplied to the parties free of cost.