ORDER

PER SH. RAKESH KAPOOR, PRESIDENT

The husband of the complainant had taken a rural accident package
policy from the OP which was valid for the period 20.7.2008 to
19.7.2013. It is alleged that the husband of the complainant had met
with an accident on 15-9-2011 and had expired due to the injuries
received in the same. The complainant had lodged a claim with the OP
which was repudiated on the ground that the claim was filed beyond the
period of one month. It is claimed by the complainant that the
repudiation of the claim was uncalled for and amounts to deficiency in
service on the part of the OP.

The OP has contested the complaint and has filed a written statement.
It has denied any deficiency in service and has claimed that the
complaint is false and is liable to be dismissed. The OP has admitted
that the husband of the complainant had purchased a rural accident
package policy which was effective for the period 20.7.2008 to
19.7.2013. It has not denied that he had died in an accident on
15.9.2011. It has however justified its action of the repudiation of
the claim on the ground that the complainant was guilty of violation
of terms and conditions of the policy of insurance.

We have heard arguments advanced at the bar and have perused the record.

It is admitted by the OP that the deceased husband of the complainant
had purchased a Rural Accident Package Policy which was effective for
the period 20.7.2008 to 19.7.2013. The op has not denied that the
insured had expired on 15.9.2011 after he had met with an accident. It
has admitted that the complainant had filed a claim with it under the
said policy. It has however claimed that the complainant was guilty of
violation of the terms of the policy as she was bound to give
information within one month but had given intimation after the lapse
of about 11 months. We have considered the grounds on which the claim
has been repudiated. IRDA has given instructions to the insurance
companies not to repudiate the claims merely the ground of delay in
intimation. The insurance company appears to have overlooked those
guidelines while repudiating the present claim. It should have
processed the claim regardless of the fact that the intimation about
the death was given to it at a late stage. We, therefore, hold that
the OP insurance company was guilty of deficiency in service towards
the complainant and direct it as under:-

Pay to the complainant a sum of Rs. 1,00,000/- along with interest @
10% p.a. from the date of institution of this complaint i.e. 15.3.2013
till payment.

Pay to the complainant a sum of Rs. 20,000/- as compensation for pain and agony.

Pay to the complainant a sum of Rs. 5,000/- as cost of litigation.



The OP shall pay this amount within a period of 30 days from the date
of this order failing which they shall be liable to pay interest on
the entire awarded amount @ 10% per annum. IF the OP fails to comply
with this order, the complainant may approach this Forum for execution
of the order under Section 25/27 of the Consumer Protection Act.

Copy of the order be made available to the parties as per rule.

File be consigned to record room.

Announced in open sitting of the Forum on.....................