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Santosh Umakant Jawadkar Vs. Golden Multi Services Club Ltd. and Others - Court Judgment

LegalCrystal Citation
CourtMaharashtra State Consumer Disputes Redressal Commission SCDRC Aurangabad
Decided On
Case NumberFirst Appeal No. 669 of 2009 In Complaint Case No. 403 of 2008
Judge
AppellantSantosh Umakant Jawadkar
RespondentGolden Multi Services Club Ltd. and Others
Excerpt:
.....received all the required documents with the claim form. but with view to avoid settlement of the claim insurance company repudiated the claim on the flimsy ground that non-receipt of the required document. at the most insurance company would have asked the appellant to supply all the documents but instead of that they straight way repudiated the claim of the appellant. this itself is deficiency in service. district consumer forum also ignored the said fact while dismissing the complaint. it is further submitted by adv.ladda that condition regarding submission of claim form within stipulated period is directory one and not mandatory. therefore repudiation of claim on only ground of limitation is not at all proper and legal. hence appeal be allowed. 8. adv.s.v.kulkarni for respondent.....
Judgment:

Uma S. Bora, Member:

1. Shri.Santosh Umakant Jawadwar resident of Nanded appellant herein/org.complainant challenges in this appeal dismissal of complaint case No.403/2008 on 22.7.2009 by District Consumer Forum, Nanded.

2. Facts giving rise to this appeal are that:-

Complainant had obtained group personal accident policy in the name of his wife Kalpana bearing No.100300/47/01/9600022/03/96/30263 from respondent No.1 Golden Multi Services Club Ltd. of respondent No.2 National Insurance Company Ltd. Said policy was for the period 1.11.2003 to 31.10.2018. Sum insured under the said policy was Rs.5 lakhs. Life assured was wife of complainant. On 20.2.2005 policy holder Kalpana died accidental death in her residential house due to burning. Accordingly Cr.No.65/2005 was registered at Police Station, Bhagyanagar, Nanded on 31.2.2005. Session case bearing No.147/05 was filed against complainant on the ground that he had illicit relation with one lady, therefore deceased Kalpana might have committed suicide and complainant is liable for abatement of suicide. On 7.4.2006 said session case was decided and complainant was acquitted in absence of any evidence. Therefore complainant preferred the claim with the insurance company with all required documents on 4.5.2006. Opponent No.1 Golden Multi Services after investigating matter and after scrutinizing papers forwarded all the documents to insurance company i.e. respondent No.2 on 20.6.2006. On 4.7.2008 complainant received repudiation letter from insurance company. According to said letter complainant preferred the claim after seven months of the accident and required documents were also not supplied by the complainant such as police report and judgment of the session court. Therefore complainant approached to Forum and claimed Rs.5 lakhs as policy amount with 18% interest from 20.6.2006, Rs.10,000/- for mental agony and Rs.5000/- for cost of the complaint.

3. Opponent No.1 appeared before the Forum and resisted the complaint on the ground that they are only commission agency. They are collecting premium and forwarding the same to the insurance company. Accordingly all the documents which were received by them were forwarded to the insurance company. Therefore they are not liable for any deficiency in service.

4. Opponent No.2 and 3 i.e. National Insurance Company Ltd. appeared before the Forum and resisted the complaint on the ground that accidental death of Kalpana had occurred on 20.2.2005. Thereafter the claim was preferred after 7 months of the incident. Therefore the claim was rightly repudiated on the ground of limitation. As per terms and conditions of the policy claim ought to have been preferred within 90 days after incident/death. As claim was preferred after 7 months of accidental death of Kalpana, claim was rightly repudiated. Hence insurance company is not at all liable to pay insurance amount.

5. After hearing both parties District Consumer Forum dismissed the complaint on the ground that complainant preferred the claim after the period of limitation.

6. Dissatisfied with the said judgment and order original complainant came in appeal.

7. Adv.D.S.Ladda appeared for appellant, Adv.Shri.S.V.Kulkarni appeared for respondent No.2 and 3. None appeared for respondent No.1. Hence appeal proceeded exparte against respondent No.1. It is submitted by Adv.Ladda that deceased Kalpana i.e. wife of appellant who was policy holder died accidental death on 20.2.2005. Immediately criminal case was registered with Bhagyanagar Police Station, Nanded. As criminal case was filed against appellant U/s 306 r/w 34 of IPC he was required to face trial. Therefore he could not prefer the claim in time. On 7.4.2006 said case was decided by Session Court and appellant was acquitted from the charges. Therefore in the month of May 2006 appellant immediately preferred the claim with respondent No.1 Golden Multi Services with all required documents such as; i) Charge sheet ii) Certified copy of judgment, iii) Post-mortem report etc. Respondent No.1 after verifying all the documents and investigating in the matter forwarded the claim form and papers to the National Insurance Company on 20.06.2006 and also requested insurance company to settle the claim. It is submitted by Adv.Ladda that it can be seen that insurance company had received all the required documents with the claim form. But with view to avoid settlement of the claim insurance company repudiated the claim on the flimsy ground that non-receipt of the required document. At the most insurance company would have asked the appellant to supply all the documents but instead of that they straight way repudiated the claim of the appellant. This itself is deficiency in service. District Consumer Forum also ignored the said fact while dismissing the complaint. It is further submitted by Adv.Ladda that condition regarding submission of claim form within stipulated period is directory one and not mandatory. Therefore repudiation of claim on only ground of limitation is not at all proper and legal. Hence appeal be allowed.

8. Adv.S.V.Kulkarni for respondent No.2 and 3 submitted that accidental death of wife of appellant was doubtful and therefore criminal case was filed against the appellant. As criminal case was filed against appellant only who claimed the policy amount. It seems that there is ill intention behind the said incident. Therefore he is not entitle to claim compensation . It is further submitted by Adv.S.V.Kulkarni that complainant did not submit all the required documents such as police report and report regarding confirmation of death as accidental. Therefore his claim was rightly repudiated. In support of his contention he relied on "L.I.C. of India -Vs- N Shankar Reddy" reported in 2013(4) CPR 563(NC). It is held by National Commission that to prove death by accident either police report or hospital records confirming death as accidental were to be produced. Accidental death has not been proved to the satisfactory of the insurer.

9. We thus heard both the counsel and perused the record. it is admitted fact that complainant had obtained group personal accidental policy in respect of his wife Kalpana. It is admitted fact that said Kalapana died accidental death due to burning in her house. It is seen from the record that session case No.147/05 was filed against present appellant. He acquitted in the said case on 7.4.2006. Therefore after getting acquittal he preferred the claim with insurance company. As he was facing trial he could not preferred the claim within limitation. While preferring claim appellant submitted all the required documents i.e. post-mortem report, charge sheet and certified copy of judgment of Session Court. Respondent No.1 after scrutinizing all the papers forwarded the same with insurance company. Therefore stand of insurance company that all the required documents were not supplied, cannot be sustained. Respondent insurance company repudiated the claim on the ground of limitation also. In our view delay of 7 months is not abnormal or inordinate. As appellant was facing trial he could not prefer the claim. Appellant preferred the claim with all required documents and it is admitted position that wife of appellant Kalpana died due to accidental death. In our view therefore appellant is entitle to the sum assured. District Consumer Forum did not consider the fact and evidence in proper perspective and dismissed the complaint. Order passed by Forum is required to be quashed and set aside. Hence we pass the following order.

ORDER

1. Appeal is allowed.

2. The impugned judgment and order passed by District Consumer Forum is hereby quashed and set aside.

3. Respondent No.2 and 3 are directed to pay Rs.5 lakhs with interest @ 6% p.a. from the date of repudiation i.e. 4.7.2008 till realisation of the amount.

4. No order as to cost.

5. Copies of the judgment be supplied to both the parties.


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