ICICI LOMBARD GENERAL INSURANCE CO LTD vs SINDHUBHAI KHANDERAO KHAIRNAR

THIS appeal filed by I. C. I. C. I. Lombard General Insurance Co. Ltd. /org. opposite party in Consumer Complaint No. 125/2006 is directed against the order dated 29. 12. 2006 passed by District Forum, Nashik, whereby the Forum below directed the Insurance Company to pay the sum assured to the org. complainant. Insurance Company has taken exception to this order and has come up in appeal.

THERE is delay of 192 days in filing the appeal. Therefore, appellant has filed an application for condonation of delay. In para 3 of the application, it is stated that the certified copy is received on 29. 12. 2006. However, it was not traceable or lost. There is inordinate delay in filing the appeal. Inordinate delay of 192 days is not at all satisfactorily explained. We are, therefore, not inclined to condone the delay. Prayer for condonation of delay stands rejected. By way of abundant precaution, we examined the correctness of the order. The State of Maharashtra taking into consideration plight of poor Agriculturists introduced an insurance scheme. This scheme is known as "agriculturist Accident Insurance Policy" (Shetkari Apghat Vima Yojana) in 2005. As per the said scheme, the claim was to be submitted to Tahsildar in case of accidental death of an Agriculturist. Village Revenue Officer was also involved in the said scheme. The Tahsildar is to verify as to whether particular person is eligible for grant of insurance amount. After receipt of particulars from the Village Revenue Officer, Tahsildar is to submit the claim directly to ICICI Lombard General Insurance Co. Ltd. , Mumbai. The Government prescribed the procedure for verification and submission of claim form to the Insurance Company. In case of disability, the agriculturist was required to produce certificate of Doctor from Primary Health Centre/civil Surgeon. Timelimit is also prescribed for submission of the said claim. The beneficiary was required to open an account in District Central Co-operative Bank. Tahsildar is to communicate the particulars of the bank account of the beneficiary to the Insurance Company. Insurance Company is supposed to credit the amount strictly in the bank account of the beneficiary.

Mr. Khanderao Krishna Khairnar was insured under the "agriculturist Accident Insurance Policy" (Shetkari Apghat Vima Yojana ). He met with an accident on 4. 6. 2005. He was admitted in Civil Hospital, Nashik. He had head injury. Accident was reported to the Satara Police Station. Necessary information was transmitted to Tahsildar, Satara. After following the procedure, the claim was submitted to the Insurance Company. Insurance Company rejected the claim on the ground that the claim papers were submitted after 110 days instead of 60 days after the death. The Insurance Company rejected the claim on the following terms and conditions: "5. Policy related terms and conditions (i) Upon the happening of any event, which may give rise to a claim under the policy written notice with full particulars must be given to the company immediately. In case of death, written notice must be given before internment, cremation and in any case, within 60 days after the death, unless reasonable cause is shown. In the event of loss of sight or amputation of limbs, written notice thereof must be given within one month after loss of sight or amputation. "

WIDOW, Smt. Sindhubai Khanderao Khairnar filed consumer complaint in the District Consumer Forum, Nashik. The said claim was resisted by the Insurance Company on the ground that requisite papers for consideration of the claim were not submitted within stipulated time. The Forum below has observed in the body of the order that except driving license all the required papers/documents were submitted to the Insurance Company. The Forum below has observed that the rejection of claim was unreasonable and consequently directed the Insurance Company to pay the sum assured to the widow of the deceased. The Insurance Company has taken exception to this order and has come up in appeal. The deceased Mr. Khanderao Krishna Khairnar was an agriculturist and was beneficiary of "agriculturist Personal Accident Insurance Policy". The Village Revenue Officer after verification of revenue record certified that deceased owned and possessed landed property. The 7/12 extract and Khata extract were also annexed to the certificate issued by Village Revenue Officer. All the documents were sent to Tahsildar, Satara. Tahsildar submitted the claim to the Insurance Company. The name of widow was shown as recipient of the insurance amount. As per the scheme declared by the Government following conditions are imposed for getting benefits of the insurance scheme: 1. Age of an agriculturist must be between 15 and 70 years. 2. An agriculturist must hold agricultural land. 3. The Village Revenue Officer must certify the heirs. 4. For purpose of verification of age of an agriculturist, school leaving certificate, ration card, election identity card, certificate of school heard master or certificate issued by Grampanchayat are required.

As per the scheme, accidents are classified as under: 1. Accident occurred on the road. 2. Accident occurred on railway track. 3. Accident in the well and river. 4. Accident occurred on account of electric shock. 5. Murder. 6. Fall from height. 7. Death by snake bite. 8. Murder by naxalite. 9. Death by animal bite. 10. Riot and any other accident.

HAVING regard to the conditions laid down by the State of Maharashtra, deceased Mr. Khanderao Krishna Khairnar fulfilled all the conditions. He was an agriculturist. He held agriculture land in the State of Maharashtra. His name is recorded in the revenue record. His name is also shown in the 7/12 extract and Khata extract. He was 60 years of age at the time of death. The copy of recital of the FIR would clearly go to show that he died in an accident. The post-mortem report would clearly go to show that he died because of head injury. The copy of FIR, the inquest Panchanama, mutation extract, copy of the ration card, 7/12 extract, Khata extract and nomination form of widow for the claim are placed on record to show that required procedure was completed substantially. The Insurance Company insisted for driving licence. In fact, driving licence is not necessary. From the perusal of the FIR, it is revealed that one Hundai car gave dash to the motor cycle from behind, which was being driven by the deceased. In the said accident Mr. Khanderao Krishna Khairnar sustained serious head injury and ultimately succumbed to the head injury in Civil Hospital on 7. 6. 2005. He was not at the fault. He did not attribute for the commission of an accident. Therefore, driving licence is not at all necessary to settle the insurance claim. In case of an accident on the road, information report, spot Pachanama, inquiry report and post-mortem report are required as per the scheme. In fact, these documents were submitted to the Insurance Company. There is nothing on record to show that the deceased was under influence of any intoxication. Mr. Khanderao Krishna Khairnar died because of head injury sustained in the road accident. Therefore, as per the scheme, widow of the deceased was one of the complainants. Widow stands at serial No. 1 in the list of claimants. The widow was nominated to receive insurance amount in the nomination form. Insurance Company rejected the claim on the hypertechnical ground. The widow cannot be blamed for belated submission of claim. As per the procedure laid down by the Government of Maharashtra, Village Revenue Officer and Tahsildar are mainly responsible for submission of claim to the Insurance Company. Immediately after the accidental death necessary information was given to the Village Revenue Officer. Therefore, the time should commence to run from the date of intimation of accidental death to the Village Revenue Officer. Moreover, the clause with regard to timelimit prescribed for the submission of the claim is not mandatory. In case of serious accident if death occurs of bread winner of the family and if, immediate financial assistance is not received in time, the entire family comes on the street. Therefore, time limit for submission of the claim is prescribed. Provision with regard to time limit made in this behalf cannot be used to defeat the genuine claim. In this particular case, claim submitted by the Tahsildar was very much genuine. The Insurance Company should have acted promptly and should have credited the insurance amount in the bank account of the widow. The Government declares various benevolent schemes for agriculturists and person coming from lower strata of society. For effective implementation of the claim, Government prescribed simple procedure. Taking into consideration the illiteracy in the rural areas, the liability is imposed on the Village Revenue Officer and Tahsildar for purpose of collection of necessary documents and submission of the claim to the Insurance Company. The success of benevolent scheme depends as to how and in what manner such schems are implemented. Unfortunately, because of lukewarm and obstructive attitude of Insurance Company, genuine and honest claim of widow is defeated for no fault of her. The Insurance Company cannot hike its profit by rejecting genuine and honest insurance claim. After having scanned the entire material placed on record and after having considered the circumstances of the case, we are of the clear opinion that the impugned order passed by the Forum below is perfectly legal and correct. Appeal filed by the Insurance Company is devoid of any merits. In the result, we pass following order: ORDER 1. Appeal stands dismissed with cost of Rs. 5,000. 2. M. A. No. 1350/2007 stands disposed of. 3. Pronounced and dictated in open Court. 4. Copies of the order herein be furnished to the parties.

Appeal dismissed.