RAMAYANVATI vs Oriental Insurance Co. Ltd.

-THIS appeal under Section 15 of the Consumer Protection Act, 1986, is directed against the order dated 30.10.2006 in Complaint No. 20/2005 by District Consumer Disputes Redressal Forum, Korea, Baikunthpur (hereinafter called "District Forum" for short), dismissing the appellant''s complaint.

THE averments in the complaint stated in brief are that : the husband of the complainant Hiralal @ Rekha Singh was an employee of respondent No. 2, South Eastern Coal Fields Limited (hereinafter called ''SECL'' for short). It was further averred that respondent No. 1, insurer, the Oriental Insurance Company Ltd., had covered the risk of the employees of the S.E.C.L. in the event of accidental death under the Group Janta Personal Accidental Policy (hereinafter called ''Janta Policy'' for short) No. 47/00257/2000. THE husband of the complainant Hiralal @ Rekha Singh was also one of the insured member, under the said policy. It was averred that assured amount of Rs. 5,00,000 was payable in the event of accidental death of the insured member. It was further averred that premium was deducted in two instalments, from the salary of the complainant''s husband insured Hiralal @ Rekha Singh. Further averments of the complaint were that on 8.9.2001 her husband died in a road accident. The complainant also averred that she is a villager and illiterate woman, she did not know about the Janta Policy and coverage of risk of her husband thereunder; therefore, she could not prefer her claim earlier. When the complainant came to know about the policy as above she preferred the claim and submitted claim form with the respondent No. 1 - insurer on 29.9.2004. The complainant''s claim as above was repudiated by the respondent No. 1-insurer by its letter dated 6.10.2004, on the ground that the complainant preferred the claim after three years of her husband''s death, while as the terms of the policy were that the claim should have been preferred within 15 days after the occurrence. Aggrieved by the repudiation as above, the complainant approached the District Forum and filed the complaint.

Respondent No. 1-insurer resisted the complaint. It was averred that as per the terms of the policy, intimation about the occurrence of death of the complainant''s husband should have been given to the insurer within 15 days but this having not been done, therefore, there was a breach of the terms of the policy, as a result of which complainant is not entitled to get the claim. It was further averred that the complainant is not the nominee under the policy. It was averred that one Sonkunwar is the nominee under the policy. Hence, the complainant is not entitled to receive the assured amount under the policy. It was further averred that policy was cancelled by the respondent No. 1/insurer. It was further averred that complaint was barred by time.

THE District Forum in the impugned order held that the complainant was not the nominee under the policy and as she intimated the insurer about the death of her husband much belatedly i.e., after 3 years. Hence, she was not entitled to get the claim under the policy. THErefore, repudiation of her claim by the respondent No. 1 - insurer does not amount to deficiency in service. Accordingly, the complaint was dismissed. We have heard the learned Counsel for the parties and perused the record.

INDISPUTABLY, Hiralal @ Rekha Singh was an employee of the respondent No. 2/S.E.C.L. It further appears from the documents placed on record that the deceased Hiralal @ Rekha Singh died in a road accident. The intimation thereof was given by the complainant on 29.9.2004 to the respondent No. 1-insurer. In the above context, post mortem Report and other material placed on record would go to show that name of the deceased was Hiralal @ Rekha Singh. The name as above of the deceased was also mentioned in the Panchnama of the dead body. The said documents, therefore, clearly indicate that the name of the deceased was Hiralal @ Rekha Singh. Therefore, there appears to be no doubt that complainant''s husband Hiralal @ Rekha Singh died in road accident as would be clear from the documents filed on record. The claim of the complainant was repudiated by the respondent No. 1 - insurer by their letter dated 2.11.2004, in which respondent No. 1- insurer has referred to their earlier letter dated 6.10.2004. It was stated in the repudiation letter dated 2.11.2004 that explanation and reply was called for by their letter dated 6.10.2004, but have not been received. It was further stated in the said letter that if the complainant fails to reply to the letter dated 2.11.2004 within 7 days, her claim would be closed. In the said letter dated 6.10.2004, referred in the letter dated 2.11.2004, it was stated that the claim form has been received from the complainant on 29.9.2004 but matter should have been reported within 15 days of occurrence while it was so done after 3 years, and the documents also are not complete. It may be noticed that in the said letter dated 6.10.2004, no details have been mentioned as to what documents are incomplete and what further particulars or documents are to be provided. The respondent No. 1 should have specifically stated as to what further information was required to be furnished by the complainant. Further, it may be noted that by their letter dated 6.10.2004, the claim of the complainant was repudiated. It is rather strange as to how after repudiation of the claim by letter dated 6.10.2004, another letter dated 2.11.2004 was addressed to the complainant? In any case, it appears that by letter dated 6.10.2004, repudiation was on the ground that the complainant informed to the respondent No. 1-insurer about the death of the insured belatedly after 3 years of the occurrence.

IN the above context, the complainant has averred that she is an illiterate tribal woman and never knew about the existence of the policy and had not received any information about it. She preferred the claim with the respondent No. 1 through employer respondent No. 2-SECL. There appears to be no reason to disbelieve the averments of the complainant, as above. IN fact, it appears that the respondent No. 1 insurer had collectively insured the employees of the respondent No. 2/S.E.C.L., it does not appear that the complainant''s husband was ever issued an individual policy, as no such policy has been produced by the respondent No. 1-insurer. Moreover respondent No. 2/S.E.C.L. also does not state that any such policy was ever issued in the name of the complainant''s husband or other employees.

THEREFORE, it appears in the above circumstances that the complainant was unaware of the existence of the policy and thus she made no delay in preferring the claim, as soon as she came to know about the existence of the policy. Moreover, it may be mentioned in the above context that there appears to be no reason as to why the complainant would not have preferred the claim earlier, had she known about the existence of the policy. In fact, it appears that it was the duty and obligation of the employers to have taken steps to intimate the complainant about the policy, and the employer should also have taken steps with respondent No. 1 - insurer, for payment under the policy after the death of their employee Hiralal @ Rekha Singh. The repudiation as above was solely based on the ground of delay in intimation by the complainant. However, it appears that the complainant preferred the complaint without undue delay. The delay in preferring the claim would not have the effect of rejection of the complaint in the forgoing circumstances. Therefore, repudiation cannot be held to be justified.

Learned Counsel for the respondent No. 1 - insurer also tried to raise as plea that the complainant, in fact, is not the nominee under the policy. It is stated that the mother of the deceased Sonkunwar was the nominee. However, the learned Counsel for the complainant/appellant submitted that Sonkunwar, the mother of the complainant''s husband already expired. Moreover, there appears to be no material on record to show that complainant/appellant is not the wife of the deceased insured Hiralal @ Rekha Singh and she is thus legal representative of the insured Hiralal @ Rekha Singh. The complainant, therefore, is entitled to get the benefit under the policy, even if, it is assumed that she was not the nominee under the policy.

THE District Forum erred in dismissing the complaint ignoring above vital aspects involved in the case. Accordingly, this appeal against the dismissal of the complainant/appellant''s complaint deserves to be accepted. Accordingly, this appeal is allowed. The impugned order is set aside. It is directed that the respondent No. 1-insurer shall pay to the complainant/appellant a sum of Rs. 5,00,000 (Rupees five lakh) with interest @ 9% p.a. thereon payable from 6.10.2004. The respondent No. 1-insurer shall also pay to the complainant/appellant cost of this litigation which includes that of complaint as well as of this appeal, which is quantified at Rs. 5,000 (Rupees five thousand) only. Appeal allowed.