Madhya Pradesh

StateCommission

A/09/2469

ICICI LOMBARD GIC - Complainant(s)

Versus

SMT SUGAR BAI - Opp.Party(s)

25 Oct 2018

ORDER

M. P. STATE  CONSUMER  DISPUTES  REDRESSAL  COMMISSION,

PLOT NO.76, ARERA HILLS, BHOPAL

 

                                      FIRST APPEAL NO. 2469 OF 2009

(Arising out of order dated 07.11.2009 passed in C. C. No. 17/2009 by District Forum, Vidisha)

 

ICICI LOMBARD GENERAL INSURANCE CO.LTD.

THROUGH ITS MANAGER,

PLOT NO.11, ALANKAR PALACE, NEAR PRAGATI PETROL PUMP,

M.P.NAGAR, ZONE-II, BHOPAL (M.P.)                                                                                         ….       APPELLANT.

 

Versus

 

1. SMT. SUGAN BAI,

    W/O SHRI PRAG SINGH,

    R/O VILLAGE-KHEJDA GOPAL,

    TEHSIL-SIRONJ, DISTRICT-VIDISHA (M.P.)

 

2. JILA SAHAKARI KENDRIYA BANK MARYADIT,

     VIDISHA, DISTRICT-VIDISHA.                                                                                                 ….       RESPONDENTS.   

                     

BEFORE :

            HON’BLE SHRI S. D. AGARWAL           :         PRESIDING MEMBER

            HON’BLE DR. (MRS) MONIKA MALIK   :          MEMBER

        

COUNSEL FOR PARTIES :

Shri Aditya Sharma, learned counsel for the appellant.

            Shri Indel Singh Sengar, learned counsel for the respondents.

                                                     O R D E R

                                       (Passed On 25.10.2018)

                   The following order of the Commission was delivered by Dr. (Mrs) Monika Malik, Member:

           

                   This appeal is by the opposite party/appellant, against the order dated 07.11.2009 passed by the District Consumer Disputes Redressal Forum, Vidisha in C.C.No. 17/2009, whereby the complaint filed against them has been allowed.

2.                Brief facts of the case are such that the complainant no.2’s/respondent no.1’s late husband Shri Prag Singh (hereinafter referred as ‘deceased’) was insured under the ‘Janta Personal Accident Insurance Policy’ obtained by the complainant no.1/respondent no.2 Jila Sahakari Kendriya Bank Maryadit, Vidisha (hereinafter referred as ‘bank’) for Kisan Credit Card Holders.  The insurance cover was provided by the opposite party/appellant the ICICI Lombard General Insurance Company (hereinafter referred as ‘insurance company’), which was effective for the period from 24.02.2006 to 23.02.2007.  During this period if the credit card holder dies in an accident, the insurance company is liable to pay pay Rs.50,000/- to his nominee. On 21.09.2006, Shri Prag Singh died in an accident regarding which a

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claim was lodged with the insurance company.  The bank forwarded the duly filled claim form of the deceased to the insurance company on 22.06.2007 accompanied with post-mortem report, death certificate, Kisan Credit Card, Ration Card along with reference of loan accounts.  The insurance company did not decide the claim.  Aggrieved complainant no.2/respondent no.1 (hereinafter referred to as ‘complainant’) filed complaint alleging deficiency in service on part of the insurance company before the District Forum.

3.                The opposite party/insurance company resisted the complaint on the ground that the complaint is filed after period of two years of occurrence of death of the credit card holder and is therefore barred by limitation.  The complaint is thus not maintainable. Further, it has not been proved that there was accidental death of the insured. It is further stated that as per policy terms and conditions, claim form along with requisite documents was required to be submitted within 14 days of occurrence of the event.  The opposite party insurance company prayed for dismissal of complaint.

4.                The District Forum after considering the evidence on record partly allowed the complaint and ordered the insurance company to give Rs.50,000/- (sum assured) to the complainant i.e. nominee of deceased Shri Prag Singh.  Compensation of Rs.2,000/-, with Rs.500/- as cost of litigation was also awarded to complainant.  Hence this appeal.  

5.                Heard learned counsels for the parties.  Perused the record.

6.                Learned counsel for complainant and the bank argued that Late Shri Prag Singh was insured under the policy no.4012/0000969 for a period from 24.02.2006 to 23.02.2007.  Under this policy, a sum assured of Rs.50,000/- was payable in case of accidental death of the Kisan Credit Card Holder.  The husband of the complainant died in an accident on 21.09.2006. Duly filled claim form along with requisite documents was sent by the bank to the insurance company on 22.06.2007.  Despite reminders on various dates, the complainant has not been

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given sum assured of Rs.50,000/-.  He argued that the learned Forum has passed the order after proper consideration of the facts and circumstances of the matter.

7.                Learned counsel for opposite party/appellant-insurance company argued that the bank had entered into an agreement to cover risk of Kisan Credit Card Holders who were beneficiaries under the policy no. 4012/0000969.  Neither claim was raised by the complainant nor is she entitled for compensation on account of inordinate delay in institution of the case. He further argued that the insurance cover in the instant matter was obtained by the bank and bank is ‘insured’ under the policy.  The insurance company had entered into contract with the bank and there is no contract directly between the beneficiary and the insurance company.  Further, the accident, as alleged to have been happened is not proved.  The claim arising out of the insurance cover was to be intimated through proper channel within a period of 14 days. He argued that the complaint filed is highly time barred and therefore, the District Forum has erred in allowing the same and passing the order against the appellant. Learned counsel referred to various judgments in cases of Haryana Urban Development Authority Vs B. K. Sood (2006) 1 SCC 164, Kerala Agro Machinery Corporation Ltd Vs Bijoy Kumar Roy (2002) 3 SCC 165, State Bank of India Vs M/S B. S. Agricultural Industries I JT (2009) (4) SC 191, Kandimalla Raghavaiah & Co. Vs National Insurance Co.Ltd. Civil Appeal No.4962 OF 2002 decided on July 10, 2009, Union of India & Another Vs British India Corporation Ltd. & Others (2003) 9 SCC 50 and Gannmani Anasuya & Ors Vs Parvatini Amarendra Chowdhary & Ors. (2207) 10 SCC 296.

8.                As we carefully peruse the documentary evidence on record, we observe that there is a letter dated 22.06.2007 from the bank, which was sent to the insurance company, regarding the claim of the deceased. The bank had sent another reminder to the opposite party/appellant-insurance company, wherein it is specified that the claim form of the deceased Prag Singh was sent vide letter no.1730 dated 22.06.2007.  There is a reference that duly filled claim form accompanied with

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application from nominee, post-mortem report, death certificate, Panchayat Pramaan Patra, Kisan Credit Card, Ration Card, Copy of loan account was sent to the opposite party/appellant-insurance company. An affidavit in this regard by Branch Manager is annexed in the record.  The opposite party/appellant before the District Forum had even raised objection that the complainant no.1 was not a beneficiary under the aforesaid scheme.  There is an affidavit from the bank confirming his insurance as well.  The deceased had died under the policy cover period. In this light, there is no reason to believe that claim was not sent to the opposite party/appellant insurance company. However, we observe that the opposite party/appellant-insurance company did not decide the complainant’s claim.       

9.                It is pertinent to mention that besides sending the claim form, reminders, including a legal notice, were also sent by the bank to the insurance company. Hon’ble Supreme Court in Lakshmi Bai & Ors Vs ICICI Lombard General Insurance Company Limited & Ors. 2011 (4) CPR 64 (NC) has observed that cause of action will continue till the day, the insurance company pays or rejects the claim.  In the foregoing discussion, the objection of the opposite party/appellant-insurance company, regarding complaint being barred by limitation is not sustainable. The appellant is not benefitted by the judgment (referred by him during the course of arguments), passed by this Commission in First Appeal No.426/2011 Tulsiram Lovanshi Vs ICICI Lombard & Anr. on 27.02.2016, since in the case in hand, there is evidence that the claim was forwarded to the appellant-insurance company.

10.               The Janata Personal Accident Insurance Policy (P-12) sub-clause (b) of Clause (iii) Claims Procedure provides that- “The Insured shall deliver to the Company, within 14 days of the date on which event shall have come to his knowledge, a detailed statement in writing as per the claim form and any other material particular, relevant to the making of such claim.”

                   We infer that the insured/bank was required to deliver to the company, within 14 days of the date on which the event came to his knowledge.  This nowhere

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leads us to conclude that the claim was required to be filed within 14 days of the death of the deceased.  Moreover, there is no specific mention that the claims which are filed late, will not be payable.

11.               In this view of the matter, considering the facts and circumstances of the case, we do not find any illegality or infirmity in the impugned order.  We concur with                                                           the observations of the District Forum and hold that the order was passed after correct appreciation of evidence on record.  We conclude that the complainant no.2/respondent no.1 deserves the sum assured under the aforesaid scheme. The impugned order is affirmed and the appeal is dismissed.  No order as to costs of this appeal.   

 

               (S. D. AGARWAL)                                  (DR. MRS MONIKA MALIK)

                    PRESIDING MEMBER                                           MEMBER