IMPORTANT POINT
The petitioner/complainant should not be penalised for the time taken by BSF in forwarding his claim to the insurer

V.K. Jain, Presiding Member—The complainant/ petitioner was working as a Constable (Constable No.92477237) with the Border Security Force (BSF). He was covered against death or disability under a Group Insurance Scheme issued by respondent No.2 United India Insurance Co. Ltd. to respondent No.1 the Border Security Force. On 13.5.2002, the petitioner/complainant suffered a mine blast injury, as a result of which he became disabled to the extent of 30%. He joined duty on 9.11.2002 and submitted a claim which the Border Security Force forwarded to the insurer on 2.8.2003. The claim, however, was repudiated vide letter dated 28.3.2004 which to the extent it is relevant, reads as under:-

“With reference to above claim, it is noted that the accident of CT Pawan Kumar on 13.05.2002. However, the intimation submitted to us on 12.08.2003. So there has been delay of same approximately one year three months in reporting the claim to us.

As per the condition of the GPA policy the claim has been reported within 30 days of the occurrence of the incident to us. But our Head Office has relaxed the period of intimation to one year of the date of accident. However, as the claim was reported even beyond one year and also, we have written a letter to you on 24.9.2003 for clarifying the delay but till date you have not clarified the same. So we are constrained to repudiate the claim.”

2. Being aggrieved from the rejection of the claim, the complainant/petitioner approached the concerned District Forum by way of a consumer complaint. The complaint was resisted by the insurer primarily on the ground on which the claim had been repudiated.

3. The District Forum having ruled in favour of the petitioner, the insurer approached the concerned State Commission by way of an appeal. Vide impugned order dated 23.8.2017, the State Commission allowed the appeal and consequently dismissed the complaint solely on the ground that the claim had not been lodged with the insurer within one month of sustaining the injury. Being aggrieved from the aforesaid order of the State Commission, the petitioner is before this Commission by way of this revision petition.

4. The main question involved in this petition as to whether the time period of one month from the date of injury, for lodging the claim with the insurer, which was stipulated in the policy, was mandatory or directory. A perusal of the letter dated 28.3.2004 itself would show that the insurer itself has extended the time for lodging the complaint to one year, meaning thereby that the insurer itself did not treat the one month time period for lodgement of claim to be mandatory. Moreover, in the letter dated 28.3.2004, the insurer also stated that the delay had not been clarified. This would imply that had the delay been explained, it could have been relaxed by the insurer even beyond one year from the date of which the injury was sustained. This is yet another proof that the insurer itself was not treating the aforesaid time period of one month to be mandatory.

5. The learned counsel for the petitioner has also drawn my attention to a chart placed by BSF before the District Forum. A perusal of the said chart would show that in a large number of cases the insurer itself had relaxed the time period for lodgement of the claim, much beyond one year and three months. In fact in one case the delay was to the extent of more than 11 years. The relaxation of delay by the insurer, in my opinion, was fully justified considering the very nature of the scheme under which the claim was lodged. In a claim of this nature, the insurer would be well advised to examine the claims on merits instead of repudiating them on the ground that the same were lodged after expiry of the time period stipulated in this regard in the insurance policy. In the present case, the petitioner/complainant joined the duty only on 9.11.2002. Therefore, it was not possible for him to lodge the claim within one month of his having injury on 13.5