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NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
V.K. Jain, Presiding Member
Assistant Commissioner
Commercial Tax —Petitioner
versus
New India Assurance Co. Ltd.
and Anr. —Respondents
Revision Petition No.1133 of 2017
(Against the Order dated 20/07/2016 in Appeal No. 126/2015 of the State Commission Uttaranchal)
Decided on 28.2.2019
For the Petitioner:Mr. Krishnan Mishra, Advocate for Mr. J.K. Bhatia, Advocate
For the Respondent No.1:Mr. Amit Kr. Singh, Advocate
For the Respondent No.2:Mr. P. Gowtham and Mr. Ajay Sharma, Advocates
IMPOTENT POINTS
1. Genuine claim should not be rejected only on the ground of delay in intimation of death to the Insurance Company.
2. It is the duty of the employer, not only to verify the claim, but also to assist the claimant to get it from the Insurance Company.
Headnote:Consumer Protection Act, 1986—Section 21(b)—Insurance—Group Insurance Policy for registered dealers taken-insured died in road accident-death intimated to the Insurance Company after 21 months, hence claim repudiated—Insurer relied upon MOU between it and the employer-the name of the claimant was also not included in the list sent to the Insurance Company by the employer—District Forum allowed complaint against both the employer and the Insurance Company. Insurance Company challenged by way of appeal before State Commission-appeal filed by the Insurance Company was allowed and the entire liability was fastened on the petitioner—Hence, Revision—Death was intimated to the petitioner by the claimant after one month from the date of death—Held, the beneficiary of the scheme cannot be made to suffer on account of the delay on the party of the petitioner in transmitting the intimation to the insurer. No proof that the petitioner had asked for requisite documents from the respondent—It is the duty of the employer, not only to verify the claim, but also to assist the claimant to get it from the Insurance Company.
Held: The insurer should pay 75% of the claim and the employer should pay 25% of the claim. No interest and compensation awarded. (Paras 10 and 11)
Result: Order modified.
V.K. Jain, Presiding Member—The petitioner before this Commission who is Assistant Commissioner in the Commercial Tax Department in Uttarakhand had taken a group insurance policy from respondent No.1 in respect of the dealers registered with the Commissioner of Tax, Uttarakhand. Under the said group insurance cover, in the event of death of a registered dealer in an accident, a sum of Rs.5 lakhs was payable to his family. Late Sh. Radhey Shyam, who was a registered dealer in the Commercial Tax Department of Uttarakhand at Rurkee died in a road accident on 26.10.2010. Vide letter dated 29.11.2010, the petitioner was informed of the death of Shri Radhey Shyam in a road accident and was requested that the insurance amount may be paid to his widow Smt. Rekha who is respondent No.2/complainant in this petition.
2. As per the MOU executed between the petitioner and respondent No.1 on 18.11.2009, the claim was to be forwarded to the insurer within 30 days of the accident after it had been duly verified by the Joint Commissioner. On receipt of all the documents, the insurer in its option, could get the claim verified and make the payment. The case of the petitioner is that though the application dated 29.11.2010 was received by them, it was returned since it was not accompanied by the requisite documents. Another intimation of death was given to the petitioner on 18.6.2012. It was allegedly forwarded to the insurer on 19.6.2012. The claim, however, was rejected vide letter dated 6.7.2012 which, to the extent it is relevant, reads as under:-
“With reference to above subject your letter received to me on 5.7.2012 whereby you have sent documents relating to death of Late Radhey Shyam in accident. In this regard we went to inform you that death of Radhey Shyam happened on 26.10.2010 and the information of the same received to us after about 21 months. According to memo of understanding entered between you and our company in case of accidental death the information should have been received to us within 30 days whereas this information received to us after about 21 months in such situation according to conditions mentioned in MOU the claim is not payable. Copy of MOU is enclosed. This is also to inform you that the letter dated 20.5.2011 of the Commissioner Tax Uttarakhand received to us on 23.5.2011 wherein he had told name of 06 claimants, the name of late Radhey Shyam is not included in above list. The copy of letter is enclosed.”
3. Being aggrieved from the rejection of the claim, the complainant approached the concerned District forum by way of a complaint impleading both the petitioner as well as the insurer as the opposite parties in the complaint.
4. The complaint was resisted by the petitioner on the ground that the first intimation received by them was returned being unaccompanied by documents and the second application was forwarded by them to the insurer. The claim was resisted by the insurer primarily on the ground on which the claim had been repudiated. The District Forum vide its order dated 3.6.2015 allowed the complaint against both the petitioner as well as the insurer and directed both the opposite parties in the consumer complaint to pay Rs.5 lakhs to the complainant along with compensation quantified at Rs.10,000/-.
5. The order passed by the District Forum was not challenged by the petitioner but was challenged by the insurer. Vide impugned order dated 20.7.2016, the State Commission allowed the appeal filed by the insurer and set aside the order of the District Forum to the extent it was directed against the insurer. However, the petitioner was directed to pay the amount awarded by the District Forum to the complainant. Being aggrieved from the order passed by the State Commission, the petitioner is before this Commission.
6. Vide Circular dated IRDA/HLTH/MISC.CIR/216/09/2011 dated 20.9.2011 Insurance Regulatory and Development Authority (IRDA) directed the insurer as under:
“The Authority has been receivin
