IMPORTANT POINT
Repudiation on the ground of delay in intimation to Insurance Company is not justified.—Para 11

M. Shreesha, Member—Aggrieved by the order dated 08.04.2013 in Consumer Complaint No. 91 of 2006 passed by the State Consumer Disputes Redressal Commission, Maharashtra (in short “the State Commission”), both the Complainant Sh. Santosh Umakant Jawadwar and the Opposite Party namely Tata AIG General Insurance Company Ltd. (hereinafter referred to as “the Insurance Company”) preferred these Appeals i.e. FA No. 389 of 2013 and FA No. 407 of 2013 respectively under Section 19 of the Consumer Protection Act, 1986 (for short “the Act’). By the impugned order, the State Commission has allowed the Complaint in part directing the Insurance Company to pay Rs.55,00,000/- on account of the death of the Complainant’s wife and Rs.5,00,000/- towards educational benefit to the daughter of the Complainant within a period of 60 days from the date of the Order, failing which the amount shall carry interest @ 6% p.a. from the date of the expiry of the stipulated period till the date of realization.

2. The facts in brief are that the Complainant had taken a Policy bearing No. 020001364400 and paid a premium of Rs.17,110/- vide DD No. 499898 dated 24.02.2004 for the period covering 27.02.2004 to 26.02.2005. It is averred that the Policy covered all the family members of the Complainant i.e. his wife for an amount of Rs.50,00,000/- and his daughter Ms. Mansi for an amount of Rs.10,00,000/-. The Complainant himself was insured for an amount of Rs.1,00,00,000/-. While so, on 20.02.2005, the Complainant had gone to drop his daughter at her maternal aunt’s residence, leaving his wife, Smt. Kalpana who was 8 months pregnant at his residence. It is averred that his wife was advised rest as she was in the advanced stage of pregnancy and, therefore, did not accompany them. Both of them had their dinner at around 6 p.m. and thereafter the Complainant went to visit his relatives. On the way back he picked up his daughter and at about 8.30 p.m. reached his house and found smoke bellowing out of the kitchen window of his second floor flat. Having failed to receive any response from the land-line number at his residence, the Complainant informed the Police and the Fire Brigade.

3. It is stated that Fire Brigade Officers opened the door and found his wife lying dead with severe burn injuries on the floor of the kitchen. It is averred that the Police found the death to be accidental. However, upon the Complaint filed by his brother-in-law, the Police registered a case under Section 302, 498-A and 34 of IPC. The Complainant was arrested immediately and thereafter released on bail by the Court on 16.03.2005. It is averred that as the Complainant was in grief he could not immediately intimate the Insurance Company but thereafter vide a letter dated 22.09.2005 intimated the Insurance Company and an Officer recorded his statement and also took the statements of the Doctors and the office boy. Thereafter the Complainant did not pursue the claim because of the time consumed in the trial before the Sessions Judge, Nanded, which had acquitted the Complainant holding that the death of his wife was purely accidental. Thereafter, vide letter dated 04.05.2006, the Complainant submitted all the documents together with the copy of the Judgement to the Insurance Company. Subsequently, the Insurance Company repudiated the claim vide a letter dated 06.06.2006 on the ground of delayed intimation and belated submission of documents relying on Conditions No. 8 and 10 of the Policy. The Insurance Company also unilaterally concluded that the death was Suicide and did not settle the claim.

4. It is averred that the daughter of the Complainant is entitled to reimbursement of Tuition Fees of Rs.60,000/- for the Academic Year 2005-06 and 2006-07. Further in terms of Clause C-52, a sum of Rs.5,00,000/- which is 10% of the sum insured is also to be paid. Despite several requests as the claim was not settled, the Complainant approached the State Commission seeking the following reliefs: