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MAHARASTRA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Usha S. Thakare, Presiding Member, Dhanraj Khamatkar and Narendra Kawde, Members
REKHA SAMBHAJI BHOSALE - Appellant
Versus
ORIENTAL INSURANCE CO. LTD. AND ORS. - Respondents
First Appeal No. A/11/837
Decided on : 13-08-2013
Mr. P.D. Pise, Advocate, for the Appellant; Mr. Hemant Hadawale, Proxy for Mr. Sanjay Mhatre, Advocate, for the Respondent
Headnote:
Insurance Claim - Agriculture Insurance - Consumer Protection Act, 1986 - [Consumer Protection Act, 1986, Section 2(1)(d), Section 2(1)(g), Section 2(1)(o), Section 2(1)(r), Section 21, Section 24, Section 27] - The court discussed the provisions of the Consumer Protection Act, 1986, including the definition of consumer, deficiency in service, and the powers of the District Forum. The court also highlighted the agreement between the Government of Maharashtra and the Insurance Company, emphasizing the importance of adhering to the guidelines in deciding insurance claims.
Fact of the Case:
The deceased, an agriculturist covered by an insurance policy, died due to an accident. The insurance claim was submitted, but the Insurance Company neither sanctioned nor repudiated the claim. The Complainant filed a consumer complaint alleging deficiency in service.
Finding of the Court:
The court found that the Insurance Company wrongfully repudiated the claim and failed to communicate its decision to the Complainant. The District Forum's dismissal of the complaint was deemed to be a clear deficiency in service on the part of the Insurance Company.
Issues: The issues revolved around the timeliness of the complaint, the jurisdiction of the District Forum, and the wrongful repudiation of the insurance claim by the Insurance Company.
Ratio Decidendi: The court held that the Insurance Company's repudiation of the claim was wrongful and that it failed to communicate its decision to the Complainant. The District Forum's dismissal of the complaint was set aside due to a clear deficiency in service on the part of the Insurance Company.
Final Decision: The impugned order was set aside, and the consumer complaint was partly allowed. The Insurance Company was directed to pay the Complainant the insurance amount with interest, and each party was to bear their own costs.
ORDER
Dhanraj Khamatkar, Member - This appeal takes an exception to an order dated 26.4.2011 passed by the District Consumer Disputes Redressal Forum, Satara (hereinafter referred to as the District Forum for the sake of brevity) in Consumer Complaint No. 14 of 2011, Smt. Rekha Sambhaji Bhosale v. Manager, The Oriental Insurance Company Ltd. and Others. The facts leading to this appeal can be summarized as under:
2. Shri Sambhaji Yeshwant Bhosale, deceased husband of the Appellant/Complainant Smt. Rekha Sambhaji Bhosale (hereinafter referred to as the Complainant for the sake of brevity) was an agriculturist and being an agriculturist he was covered by the insurance policy which is taken by the Government of Maharashtra for its agriculturists from the Respondent/Opponent No. 1 The Oriental Insurance Company Ltd. (hereinafter referred to as the Insurance Company for the sake of brevity). Deceased Mr. Sambhaji Yeshwant Bhosale died on 26.11.2007 because of an accident. Hence, the present Complainant being the wife of the deceased filed an insurance claim with the Village Talathi, Akaichi Wadi and said Village Talathi had submitted the said claim to the Tehsildar, Karad, who in turn, forwarded the insurance claim to the Respondent/Opponent No. 2 Cabal Insurance Services Pvt. Ltd., who is the facilitator between the Government of Maharashtra and the Insurance Company. Respondent/Opponent No. 2 had raised certain queries and asked the Complainant to furnish certain papers. Accordingly, necessary papers were submitted to the Respondent/Opponent No. 2, who in turn, forwarded the insurance claim to the Insurance Company on 26.9.2008. The Complainant contended that the Insurance Company had neither sanctioned the claim nor repudiated the same and hence, alleging deficiency in service on the part of the Insurance Company, she filed the consumer complaint claiming the insurance amount of Rs. 1,00,000 together with interest thereon and other consequential relief of compensation for mental agony and costs.
3. Insurance Company filed a written version challenging the complaint stating that it had issued an insurance policy in the name of Government of Maharashtra for the agriculturists in the State of Maharashtra. However, it is contended that since address of the Insurance Company being in Nagpur, the District Forum, Satara had no territorial jurisdiction to entertain, try and decide the consumer complaint. It is further contended that the complaint is filed after lapse of a period of three to four years after the cause of action and thus, it is beyond the period of limitation and hence, time-barred. Insurance Company contended that they have not received the insurance claim. It is further contended that as per the agreement between the Government of Maharashtra and the Insurance Company, if there is a dispute regarding the claim it is to be decided by a committee appointed by the State Government. It is further alleged that the Complainant has not impleaded all the legal heirs of the deceased Mr. Sambhaji Bhosale, who are the necessary party. It is further stated that the Government of Maharashtra had filed 2232 insurance claims as against this Insurance Company before the National Consumer Disputes Redressal Commission, New Delhi and the insurance claim of the present Complainant is included in those claims. On these grounds and other grounds as set out in the written version, it is prayed that the complaint may pleased be dismissed.
4. Respondent/Opponent No. 2, in its written version, stated that they are the mediators between the Government of Maharashtra and the Insurance Company and their job is only to forward the claims received from the government machinery to the Insurance Company. On these grounds, it is prayed that the complaint may pleased be dismissed.
5. Respondent/Opponent No. 3-Govern-ment of Maharashtra, through District Collector, Satara filed a written version stating that he had forward the claim to the Respondent/Opponent
