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2022 Supreme(Mad) 812
BEFORE THE MADURAI BENCH OF MADRAS HIGH COURT
R. VIJAYAKUMAR, J.
S. Shanmugavalli - Petitioner
Versus
The Managing Director Southern Railway Employees Co-operative Credit Society Ltd., Tiruchirappalli & Others - Respondents
W.P.(MD) No. 7365 of 2011
Decided On : 20-07-2022
For the Petitioner: K. Guhan.
For the Respondent: H. Mohamed Imran, S. Sethuraman, D. Sivaraman.
The claim under an Insurance Policy must be made strictly in accordance with the conditions incorporated therein, and failure to do so without showing reasonable cause may result in the rejection of the claim.
Headnote:
Insurance Policy - Accident Claim - The court dismissed the writ petition challenging the rejection of the accident claim, stating that the claim was not made within the stipulated time period as per the policy conditions, and the petitioner failed to show any reasonable cause for the delay.
Fact of the Case:
The petitioner's husband, a member of a Cooperative Society, passed away due to an accident. The petitioner's claim for accident benefits was rejected by the first respondent, citing delay in submitting the claim to the Insurance Company.
Finding of the Court:
The court found that the claim was not made within the stipulated time period as per the policy conditions, and the petitioner failed to show any reasonable cause for the delay. The court dismissed the writ petition.
Issues: Challenge to rejection of accident claim, delay in submitting the claim, interpretation of policy conditions.
Ratio Decidendi: The claim under an Insurance Policy must be made strictly in accordance with the conditions incorporated therein. The pendency of a criminal case is not connected with a claim to be made before the Insurance Company. Failure to make the claim within the stipulated time period without showing reasonable cause may result in the rejection of the claim.
Final Decision: The writ petition challenging the rejection of the accident claim was dismissed by the court.
JUDGMENT :
(Prayer: This Petition filed under Article 226 of the Constitution of India, to issue a Writ of Certiorarified Mandamus, calling for the records of letter dated 02.02.2011 relating to the letter No.JPA1/2/2011 dated 02.02.2011 passed by the first respondent and consequently the order passed by the second respondent dated 02.02.2011 as against the petitioner and quash the same and directing the respondents to sanction the accident claim benefits of the petitioner's husband to the petitioner.)
1. The present writ petition has been filed challenging an order passed by the first respondent under which the request of the petitioner for accident claim has been rejected.
2. According to the petitioner, the petitioner's husband was working in Southern Railway from 19.10.1980 onwards. He was a member of the first respondent Society. He was removed from service on 10.08.1998. Thereafter, he met with an accident and passed away on 10.12.1999. The conviction of the petitioner's husband was challenged by the writ petitioner after death of her husband. The said conviction was set aside on 21.08.2009. According to the petitioner, her husband being a member of the first respondent Society, he has an accident coverage Insurance Policy namely Janatha Personal Accident Insurance Policy. Since the petitioner's husband had passed away due to an accident, she is entitled to receive the said compensation.
3. The petitioner made an application to the first respondent Cooperative Society on 02.02.2011. On the same day, the first respondent Society has sent impugned communication stating that as per agreement of the Society with the second respondent Insurance Company, the claim should be submitted to the Insurance Company within a period of 30 days from the date of death. Since the petitioner's husband had passed away in the year 1999 and the claim is made in the year 2011, the same has to be decided only by the Insurance Company. This communication is under challenge in the present writ petition.
4. According to the learned counsel for the petitioner, her husband died on 10.12.1999. Since criminal case was pending and it was disposed of only on 21.08.2009, there was some delay in approaching the Society in getting the Insurance claim. Hence, he prayed for allowing the writ petition with a direction to the Insurance Company to disburse the claim amount.
5. The learned counsel appearing for the Co-operative Society had contended that they are having a tie up with the Insurance Company and hence, it is for the Insurance Company to decide about the acceptability or rejection of the claim.
6. The learned counsel appearing for the second respondent/Insurance Company pointed out that as per Condition No.1, unless reasonable cause is shown, claim should be made within a period of one calender month after the event which may give rise to a claim under the policy. Hence, he contended that since the petitioner's husband had passed away on 10.12.1999 and the claim being made on 02.02.2011, the same cannot be considered in view of the policy condition.
7. I have considered the submissions made on either side.
8. The petitioner's husband was admittedly a member of Janatha Personal Accident Insurance Policy. This policy was taken by the first respondent Society in which the petitioner's husband was a member while he was working as a Helper in the Southern Railway. The petitioner's husband was removed from service due to conviction in a criminal case. While he was out of service, he died due to accident on 21.08.2009.
9. The petitioner's husband can be a member of the first respondent Society only if he continues to be an employee of the Southern Railway. Admittedly, he was removed from service on 10.08.1998 and thereafter, he cannot be a member of the first respondent Society. The byelaws of the first respondent Society have not been produced to find out whether after removal or retirement from service of the Southern Railway, any one would continue as member of t
