Insurance claims under social security schemes for unorganized sectors should be construed liberally; genuine claims cannot be repudiated solely based on delay in intimation, especially when a police report exists and the insurer fails to prove non-coverage with evidence.

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Order :

PER HON’BLE SMT. MEENA RAMANATHAN, MEMBER (NON-JUDICIAL)

1. The appeal is filed u/s 41 of Consumer Protection Act, 2019 by the Opposite Party, aggrieved by the order of District Consumer Commission, Nalgonda, dated 24.11.2023 in CC 12/2022, where under, the opposite party is directed to pay to the complainant an amount of Rs.4,25,000/- towards sum assured under Group Personal Accident Policy, Andhra Pradesh Transport Drivers and Non-Transport Drivers Social Security Scheme 2008, with interest @ 9% p.a. from the date of registration of the complaint i.e. 19.02.2022 till realization, Rs.10,000/- towards compensation for mental agony and Rs.5,000/- towards costs, within thirty days from the date of receipt of this order”.

2. The parties are herein after referred to as they were arrayed before the District Commission, as complainant and opposite party.

3. The brief averments of the complaint are that the complainant is the mother and nominee of deceased Challa Rajendra, who was a Member of Andhra Pradesh Transport Drivers and Non-Transport Drivers Social Security Scheme 2008. The Union of India provided a Group Life Insurance for an amount of Rs.75,000/- to each Transport Driver and non-Transport Driver from the Life Insurance Corporation of India, through the Commissioner of Labour, Vijayawada. The Andhra Pradesh State Government has provided a group personal accident insurance scheme to the transport drivers and non-transport drivers from Commissioner of Labour, Vijayawada to the opposite party vide policy No.6104002160100000010, valid for the period 01.05.2016 to 30.04.2017. The opposite party had assured an amount of Rs.4,50,000/- to each transport and non-transport drivers.

b) On 28.07.2016 at about 06:30 p.m., son of the complainant – driver of the tipper bearing No.AP 26 TC 8429, was loading stones when there was heavy rain and was struck by a bolt of thunder and died instantaneously. The police Saidapuram, registered a case and took up the investigation. The complainant, an illiterate woman was in shock and submitted the claim form only on 13.03.2017. The claim was repudiated on the ground that there was delay in intimation.

c) The present complaint is filed for legal remedy against the opposite party stating that a genuine claim cannot be repudiated on the ground of delay in intimation. The opposite party also raised a plea before the Insurance Ombudsman that the deceased was not on the list with the Commissioner of Labour. The complainant has also contended that LIC of India has settled the claim of Rs.75,000/- to the complainant but the opposite party has acted negligently and failed to settle the claim. The present complaint is raised claiming the entitled amount along with compensation and costs.

4. The opposite party filed their written version and it is denied that the deceased Challa Rajendra, was a member of Andhra Pradesh Transport Drivers and Non-Transport Drivers Social Security Scheme 2008, provided by the Union of India from Group Life Insurance Company for an amount of Rs.75,000/- to each Transport Driver and non-Transport Driver through the Commissioner of Labour, Vijayawada. It is also denied that the Government of Andhra Pradesh provided a group personal accident insurance scheme to the transport drivers and non-transport drivers for a sum of Rs.4.50 lakh through the Commissioner of Labour