Posted on January 15, 2013 by Akanksha
The Maharashtra state consumer disputes redressal Commission has held that filing a insurance claim late cannot be the reason for rejecting it. The commission, while upholding a district forum’s order, directed the Oriental Insurance Company to pay the widow of a man who died in a 2006 accident the entire claim of Rs 1 lakh plus a compensation of Rs 46,000 even though the claim had been filed well past the one-month deadline.
The commission held that deadline was not a mandatory condition but, a kind of directive and hence, breach of this condition does not empower the appellant insurance company to forfeit or foreclose the insurance claim required to be duly settled.
Shri Vitthal Sahakari Sakhar Kharkhana Ltd had subscribed to a Group Janata Personal Accident Insurance Policy to provide insurance cover to members in their factory.
During the term of the policy, one of the members, Vitthal Gavande, died in a road accident on 31 December 2006. The insurance claim was filed on 18 January 2008.
The insurance company repudiated the claim on the ground of non-compliance of terms and conditions mentioned in the policy document.
Aggrieved with the repudiation, in 2009, Shri Vitthal Sahakari Sakhar Kharkhana along with Gavande’s wife Rani Gavande filed a consumer complaint before the district forum in Solapur. On 7 December 2010, district forum passed order in their favour.
Aggrieved, the insurance company filed an appeal in the state commission. According to the state commission, the only point challenged by the insurance company was that the terms and conditions were violated by the complainants as intimation of the claim was not received within the stipulated period but after almost 13 months.
The insurance company said that as per the terms and conditions a claim under the Group Janata Personal Accident Insurance Policy was required to be brought to the notice of the insurance company within one month of the date of the incident leading to the claim.
The commission observed that during the arguments, the insurance company did not point out the penal provisions for non-compliance of the policy condition.
vinay mohanty
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