JAYABEN RAMANLAL SHAH Vs. NATIONAL INSURANCE CO LTD

JUDGEMENT

(1.) By way of this complaint, the complainant, aged about 72 years, mother of Sunilbhai Ramanlal Shah, since deceased, has prayed for recovery of the insurance amount of Rs.5 lakhs with interest at the rate of 18% p. a. from the date when the claim form was submitted till payment and cost quantified at Rs.1,500/-. The complainant has alleged that his son was residing in Swapna Sakar Flats, Bhatta, Paldi, Ahmedabad with his wife and two children. He had taken Janata Personal Accident Policy of Rs.5 lakhs and paid premium in the sum of Rs.1,950/- to opponent No.2, opponent No.1's agent and the opponent No.1 issued insurance certificate dated 5.2.1999 for the period from 5.2.1999 to 4.2.2011 (15 years ). Unfortunately, the flat in which the insured was residing with his family collapsed as a result of the earthquake which disturbed the whole of the State on 26.1.2001. Not only the complainant's son died in the incident but his wife and two children also lost their lives. The complainant submitted claim form and wrote letter dated 6.3.2001 to opponent No.1 Insurance Company who replied by letter dated 14.3.2001 inter alia saying that the policy was for a period of one year only from 5.2.1999 to 4.2.2000 and the policy certificate erroneously mentioned the period of 15 years. It was alleged that the insured was informed to return the original policy certificate but he did not do so. Under such circumstances, since the policy did not extend beyond the period of 4.2.2000, claim submitted by the complainant was treated as 'no claim'. The complainant was, therefore, required to file the present complaint as stated above.

(2.) Opponent No.2, agent of opponent No.1 Insurance Company has not filed any reply to the complaint, though served. No one has remained present for the opponent No.2. Opponent No.1 has filed written statement at Exh.11. Briefly stated the opponent No.1 has resisted the claim on the same ground as noted in its letter dated 14.3.2001. We, therefore, need not repeat the same. The question which is required to be decided by this Commission is whether there was any error committed by opponent No.1 Insurance Company in issuing the policy for a period of 15 years and not for a period of one year as alleged by opponent No.1 Insurance Company. We have gone through the documents placed on record. The policy certificate (Xerox copy) which has been produced by the complainant indicates 15 years so as to support the case of the complainant. Xerox copy of the corrected certificate placed on record by the Insurance Company does show period of 15 years but there is a correction in ink done and initialled by signatory of the opponent Insurance Company, though the certificate bears signatures of concerned authorities of opponent No.1 as well as opponent No.2. But the correction is initialled only by opponent No.1 through its signatory. That correction does not bear any date. In support of the submission flowing from the aforesaid stand taken by opponent No.1 Insurance Company reference is made to a copy of statement of accounts showing payment of Rs.230/- by opponent No.2 to opponent No.1. This again is not explained by the opponents by producing any cogent or convincing evidence or even by showing any document which would clarify the alleged correction and due intimation thereof to the insured. As against that the receipt which has been produced by the complainant clearly indicates payment of Rs.1,950/- in cash. That is dated 2.2.1999. The receipt is issued by opponent No.2 who is admittedly agent of opponent No.1 Insurance Company. That receipt or copy of said receipt which might be in the possession of the opponents or either of them still remains unexplained. It is not the case of even opponent No.1 Company that there was any correction made in the receipt. Thus, the payment of Rs.230/- stated to have been recorded by opponent No.1 Company and payment of Rs.1,950/- evinced by receipt issued by opponent No.2 Company, admittedly, opponent No.1's agent is not explained. No material has been placed on record to show that the insured was informed about the alleged mistake although there is a reference in letter dated 14.3.2001 with regard to some letter dated 23.2.1999 having been issued by opponent No.1 Company to the insured. Copy of said letter is also produced by opponent No.1 Company now but there is no acknowledgement of the insured with regard to he having received said letter. It is not probable that the insured would sit silent and would not at all react to such letter if received. To this, it has been submitted that opponent No.2 Company appears to have practised fraud on opponent No.1 Company as also the complainant. It is not in dispute that opponent No.2 was admittedly agent of opponent No.1 Company and even the policy certificate which has been issued is a printed certificate showing both the opponents as signatories. If that is so, the documentary evidence which has been placed on behalf of the complainant remains not explained, particularly with regard to period of policy of insurance which is the matter in dispute in this complaint. If opponent No.1 Insurance Company had informed the insured to return the original policy as having been erroneously issued for a period of 15 years instead of for a period of one year, there was no reason for the opponent No.1 Insurance Company not to issue corrected policy there and then. However, alleged corrected policy still remains in the possession of the opponent No.1 Insurance Company which speaks volumes about the conduct of concerned officers or authorities of both the opponents. Assuming the submission that opponent No.2 Company practised fraud against opponent No.1 Insurance Company, opponent No.1 Company would be vicariously liable for the acts or omissions on the part of the opponent No.2 Company. We are unable to comprehend the situation that the insured would pay Rs.230/- and would receive receipt for Rs.1,950/- and yet the payment of Rs.1,950/- alleged to have been erroneously recorded would remain as it is for considerably long period. There was no reason for the insured to receive receipt for Rs.1,950/- if he had in fact made payment of Rs.230/-. The figures do not in any way reconcile with the stand taken by the opponent No.1 Insurance Company.

(3.) In above view of the matter, no sooner it is found that the claim has not been honoured as per the policy that was issued by opponent Insurance Company and submitted for processing to the opponent No.1 Insurance Company, that clearly would show deficiency in service on the part of the opponent Insurance Company. It is not necessary to make specific averment using the words 'deficiency ' in service. It is to be gathered from the facts and circumstances alleged in the complaint. As a matter of fact the complainant has specifically stated all the facts in the complaint and she has averred in Para 5 of the complaint that the claim preferred by her was rejected on incorrect and improper reasons for which the complainant did give reply. In our considered opinion, opponent No.1 Company would be liable to honour the claim. Bearing in mind all the aforesaid facts and circumstances of the case, following order is passed. ORDER opponents are directed to pay to the complainant Rs.5,00,000/- with interest at the rate of 10% p. a from 1.6.2001 till payment and cost of the complaint quantified at Rs.1,500/- within six weeks from today. It will be open for the opponent No.1 Insurance Company to take up the matter with opponent No.2 Company in case there is any fraud practised by opponent No.2 Company against opponent No.1 Company. We do not propose to express any opinion on that aspect of the case. This complaint will accordingly stand disposed of. Complaint disposed of.