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2013 DIGILAW 1138 (MAD)

A. Natarajan v. Senior Divisional Manager, National Insurance Company Limited Division III, Kolkatta

2013-02-27

VINOD K.SHARMA

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JUDGMENT 1. The petitioner prays for issuance of a writ in the nature of Certiorari, to quash the order passed by the Senior Divisional Manager, National Insurance Company Limited, vide No.100300/JPA dated 16.12.2008, rejecting the claim of the petitioner for payment of the policy claim on the death of his son. 2. The son of the petitioner, Late.T.N.Ramesh was working as driver with Mrs.Chitra, W/o.Karupannan, Namakkal, who owned a vehicle with Trailor bearing Regn. No.KA 01 AG 8659. The vehicle was insured with the National Insurance Company Limited, Thanjavur, vide Policy No.650700/31/05/630001500. 3. It is submitted that while driving the Trailor, the son of the petitioner met with an accident on 27.09.2005, in which he received grievous injuries, which resulted in his death. The complaint about the accident was filed by one Mr.Hari, S/o.Muthuraj, who was accompanying the son of the petitioner and was the only eye witness to the accident. 4. On the complaint filed by Mr.Hari, S/o.Muthuraj, a case under Sections 279, 337 and 304-A of IPC was registered against the driver of the offending vehicle. 5. The deceased was holding Janata Accident Insurance Policy for a sum of Rs.3,00,000/- (Rupees three lakhs only) covering the accidental death out of accident. 6. The case of the petitioner is, after the death of his son, he took steps to collect all the particulars and necessary documents with respect to the accident, which were in Hindi. After coming to know about the full details and the cause of death of his son, the petitioner approached the Senior Divisional Manager, National Insurance Company Limited, for payment of the insured amount. 7. The petitioner, in support of his claim, sent the original insurance policy certificate, death certificate, F.I.R., final report of the police and post-mortem report, for processing the claim of the petitioner. 8. The claim of the petitioner stands rejected only on the ground of delay, as the petitioner claimed the insured amount eight months after the death of his son. The reminder filed by the petitioner also did not meet any response. 9. The petitioner, thereafter, approached the Insurance Ombudsman, Chennai, who also did not entertain the claim of the petitioner on the ground, that as per guidelines, for Redressal of Public Grievance Rules, 1998, no complaint to the Ombudsman can be entertained after one year. 10. The reminder filed by the petitioner also did not meet any response. 9. The petitioner, thereafter, approached the Insurance Ombudsman, Chennai, who also did not entertain the claim of the petitioner on the ground, that as per guidelines, for Redressal of Public Grievance Rules, 1998, no complaint to the Ombudsman can be entertained after one year. 10. The petitioner, having been left with no option, has approached this Court with a prayer for quashing the impugned order rejecting the claim of the petitioner being arbitrary and violative of Article 14 of the Constitution of India. 11. The writ petition is opposed by respondent No.1 by filing a counter. In the counter, it is not disputed that the son of the petitioner was holder of Janata Accident Insurance Policy and under the said policy, the Company was liable to pay a sum of Rs.3,00,000/-(Rupees three lakhs only) on death of the holder of the policy and that the son of the petitioner, who was the policy holder, had died. 12. The stand in the counter is that the claim is barred by terms of policy, therefore, the respondents have repudiated the claim filed by the petitioner on 23.07.2007. 13. The other stand is, that the petitioner could have lodged the claim with the help of the Erode Golden Trust Financial services, therefore, there is no justification for not filing the claim within the stipulated period, as per the policy. 14. The objection is also raised with regard to the maintainability of the petition, on the plea that disputed questions of facts have been raised, therefore, this Court cannot exercise the extraordinary writ jurisdiction, as the remedy lies somewhere else. 15. However, the respondents, for the reasons best known, have not placed on record the policy or the terms and conditions, therefore, an adverse inference can safely be drawn against the respondents, to reject the defense. 16. Otherwise also, the impugned order itself shows, that there was no bar to entertain the claim even after the expiry of the period stipulated in the policy, as the policy stipulates that on reasonable cause being shown, the claim can be entertained even after the time stipulated under the policy for lodging the claim. 17. The impugned order reads as under:- "100300/JPA Regd. Post 16/12/2008 Without Prejudice Mr. A. Natarajan, F/o.Lt.T.N.Ramesh, Theerthampalayam, Manappalli Post, Pramathi- Velur Taluk, Namakkal District. 17. The impugned order reads as under:- "100300/JPA Regd. Post 16/12/2008 Without Prejudice Mr. A. Natarajan, F/o.Lt.T.N.Ramesh, Theerthampalayam, Manappalli Post, Pramathi- Velur Taluk, Namakkal District. Dear Sir, Re: JPA Claim No.100300/47/06/9690001176 Date of death : 27/09/2005 Sum-Insured : Rs.3,00,000/- A/c. Lt.T.N.Ramesh We are in receipt of your letter dated 06/12/2008 on the captioned subject. While going through the claim it is found that your son had died on 27/09/2005. You had intimated the above claim vide your letter dated 07/06/2006 which was received by us as well as GMSC on 20/06/2006 i.e. the claim intimation letter had already been received by us after a lapse of more than eight months from the date of death on 27/09/2005. After receiving the claim form, the supporting documents along with the completed claim form on 06/12/2006 was received by M/s.GMSC on 21/12/2006. These documents along with the completed claim form was submitted to us by M/s.GMSC on 04/01/2007 i.e. after an expiry of one year from the date of death. Under the circumstances cited above, we would like to inform you that the Policy Condition enumerated on the reverse of the Policy Certificate specifically states that "Upon happening of any event which may give rise to a claim under this Policy, the insured forthwith give notice thereof to the Company. Unless reasonable cause is shown, the insured should within one calendar month after the event which may give rise to a claim under this Policy give written notice to the Company with full particulars of the claim." Please be noted that the above claim was repudiated vide our letter dated 23/07/2007 since the aforesaid claim had been made inordinate delay i.e. not intimated within the stipulated time which was violated the limitation ground of the Policy Condition. In view of the above, we are constrained to repudiate the above claim and treat it as NO CLAIM. Regretting the convenience caused." 18. The condition for lodging the claim within one calendar month of the event cannot be said to be mandatory, as it is open to the respondents to waive the delay to entertain the claim. 19. In view of the above, we are constrained to repudiate the above claim and treat it as NO CLAIM. Regretting the convenience caused." 18. The condition for lodging the claim within one calendar month of the event cannot be said to be mandatory, as it is open to the respondents to waive the delay to entertain the claim. 19. The insurance policy taken out by the son of the petitioner was for the benefit of the policy holder, therefore, this Court, while interpreting the policy, has to interpret the terms and conditions, which will advance the object for which the policy has been taken, than to take a technical view as taken by the insurance company/ respondents. 20. The objection of respondents to maintainability of writ also deserves to be rejected, as it is not disputed by the respondents that the policy was in full force and was taken out by the son of the petitioner. It is also not in dispute that on account of death of the policy holder, he was to be paid a sum of Rs.3,00,000/-(Rupees three lakhs only) as the insured amount. The reason for rejecting the policy on the ground of delay in lodging the claim cannot be accepted, especially when the petitioner gave good reasons for the delay in lodging the claim. Therefore, writ does not raises any disputed question of facts. 21. It may also be noticed, that it is not only for the beneficiary to lodge claim but there was corresponding obligation on the respondents also to process the claim on coming to know about the death of the policy holder. 22. The impugned order, therefore, can be safely said to be totally arbitrary, thus, hit by Article 14 of the Constitution of India. 23. The respondents being a State within the meaning of 12 of the Constitution of India cannot be allowed to act in an arbitrary manner to defeat the right of the policy holder, who had paid the necessary premium and the policy was alive at the time of death. 24. Consequently, this writ petition is allowed. The impugned order is set aside, and a writ in the nature of mandamus is issued to the respondents, to pay the policy amount of Rs.3,00,000/- (Rupees three lakhs only) to the petitioner within two months of receipt of certified copy of this order. 24. Consequently, this writ petition is allowed. The impugned order is set aside, and a writ in the nature of mandamus is issued to the respondents, to pay the policy amount of Rs.3,00,000/- (Rupees three lakhs only) to the petitioner within two months of receipt of certified copy of this order. The petitioner shall also be entitled to interest on this amount from the date of lodging of claim till payment at the rate of 9% p.a. 25. No costs.