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2024 DIGILAW 1626 (ALL)

Oriental Insurance Company Ltd. v. State of Uttar Pradesh

2024-07-08

ALOK MATHUR

body2024
JUDGMENT : ALOK MATHUR, J. 1. Heard Sri Sumit Kumar Srivastava, learned counsel for the petitioner as well as learned Standing Counsel for respondent nos. 1 and 2 and Sri Dhruv Kumar, learned counsel appearing for respondent no. 3. Rejoinder affidavit filed today is taken on record. 2. By means of present writ petition the petitioner has challenged the order 01.04.2024, passed by the Permanent Lok Adalat, Lucknow in PLA Case No. 28 of 2018 whereby the claim of respondent no. 3 made under the Mukhyamantri Kisan Evam Sarvahit Bima Yojana (MKSBY) has been allowed and the petitioner Insurance Company has been directed to pay an amount of Rs.5,00,000/-which is the insured amount to respondent no. 3 alongwith legal expenses of Rs.5000/-and Rs.1000/-per week Penalty from the date of rejection of claim till its actual payment has been awarded. 3. It has been submitted by learned counsel for the petitioner that the husband of respondent no. 3 had met a fire accident wherein he received serious burn injuries on 04.01.2017 and was admitted to PGI, Safai, where be succumbed to injuries on 16.01.2017. Postmortem was also conducted and Punchnama was also recorded with regard to aforesaid incident. Respondent no. 3 is the wife of deceased Sandeep who was working as agricultural labourer and used to make earning out of working in fields owned by other persons. The deceased was daily labourer and was the bread earner of the family and there is no dispute with regard to this fact. At the time of death of deceased he was aged about 25 years and it is stated that his annual income was Rs.36,000/-. 4. It is in the aforesaid circumstances an application was made to the petitioner seeking compensation under the MKSBY Scheme, but the same was duly considered and rejected by the petitioner on 10.11.2017 on account of two facts, firstly, that the deceased was not a farmer and secondly that income certificate as required under the said scheme has not been furnished. 5. The respondent no. 3 being aggrieved by the rejection of her claim and having no other forum, filed an application before the Permanent Lok Adalat, Lucknow (hereinafter referred to as "the PLA"). The PLA duly considered the entire facts of the case and after framing the issues and receiving evidence and considering contentions of all the parties, allowed the claim of respondent no. 3. The PLA duly considered the entire facts of the case and after framing the issues and receiving evidence and considering contentions of all the parties, allowed the claim of respondent no. 3. The petitioner in the present writ petition has challenged the said order on the ground that the income certificate of the deceased was filed only during the proceedings before the PLA and not at any time prior to the same. 6. It is stated that as per terms of the Policy income certificate had to be filed within 45 days of the death of the insured and the respondent not having filed the certificate were not entitled to receive any claim in this regard. In support of his submissions the petitioner has relied upon the Samajwadi Kisan Evam Sarvahit Bima Yojna form, which according to the petitioner had been issued by the State Government itself. 7. Learned counsel for the respondents on the other hand has opposed the writ petition by submitting that the Scheme has been launched by the State Government taking into account the socio-economic condition of rural-agricultural and marginal farmers and land less labourers known as Samajwadi Kisan Evam Sarvahit Bima Yojna for their benefit so that the poor and marginal farmers and agricultural labourers can be benefited on account of any accidental death occurring to the bread earner of the family. The main object of the scheme is a preventive measure to save the entire family from becoming destitute and accordingly, it is in pursuance to the aforesaid scheme that respondent no. 3 had moved her claim before the petitioner-Insurance Company on account of death of her husband who died due to burn injuries on 16.01.2017. 8. Perusal of provisions as well as the form annexed alongwith the Samajwadi Kisan Evam Sarvahit Bima Yojna do provide eligibility conditions for a person to be paid compensation of Rs.5,00,000/-on death of the bread earner. As per conditions as laid down in the form, details of deceased have to be provided and also that he had been earning less than Rs.75,000/-per month. 9. Learned counsel for the respondent no. 3 while contenting the claim has submitted that in the written statement filed by the petitioner itself it is stated that income of the applicant-claimant was disclosed rather then income of the deceased. Income of the claimant was shown to be less then Rs.75,000/-per month. 9. Learned counsel for the respondent no. 3 while contenting the claim has submitted that in the written statement filed by the petitioner itself it is stated that income of the applicant-claimant was disclosed rather then income of the deceased. Income of the claimant was shown to be less then Rs.75,000/-per month. Even in the form which has been relied upon by the petitioner there is no mention of the fact that income of the deceased has to be given. 10. In any view of the matter it is not the case of the petitioner that either the deceased or the claimant or the entire family was earning more than Rs.75,000/-per month. This aspect of the matter has also been looked into by the Permanent Lok Adalat and they have recorded a finding that the claimant was fully covered under the Mukhyamantri Kisan Evam Sarvahit Bima Yojana (MKSBY), as the deceased was earning about Rs.3000/-per month and annual income of Rs.36,000/-. 11. With regard to objection in the rejection letter dated 10.11.2017, that the deceased was not a farmer, there is no material available with the petitioner to support the said reasoning. Neither before the Permanent Lok Adalat nor before this Court there is any material available to record a different finding that the deceased was not a farmer. 12. The court is of the considered view that welfare, beneficent aur social justice oriented legislation should always receive a liberal construction. The insurance scheme namely Mukhyamantri Kisan Evam Sarvhit Bima Yojana (MKSBY) being a welfare scheme whose terms have to be interpreted taking into consideration the hardships and welfare of the insured. 13. Hon'ble Supreme Court in the case of Om Prakash v. Reliance General Insurance, (2017) 9 SCC 724 while dealing with the issue regarding rejection of claim by the Insurance Companies, has held as under: “10. The decision of the insurer to reject the claim has to be based on valid grounds. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. Rejection of the claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy-holders in the insurance industry. If the reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. It is also necessary to state here that it would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by the investigator. The condition regarding the delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine.” 14. In case of insurance contract, it is necessary that the essential conditions of the Insurance policy are fullfilled. However, those essential conditions are to be construed liberally and has to be substantially fulfilled. 15. In this case, submission of Income certificate is a necessary condition and therefore, its submission is mandatory. However, the time limit prescribed for submission is merely a technical and directory provision and cannot be a basis of rejection of the claim. 16. In the aforesaid circumstances, this Court is of the considered view that the Permanent Lok Adalat has rightly come to the conclusion that the deceased was fully covered by the scheme issued by the State Government and that he was the sole bread earner of the family and was earning less than Rs.75,000/- per month. 17. In view of above, this Court does not find any infirmity in the impugned order calling for interference under Article 226/227 of the Constitution of India. 18. The writ petition being devoid of merits is dismissed.