A consumer commission here has directed an insurance company to pay a claim of Rs 2 lakh under a Maharashtra government scheme to the wife of a farmer who died in a road accident in 2017.

The District Consumer Disputes Redressal Commission, South Mumbai, in the order passed on April 18, said the insurance company "failed in its responsibility" given by the state government by rejecting the woman's claim in an "arbitrary" manner.

The complainant, wife of a farmer from Solapur, said her husband died in an accident on November 25, 2017 while returning home from a vegetable market in the area.

The farmer was severely injured after being hit by a state transport bus. He was rushed to a nearby hospital where doctors declared him dead, as per the complaint.

After coming to know about their policy under the 'Gopinath Munde Farmers Accidental Insurance Scheme' introduced by the Maharashtra government, the woman submitted a claim to the authorities concerned.

However, the insurance company "deliberately" and in a malafide manner did not sanction her genuine claim and this amounted to deficiency in service, the woman said in her complaint and approached the commission.

The Oriental Insurance Company, chosen by the state government through a notification, said the deceased farmer was aged above 75 and hence ineligible to avail the claim.

A farmer between 10 and 75 years of age is eligible to claim benefits under the scheme.

The insurance company further submitted that the claim has been rightly repudiated because documents were submitted after the prescribed time period of 90 days.

The commission, after hearing both the sides and perusal of documents, said that in the police FIR, the birth year of the deceased was written as 1972 and the postmortem report mentioned his age as approximately 70 years.

No documentary evidence has been produced by the insurance company to show the deceased was 75 years old, it said.

Hence, the commission concluded that in the absence of evidence from the insurance company, the age mentioned in police reports as 70 years is correct.

It was highly objectionable to mention the age of the deceased above 75 years without any confirming documentary evidence, the order said.

On late submission of documents, the commission said it is clearly mentioned in the government notification of November 25, 2016 (for the scheme) that the insurance company is bound to accept the claims even after 90 days' delay if there are valid reasons.

The insurance company failed to explain why the claim received after the grace period was rejected, it said.

The commission said upon receiving the documents, it was entirely the insurance company's responsibility to process the claim.

"Unfortunately, it is seen that the opposite party number 1 (insurance company) has failed in its responsibility which was shouldered on it as per government notification," the commission observed.

"Considering these findings, we come to the conclusion that the opposite party (insurance company) has incorrectly repudiated the insurance claim of the complainant and hence not justified," it said.

Thus, the repudiation order of June 21, 2018 "is arbitrary and bad in law", the commission said.

The complainant is justified to claim Rs 2 lakh with a penal interest of 6 per cent per annum from the date of repudiation (June 21, 2018) till its realization, it said.

The commission also asked the insurance company to pay the complainant a compensation of Rs 20,000 for mental agony and Rs 5,000 towards the cost of litigation.

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