State Consumer Disputes Redressal Commission
C.S.Power Holding Co. Ltd. vs The Oriental Insurance Co. Ltd on 28 September, 2011
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
(A/11/2649)
Appeal No.368/2011
Instituted on : 30/06/2011
Chhattisgarh State Power Holding Co. Ltd.,
Dagania, Raipur
Through : Managing Director. ... Appellant
Vs.
1. The Oriental Insurance Co. Ltd.,
Divisional Office No.1,
Madina Manzil, Kutchari Chowk, Raipur
Through : Divisional Manager.
2. Smt. Jirmaniya Devi,
W/o Late Shri Sohar Sai,
R/o. Wadraf Nagar,
D/c : under O & M Division,
Ambikapur, District Sarguja (C.G.)
3. Rajesh Kumar, S/o Late Shri Sohar Sai,
R/o. Wadraf Nagar,
D/c : under O & M Division,
Ambikapur, District Sarguja (C.G.)
4. Ku. Gayatri, D/o Late Shri Sohar Sai,
R/o. Wadraf Nagar,
D/c : under O & M Division,
Ambikapur, District Sarguja (C.G.) ... Respondents
(A/11/2666)
Appeal No.385/2011
Instituted on : 12/07/2011
The Oriental Insurance Company Ltd.,
Through - Divisional Manager,
Divisional Office No.1, Madina Manzil,
Kutchery Chowk,
Raipur (C.G.) .... Appellant
// 2 //
Vs
1. Managing Director,
Chhattisgarh Power Holding Company Limited,
Dangania,
Raipur (C.G.)
2. Mrs. Jirmaniya Devi, W/o Late Sohar Sai.
3. Rajesh Kumar, S/o Late Sohar Sai.
4. Ku. Gayatri, D/o Late Sohar Sai,
All R/o. Wadraf Nagar, Sarguja (C.G.) .... Respondents
PRESENT :
HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT
HON'BLE SMT.VEENA MISRA, MEMBER
HON'BLE SHRI V.K. PATIL, MEMBER
COUNSEL FOR THE PARTIES IN BOTH APPEALS ::
Shri M.K. Vyas, for Chhattisgarh State Power Holding Company
Limited/Complainant.
Shri Manoj Prasad & Shri Sanjay Nayak, for The Oriental Insurance
Company Limited/O.P.No.1.
Shri Vikas Agrawal, for LRs of the deceased Shri Sohar Sai/O.P.Nos.2,
3 & 4.
ORDER (ORAL)
DATED : 28/09/2011 PER :- HON'BLE SHRI JUSTICE S.C. VYAS, PRESIDENT. This order will govern disposal of Appeal No.368/2011 as well as Appeal No.385/2011, which have been preferred respectively by Chhattisgarh State Power Holding Company Limited (hereinafter called "Power Holding Company Limited)/complainant and The Oriental Insurance Company Limited (hereinafter called "Insurance Company" for short)/O.P.No.1 against the same impugned order dated 02.06.2011, passed by District Consumer Disputes Redressal Forum, Raipur (C.G.) (hereinafter called "District Forum" for short) in // 3 // Complaint Case No.130/2007 directing the Insurance Company/O.P.No.1 to pay a sum of Rs.67,420/- to the complainant along with interest @ 6% p.a. w.e.f. 03.11.2007 (wrongly noted by the District Forum at the place of 03.04.2007) till date of payment. The Power Holding Company Limited, who was complainant before the District Forum, has also been directed to pay in turn this amount to the L.R's of the deceased Shri Sohar Sai. Apart from it, Insurance Company/O.P.No.1 has further been directed to pay Rs.700/- as cost of litigation to the complainant. For the purpose of convenience, hereinafter the parties will be referred in this order as per their original nomenclature in the complaint case. Original of this order be retained in record of Appeal No.368/2011 and a copy thereof be placed in the record of Appeal No.385/2011.
2. It is not in dispute that an agreement was entered into between Power Holding Company Limited/complainant as well as the Insurance Company Limited/O.P.No.1 under which 17295 employees of the complainant/Power Holding Company Limited were insured by the Insurance Company /O.P.No.1 under Group Janta Personal Accident Insurance Policy bearing No.42/17/2005 and for that purpose, premium of Rs.22,87,091/- was paid by the complainant to the Insurance Company. The period of insurance was w.e.f. 11.09.2004 to 10.09.2005 and as per the contract between the parties, the Insurance // 4 // Company was to pay Rs.4,00,000/- in case of accidental death of any employee during the period of insurance of the complainant/Power Holding Company Limited.
3. The case of the complainant/Power Holding Company Limited before the District Forum was that one of its employee, Shri Sohar Sai, died accidentally on 09.02.2005. A claim under Group Janta Personal Accident Insurance Policy along with all papers, was preferred before the Insurance Company/O.P.No.1 on 12.07.2006, but it repudiated the claim by saying that the claim was filed very much late and thus the conditions of the policy were violated. Feeling aggrieved by such letter of repudiation, the complainant/ Power Holding Company Limited filed a consumer complaint under Section 12 of the Consumer Protection Act, 1986 before District Forum.
4. The Insurance Company/O.P.No.1 in its reply of the complaint, averred that the claim was preferred before it by the complainant after 17 months from the date of accident and, so, it committed no deficiency in service in repudiating the claim of the complainant on the ground of delay. It has also been averred that as per terms of the insurance policy, it was necessary that intimation regarding accidental death of the employee, should be provided to the Insurance Company immediately or before cremation or thereafter within a period of a month. On account of late intimation of the accidental death of the // 5 // employee, the Insurance Company was deprived of making any investigation and so it repudiated the claim of the complainant.
5. Learned District Forum, after having considered rival contentions of both parties earlier vide order dated 28.05.2008 allowed the complaint and directed the Insurance Company to pay sum assured to the complainant along with interest @ 9% p.a. w.e.f. 18.08.2006 till date of payment and also pay Rs.500/- as cost of litigation. That order was challenged by the Insurance Company before us by way of Appeal No.388/2008. This Commission decided that appeal vide order dated 12.11.2009 and allowed it only on the ground that as L.R's of the deceased Sohar Sai were not made party in the complaint and so they be also made party in the complaint, so that right persons can get benefits of the insurance policy. For that purpose, permission was granted to the complainant for amending the complaint. That order was challenged by the complainant/Power Holding Company Limited before Hon'ble National Commission vide Revision Petition No.14 of 2010, which was decided by the Hon'ble National Commission on 22.02.2010 and it was observed that the matter be decided by the District Forum within three months from the date of receipt of that order. It was made clear that if the petitioner company has already paid the amount due under the policy to the beneficiaries/nominees of the deceased employee, then petitioner // 6 // company will alone be entitled to receive the policy amount from the respondent Insurance Company. So far as findings of this Commission in order dated 12.11.2009 passed in appeal No.388/2008 are concerned, no interference was made by the Hon'ble National Commission. It has also been held by the Hon'ble National Commission in its order dated 22.02.2010 that strictly speaking, going by the entirety of the facts and circumstances of the case and considering that the contract of insurance was entered into between the petitioner and the respondent Insurance Company, it was not necessary to implead the nominees/beneficiaries of the deceased employee as complainants. However, it appears that in order to avoid any controversy between the petitioner and the beneficiaries of the deceased employee and with the intention that the amount of insurance reached the right hands, the State Commission has directed the petitioner to implead the legal heirs of the deceased employee, and so no interference was made by Hon'ble National Commission in the order of this Commission.
6. We have heard arguments advanced by all parties and perused record of the District Forum.
7. Counsel for the complainant/Power Holding Company Limited submitted that as per agreement entered into between the complainant and Insurance Company, the complainant company was entitled to receive the benefits of the policy in full from the Insurance Company.
// 7 // It has also been submitted that under some confusion, the District Forum in paragraph No.22 of the impugned order has wrongly mentioned that Rs.3,32,580/- was deposited by the Insurance Company/O.P.No.1 under the policy and therefore the Insurance Company is liable to pay only Rs.67,420/-. It has been submitted that amount of Rs.3,32,580/- was deposited by the complainant/Power Holding Company Limited and the Insurance Company/O.P.No.1 has not deposited any amount anywhere under the policy. It has also been submitted that liability of the Insurance Company/O.P.No.1, is for payment of the full sum assured along with allied benefits and interest. So learned counsel for the complainant/Power Holding Company Limited submitted that the impugned order be interfered with to that effect and Insurance Company/O.P.No.1 be directed to pay full sum assured to the complainant/ Power Holding Company Limited.
8. Learned counsel for the Insurance Company/O.P.No.1 submitted that it was the case of the Insurance Company/O.P.No.1 right from very beginning that there was delay of 17 months in providing information to the Insurance Company regarding the death of employee of the complainant/ Power Holding Company Limited and on account of such inordinate delay, the Insurance Company/O.P.No.1, could not investigate the matter. It has been submitted that it was violation of the terms of the insurance policy // 8 // and Insurance Company was not liable and it has rightly repudiated the claim of the complainant/Power Holding Company Limited in respect of death of its one employee Shri Sohar Sai.
9. Counsel for the L.R's of the deceased Shri Sohar Sai/O.P.Nos.2 to 4 submitted that the employer, complainant/Power Holding Company Limited has paid Rs.3,32,580/- to the L.R's of the deceased employee and remaining amount is yet to be paid. It has been submitted by him that Insurance Company/O.P.No.1 be directed to pay this amount directly to the L.R's of the deceased employee to avoid unnecessary official procedure in the office of the complainant/Power Holding Company Limited.
10. We have considered the aforesaid arguments and also perused record of the District Forum.
11. We find that earlier plea of the Insurance Company was turned down by the District Forum vide order dated 28.05.2008 in respect of delay in making claim by observing at paragraph No.10 that as per pronouncement of Hon'ble Supreme Court in the case of Madras Port Trust Vs. Hymanshu International, (1979) 4 Supreme Court Cases 176, "Public authority should not resort to plea of limitation to defeat just claim of citizen, though such plea is permissible under law which can only be taken when the claim is not well founded."
// 9 //
12. Thus, the plea of limitation was turned down by the District Forum by order dated 28.05.2008. When that order was challenged before us by way of Appeal No.388/2008 by the Insurance Company, then at that time, nothing was specifically argued regarding the plea of delay in intimation of the accident. Even before Hon'ble National Commission, when Revision Petition No.14 of 2010 was preferred by complainant/Power Holding Company Limited, then also Insurance Company had not pressed that plea of limitation. Thus, it appears that plea of delay in intimation of accident was merely taken by the Insurance Company in the written version and when it was turned down by the District Forum, then the Insurance Company has not chosen to challenge that finding of the District Forum before State Commission or Hon'ble National Commission and that is why nothing was argued and no finding was given by this Commission as well as by Hon'ble National Commission. Otherwise also from the law laid down by the Hon'ble Supreme Court in the case of Madras Port Trust Vs. Hymanshu International (Supra), it is clear that a nationalized Insurance Company, was not required to resort to plea of limitation to defeat just claim of citizen, which is a claim of an employee, who has lost his life accidentally and regarding which accidental cover was provided by the Insurance Company. No material was brought on record to show that his death was not accidental. On the contrary, // 10 // papers which have been filed before District Forum by the complainant/Power Holding Company Limited are sufficient to show that after full investigation and inquiry, the Police recorded finding that deceased employee accidentally fell down from electric pole on getting electric current and died. Postmortem Report of the deceased also shows that he was having multiple injuries on his body and mode of death has been certified by the Autopsy Surgeon as "accidental" because he died on account of electrocution injuries as well as some external injuries. So considering these documents, we have no doubt in our mind that death of deceased Shri Sohar Sai was not accidental. The claim preferred by the complainant/Power Holding Company Limited was a just claim and therefore, the Insurance Company/O.P.No.1 was not required to take plea of limitation to defeat such just claim.
13. In view of aforesaid, we find that Insurance Company/O.P.No.1 is liable to pay sum assured Rs.4,00,000/- to the complainant/ Power Holding Company Limited and the complainant/ Power Holding Company Limited is required to make payment of the entire amount of Rs.4,00,000/- to the L.R's of the deceased employee. The amount which has already been paid by the complainant/Power Holding Company Limited to the L.R's of the deceased, amounting to Rs.3,32,580/-, may be retained by the // 11 // complainant/ Power Holding Company, but remaining amount of Rs.67,420/- will be paid by it to the L.R's of the deceased Shri Sohar Sai, within a month from its payment by the Insurance Company to the complainant. The entire amount of Rs.4,00,000/- will carry interest @ 6% p.a. from the date of filing of the complaint i.e. 03.04.2007 till date of payment. The cost of litigation is quantified as Rs.2,000/- and it will also be payable by the Insurance Company to the complainant. With these directions, both these appeals are disposed of.
(Justice S.C. Vyas) (Smt. Veena Misra) (V.K. Patil)
President Member Member
/09/2011 /09/2011 /09/2011