State Consumer Disputes Redressal Commission
Sr. Divisional Manager, The New India ... vs Sh. Jagdish Lal And Others on 19 April, 2006
STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARANCHAL - 2 - STATE CONSUMER DISPUTES REDRESSAL COMMISSION UTTARANCHAL DEHRA DUN FIRST APPEAL NO. 184 / 2005 Sr. Divisional Manager, The New India Assurance Co. Ltd. ......Appellant Versus Sh. Jagdish Lal and Others .....Respondents Sri M.N. Mishra, Learned Counsel for the Appellant Sri S.K. Gupta, Learned Counsel for the Respondent No. 1 None for Respondent Nos. 2 to 4 Coram: Hon'ble Justice Irshad Hussain, President Surendra Kumar, Member Dated: 19.04.2006 ORDER
(Per:
Mr. Justice Irshad Hussain, President):
This is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 13.07.2005 passed by the District Forum, Chamoli.
2. The facts in brief, which led the complainants to approach the District Forum, are as below:
In the month of March - April 2003 Three Phase Panchayat Elections were conducted by Rajya Nirvachan Ayukt, Uttaranchal. It purchased a policy of Group Personal Accident Insurance of Govt. Employees, Security Personnel and Driver / Cleaner of Govt. / Private Vehicles entrusted with election duty and sum insured per person was Rs. 5,00,000/-. Polling dates were 21st, 24th and 27th March 2003 and counting was scheduled for 30th March 2003 (Paper Nos. 71 to 73). Late Sh. Sant Lal, an employee of District Youth Welfare and Development Office, Chamoli (Gopeshwar) was assigned election duty as Security Volunteer and was thus covered under the said Group Personal Accident Policy of the insurer. He had reported for the election duty and reached the Polling Station of Booth No. 12 of Jorasi, District Chamoli on 22.03.2003 alongwith other personnel on election duty. He, however, left that place in the early hours of 24.03.2003 at about 3:15 A.M. and did not return alive at the said Polling Station and finally his dead body was found lying with injuries within the Patwari Circle Trishula, District Chamoli. After necessary formalities, the dead body was dispatched for postmortem which was performed on 03.04.2003 at 4:30 P.M. and it was reported that the death was due to shock and haemorrhage as a result of anti-mortem injuries about 4 to 5 days ago (Paper Nos. 62 &
63). The dead body was partially decomposed and 3rd, 4th and 5th ribs of right chest were fractured on lateral side. The beneficiaries, the three sons of the deceased, under the policy of the insurance preferred claim, which was repudiated by the insurer on 16.03.2004 on the following grounds:
That Sh. Sant Lal left the Polling Station at 3:15 A.M. on 24.03.2003 without prior information and permission of the competent officer and as such he did not attend to election duty on that date.
As per the Postmortem Examination Report, the death of late Sh. Sant Lal occurred probably after 26.03.2003 and whereas the risk covered under the policy was from 21.03.2003 to 26.03.2003.
The claim preferred thus did not fall within the purview of the Group Insurance Policy obtained by the insured, Rajya Nirvachan Ayukt, Uttaranchal.
The beneficiaries, who are the complainants, approached the District Forum for Redressal of their grievance alleging deficiency on the part of the insurer in repudiating the claim malafidely.
3. The defence taken by the insurer was mainly based on the grounds of repudiation of the claim as stated above besides alleging that its independent investigator Sh. Anil Maikhuri vide investigation report dated 29.08.2003 found the claim as not genuine.
4. The District Forum on an appreciation of the material on record came to the conclusions that the Group Accident Insurance of the employees was effective from 21.03.2003 to 29.03.2003; that late Sh. Sant Lal was assigned election duty for two phases viz. 24.03.2003 and 27.03.2003 and was thus on election duty w.e.f. 21.03.2003 to 29.03.2003; that the death of late Sh. Sant Lal probably took place either on 29.03.2003 or prior to it and that too accidentally probably after he was made to leave the Polling Station and thus kidnapped and done to death. With these conclusions, the District Forum was of the opinion that the insurer did not act bonafidely in repudiating the claim and thus made deficiency in service and the complaint was accordingly allowed awarding the compensation of Rs. 5,00,000/- together with interest @5% from the date of filing of the complaint before the District Forum till the date of the payment and Rs. 1,000/- as costs of the litigation.
5. Aggrieved by the impugned order dated 13.07.2005, the insurer preferred this appeal.
6. We have heard the Learned Counsel for the appellant and respondent No.
1. None appeared on behalf of respondent Nos. 2 to 4 before us to put forward arguments in the appeal and have carefully considered the submissions of the Learned Counsel in the light of the legal aspects of the case and the material on record. At the outset, it need to be stated that the insurer obtained report from its investigator Sh. Anil Maikhuri which is dated 29.08.2003 (Paper Nos. 16 to 20) and this led to make some queries by the insurer from the District Magistrate, Chamoli particularly about the days for which late Sh. Sant Lal was assigned election duty, vide letter dated 17.09.2003 (Paper No. 46). In response to this, the District Magistrate reported that late Sh. Sant Lal was assigned duty for two phases of the election scheduled for 24th and 27th March 2003 and he was not relieved from his election duty till date (Paper Nos. 48 & 49). The revised election schedule of the insurance policy (Paper No. 72) indicate that it was effective, including both the polling dates, from 21.03.2003 to 29.03.2003. In view of the letter of the District Magistrate, it cannot be doubted that Sh. Sant Lal was assigned duty for the above two phases of election. In the opinion of the Medical Officer who performed the postmortem examination, the death occurred 4 to 5 days before 03.04.2003. Considering the period of death given and the partial decomposed dead body of the victim, there could be, on medico-legal considerations, a difference of 2 or 3 days in the duration of the death and in that eventuality the death of the said victim would have even occurred on 29.03.2003 and even a day or two before it. Therefore, the District Forum was justified in coming to the conclusion that the death of the victim had probably occurred before 29.03.2003 and we see no merit in the argument of the Learned Counsel for the appellant that on the basis of the opinion of the Medical Officer, the death of the deceased could only be held to have taken place after 29.03.2003. On this account, we are inclined to disagree with the observation of the investigator Sh. Anil Maikhuri made in his report dated 29.08.2003 to the effect that the death of late Sh. Sant Lal had taken place beyond the duration of the election duty. Therefore, the same could not have legally been made a ground to repudiate the claim preferred under the Insurance Policy.
7. As is evident from the grounds of repudiation of the claim, it is not in dispute that late Sh. Sant Lal was on election duty on 24.03.2003 and he suddenly left the Polling Station in the early hours of the morning on that day at about 3:15 A.M. and thereafter did not return to the Polling Station and was not seen alive. Considering the peculiar feature of the case, the question which arise for consideration is whether or not the death of late Sh. Sant Lal was accidental? It is well known that a dictionary meaning of the word "accidental" is happening by chance or not expected. Perusal of the Postmortem Examination Report (Paper Nos. 62 & 63) clearly reveal that there were large numbers of abrasions on various parts of the body besides a small lacerated wound on the left eye brow. Nothing abnormal was detected in any vital organ of the body except that the three ribs of the right chest were fractured. The seat and nature of the anti-mortem injuries are suggestive of the fact that these were probably sustained on account of fall from a hillock into a deep ravine and these do not naturally appear to be result of some external deliberate and designed assault on the victim. To us it appear that late Sh. Sant Lal suddenly left the Polling Station in the early hours of 24.03.2003 on account of some urgency such as natural call and due to darkness of the early hours of the morning got strayed and ultimately met his end in all probability due to fall into a deep ravine of the locality known as Trishula, from where his dead body was retrieved and sent for postmortem. In the peculiar circumstances of the case, we do not find it safe to subscribe to the observation of the District Forum that late Sh. Sant Lal was perhaps kidnapped and was thereafter assaulted to death. In the face of the facts of the case and the inferences drawn by us from the material on record, the written submission of the Learned Counsel for the complainants that it was either a case of kidnapping coupled with murder or a case of some quarrel at the place of the Polling Station and thereafter total neglect of the victim till his death clearly appear to be out of tune and the appellant cannot be permitted to make capital out of it and to assert that the probability, of death being accidental, is completely ruled out. It shall also not be out of place to mention that the claim under the policy was not repudiated on the ground that the death of late Sh. Sant Lal was not accidental.
8. In view of the discussion aforesaid, we are of the firm view that the death of late Sh. Sant Lal fall in the category of the accidental death duly covered under the Insurance Policy taken by the insured for the benefit of the employees deputed and assigned election duty.
9. For the reasons and inferences drawn above, we are convinced that the claim under the Group Insurance Policy preferred by the beneficiaries, the sons of the victim late Sh. Sant Lal was repudiated malafidely by letter dated 16.03.2004 and it was a case of deficiency in service as also held by the District Forum vide its order dated 13.07.2005. There is no merit in this appeal, the same is liable to be dismissed.
10. Appeal is dismissed. No order as to costs.
(SURENDRA KUMAR) (JUSTICE IRSHAD HUSSAIN)