State Consumer Disputes Redressal Commission
The Oriental Insurance Co. Ltd vs Smt. Kamla Devi & Others on 15 February, 2013
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION
PANDRI, RAIPUR
Appeal No.FA/12/322
Instituted on 05.07.12
The Oriental Insurance Co. Ltd.,
Through: Its Sr. Divisional Manager,
Divisional Office - Geetanjali Bhawan, Main Road,
KORBA(C.G.) ... Appellant.
Vs.
1.Smt. Kamla Devi, W/o: Late Shri Leela Ram, R/o: Paraspani, Bartunga Colliery, P.S.Chirmiri, Dist. KOREA (C.G.)
2. General Manager, SECL, Chirmiri Area, Head Office, Malviya Nagar, West Chirmiri, P.S. Podi, Tah. Baikunthpur, Dist. KOREA (C.G.)
3. C.M.D.SECL, Seepat Road, Bilaspur, Dist. BILASPUR (C.G.) ... Respondents.
PRESENT: ‐ HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT COUNSEL FOR THE PARTIES: ‐ Shri R.N.Pusty, for appellant.
Shri Santosh Yadav, for respondent no.1.
Shri O.P. Agrawal, for respondent nos.2&3.
ORDER Dated:15/02/2013 PER: ‐ HON'BLE JUSTICE SHRI S. C. VYAS, PRESIDENT This appeal, of the insurance company, has been preferred feeling aggrieved by order dated 06.06.12 of District Consumer Disputes Redressal Forum, Baikunthpur-Korea (hereinafter called "District Forum" for short) in complaint case No.20/2010, whereby the insurance company has been directed to pay Rs.5,00,000/‐ to the // { PAGE \* MERGEFORMAT } // respondent No.1 / complainant along with interest @ 9% p.a. from the date of order till the date of payment on account of death of husband of the respondent No.1 / complainant in an accident.
2. Briefly stated the facts of the case are that the appellant insurance company and the SECL i.e. South Eastern Coalfields Ltd., which was employer of husband of the complainant, entered into an agreement of Group Janta Personal Accident Insurance Policy in respect of permanent employees and their spouse for a period between 16.10.1999 to 15.10.2009 on payment of premium. As per terms of the agreement entered between the parties in the event of accidental death of the employee Rs.5,00,000/‐ was to be paid by the insurance company to the LRs of the employee. Husband of the complainant died on 16.12.07 and the case of the complainant was that he died an accidental death. Thereafter on 10.09.09, she moved an application before the employer for payment of amount of group insurance. The insurance company vide letter dated 20.11.09 informed the complainant that the claim is not acceptable and thus repudiated the claim. Then consumer complaint was filed before the District Forum. The defence of the insurance company was that the contract of insurance with the employer was already cancelled by the insurance company and the // { PAGE \* MERGEFORMAT } // amount of premium was also refunded and thereafter the insurance company was not liable to pay any amount to any of the employee. This defence was also taken that as per the terms of the insurance contract information to the insurance company was not given within 15 days from the date of incident and so also the claim was not payable and thus the insurance company has not committed any deficiency in service in dismissing the claim. The fact of accidental death of the deceased was also challenged by the insurance company.
3. Learned District Forum after having considered the rival contentions of all parties allowed the complaint and directed the insurance company to pay the sum assured.
4. I have heard arguments advanced by all parties and perused the record of the District Forum.
5. So far as cancellation of Group Janta Personal Accident Insurance Policy is concerned in a catena of cases, this Commission has already decided that unless individual notice for cancellation of insurance policy is given along with refund of pro rata premium, the contract of insurance cannot be cancelled by the insurance company // { PAGE \* MERGEFORMAT } // unilaterally. Therefore, this defence of the insurance company was having no substance and has rightly been dismissed by the District Forum.
6. Learned counsel for the appellant has further contended that there is no certificate of insurance filed by the complainant and there is nothing on the basis of which it can be said that premium on behalf of the deceased was paid to the insurance company. To counter this argument, learned counsel for the respondent No.1 / complainant has drawn our attention towards Group Janta Personal Accident Insurance Policy issued by the insurance company, which provides that all the permanent employees of Hasdeo, Baikunthpur, Johilla, Bishrampur, Sohagpur, Korba, Raigarh, Bhatgaon, Chirimiri, Gavra Areas and Head Quarter Bilaspur and their Spouse, were the persons who were insured under the policy and the sum assured was Rs.5,00,000/‐ per permanent employee and Rs.1,00,000/‐ per spouse. Thus, under this policy insurance cover was extended to all the permanent employees of SECL, working in different areas, which have been enumerated in the policy document and for that purpose lump sum premium of Rs.3,30,00,000/‐ was paid by the SECL to the appellant insurance company, which was accepted.
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7. The complainant has brought on record the information received from the Office of SECL under Right to Information Act. This certificate was issued by the Senior Officer (Personnel) of Chirimiri Underground Block, certifying therein that deceased Leelaram S/o. Mahadeo was working in Chirimiri Underground Block on the post of Hammer‐Man and as per the available record in the Office in the month of August 1999 an amount of Rs.175.00 and in the month of September 1999 Rs.309.00, total Rs.484.00 was deducted from his salary. As per Office record, the wife of the insured worker Smt. Kamla Devi was nominated by him under Group Janta Personal Accident Insurance Policy. Another document further clarifies that amount was deducted from the salary of Leelaram in respect of Group Janta Personal Accident Insurance Policy. From these documents it is clear that the amount of premium was deducted from the salary of the employee. It is further clear that for its all the permanent employees lump sum premium was paid by the employer to the insurance company and therefore the deceased Leelaram was very well covered under the Group Janta Personal Accident Insurance Policy, so far as the question of payment of premium and deduction of premium amount from his salary is concerned.
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8. Next contention of learned counsel for the appellant is that death of the Leelaram was not accidental and there is no material or evidence on the basis of which it can be said that he died accidentally. In this regard, learned counsel for the insurance company has drawn our attention towards postmortem report of the deceased Leelaram and submitted that the Doctor who conducted autopsy has not expressed any opinion regarding cause of death and preserved viscera and left tibial bone for examination and sent to F.S.L. It has been submitted that no F.S.L. report has been filed by the complainant, therefore it cannot be said that the death was accidental. It has further been submitted by him that when dead body was recovered near a pond of water, then it was found that he was merely wearing underwear and rest of the body was naked. It has been noted by the police that depth of the water at the place of incident was only 1 ft. This much depth is not sufficient for drowning and one can easily come out from water to save life, so it has been submitted that on the basis of inquest report and postmortem report it cannot be held that the death was accidental.
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9. I have very minutely considered the postmortem report and inquest report. In the application for conducting postmortem it has been noted by the Police Officer that the dead body was recovered from Fatarra nullah where there was water and the deceased was found in naked condition and was wearing only underwear. Foul smell was coming from the dead body and no definite opinion has been received regarding the cause of death. In the postmortem examination report, in the column of examination of dead body from the outside it has been found that pupils of both eyes hazy, conjectiva pale, eye closed and edematms. Living white maggots present in nares of nose. Eruption of skin was found present on both lateral side of the face below eye. Right hand dorsal side irrupted. On external examination, it appears that some remarkable injuries could be noticed. On postmortem it was found that there was haemetoma around the left knee joint, black colour blood in cutting section. The scalp and brain were found healthy and the spine was intact. In the chamber of heart 100 ml blood stained fluid was present. Another chamber was found empty. Lungs were found healthy and congested. On cut section frothy blood was found. In pericardium 50 ml blood fluid was present. There was complete dislocation of upper end of tibia fibula bone along with knee joint. Haematoma of left knee joint at // { PAGE \* MERGEFORMAT } // lower limb. There was also sow edema of left thigh after cutting sow black colour blood around it.
10. In the inquest report it was noted that the spot Fatarra nullah was a lonely place in jungle which was around 30 ft. deep from the ground level, where dead body was found. When we consider this observation along with injuries which were found and posture of body of the deceased then it appears that the deceased must have fell down from the ground level in the nullah, suffered fractures, dislocation of lower limbs, then became unable to move and ultimately died on the spot itself. Thus, though the Doctor has not expressed any definite opinion regarding cause of death but from the circumstances it appears that the death was not natural and it was accidental in nature on account of fall in a deep nullah from the ground level causing breaking of knee joint and sustaining fractures, which prevented him from any movement from the spot, as it is not possible for any person to climb height, who fell down from a height of 30 ft. and having total dislocation of tibia bone and fibula along with knee joint, so he died. In these circumstances, death of the insured clearly appears to be accidental and is very well covered under Group Janta Personal Accident Insurance Policy, issued by the appellant insurance company.
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11. Last contention of learned counsel for the appellant is that the claim of the complainant was rejected on 20.11.09 and then the complaint was filed on 11.03.10 and there is no application for condonation of delay.
12. It is true that the incident of accidental death of the deceased happened on 16.12.07, but thereafter the complainant was moving to the employer, writing to it and police was also conducting investigation in the matter to ascertain as to what was the cause of death. Ultimately, on 08.09.09 a closure report was recorded by the police, in which it has been reported that report regarding death of Leelaram was written in the Police Station Chirimiri on 16.12.07 and Merg No.66/2007 under Section 174 of Cr. P.C. was registered. Postmortem has been conducted. Now viscera have been deposited with the F.S.L. Raipur. Test report was not received and thus, the inquiry of the police was incomplete by that time. Thus, nothing definite was said by the police and that is why the complainant was having no other option but to wait for final words from police for some more time. But there appears immediate action after receiving the report from the police and immediately after two days on 11.09.09 she // { PAGE \* MERGEFORMAT } // moved an application before the insurance company claiming benefits under the Group Janta Personal Accident Insurance Policy and then on 14.09.09 the insurance company directed her to produce the insurance certificate, death certificate and documents of criminal case. It is worth mentioning that along with application dated 11.09.09 copy of death certificate, copy of Merg Intimation, copy of application for postmortem examination and copy report of postmortem were also submitted and as per the case of the complainant, separate insurance certificate was not provided, so she moved an application on 05.11.09 to that effect and again submitted all the available documents to the insurance company, but the insurance company vide letter dated 20.11.09 has rejected her application solely on the ground that the policy in question has already been cancelled and therefore her claim cannot be entertained. This letter was basing upon erroneous interpretation of law and assumption of facts and therefore it cannot be said that the claim was properly repudiated by the insurance company and even if I treat this letter as repudiation of claim, then also the complaint before District Forum was filed within four months from the date of this letter of repudiation and so it cannot be said that the complaint has been filed late.
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13. Learned counsel for the appellant insurance company has drawn attention towards pronouncement of Hon'ble Supreme Court in the case of Kandimalla Raghavaiah & Co. Vs. National Insurance Co. Ltd. & Anr., 2010 AIR SCW 2528. That was a case of fire insurance policy and the claim before District Forum was filed after 9 years from the date of incident, which was found beyond the prescribed period of two years. In that case plea of the appellant was that the delay was on account of pendency of criminal case filed by the Bank and failure of the Bank to convey result of the criminal case to him. It was not found relevant. It appears that the facts of that case were altogether different. Here in the facts of the present case immediately after the incident, the complainant moved to the employer and thereafter to the insurance company. But the insurance company has merely denied its liability on the ground that the policy in question has been cancelled. That ground was erroneous and was not tenable, as per the settled legal position and therefore it is clear that the insurance company has not rejected the claim on a legal ground or valid reasons. Even from the date of that letter of rejecting claim the complaint has been filed within two years and so, it cannot be said to be barred by limitation.
14. In view of the aforesaid, I find that the District Forum has not committed any error in allowing the complaint of the respondent No.1 // { PAGE \* MERGEFORMAT } // / complainant and directing the appellant insurance company to pay the Sum Assured. The impugned order does not suffer from any infirmity and call for interference. The present appeal fails and is dismissed. No order as to cost.
(Justice S.C.Vyas) President /02/2013