State Consumer Disputes Redressal Commission
Smt. Batisiya Devi vs Branch Manager, United India Insurance ... on 17 January, 2012
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G.)
(A/11/2599)
Appeal No.318/2011
Instituted on : 01.06.2011
Smt. Batisiya Devi,
W/o Late Shri Ramchandra Bhagat,
R/o : Near Government Primary School,
Vrindanagar Camp - 1,
Bhilai, Teshil & District - Durg (C.G.) .... Appellant.
Vs.
1. Branch Manager,
United India Insurance Company Limited,
Branch Office - Tara Complex, Power House, G.E.Road,
Bhilai, Tehsil & District - Durg (C.G.)
2. Junior Manager (Personnel),
Steel Employees Welfare Association (SEWA),
Bhilai Steel Plant,
Bhilai, Tehsil & District - Durg (C.G.) .... Respondents.
PRESENT :
HON'BLE SHRI JUSTICE S.C. VYAS, PRESIDENT
HON'BLE SHRI V.K. PATIL, MEMBER
COUNSEL FOR THE PARTIES :
Shri R.K. Bhawnani, for appellant.
Shri Shekhar Amin, for respondent No.1.
Respondent No.2, present in person..
ORDER (ORAL)
DATED : 17/01/2012 PER :- HON'BLE SHRI JUSTICE S.C. VYAS, PRESIDENT The only ground of challenge of the impugned order, passed by the District Consumer Disputes Redressal Forum, Durg (C.G.) (hereinafter called "District Forum" for short) on 30.04.2011, in Complaint Case No.409/2010 is that, the deceased was covered under // 2 // three different insurance policies and the total sum assured under three policies was Rs.4,50,000/-, and therefore, the appellant herein, was entitled to receive that much amount from the Insurance Company and the District Forum has committed an error in awarding only Rs.2,00,000/- under all three insurance claims.
2. Briefly stated, the facts of the case are that, husband of the complainant, Shri Ramchandra Bhagat, was an employee of Bhilai Steel Plant and was covered under three different insurance policies by respondent No.1/Insurance Company against accidental death. The said policies were issued in favour of Members of M/s. Steel Employees Welfare Association. The insured died an accidental death on 13.07.2010, therefore, three different claims were preferred by the complainant before Insurance Company, under each of the policy. The claims of the complainants were repudiated by the Insurance Company, on the ground that deceased insured was driving the vehicle at the time of accident under the influence of liquor and therefore, under the Exclusions Clause of the policy, nothing was payable to the L.R. of the deceased.
3. Learned District Forum, has not agreed with the Insurance Company on the question that death of the deceased insured come under any of the Exclusions Clause, but, so far as amount payable by the Insurance Company to the L.R. of the deceased is concerned, the District Forum agreed with the Insurance Company and concluded // 3 // that under the terms of the policy, Rs.2,00,000/- only was payable and on this finding the impugned award has been passed.
4. Learned counsel for the appellant has argued before us that, as the death of the insured was covered under three different insurance policies and the terms of the insurance policies were never made known to the deceased insured, therefore, L.R. of the deceased is entitled to get the sum assured, under each of the insurance policy and District Forum has committed a mistake in awarding lesser amount, whereas, learned counsel for the respondent No.1/Insurance Company relying upon the Exclusions Clause of the Insurance Policy submitted that District Forum has passed just and appropriate award and such award does not call for any interference.
5. We have considered the aforesaid arguments and gone through the record of the case.
6. We find that respondent No.1/Insurance Company has issued Rural Accident Package Policy in favour of Members of M/s. Steel Employees Welfare Association, and under that policy the Members of the Society were insured against accidental death or loss of toes, loss of hearing, loss of four fingers etc. The relevant provisions, as per terms & conditions of the Rural Accident Package Policy contained in page No.3 of the policy are as under :-
// 4 // "NOW THIS POLICY WITNESSETH that subject to the terms, exclusions, definitions and conditions contained herein or endorsed or otherwise expressed hereon the company will pay the insured as hereinafter as mentioned :
I. Death only Cover :
If at any time during the currency of this policy, the insured shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means and if such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the death of the insured then the Company shall pay to the assignee the Capital Sum Insured stated in the Schedule hereto.
II. Standard cover :
If at any time during the currency of this policy, the insured shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means, then the Company shall pay to the insured or his assignee as the case may be, the sum or sum hereinafter set forth that is to say :-
a) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the death of the insured, the Capital Sum Insured stated in the Schedule hereto.
b) If such injury shall within twelve calendar months of its occurrence be the sole/or direct cause of the total and irrecoverable loss of :-
(i) Sight of both eyes, or the actual loss by physical separation of the two entire hands or two entire feet, or one entire hand and one entire foot or such loss of sight of one eye and such loss of one entire foot or one entire hand, the Capital Sum Insured stated in the Schedule hereto.
(ii) Total irrecoverable loss of use of both hands or two feet or one hand and one foot, the Capital Sum Insured stated in the Schedule.
c) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of :
// 5 //
(i) The sight of one eye or of the actual loss by physical separation of one entire hand or one entire foot, fifty percent (50%) of the Capital Sum Insured stated the Schedule hereto.
(ii) Total and irrecoverable loss of use of a hand or a foot without physical separation, fifty percent (50%) of the Capital Sum Insured stated in the Schedule hereto.
NOTE : For the purpose of clause (b) and (c) above physical separation of hand or feet means separation at or above the wrist and at or above the ankle respectively.
(d) If such injury shall within twelve calendar months as a direct consequence thereof permanently, totally and absolutely disable the insured from engaging in any employment or occupation of any description, whatsoever, then a Lump Sum equal to hundred percent (100%) of the Capital Sum Insured.
III. Comprehensive Cover :
If the insured sustain any bodily injury resulting solely and directly from accident caused by external , violent and visible mean then the Company shall pay as per clauses of (a) (b) (c) and (d) above to the insured or his assignee as the case may be : such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of use of or the actual loss of or physical separation of the following then the percentage of the Capital Sum Insured as indicated below shall be payable. ................
................"
The Exclusions Clause of the Policy reads as under :-
"EXCLUSIONS The Company shall not be liable under this policy for :-
1. Payment of compensation in respect of death, injury or disablement of insured
(a) from intentional self injury, suicide or attempted suicide.
(b) whilst under the influence of intoxicating liquor or drugs.
// 6 //
(c) whilst engaging in aviation or ballooning into dismounting from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise).
1.............
2.............
3............."
4. SPECIFIC EXCLUSIONS FOR ACCIDENTAL COVER :
The Company shall not be liable under this policy for :
(i) Compensation under more than one of the foregoing sub clauses in respect of the same period of disablement.
(ii) Any other payment after a claim under one of the sub clauses (a), (b), (c) or (d) has been admitted and become payable.
(iii) Any payment in case of more than one claim under the Policy during any one period of insurance by which the maximum liability of the Company in that period would exceed the sum insured under the policy.
5......................"
7. From this EXCLUSIONS Clause, it is clear that the Insurance Company was not liable under the policy for any payment in case of more than one claim in respect of such insured person under the policy during any one period of insurance by which the maximum liability of the company in that period would exceed the sum payable under the policy to such insured person, can never exceed the sum mentioned in the policy.
8. In view of this, we find that District Forum has not committed any error in awarding an amount of Rs.2,00,000/- in respect of // 7 // accidental death of a Member of the Society covered under three different policies, might have been obtained at different point of time, but, were for the same period. The Exclusions Clause of the Policy is very much clear and it restricts the liability of the Insurance Company to the sum, which has been mentioned in the policy for a single person for a duration.
9. Thus, we do not find any error in the order passed by the District Forum. The appeal has got no substance and is hereby dismissed. No order as to the cost of this appeal.
(Justice S.C. Vyas) (V.K. Patil)
President Member
/01/2012 /01/2012