State Consumer Disputes Redressal Commission
Smt. Bhagmati Bai Verma vs B.M. The Oriental Insurance Co. Ltd. on 4 December, 2010
CHHATTISGARH STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
PANDRI, RAIPUR (C.G)
Appeal No.558/2010
Instituted on : 09/09/2010
Smt. Bhagmati Bai Verma,
W/o Shri Thanuram Verma,
R/o : Camp-2, Quarter No.21, Tata Line,
Bhilai, District Durg (C.G) .... Appellant
Vs.
Branch Manager,
The Oriental Insurance Company Limited.
16, Ravishankar Shukla Market, Power House,
Bhilai, Tehsil & District Durg (C.G)1 ..... Respondent
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 :
Shri Madan Prasad Lodhi, for appellant.
Shri L.K. Joshi, for respondent.
ORDER (ORAL)
DATED : 04 /12/2010 PER :- HON'BLE JUSTICE SHRI S.C. VYAS, PRESIDENT This appeal is directed against the order dated 11/08/2010 of District Consumer Disputes Redressal Forum, Durg (C.G) (hereinafter called "District Forum" for short) in Complaint Case No.177/2010, whereby the complaint of the appellant was allowed in part and Insurance Company, has been directed to pay an amount of Rs.50,000/- under the Group Janta Personal Accident Insurance Policy // 2 // to the complainant/appellant, on account of the fact that two policies were issued by the Insurance Company, in respect of employees of the same C.G. Co-operative Credit Society Limited, Sector 1, Bhilai and under the Insurance Policy, the benefit of the policy, can be provided only to the extent of 100% of the amount mentioned in the policy document and not more than that.
2. The facts of the case are that husband of the complainant/appellant was insured by the respondent under Group Janta Personal Accident Insurance Policy. He was an employee of C.G. Co-operative Credit Society Ltd. Bhilai and premium of insurance policy was paid by the Society. The said insured died on 15/12/2008 by drowning in a Pond, which was an accidental death, then a claim was preferred before the Insurance Company. The Insurance Company repudiated the claim of the complainant, then, a consumer complaint was filed before the District Forum. In reply of which the Insurance Company took the defence that deceased insured was intoxicated at the time of incident and died on account of consuming an intoxicated substance, so no amount was payable under the Insurance Policy.
3. Learned District Forum, after having considered the material place before it by both parties came to the conclusion that the death of the insured, was accidental and therefore, the Insurance Company is // 3 // bound to pay the amount under the Insurance Policy, but District Forum has also taken note of the fact that deceased as well as employees of the C.G. Co-operative Credit Society Limited, who were insured by the Insurance Company under two different Group Janta Personal Accident Insurance Policies and as per Exclusion Clause -3 of the Policy, benefits upto 100% can only be provided and not more than that. Considering this fact, an amount of Rs.50,000/- has been awarded along with further amount of Rs.1,000/- as compensation for mental agony, Rs.1,000/- as cost of litigation and interest @ 6% p.a. on the awarded amount in each complaint case filed by the same complainant, so as to make total aggregate amount of benefit of insurance as Rs.1,00,000/- for the death of one insured.
4. This appeal has been preferred by the appellant on the ground that two different policies, were obtained by the employer of the deceased insured and therefore, Insurance Company was required to pay benefits of both the insurance policies independently. It has also been submitted that in case of some other employees, who died accidentally, the Insurance Company paid separate benefits under two policies and paid Rs.1,00,000/- under each policy to those employees, and therefore, in the case of husband of the present appellant also, amount under each policy Rs.1,00,000/-, should be paid.
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5. We have gone through the record of the District Forum and considered the arguments advanced by both parties.
6. We find that question involved in the matter is not more than res-integra in view of earlier judgment of this Commission in the case of The Oriental Insurance Company Ltd. Vs. Smt. Anika Thakur & ors., in Appeal No.371/2008 dated 19/08/2009, whereby it was held by this Commission "As the insurance cover was provided to the employer of the deceased for minimum sum of Rs.1,00,000/-, therefore only that much sum is payable to the L.R's of the deceased. Policies have been obtained from the different Insurance Companies and both the policies are having such term regarding limit of maximum benefit, which can be provided in a particular claim, then in such a case liability be shared by both Insurance Companies, so that total benefit to the L.R.'s of the deceased may not be more than the sum assured under the Personal Accident Insurance Policy." We find this judgment of this Commission still holds the field. The District Forum has also relied on the same judgment and passed the impugned order. We are of the view that order recorded by the District Forum following order of this Commission, calls for no interference. The law was earlier settled by this Commission and in case of accidental death, the liability of Insurance Company may be under one or more than one policy, then the benefit will be provided upto maximum liability // 5 // of the Insurance Company specified in the Schedule applicable to such insured person and more benefit than the maximum liability has been excluded under Exception No.3 of the Insurance Policy. We find that District Forum has awarded the amount of maximum liability under the Personal Accident Policy as sum assured per person to the complainant in two different cases and therefore, such decision does not call for any interference.
7. So far as the documents, which have been filed by the appellant before us, along with appeal memo are concerned, they are the documents, which have been provided by the employer of the deceased insured, to the complainant containing information that the Insurance Company has paid double benefit to two other employees of the Society. There appears nothing on the basis of which, it can be treated as admission by the Insurance Company that it is liable to pay double benefit under Group Janta Personal Accident Insurance Policy in case of death of a single employee. If the Insurance Company has committed any mistake in case of two other employees, then that never means that terms of the policy can be interpreted on the basis of such mistake committed by the Insurance Company. Therefore, we find that the documents, which have been filed by the appellant before us at the appellate stage, are also of no avail to the appellant.
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8. Thus, the appeal has got no force and is hereby dismissed. No order as to the cost of this appeal.
(Justice S.C.Vyas) (Smt. Veena Misra) (V.K. Patil)
President Member Member
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