Rajasthan High Court - Jodhpur
Smt. Sunita vs State & Ors on 5 September, 2016
Author: Jaishree Thakur
Bench: Jaishree Thakur
IN THE HIGH COURT OF JUDICATURE FOR RAJASTHAN AT JODHPUR ------------------------------------------------
CIVIL WRIT (CW) No. 298 of 2016
Smt. Sunita wife of late Shri Vinod Kumar, Aged about 34 years, Resident of H, Gali No.120, Purani Loco Colony, Near Sati Mata Temple, Ratanada , Jodhpur (Raj.)
VS
1. State of Rajasthan through its Secretary, Medical & Health Department, Secretariat, Jaipur.
2. Additional Director, Department of State Insurance and Provident Fund, Finance Department, D-Block, Second Floor, Janpath, Jyoti Nagar, Jaipur.
3. Deputy Director, Department of State Insurance and Provident Fund, Bima Bhawan, Kachhari Campus, Jodhpur.
4. The Chief Medical and Health Officer, Jodhpur.
Date of Judgment : 5.9.2016
HON'BLE Miss JUSTICE JAISHREE THAKUR
MR. RAJESH PUNIA}, for the Petitioner
MR. YP KHILEREE
MR.PARBAT SINGH FOR MR. N.S. RAJPUROHIT, for the Respondents.
ORDER
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1. The claim in the present writ petition is for release of compensation amount payable under the General Insurance Policy (Group Personal Accident Policy) on account of unnatural death of petitioner's husband along with interest for delayed payment.
2. The petitioner herein is a widow of late Sri Vinod Kumar, an employee of Department of Medical & Health. He being a State employee had subscribed to General Insurance Policy (Group Personal Accident Policy) (hereinafter referred as 'the Policy') and Insurance Certificate No.693918 was issued in his favour under the Rajasthan State Employees Insurance Rules, 1953. Regular deductions were made from his salary towards Group Personal Accident Policy. The husband of the petitioner expired on 12.11.2010 and as per Postmortem Report, the cause of death was stated to be "antemortem head injury". The petitioner thereafter submitted an application in the requisite format along with supporting documents. However, the claim of the petitioner came to be rejected by an order dated 11.03.2013. An appeal against the said order was preferred on 17.05.2013 before the Director, State Insurance & Provident Fund Department but the same was not taken up for consideration and is pending. On denial of release of benefits under the Scheme the petitioner approached the Consumer Forum by filing a Complaint under the provisions of Section 12 of the Consumer Protection Act, 1986. However, the said complaint was returned as not maintainable. Aggrieved against on account of denial of compensation, the present writ petition has been filed.
3. Learned counsel appearing on behalf of petitioner submits that the cause of death as per the postmortem report is mentioned as ''antemortem head injury" and the final report filed by the police also notices that the deceased felt giddy and fell down which resulted in a head injury which became the cause of his death.
4. Per contra, learned counsel appearing on behalf of respondents argues that the claim of the petitioner is not sustainable since her husband did not meet with an accident and died of natural causes.
5. I have heard learned counsel for the petitioner and have perused the record of the case.
6. There is no doubt that the petitioner was a member of the Group Insurance Scheme, 1995. The said Scheme came to be introduced by the Government of Rajasthan for it employees in the Year 1995, with an object to provide social security to its employees and their wards in the event of death or disablement of its employees. As per the Policy in case a person insured sustained any bodily injury which arose solely and directly from an accident caused by external, violent and visible means, the compensation would be paid to the Insured Persons as specified in the Policy. In clause 4 of the Exceptions to the General Insurance Policy (Group Personal Accident Policy) it has been specified in that compensation shall not be payable under this Policy in respect of Death, injury or Disablement of the Insured Person:
"(a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxication liquor or drugs or any such substances whether directly or indirectly caused by or contributed to by it, (c) whilst engaging in Aviation or Ballooning or whilst mounting into dismounting from or travelling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world, (d) directly or indirectly caused by any disease or insanity, (e) arising or resulting from the insured person committing any breach or law with or without Criminal intent, (f) If claim form is received after twelve months of the accident/death (g) If premium is received after death, injuries or accident, (h) If there is violation of Motor Vehicle Act, 1989, (I) Absence of FIR, PMR, FR and other evidences in case of death due to snake bite/poisonous animal, (j) Absence of the FIR, FR, PMR in case of drowning."
7. Counsel for the respondents would argue that the petitioner's case is covered under Clause 4 (d) of the exceptions "directly or indirectly caused by any disease or insanity". It is argued that the husband of the petitioner become giddy, fell down and in this process suffered injury on his head which became the cause of his death. The argument as raised is not sustainable as a reading of the Post Mortem Report and the Final Report as submitted by the police in the FIR, the petitioner's husband was not suffering from any disease as such nor was he insane. The deceased on account of his giddiness fell down and struck his head . The actual cause of his death was on account of the head injuries suffered and it cannot be said that a young man of 35 years had a 'disease'. Therefore, repudiation of the claim by invoking Clause 4 (d) of the exception of the Policy is not maintainable.
8. There is no other clause or provision in the said Policy which would not entitle the petitioner from the claim. The object of the Scheme as mentioned is to secure the family of the deceased financially. In the instant case, the petitioner has complied with all the formalities as stipulated in the Insurance Scheme by lodging an FIR and has also got a postmortem done. The interpretation as given out that the petitioner's husband died of natural causes is fallacious since postmortem report itself shows that the petitioner's husband died due to "antemortem head injuries". The deceased was not suffering from a disease or insanity to not entitle the petitioner from being entitled to claim compensation under the Insurance Scheme.
9. Resultantly, the writ petition is allowed. The impugned order dated 11.03.2013 passed by Additional Director, State Insurance & Provident Fund Department, Jaipur is quashed and set-aside and respondents are directed to release the amount due within two months from today along with 6% interest on the said amount.
( JAISHREE THAKUR ),J.
mamta 6