ORDER

(Passed on  30/04/2019)

PER SHRI.ATUL D.ALSI, PRESIDENT.

The complainant has filed this complaint U/s 12 of the Consumer Protection Act,1986 against the repudiation of insurance claim amounting to Rs.7,13,960/- alongwith 12% interest thereon and thereby also claiming compensation of Rs.20,000/- towards mental torture and further Rs. 10,000/- towards cost of proceeding.

2.       The facts in short giving rise to this petition are that the complainant is an employer and is engaged in the operation, handling and maintenance of fly ash plant of Chandrapur Thermal power Station, Chandrapur.  For this purpose he has engaged employees.  For the purpose of safeguarding interests of the workers the complainant had insured his 20 unnamed employees vide policy No. 281801/41/16/8600000538 for the period from 13/11/2016 to 12/11/2017 whereby each of the worker was insured for a sum of Rs.50,000/- towards mediclaim and for Rs.5 lac on his life.

3.        The deceased Ranjit Sunderdas Hake was working with the complainant as labour. On 12/8/2017 while on duty, said Ranjit met with an accident and died within the premises of Thermal Power Station, Chandrapur.  Due to the accidental death of a labour while on duty, it created enormous tension amont the workers and due to the pressure of labour organization the complainant had to immediately compensation of Rs.5 lac to the family members of said deceased labour Ranjit.  The information about accrual of accident  was immediately reported to the OP on the same day i.e. 12/8/2017 and on 27/9/2017 the complainant filed insurance claim with relevant documents i.e. death certificate, PM report, copy of Policy, Pan card, Adhar card, TC to the OP. However, despite its receipt, the OP did not acted upon it and hence on 20/11/2017, the complainant issued legal notice to the OP through his advocate but the OP did not respond.

4.                 The deceased was in the employment of complainant and he had drawn a total salary of Rs.1,00,496/- during the period August,2016 to July,2017. At the time of accident said Ranjit was of 42 yrs of age. Therefore, according to provisions of Workman’s Compensation Act, 1923 the relevant factor comes to 178.49 and considering his monthly salary as Rs.8,000/- per month, the legal heirs of the deceased are entitled to 50% of wages multiplied by relevant factor as per compensation schedule amounting to Rs.7,13,960/-.  However, inaction on the part of OP with regard to the said insurance claim amounts to deficiency in service and hence, the complainant has filed this complaint.

5.       The complaint is admitted and notices were served on the OP. The OP filed its reply and thereby denied allegations against them and submitted that though the insurance policy in question is for unnamed workers, yet as per the terms and conditions of the policy it was incumbent on the complainant to submit the list of workers deployed by him to the OP insurance company to cover the risk factor as against Insurance policy. However, in spite of repeated demand the complainant did not submit the said list. In view of this fact, the claim submitted by the complainant was not legal, proper and actionable and therefore there was no necessity to attend the same in view of terms and conditions of the policy.  There is no deficiency in service on the part of OP and, therefore, the petition deserves t o be dismissed with costs.

6.       Counsel for the complainant submitted that the complainant has filed insurance policy of workers, copy of muster card, FIR, spot panchnama, PM report to the OP, but the OP with an intention to avoid its liability did not settle his claim.

7.       Counsel for the OP argued that though the insurance policy in question is for unnamed workers, yet as per its terms and conditions, it was incumbent on the complainant to submit the list of workers deployed by him to the OP insurance company to cover the risk factor as against Insurance policy. However the complainant failed to do so. In view of this fact, the claim submitted by the complainant was not legal, and actionable. Hence the petition deserves to be dismissed with cost.

8.          We have gone through the complaint, written versions filed by OP, affidavit, documents and WNA filed by the parties. We have also heard the oral arguments advanced by parties.

                    Points                                                                                     Finding

1. Whether the complainant is a Consumer ?                                      Yes

2.  Whether  there is deficiency in service on the part of

      OP in repudiating the insurance claim ?                                            Yes

3.  What order ?                                                                  As per final order..

As to issue No.1

9.      The O.P. has not denied the insurance policy in question and as such undisputedly the complainant is the Consumer of OP insurance company.

As to issue No.2

10.      The basic dispute between the parties is as to whether the deceased was in the employment of the complainant at the time of accident. The complainant has filed the copy of insurance policy, PM report, living certificate, death certificate, salary statement to the OP while preferring insurance claim with the OP. The OP has acknowledged receipt of these documents as per receipt dated 27/9/2017 which also bears seal of the OP which is filed by the complainant at Sr.No.4 alongwith list of documents filed on 11/1/2018.

11.    The OP has not denied the accrual of accident and resultant death of Ranjit Sunderdas Hake, in their written version, affidavit and in notes of arguments which is filed on 27/12/2017 neither there is contention of OP that the death of the deceased was not accidental. The only defense put forth by the OP is that at the relevant time of accident, said Ranjit was not in the employment of the complainant. However, the complainant has filed on record salary statement of said deceased Ranjit which makes it amply clear that said Ranjit was in employment of the complainant till his death and has also drawn salary. Therefore, it is proved that the deceased was in employment of the complainant till his death and his death occurred during the course of his employment. Therefore, the complainant is entitled for insurance claim to its maximum limit i.e. Rs.5 lac alongwith interest thereon @10% p.a. from the date of death of deceased worker Ranjit i.e. 12/8/2017 till realization alongwith compensation for physical and mental agony of Rs.20,000/- and cost of proceeding Rs.10,000/-.

As to issue No.3

12.     In view of our observations as above, we pass the following order..

Final order

1. The Complaint is partly allowed.

2. The OP shall pay to the complainant insurance claim amount of Rs.5 lac alongwith interest thereon @10% p.a. from 12/8/2017 till realization and shall further pay compensation for physical and mental agony of Rs.20,000/- and cost of proceeding Rs.10,000/-.

3. Copy of the order be furnished to both the parties free of cost.

(Smt.Kalpana Jangade (Kute)  (Smt.Kirti Vaidya (Gadgil)     (Shri.Atul D.Alsi)

               Member                                 Member                                    President