BEFORE:

HON’BLE MR. SUBHASH CHANDRA, PRESIDING MEMBER

HON’BLE DR. SADHNA SHANKER, MEMBER

For the Appellant         Mr. Amit Kumar Singh, Mrs. Enatoli Sema and

Mr. A. Orenvungo Ezung, Advocates      

For Res. nos.1-3          Mr. Byrapaneni Suyodhan and

Mr. Kumar Shashank, Advocates

                                Mr. Abhishek Gupta, and Mr. Kapil Raghav,

                                Advocates for RINL                     

ORDER

PER MR SUBHASH CHANDRA

1.     The challenge in this appeal under Section 51 of the Consumer Protection Act, 2019 (in short, ‘the Act’) is to the order dated 10.06.2022 in Complaint No.5 of 2019 of the A.P. State Consumer Disputes Redressal Commission, Vijayawada (in short, ‘the State Commission’) allowing the complaint in part and directing OP Nos.1 to 3 (Appellants No. 1 to 3 herein) to pay the sum assured under the Group Insurance Policy with interest @ 9% p.a. from the date of repudiation till realization along with costs to the Complainant/Respondent No.1 within two months from the date of the order while dismissing the complaint against Opposite Party/Respondent No.4.

2.     This order will also dispose of FA nos. 756 to 762 of 2022 which are also related to the same issue, i.e., repudiation of claim under the Group Insurance Policy in question in respect of employees of respondent no.4 on whose behalf the insurance cover for life had been obtained by respondent no. 4.

3.     We have heard the learned counsel for both the parties and carefully considered the material on record.

4.     For the reasons stated in the application for condonation of delay, the delay of 85 days in the filing of FA no.755 of 2022 was condoned in the interest of justice.

5.     The relevant facts in FA no.755/2022 are that the Respondent No.4, which is a Public Sector Undertaking, had obtained a Group Insurance Policy  covering personal accident insurance in respect of its employees called the Personal Accident Insurance Policy (Group) (in short, ‘the Policy’) and paid premium of Rs.7,60,77,419/- including GST vide proposal dated 01.04.2016. Based on the category of the employee, the Policy provided for different amounts of insurance to a life covered. Under this Policy, the insured employees in the Schedules attached to the Policy were covered for accident and injury which was to be verified and certified by a medical practitioner.  Coverage included death of the insured person due to “accident” as defined in the Policy outside his/her residence and under a Special Free-Benefit, in addition to the amount payable under Sub Clause 1(a), a lump sum of 2% of capital sum insured or Rs.25,000/-, whichever is less, was payable for transportation of the insured person’s dead body to the place of residence. As per the Policy, an ‘accident’ was defined as a sudden, unforeseen and involuntary event caused by external, visible and violent means. As per the Policy, an ‘injury’ was defined as an accidental, physical bodily harm including illness or disease solely or directly caused by external, violent and visible and evident means which is verified and certified by a medical practitioner. Under the Policy, if such injury, within 12 calendar months of its occurrence, was the sole and direct cause of the death of the insured person, the capital sum insured under the policy was applicable to such person. Exceptions to this policy included the following:

“Payment of compensation in respect of Death, injury of Disablement of the Insured person (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or Ballooning whilst mounting into, dismounting from or traveling 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 venereal diseases, aids or insanity, (e) arising or resulting from the insured person committing any breach of law with criminal intent, (Standard type of Aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned OR chartered OR operated by a regular airline OR whether such an aircraft has a single engine or multi engine.

(6)  Payment of compensation in respect of Death, Injury or Disablement of the Insured person due to or arising out of or directly of indirectly connected with or traceable to: War, Invasion, Act or foreign enemy, Hostilities (whether war be declared or not), Civil War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power Seizure, Capture, Arrests, Restraints and Detainments of all kings, princes and people of whatesoever nation condition or quality.

The policy also provided for payment of compensation as stated below in the policy:

7. Payment of Compensation in respect of death of, or bodily injury or any disease or illness to the Insured person-

(a) directly or indirectly caused by or contributed to by or arising from ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self-sustaining process of nuclear fission.

(b) directly or indirectly caused by or contributed to by or arising from nuclear weapons material.

Provided also that the due observance and fulfillment of the terms and conditions of this Policy (which conditions and all endorsements hereon are to be read as part of this Policy) shall so far as they relate to anything to be done or not to be done by the Insured and/or Insured person be a condition precedent to any liability of the Company under this Policy.”

6.     The claim procedure provided for a written notice with all particulars to be given to the company immediately upon an event resulting in the rise to a claim and, in the case of death, unless reasonable cause was shown, to be given before internal crimination and, in any case, within one calendar month of the death. It was also stated that:

“The Company shall not be liable under this Policy for:

1. Compensation under more than one of the foregoing Subclauses in respect of the same period of disablement of the Insured person

2. Any other payment to the same person after a claim under one of the Sub-Clauses (a), (b), or (d) has been admitted and become payable. However, amounts relating to medical expenses, carriage of dead body would be payable in addition, if applicable.

3. 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 specified in the schedule applicable to such Insured person would exceed the sum payable under sub-clause (a) of this Policy to such insured person. However, amount relating to medical expenses and carriage of dead body would be payable in addition if applicable.”

7.     Respondent No.1, Kare Suneetha, filed a claim in respect of the accidental death of her late husband, Kare Nagaraju, working as a foreman, RINL (Employee No.11372) who died in an accidental death in the scooter parking area near his house on 07.12.2016 after he left for work at 8.45 a.m. The body was discovered at around 11 a.m. by his wife and was shifted to Vizag Steel Govt. Hospital by summoning friends of the deceased where the hospital authorities declared him “brought dead” to the Casualty Ward at 12.25 p.m. The Police registered a case under Section 174 Cr. PC in CR No. 151 of 2016 and the body was sent to King George Hospital for postmortem examination. On 08.12.2016, the postmortem report concluded the cause of death as “head injury”. The AGM (F&A), RINL intimated the death of the said Kare Nagraju on 14.12.2016 to the Insurance Co. and thereafter, on 31.03.2017, the claim form with requisite documents under the Policy was submitted to settle the claim. On receiving the claim application, the Insurance Co. appointed a Surveyor/Investigator to investigate the cause of death of the insured. Based on the Postmortem Certificate and other documents, the Police closed the case under Section 174 of Cr.PC, vide proceedings dated 04.06.2017. On 22.03.2018, the Investigator appointed by the appellant submitted a report stating that the death was not accidental in nature and therefore the claim was not payable. On the basis of this report, the claim was repudiated. Aggrieved by the repudiation, Respondent Nos.1 to 3 filed Consumer Complaint No.5 of 2019 before the State Commission which came to be decided on contest, through order dated 10.06.2022, partly allowing the appeal and directing the Appellant Nos.1 to 3 to pay Rs.31 lakhs with interest @ 9% p.a. from the date of repudiation (10.05.2018) till the date of realization with Rs.25,000/- towards cost within two months from the date of order. This order is impugned before us.

8.     The grounds of appeal taken by the Appellant are that (i) the State Commission exceeded its jurisdiction and acted with material irregularity in not appreciating the fact that there was no intimation about the manner of death by Respondent No.4 as the date of accident was 07.12.2016 and the Insurance Co. was intimated on 14.12.2016 and this delay in intimation of the date of accident was not explained or the Insurance Co. given an opportunity to investigate the genuineness of the claim under Condition no.1 of the Policy which was not adhered to by the Respondent No.4, since intimation was to be given before internal cremation; (ii) the State Commission failed to appreciate that the investigating agency did not investigate either the watchman or the neighbours of the deceased and hence the Complainants and the Police had colluded and foisted the story of accidental death through false investigation to gain illegally; (iii) the delay in intimation by the Respondents was to hide material facts as this was a case of suspicious death, the State Commission erred in not appreciating that there was no eye witness on record and that the claim form, which required an eye witness to the accident, was signed by a person who had been admittedly called by the wife of the deceased after she found him lying in a pool of blood in a public parking area, and since the wife of the deceased had contacted only two persons and not alerted neighbours or any watchman who would have ordinarily been present to verify the genuineness of the claim, there was indication of collusion and fabrication of the story. Reliance was placed on this Commission’s judgement in Madhmita R Vs. HDC Co. Ltd. and Anr. in FA/64/2014 which had held that it was incumbent on the part of the Complainant to provide proof to establish that death was accidental by clear evidence and in view of delay between the accident and the death to establish that death was attributable to an accident and resultant injury.

9.     The Respondents in their written synopsis took the preliminary objection that the appeal was barred by limitation by 145 days and no valid reasons or explanation for the delay had been provided and was therefore liable to be dismissed in terms of the judgement of the Hon’ble Supreme Court in Anshul Aggarwal Vs. New Okhla Industrial Development Authority, (2011) 14  SCC 578 and Ram Lal & Ors. Vs. Rewa Coalfields Ltd., AIR 1962 SC 361. On merits, it was argued that all relevant documents such as Postmortem Certificate and final report of the SHO, Steel Plant following completion of investigation by the Police confirming death due to head injury had been filed. The death of the insured was stated to be due to a sudden and  unforeseen event and as per the postmortem, the injuries  sustained were not due to illness. The doctor who conducted the post mortem had clearly opined that the cause of death was head injury. Therefore, in terms of the policy and the definition of injury and accident, the claim was admissible. The intimation of death was immediately given to the employer (Respondent No.4) and any lapse in filing of the claim by Respondent No.4 could not be held against the Complainants as held by this Commission in  Assistant Commissioner Commercial Tax Vs. New India Assurance Co. Ltd. 2019 SCC Online NCDRC 39. It was also contended that the Investigator’s  Report lacked details/discussions regarding the basis on which it had been concluded that the claim was not genuine and therefore was liable to be rejected as held by this Commission in Anjali Prasad Vs. The New India Assurance Co. Ltd., 2017 SCC Online NCDRC 1366. Therefore, it was contended that the order of the State Commission be upheld and the appeal dismissed.

10.   From the forgoing it is evident that Respondent No.4 had obtained a Group Insurance Policy under which its employees were insured. There is no dispute regarding the policy or its coverage in view of the premium being paid in full. Respondent No.1’s late husband was duly insured under the policy. The insured met with an accident and expired on 07.12.2016 and a case was registered under Section 174 Cr. PC in CR No. 151 of 2016. The body was sent to King George Hospital for post mortem examination. As per post mortem report dated 08.12.2016, death was concluded to be due to head injury.  Intimation of death was sent by respondent no.4 on 14.12.2016. A claim for life cover under the Group Insurance Policy was preferred by the Respondent No.4 alongwith the relevant documents on 31.03.2017. The death was investigated by the Appellant through the appointment of an investigator who concluded that the cause of death was not accidental and that the grounds advanced by the Respondent were fabricated in collusion with the authorities and accordingly the claim was repudiated vide letter dated 10.05.2019.

11.   While the appointment of a Surveyor/Investigator by the Insurance Co. is a requirement under the Insurance Act, as per the terms of the policy under which the necessary premium stood paid as on the date of the incident on behalf of the Respondent no.4, the conclusion of the Investigator as regards the case reads as follows:

“Sri Kare Naga Raju remained un-observed at the Parking Area beside his scooter for more than 2 hours (08:45 AM to 11.00 AM on 07-12-2016) and was finally seen by his wife, incidentally.

Skidding or slipping in the Scooter Parking area resulted in severe wound near stomach, head injury and ear injury.

Sri M Mohan Babu and Sri Johnson, friends of Kare Naga Raju have not mentioned about injures in their statements to Police. Only Kare Suneetha made a mention about head injury.

RECOMMENDATION:

From the material available in the above findings, the undersigned feel that the death of (late) Kare Naga Raju, Sr Foreman of Visakhapatnam Steel Plant Emp. No. 113723, was "NOT OF ACCIDENTAL" in nature and therefore, claim preferred by Smt Kare Suneetha, wife of late Kare Naga Raju, may not be considered.”

The claim has been repudiated by the Appellant Nos.1 to 3 on this basis.

12.   From the record it is evident that intimation of the death of the insured employee was submitted by Respondent No.4 within a week of the incident. The other details including Postmortem Report and Police investigation were submitted alongwith the claim form immediately on conclusion of Police inquiry to the Insurance Co. The allegation of the Insurance Co. that there was inordinate delay in intimation by Respondent No.4 has to be viewed in this context. The provision regarding intimation of an accident / incident resulting in death under the Policy clearly states that information has to be provided within a period of one month. In view of the fact that Respondent no.4 intimated the cause of death to the Appellants as required under the policy, Respondent No.1 cannot be deprived of a claim for this reason.

13.   As regards the conclusion of the Investigator that the cause of death was not accidental, it is apparent that the injuries to stomach, head and ear have been recorded due to slipping/ skidding near the scooter. The conclusion that these were not due to a fall is based on conjectures and surmises that the insured’s falling down and incurring a head injury was not likely to have been on account of a fall from a scooter. Issues of statements by the Respondent and others are all matters of investigation which was concluded by the Police as the appropriate investigating agency. When there is an investigation report of the Police indicating accident resulting in head injury and Postmortem report indicating that the death was a result of a head injury, the Investigator cannot super impose his conclusions on such findings or pass aspersions on the genuineness of such reports to state so unless he has cogent evidence to the contrary. The contention that there was collusion between the authorities to establish “accidental” death is not based on any evidence brought on record by the Appellants and must therefore, be treated as conjectural. The onus of disproving the investigation report of the police lies upon the Investigator/Appellants which they have failed to discharge by leading evidence in support of their contention. The existence of the policy and inclusion of the deceased life assured as a beneficiary under the scheme is not in question. Therefore, the order of the State Commission cannot be faulted on the grounds that it did not appreciate the evidence on record with regard to the accidental death of Kare Nagaraju for which a claim of insurance had been preferred.

14.   In view of the fact that the insurance Policy was a Group Insurance Policy under which intimation of any incident of either injury or death was required to be provided by Respondent No.4, which had obtained the policy from the Insurance Co., would necessarily entail some delay in the intimation of such an incident. While a surveyor’s report has to be given due weightage, the Hon’ble Supreme Court has held in New India Assurance Co. Ltd. Vs. Pradeep Kumar, (2009) 7 SCC 787, that the surveyor’s report is not the final word if it can be established that it was arbitrary or perverse. In the instant case the surveyor/ investigator’s report is based on speculative insinuations of collusion between the claimant, police and hospital authorities who conducted the post mortem. Repudiation of the claim of insurance has accordingly been rightly set aside by the State Commission. We, therefore, do not find any reason to consider the conclusion of the State Commission to be illegal or perverse which warrants our interference. The appeal is, therefore, disallowed and the order of the State Commission is affirmed. Parties shall bear their own costs.

15.    We would now examine the contention in the other First Appeals in light of the finding above.

16     FA no. 756 of 2022

New India Assurance Co. Ltd., vs Mrs Jysta Sridevi and Ors.,

J V D S Prasad, working as Foreman with RINL (Employee no. 115894) fell down at Rythubazar on 27.12.2016 and was shifted by his wife to the house where he fell down while climbing the stairs. After three hours, the deceased was found unconscious and was shifted immediately to King George Hospital where he was declared “brought dead”. A Police case was registered under Section 174 Cr PC in CR no. 496 of 2016 and the body sent for post mortem examination which held the cause of death to be “Head Injury”. On 02.11.2017, the insurance company received the insurance claim for Rs.31,00,000/- documents from Respondent No.4. On 02.04.2018 the claim was repudiated stating that the deceased was suffering from severe hypertension and diabetes resulting in intracranial hemorrhage which was considered a natural death not covered under the policy.

17.    FA no.757 of 2022

The New India Assurance Co. Ltd., vs Chalagali Gnana Kumari and Anr.

Yesu Prabhuvu (Employee No.114419) a Senior Foreman in RINL, visited the Steel Plant General Hospital on 08.08.2018 at 10 am where he was prescribed medicines and advised rest. At 06.30 pm respondent no.1 found the deceased had fallen from the cot. On being shifted to Steel Plant General Hospital he was declared dead at 07.20 pm. The complainants son informed the Police Station and case Cr No. 79 of 2018 under Section 174 Cr P C was registered. On 09.08.2018 the police conducted the inquest and sent the body for post mortem which concluded death due to Cervical Spinal Injury. The police closed the case after investigation. On 22.08.2018 the insurance company was informed and a claim filed for Rs.35,00,000/-. Appellant sought details on 23.08.2018 and appointed an investigator who sent the records to the Associate Professor (Medicine) Dr A Gopala Rao, RIMS General Hospital, Srikakulam for opinion. Vide opinion dated 05.04.2019, the doctor stated that injuries noted in the post mortem report indicated “accident” though the cause of death could be natural death. Hence, the insurance company on 23.04.2019 repudiated the claim.

18.    FA No.758 of 2022

New India Assurance Co. Ltd., vs Palivela Padma and Ors.

On 26.06.2018, Palivela Achibabu, Foreman fell in the bathroom of his house at 05.45 pm. Respondent nos.1 and 2 (son) shifted him to Visakha Steel Plant General Hospital where he was declared “brought dead”. Cr No. 383 of 2018 under Section 174 Cr PC was registered with Gajuwaka Police Station and post mortem conducted on 27.06.2018 which opined cause of death to be ‘head injury’. The death was intimated to the insurance company on 07.07.2018 and on 08.07.2018 K Jagannadha Sastry was appointed as investigator. Respondent no.6 on 25.09.2018 forwarded the claim of Rs.34,00,000/- to the Appellant. On 04.03.2019, the investigator reported, based on an opinion from the expert physician that the cause of death was due to past neurological medical history and not accidental due to fall in the bathroom. The claim was repudiated on 15.03.2019 by the Appellant holding that death was not an accident but due to cardiac failure.

19.    FA no. 759 of 2022

New India Assurance Co. Ltd., vs Kommanapalli' Chinnarao and Ors.

Kommanapalli Ramana, (Employee no.117709), a Senior Additional Technician in CO and CCP Department  in RINL was found in a drainage channel and was immediately shifted to Visakha Steel General Hospital where he was declared “brought dead”. A case was registered under Section 174 Cr PC in CR no. 189 of 2018 in Duvvada Police Station and post mortem done in King George Hospital. Cause of death was kept pending for RFSL Report. Dr V Chandra Sekhar, Assistant Professor, Forensic Medicine, AMC, Visakhapatnam opined that cause of death was “Shock and Hemorrhage due to blunt injury chest and abdomen”. On 22.09.2018, the Police on the basis of post mortem report closed the case before the Mandal Executive Magistrate, Gujuwaka. On 10.01.2019, respondent no.4 sent the claim of Rs.33,00,000/- to the insurance company. The insurance company appointed M/s Satya Devi Labs Pvt. Ltd. to investigate the claim who opined on 20.05.2020 that the cause of death was natural and the claim was not covered under GPAI policy conditions.

20.    FA no.760 of 2022

New India Assurance Co., Ltd., vs Mrs Kurapati Dhanalakshmi and Ors.

Kishore Kumar, Foreman (S) in SMA–2 Department (Employee no.117475) was found unconscious on 07.06.2018 and was immediately shifted to the Steel Plant General Hospital by family members where he was declared “brought dead”. On 08.06.2018, a case was registered with Gajuwaka Police Station under Section 174 Cr PC in CR no. 325 of 2018 and post mortem done on 09.06.2018 as per which cause of death was stated to be “Head Injury”. Respondent no.4 intimated the insurance company vide e-mail on 26.09.2018 and submitted the claim documents. The appellant appointed K Jagannadha Sastry, Surya Teja Associates as Investigator who opined on 31.03.2019 that the death was due to sudden stroke which was a natural death and not accidental. The claim for Rs.35,00,000/- was therefore, repudiated by appellants.

21.    FA no. 762 of 2022

New India Assurance Co. Ltd., vs Gantyada Somulamma and Ors.

G Apparao, Senior Technician in MW Department while on duty on 11.06.2018 at 04.00 pm fell down from the top of the chute and snub pulley and sustained injuries. He was immediately shifted for First Aid at CCCP where he was declared “brought dead”. GM (SP) and HoD informed the Steel Plant Police Station and a case was registered under Section 174 Cr PC in Crime no. 58 of 2018 and the body sent to K G Hospital for post-mortem which opined the cause of death as ‘Head Injury’.  The Police, based on postmortem report and investigations, closed the case before the Mandal Executive Magistrate, Pedagantyada. Respondent no.5 informed the insurance company on 21.06.2018 who appointed K Jaganadha Sastry as Investigator on 22.06.2018. Claim documents were submitted to the insurance company including additional documents on 27.12.2018. Based on investigator’s report dated 28.03.2019, death was held to be natural due to cardiac arrest leading to fall and not accidental and that head injury was not the primary cause of death. On 01.04.2019, appellant repudiated the claim for Rs.37,00,000/- under the policy.

22.    FA no.761 of 2022

New India Assurance Co. Ltd. vs Gorle Aruna and Ors.

P Atchibabbu, Chargeman fell from his two wheeler on 21.08.2015, and sustained injuries. He was immediately shifted to Visakha Steel General Hospital where he underwent surgery. Respondent no.4 addressed the Neuro Surgeon, Care Hospital, Visakhapatnam on 21.08.2015 for his treatment for Traumatic Paraplegia with fracture D 5 and D 6 with cord compression. He was discharged on 05.09.2015 and Dr N V S Mohan, Consultant Neuro Surgeon certified him to be a paraplegic on 06.01.2017 and prescribed medicines District Medical Board, Visakhapatnam issued a Disability Certificate dated 22.06.2018 for 90% permanent disability.  Consequently, respondent no.4 terminated his services on 19.01.2019. On 07.03.2019, P Atchibabbu submitted a claim for Rs.31,00,000/- under Group Personal Accident Insurance Policy to respondent no.4 who forwarded it to the insurance company.  Appellant no.2 vide letter dated 10.04.2019 repudiated the claim on the ground that the intimation was given after a lapse of three years. On 16.04.2019, Atchibabbu expired while undergoing treatment. 

23.   In all the above cases (except FA 761 of 2022), claims have been made under the Policy for various amounts (depending upon the grade of the employee as per the Policy). These claims were based upon FIR lodged and investigated by the Police and post-mortem reports of the King George Hospital. The conclusion of the post-mortem report was ‘accidental death’ in all cases except in FA 761 of 2022. In one case (FA No.758 of 2022) while the post mortem report held death to be accidental, the Expert Opinion stated it could not be conclusively stated whether the cause was pre-existing disease. However, the Police closed investigations in all cases holding death to be ‘accidental’ based upon the post-mortem report and its own investigations. However, the appellant insurance company held that there was collusive intent between the claimants and the police, hospital and RINL authorities to categorize the deaths as ‘accidental’ in order to enable unjust gain by the beneficiaries and therefore, based upon its Investigator’s report, held that the claims were untenable as they were due to ‘natural’ causes and not ‘accidental’ as mandated under the Policy.

24.   In terms of the judgment in FA no.755 of 2022, the repudiation of the claims in FA nos.757, 758, 759, 760 and 762 of 2022 by the appellant are contrary to the report of the Police, the post-mortem report and the report of the Police as accepted by the Executive Magistrate. The contention that all these agencies had colluded and that the claims were ineligible under the scheme of Group Insurance cannot be considered to be valid for the reason that no cogent evidence has been brought on the record to establish such a finding. No documents have also been brought on record to indicate whether the Appellants have contested the findings of the Police or Hospital authorities or challenged the closure of investigation reports in these cases. While a surveyor’s report has been held to be an essential and necessary requirement under law as per the Hon’ble Supreme Court’s judgment in Sri Venkateswara Syndicate Vs. Oriental Insurance Company Ltd. & Anr., in CA No. 4487 of 2004 dated 24.08.2009, (2009) 8 SCC 507, as held by the Apex Court in New India Assurance Co. Ltd. Vs. Pradeep Kumar, Civil Appeal No. 3253 of 2002 the finding of a surveyor is not that sacrosanct or final that it cannot be disregarded if it is found to be arbitrary or perverse. In the present matters, in the absence of evidence on record, the Surveyor’s report has to be held to be conjectural and based on surmises as no cogent evidence to establish the finding of accidental death has been brought on record. The surveyors report can, therefore, be considered to be arbitrary and perverse. Accordingly, the appeals in the following cases are liable to fail. The facts of the case are summarized in the table below:

TABLE I

25.    In the case of FA no.761 of 2022, the death of the insured was following hospitalization, treatment, discharge as a 90% disabled paraplegic. However, the claim was filed after a delay of 3 years. As per the policy, the respondent, is eligible for the coverage for hospitalization and treatment in addition to the claim for death. In view of the circumstances of death, and the fact that the nature and seriousness of the injury entailing protracted treatment would have led to the delayed filing of the claim, it would be logical to consider the deceased to be insured and as being eligible for the same. Accordingly, FA 761 of 2022 is allowed with the direction that the complainants who are LRs of the deceased be paid Rs.27,90,000/- along with Rs.25,000/- as costs under the Policy and litigation costs of Rs.10,000/-. If the insurance amount of Rs.27,90,000/- is not paid within 8 weeks of receipt of this order, the same shall be paid with 6% interest till realization.

26.   For the aforementioned reasons, and in view of the discussion above, FA nos., 755 to 760 and 762 of 2022 are allowed. The FAs are disposed of as per table below:

TABLE II

28.   Appellant is directed to comply with the order above in 8 weeks failing which the claims shall be paid with compensation in the form of` interest @ 6% on the claim amount from the date of repudiation till realization.

29.   All pending IAs, if any, also stand disposed of by this order.