Jharkhand

Bokaro

CC/16/149

Shanti Devi - Complainant(s)

Versus

The Secretary, Bokaro Steel Samuhik Durghatna Bima Samiti - Opp.Party(s)

Ajay Kumar Sinha

30 Apr 2019

ORDER

Complainant Shanti Devi has filed this complaint for a claim of Rs. 5,00,000/- along with 18% interest since 01.08.2014 till the payment  and compensation of Rs. 30,000/- and litigation cost of Rs. 10,000/-.

2                      The case in short is that complainant is a wife of late Narayan Kewat who was permanent employee of SAIL having staff No. 69005. Late Narayan Kewat was covered under Group Personal Accidental Bima Policy. While on 01.08.2014 complainant performed his duty in B-Shift, the deceased Narayan Kewat was found murdered by some unknown miscreants. Marafari Police Station registered U.D. Case No. 06/2014 and thereafter, FIR No. 64/2014 under section 302, 201/2014 IPC. The Postmortem report shows cause of death due to head injury which antemortum caused by hard blunt object and legation marked.  I.O. of the case has submitted FRT vide No. 85/2015 as the case is true but there was no clue. It is claimed that late Narayan Kewat was died due to an accident while he was performing his duty.

            Complainant has filed claim settlement with insurance co. O.P. No.2 but no payment was done even after issuance of legal notice, therefore, there is a deficiency in service as well as unfair trade practice, hence this case has been filed.

3                      The following documents have been filed by the complainant in support of her case:-

An x-1 and 1 /2 Photo copies of FIR and final report.

Anx-2 Photo copy of death certificate of BGH.

Anx-3 Photo copy of Govt. Death Certificate.

Anx-4 Photo copy of Postmortem report.

Anx-5 Photo copy of Medical Certificate submitted to Reliance

           General Insurance Co. Ltd.

Anx-6 Photo copy of claim repudiation letter.

Anx-7 to 7/1 Photo copies of legal notice and its reply.

4          O.P. No.1 appeared and filed W.S. It is submitted that the case is not maintainable against this O.P. and insurance co. is not liable for providing compensation amount and claim settlement and there is no direct allegation against this O.P.

5          O.P. No.2 M/s Reliance General Insurance Co. Ltd. appeared and filed W.S. It is submitted that this case is not maintainable because the complainant has concealed the material fact and it is time barred because after limitation period of 2 years, this case has been filed and further as per the U.D. case No.4/14, the deceased committed suicide and Postmortem  cardio respiratory report shows cardio respiratory  failure and the occurrence is not a accident, hence the claim is denied. It is also submitted the Deceased found in hanging position having head injury Antemortum. This is case not an accidental.

                                                            F I N D I N G S

6                      We perused the record  and hold that the complainant is a beneficiary under Group Accidental Personal Bima Policy, therefore, she is a consumer and the dispute is a consumer dispute.

7          As regard the facts of the case and objection raised by the insurance co. that the death of the deceased was not due to any accident, therefore, the insurance co. as per the terms and conditions of the policy is not liable to reimbursed the amount, because there is no evidence to support that head injury was caused due to any accident in the work place. We perused the postmortem report the injury on the head reveals that the head injury in the Antemortum in nature caused by hard blunt object and this  is a main cause for the socking and cardio respiratory failure, causing death.

            Complainant relied the ruling of NCDRC reported in 2018 SCC on line NCDR 377. It has been held by Hon’ble National Commission in Royal

Sundaram Alliance Insurance Co. Ltd. Vrs. Pawan Balram Mulchandani kamal that murder is an accident unless it is caused by willful act of the insured himself.

8          We perused and compare the fact of the case along with discussion made by NDCRS in the above mentioned case, we come to the conclusion that Post Mortem report shows head injury caused by hard blunt object is antemortum and further there is legation mark on the neck and also dragging of the deceased body are not suggestive any self inflicted injury and does not expect from deceased regarding such injury.

            Doctor has opined the main cause of death was due to sock and cardio respiratory failure. O.P. has not produced any evidence that the injury has been caused is self inflicted and simply it is objected that the death of the Narayan Kewat has not been caused due to any accident, rather it is a murder. The insurance co. has not produced any terms and conditions of the policy to show that murder is excluded from the purview of the accident.

            Therefore, considering all the evidences available on the record, we come to the conclusion that O.P. insurance co. has wrongly not allowed the claim of  the complainant and therefore, this is deficiency in service as well as unfair trade practice. On higly technical ground of late submission of the documents.

9          Accordingly, we find and hold that the case is maintainable and we allow the claim of the complainant and we direct M/s Reliance General Insurance Co. Ltd. to pay Rs. 5,00,000/- (Rs. Five lac) only to the complainant with interest of 10% per annum since the death i.e. 01.08.2014 till realization.

            We further direct to the Insurance co. to pay compensation of Rs. 10,000/- (Rs. Ten thousand) only along with litigation cost of Rs. 3000/-(Rs. Three thousand) only to the complainant.

            All the payments must be paid within 60 days of this order, failing which the rate of interest of the main claim shall be enhanced to 15% per annum till realization.