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CHHATTISGARH STATE CONSUMER DISPUTES
REDRESSAL COMMISSION, RAIPUR
Hon’ble Mr. Justice V.K. Agrawal, President;
Mrs. Veena Misra & Mr. R.S. Awasthi, Members
MRS. RAMSAKHI & ANR.—Complainants
versus
ORIENTAL INSURANCE CO. LTD. & ANR.—Opposite Parties
Complaint No. 33 of 2003—Decided on 25.3.2004
Counsels for the Parties :
For the Complainants :Mr. Brijesh Mishra, Advocate.
For the Opposite Parties :Mr. Shishir Bhandarkar, Advocate.
The main legal point established in the judgment is the entitlement of the complainants to the benefit under the Janta Personal Accident Insurance Policy based on the circumstances of the insured's death and the failure of the opposite parties to substantiate their allegations.
Headnote:
Janta Policy - Personal Accident Insurance - Section 12, 17 - Summary of Acts and Sections: The court discussed the Janta Personal Accident Insurance Policy and its terms and conditions, including the sum assured, and the requirement for submission of claim form. The court also considered the implications of the insured obtaining another group insurance policy from a different insurer and the limitations on total payment by insurers under such circumstances.
Fact of the Case:
The complaint was filed on behalf of the parents of the deceased insured Ram Dayal Singh claiming the amount under the Janta Personal Accident Insurance Policy. The insured had obtained the policy as a member of the Steel Workers Union and the claim was submitted after the insured's accidental death. The opposite parties resisted the complaint, alleging suppression of material facts by the insured and jurisdictional issues.
Finding of the Court:
The court found that the deceased died in a train accident and the complainants were entitled to the benefit under the Janta policy. The court also held that the opposite parties were not entitled to any benefit under the condition related to the insured obtaining another group insurance policy.
Issues: The issues involved jurisdictional objections, the cause of the insured's death, and the alleged suppression of material facts by the insured.
Ratio Decidendi: The court's decision was based on the findings that the deceased died in a train accident, the complainants were entitled to the policy benefit, and the opposite parties failed to substantiate their allegations of suppression of material facts by the insured.
Final Decision: The complaint was allowed, and the opposite parties were directed to pay the assured sum with interest and compensation for deficiency in service.
Mr. Justice V.K. Agrawal, President—This complaint under Section 12 read with 17 is filed on behalf of the parents of the deceased insured Ram Dayal Singh claiming the amount under the Janta Personal Accident Insurance Policy (hereinafter called the ‘Janta Policy’ for short) issued by the opposite parties.
2. It was averred in the complaint that the deceased insured R.D. Singh son of the complainant had obtained Janta Policy No. 152501/47/99/00176, as a member of the Steel Workers Union (INTUC), Bhilai. The said policy covered the risk from 9.1.1999 to 8.1.2011. The assured amount under the said policy was Rs. 5 lacs which was payable in case of accidental death of the insured. The premium of the policy was duly paid by the insured. According to averments in the complaint Ramdayal Singh while travelling by train, met with an accident near Allahabad, as he slipped down from the train and was over run by it. The accident as above proved fatal. The claim was submitted by the complainant No. 1 to the opposite party on 5.10.2000. However, the claim has still not been settled despite notice served on the respondents.
3. The opposite parties insurer resisted the complaint. It was averred that documents viz., FIR, post-mortem etc. submitted by the complainant did not bear the name of the victim, therefore, the investigation on the claim was necessitated. According to the opposite party they appointed investigator Anurag Mishra to investigate the matter. It was denied by the opposite parties/insurers that the deceased Ramdayal Singh died in train accident as averred by the complainant. It was further averred that the claim could not be settled earlier, due to delay in investigation by the Surveyor. It was further averred by the opposite parties by way of amedment that though the complainant had specifically stated and declared that the insured Ramdayal Singh did not take any group personal accident insurance policy, from any other company but during investigation it was revealed that the said declaration of the complainant was wrong and that the deceased had taken another group insurance policy from United India Insurance Company ensuring for the period from 7.5.1998 to 5.5.2003. It was, therefore, averred that the deceased obtained the insurance policy by suppressing aforesaid material facts.
4. Averments as above by way of amendment were denied by the complainant. According to them the deceased was a member of Steel Workers Union, under the scheme known as SEWA, deductions of Rs. 20/- from the salary of the deceased as well as other employees were made by the employer-Bhilai Steel Plant and the complainant has been paid Rs. 30,000/- under the said SEWA scheme. It was also averred that the said scheme ‘SEWA’ of United India Insurance Co. was not a Group Janta Personal Accident Insurance Policy. It was thus averred that the policy obtained by the insured from the opposite parties was of entirely different nature than the scheme ‘SEWA’ run by other Insurance Company namely United India Insurance Company Ltd., of which the deceased was a member.
5. Learned Counsel for the opposite parties at the outset raised preliminary objections, regarding the pecuniary jurisdiction of the State Commission. It was contended that compensation claimed in the instant case was only Rs. 6.60 lacs. It was, therefore, contended that this complaint could not be competently heard by this Commission and the matter deserves to be considered by the District Forum, as pecuniary jurisdiction of District Forum has now been raised to Rs. 20.00 lacs as amended by Act No. 62 of 2002. However, it may be noticed that this complaint was filed on 20.9.2002 prior to the said amendment as above coming in force at that time the jurisdiction of the District Forum was limited to Rs. 5.00 lacs. Thus, the complaint was within the competence/pecuniary jurisdiction of the State Commission as the said amendment has not been implemented with retrospective effect. In the above contex
