Back
MAHARASTRA STATE CONSUMER DISPUTES REDRESSAL COMMISSION
P.N. Kashalkar, Presiding Judicial Member and S.P. Lale, Member
NEW INDIA ASSURANCE COMPANY LIMITED - Appellant
Versus
SUCHITRA NANDAKUMAR DHONDE AND ANR. - Respondents
First Appeal No. 1127 of 2007
Decided on : 05-08-2008
Mr. Bhakti Barve, Advocate, for the Appellant; Mr. G.F. Shirke, Advocate, Mr. Umesh Khadpe, Advocate, for the Respondent
The central legal point established in the judgment is the interpretation of the exclusion clause in the insurance policy, emphasizing the distinction between chronic disturbance of mind and insanity as required by the clause.
Headnote:
Insurance - Accidental Death Insurance - Clause 5(d) - [Consumer Complaint No. 111/2004] - [Clause 5(d) of the insurance policy] - The court discussed the interpretation of Clause 5(d) of the insurance policy, which excluded insurance claims for death caused directly or indirectly by venereal disease or insanity. The court emphasized the distinction between chronic disturbance of mind and insanity, highlighting that the latter requires the unsoundness of mind of the highest degree. The court found that the deceased's condition did not meet the level of insanity required to trigger Clause 5(d), ultimately ruling in favor of the complainants.
Fact of the Case:
The deceased, a member of a club with accidental death insurance cover, drowned under disputed circumstances. The insurance company repudiated the claim, citing the deceased's chronic mental condition as a reason for exclusion.
Finding of the Court:
The court found that the insurance company failed to prove that the deceased was in a state of insanity at the time of his death, emphasizing the distinction between chronic disturbance of mind and insanity. The court ruled in favor of the complainants, allowing the claim for the insurance amount and compensation.
Issues: The main issue revolved around the interpretation of the exclusion clause (Clause 5(d) of the insurance policy) and whether the deceased's mental condition met the threshold of insanity as required by the clause.
Ratio Decidendi: The court's decision was based on the interpretation of the exclusion clause and the distinction between chronic disturbance of mind and insanity. It emphasized that the level of insanity required to trigger the exclusion clause was not met in this case.
Final Decision: The appeal was dismissed, and the court ruled in favor of the complainants, allowing the insurance claim and compensation.
ORDER
P.N. Kashalkar, Presiding Judicial Member (Oral)- This appeal is filed by the New India Assurance Company Limited aggrieved by the order passed by the District Forum, South Mumbai in Consumer Complaint No. 111/2004 decided on 19.6.2007 whereby the Forum below allowed the complaint filed by complainant Ku. Suchitra Dhonde and her mother Smt. Sadhna Dhonde and directed Insurance Company to pay amount of two different policies covering accidental benefit to the nominees of deceased Shri Sushilkumar Nandakumar Dhonde with interest at the rate of 9% per annum and also directed to pay compensation Rs. 50,000 and cost of Rs. 2,000 to the complainants. The order was passed jointly and severally against both the O.Ps.
2. Facts to the extent material may be stated as under:
According to the complainants, O.P. No. 2 Pan Card Club Limited of Century Bazar, Prabhadevi had introduced some schemes for the benefit of members of their club. Those benefits included accidental death insurance cover up to Rs. 1 lakh. Deceased Sushilkumar Nandakumar Dhonde became member of the club on payment of membership fee of Rs. 3,050 and Rs. 2,050 respectively on 15.7.1999. Deceased was given membership folio No. ES-346 and EC-09. O.P. No. 2 issued certificate of membership one commencing from 15.8.1999 to 15.7.2005 and another commencing from 12.5.1999 to 12.4.2005. The complainants are nominees named by the deceased in the membership. According to the complainants, Sushilkumar was hale and hearty when he became member of Pan Card Club in the year-1999. After some days he had some problem. He was treated at Tata Memorial Hospital for Bipolar disorder and Hypomania of chronic nature from 8.9.2000 but he was doing well on maintenance treatment and with lithium therapy. The deceased used to go for a walk in the morning at about 6.00 a.m. regularly at sea-shore at Vasai. As per this routine, on 16.8.2002, he had gone for morning walk but he did not turn up. Hence, the family members searched him for entire day. Next day body of the deceased was found near the sea-shore. Police recorded spot and inquest Panchanama and sent dead body for the post-mortem. The medical officer attached to Municipal Dispensary, Vasai conducted post-mortem and certified that deceased had died due to drowning. Police made some investigation and according to police deceased was in a disturbed state of mind when he was moving on Vasai beach.
3. Since deceased was having accident insurance cover, the complainants lodged claim with the Insurance Company. After about one year on 5.1.2004, the Insurance Company repudiated the claim on the ground that deceased was in a disturbed state of mind since last two years and was taking medical treatment for the same and in that disturbed state of mind he had committed the act hence under exclusion clause No. 5(d) of the policy, they were not entitled to get insurance amount. So, they closed the file as no claim . Thereafter the complainants filed consumer complaint alleging deficiency in service on the part of OPs wherein they claimed Rs. 2 lakh (Rs. 1 lakh each for two policies) and Rs. 50,000 towards mental agony and Rs. 10,000 towards cost.
4. O.P./Insurance Company resisted the complainants claim mainly on the ground that there was exclusion clause under Clause 5(d) in the policy and that is why the claim was not payable to the complainants. The exclusion clause mentioned that if there is a death, injury or disablement of the insured person directly or indirectly caused by venereal disease or insanity the amount in insurance claim would not payable. The Insurance Company pleaded that deceased was taking treatment of Dr. P.V. Pradhan, Hon. Consultant-Psychiatrist at Tata Memorial Hospital and Dr. Pradhan had issued certificate that deceased was suffering from insanity. He was suffering from Hypomania of chronic nature hence death due to drowning could not be said to be accidental in such a case. The police paper also mentioned the same and some r
