IMPORTANT POINTS
(1) Failed to discharge the services – The insurer failed to discharge its service obligations by rejecting a genuine claim based on a Chemical Analysis report showing alcohol presence, while ignoring the Post-Mortem report which confirmed death by strangulation (external violence). Rejecting a claim on grounds not proximate to the cause of death is a clear deficiency.
(2) Liability – Act of the insurer in attempting to classify “murder” as a non-accidental death to avoid liability, despite settled legal precedents establishing that murder is an accident from the victim’s perspective, was held to be an unfair trade practice.

ORDER

Shaila Wandhare, Member—The appellant namely Directorate of Insurance Maharashtra State has preferred the present appeal under Section 41 of the Consumer Protection Act 2019 challengingtheorder passedon17/02/2022 in Consumer Complaint No.CC/96/2021 (hereinafter it is referred to in short as “impugned order”) of the learned District Consumer Disputes Redressal Commission, Gondia (hereinafter it is referred to in short as “learned District Commission”) by which the complaint filed by Respondent/Complainant being complainant came to be partly allowed.

2. The parties of the appeal are hereinafter referred to by their original nomenclature as complainant and opposite parties respectively for better appreciation.

3. The facts that emerge from the original complaint are that the deceased Yogesh Kumar Surendra Bhagat was working as a land surveyor in the office of the Deputy Superintendent of Land Records (DySLR), Gondia and was a member of the State Government Employees Group Personal Accident Insurance Scheme under which the Opposite Party (O.P.) had taken a group accident insurance policy of Rs.10,00,000/- for its employees, the deceased being unmarried and his mother complainant being the beneficiary. On 13/09/2019, the deceased was murdered by unknown persons in his village. The complainant submitted the insurance claim through the office of the DySLR, Gondia along with all requisite documents which were duly verified and forwarded. Despite, repeated applications and compliance with all requirements, the O.P. rejected the claim on 04/03/2021 solely on the ground that the deceased was allegedly under the influence of alcohol as per a chemical analysis report. Such rejection was arbitrary, amounted to deficiency in service and defeated the very object of the government group personal accident insurance scheme meant for the benefit of the legal heirs of deceased employees. The complainant alleging it deficiency in service and unfair trade practice on the part of O.P. Due to the unjust repudiation the complainant suffered mental agony and financial hardship, compelling her to file the present complaint seeking payment of the insured amount of Rs.10,00,000/- with interest at 18% per annum, compensation of Rs.50,000/- for mental and physical suffering, and litigation expenses of Rs.20,000/-.

4. The Opposite Parties (O.P.) resisted the claim before the learned District Commission and denied all the allegations made against them by the complainant. They contended that the complaint alleging deficiency in service and unfair trade practice is false, baseless, misconceived and not maintainable in law. It was submitted that the complainant failed to appear in person before the Commission and has suppressed material facts and concealed the true and correct circumstances relating to the death of the deceased with an ulterior and mala fide motive. The O.P. further contended that the complainant has not disclosed any specific or sustainable grounds under the Act and has failed to place on record any cogent documentary evidence to establish deficiency in service on the part of the O.P. It was specifically submitted that the allegation of accidental death is wholly unsupported, as the available records and reports indicate that the deceased was under the influence of alcohol, a quarrel took place, and the death occurred due to murder arising out of prior enmity. According to the O.P., portraying such an incident as an accident is misleading and intended only to wrongfully claim insurance benefits. The O.P. therefore submitted that no deficiency in service or unfair trade practice is attributable to them. Therefore, they prayed to dismiss the complaint with costs.

5. After considering the evidence of the parties and their documents filed in support thereof, learned District Commission by order dated 17/02/2022 partly allowed the Consumer Complaint No.CC/96/2022 directing the O.P. to pay Rs.10,00,000/- to the complainant along with interest at the