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KALYANI KAPSE, SHAILA D. WANDHARE
Directorate of Insurance Maharashtra State – Appellant
Versus
Anusya Surendra Bahgat – Respondent
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 bei
(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 ignorin....
Insured is not entitled to compensation when on facts it is proved that he was intoxicated and that his death was due to intoxication.
Personal Accident Insurance Policy – Surveyor’s report is not the final word if it can be established that it was arbitrary or perverse.
Insurance claims must strictly adhere to policy terms; no liberal interpretations allowed.
IMORTANT POINTS (1) Insurance policy - in the matter of Insurance claims, the Courts cannot adopt a beneficial/welfare approach, and have to go strictly by the words used in the concerned Insurance P....
The court determined that despite initial perceptions of murder, the evidence supported the incident as a motor accident, warranting compensation under the Motor Vehicles Act.
Claim – No claim should be disallowed purely on technical ground or in a mechanical manner; the insurance company should reject the claim only when the insurer finds that it was liable to be rejected....
The influence of alcohol at the time of death can justify the denial of a claim under a personal accident insurance scheme. The proviso to the insurance clause aims to prevent self-injury for insuran....
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