BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

F.A.No. 358 OF 2020 AGAINST ORDERS IN C.C.270/2016 DISTRICT CONSUMER COMMISSION, RANGA REDDY Between:

SBI General Insurance Co., Ltd., Represented by its Assistant, Vice President (Health claims), Grievances Redressal Office, Natraj, 101, 201, 301, Junction of Western Express Highway and Andherin Kurla Road, Andheri East, Mumbai-500 069.

………..Appellant/ Opposite Party And:

Mohit Kumar Jagwani, S/o Satish Kumar Jagwani, Aged about 28 years, Occ.: Business, R/o Flat No.209, Sri Tirumala Harmony, Beside Saket Towers, Kapra, Ranga Reddy District.

……..Respondent/Complainant Counsel for the Appellant/Opposite Party : M/s. K.Madhusudhan Reddy Counsel for the Respondent/Complainant : Sri S.V. Suresh QUORUM :

HON’BLE SMT. MEENA RAMANATHAN, I/c PRESIDENT &

HON’BLE SRI. V.V.SESHUBABU, MEMBER – JUDICIAL WEDNESDAY, THE 14^th DAY OF MAY TWO THOUSAND TWENTY FIVE **********

Order : PER HON’BLE SRI. V.V.SESHUBABU, MEMBER – JUDICIAL

1. The appeal is filed u/s 15 of Consumer Protection Act, 1986 by the Opposite Party, aggrieved by the order of District Consumer Commission, Ranga Reddy, dated 20.12.2019 in CC 270/2016, where under the opposite party was directed to pay sum assured amount of Rs.10,00,000/- with interest @ 9% p.a. from the date of complaint (28.03.2017) till the date of realization. The opposite party is further directed to pay Rs.50,000/- towards compensation for mental agony besides costs of Rs.10,000/- to the complainant. The complainant is directed to submit the legal heir certificate while receiving the sum assured amount of Rs.10,00,000/- and compensation. Time for compliance is 30 days, failing which the interest shall be enhanced to 12% p.a. from the date of default till the date of realization.

2. The brief averments of the complaint are that the complainant’s brother Sri Dilip Kalu Jagwani have obtained Accidental Insurance Policy with the opposite party vide Certificate No.62571789, Master Policy No.143990-0000-00, dated 30.09.2014, valid from 30.09.2014 to 29.09.2015 for Rs.10,00,000/- and being the elder brother of the policy holder, he was shown as nominee; that the complainant’s brother along with his friends went to Ramapuram Beach, Cheerala, Prakasham District for site seeing; that when he was swimming at the Beach, due to the unexpected huge tidal wave, he was dragged in to the sea and had drown into the water, resulted death; that the friends of the complainant’s brother lodged a complaint with local police and the same was registered as Crime No.29/2015 u/s 174 Cr.P.C; that after due enquiry and after examination of witnesses, submitted report stating that deceased died due to “Asphyxia due to sea water drowning”. The post-mortem examination report also revealed that the deceased died due to “Sea water drowning”; that the complainant being a nominee submitted the insurance claim with the opposite party on 25.02.2015 by furnishing required documents, but they rejected the claim on the ground that “the deceased has consumed alcohol”; that the complainant issued a legal notice and the same was received by the opposite party on

04.11.2015, but there was no response; hence, the complaint.

3. The brief averments of the written version of Opposite Party are that the complaint is not maintainable either on facts or under law; that the complainant is put to strict proof of all the averments made in the complaint, except, those that are admitted; that they have issued the accidental insurance policy subject to terms and conditions of contract of insurance; that the opposite party is not aware of the registering a case under Crime No.29/2015 and when the complainant submitted the claim form, they have caused investigation on the claim and on perusal of the documents the cause of death is shown as due to sea water drowning but, the cause of it is not mentioned in the police documents, as such the causative reason for drowning of the insured cannot be assessed