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STATE CONSUMER DISPUTES REDRESSAL COMMISSION

CIRCUIT BENCH NAGPUR

FIRST APPEAL NO. SC/CB2/27/A/140/2022

DIRECTORATE OF INSURANCE MAHARASHTRA STATE

PRESENT ADDRESS - HAVING ITS REGISTERED AND HEAD OFFICE AT BLOCK NO.

264,1ST FLOOR , GRIHANIRMAN BHAVAN MAHADA ,KALA NAGAR , BANDRA EAST MUMBAI

400051 MAHARASHTRA,MAHARASHTRA.

.......Appellant(s)

Versus

ANUSYA SURENDRA BAHGAT

PRESENT ADDRESS - R/O JANATOLAA, POST GHOTI , TAHSIL GOREGAON DIST GONDIA

441801 MAHARASHTRA,MAHARASHTRA.

.......Respondent(s)

BEFORE:

HON'BLE MRS. KALYANI KAPSE , PRESIDING MEMBER

HON'BLE MS. SHAILA D. WANDHARE , MEMBER

FOR THE APPELLANT:

LEARNED ADVOCATE SHRI.LIMAYE FOR THE APPELLANT AND

FOR THE RESPONDENT:

LEARNED ADVOCATE SHRI.KSHIRSAGAR OF THE RESPONDENT

DATED: 31/12/2025

ORDER

PER MS.SHAILA WANDHARE, HON’BLE MEMBER

1. The appellant namely Directorate of Insurance Maharashtra State has

preferred the present appeal under Section 41 of the Consumer Protection Act 2019

challenging the order passed on 17/02/2022 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 report