Karamjit Kaur vs DIRECTORATE PERSONNEL, PUNJAB STATE ELECTRICITY BOARD

THIS is a complaint under Section 17 read with Section 12 of the Consumer Protection Act, 1986 (for short ''the Act'').

THE facts are not in serious dispute. THEse may therefore, be noticed with relevant brevity. THE complainant-1 is the widow and complainants-2 to 5 are minor children of Sucha Singh, deceased. Late Sucha Singh husband of Karamjit Kaur was working as an Assistant Lineman in the office of the respondent-3 Sub Divisional Officer, Punjab State Electricity Board, Rural, Sangrur. THE respondent 1 Directorate Personnel, Punjab State Electricity Board, Patiala had taken out ''Group Personal Accident Policy'' (for short ''the Insurance Policy'') for its employees from respondent 4. THE Oriental Insurance Company Ltd., Patiala (for short ''the Insurance Company''). It is common ground that Sucha Singh, deceased was fully covered by the Insurance Policy (Annex. P-l). It is alleged that on the Dewali night dated 18.10.1990, Sucha Singh, deceased slipped from the stairs and fell down in his own house at village Ganga Singh wala, District Sangrur resulting in grievous injury on his head and became unconscious. He was immediately removed to Rajindra Hospital Patiala where he remained admitted for his medical treatment till 11.11.1990 and on the same day on the advice of the doctor, the complainant-1 took her husband back to his native village Ganga Singh Wala where he died on 13.11.1990. THE post mortem examination on the dead body of Sucha Singh was conducted. Smt. Karamjit Kaur,. his widow filed a complaint for compensation in the office of the Punjab State Electricity Board along with the relevant documents. THE Electricity Board forwarded those papers along with claim application to the Insurance Company. THE Insurance Company repudiated the claim of the claimants vide its letter dated 8.1.1992 on the ground that because the fatal injury sustained by the deceased was the direct consequence of intake of liquor, it was not liable to pay any compensation to the claimants. Consequently exasperated by the delay, deficiency and negligence on the part of the Insurance Company, Smt. Karamjit Kaur, widow of Sucha Singh, deceased filed the present complaint on 9.12.1992 claiming payment of Rs. 1 lac as the insurance amount plus Rs. 10,000/- as damages on account of mental agony and harassment suffered by her. On notices being issued in the complainant, the respondents-1 to 3 filed their written statement and in substance they supported the stand of the claimants by alleging that Sucha Singh, deceased died due to head injury. So far as the factum of insurance of the deceased under the Insurance Policy and his death was concerned, the same was however, admitted. The respondent No. 4 (the Insurance Company) strenuously contested the complaint in its written statement. A preliminary objection was raised that the deceased had consumed liquor and the fatal injury which ultimately led to his death was the consequence of intake of liquor and that because of the aforesaid reason, the claim of the claimants having been repudiated, the latter were not entitled to any compensation. On merits, the allegations of the complainants were however, stoutlv controverted.

In support of the complainants'' case, Smt. Karamjit Kaur has placed on record her own affidavit alongwith the documents Annexures P-1 to P-6. The authenticity of these documents has not been challenged by the Insurance Company. In defence, the Insurance Company has placed on record five documents Annexures R-1 to R-5. The primal reliance is placed on Annex. R-1, copy of the Group Personal Accident Policy and the repudiation order Annex. R-3. No oral evidence is let in on either side.

BEFORE adverting to the rival stands of the learned Counsel for the parties, it is not only apt, but indeed necessary to notice the true import and the salient feature of the Group Personal Accident Policy (admittedly issued by the Insurance Company). As is manifest from the very name and the heading thereof, a policy of this kind is not intended to apply to any particular individual, but to a large group of persons or employees which may well run in thousands. In consideration of the payment of the premium, the Insurance Company covered the risk of bodily injuries and death caused to any of the insured person as a result of an accident. The detailed clause of paragraph-1 of the Insurance Policy fixes the percentage of the capital sum insured which is to be paid to the bodily injuries specified therein. Clause (g) thereof specifically covers the case of death resulting from such accidental bodily injuries. The policy then provides for death except to which to Insurance Company shall not be liable to provide compensation either total or partial. Lastly, the conditions which govern the payment of the claim etc. have been provided with meticulous details. It is manifest from the copy of the insurance policy (Annex. R-1) that the policy covered as many as 83826 employees of the Punjab State Electricity Board. Once the Insurance Company accepts the risk on the payment of premium on the satisfaction of their conditions, then the employees contained in the schedule become insured persons, irrespective of the individual condition of health of each one of them at the time of taking of the policy or during the subsequent period of time for which the policy is taken out or refuted. It is plain that the Insurance Policy is intended to provide the insurance cover against bodily injury or death resulting from an accident to a group of persons as a collective whole. The crux of the matter Is that the bodily injury or death must be the proximate result of an accident. Herein, there is no factual dispute that Sucha Singh, deceased had sustained head injury which proved fatal as it is manifest from the record. There is thus no dispute that the insurance policy was fully covered and was attracted in the case of Sucha Singh, deceased. The solitary question is as to what was the ultimate result of the fatal injury whether the same was within the ambit of the insurance policy.

COMING to the factual controversy, the main sheet-anchor of the defence projected by Mr. Raj Kumar, learned Counsel for the insurance Company is that the deceased had consumed liquor and the head injury sustained by him which ultimately led to his death, was the direct cause of intake of liquor. This argument of Mr. Raj Kumar has only to be noticed and rejected. It is nowhere mentioned in the documents produced by the Insurance Company that liquor was found in the body of the deceased. On 18.10.1990, the deceased fell down from the stairs and sustained head injury and he died as a result of the said injury on 13.11.1990. It is thus manifest that the head injury was the direct cause of the death of Sucha Singh and not the intake of liquor as alleged by the Insurance Company. The totality of the circumstances when viewed as a whole leads to an inescapable conclusion that the head injury sustained by the deceased was the direct result of his death. His case comes squarely within the ambit of the insurance cover provided by the Insurance Company. So an attempt to wriggle out from the liability by the Insurance Company is, therefore, unwarranted. The deceased had hired the services by securing the insurance cover issued by the Insurance Company. There is manifest on this record a glaring deficiency in the service extended out by the Insurance Company. Indeed an incalcitrant attitude adopted by the Insurance Company in not settling the claim with promptitude and the total repudiation thereafter, border clearly on negligence in law and, in callousness as a matter of fact in the context of deceased''s wife and her orphan children. The claimants have established their claim to the contractual reliefs provided by the Insurance Policy, as also for compensation for loss and injury occasioned by the negligence of the Insurance Company. The complainants have made a claim of Rs. 1 lac. The far reaching consequence of nonpayment of legitimate dues to a destitute lady with four minor children can be well imagined. Therefore, we are inclined to direct that the respondent No. 4 shall pay an amount of Rs. 1 lac with interest @ 18% p.a. from 8.1.1992, the date of repudiation of the claim till the date of payment. We further direct that damages of Rs. 5,000/-: are to be paid to the complainants for withholding their dues for about three years. She is also entitled to costs of Rs. 1,000/-.

THE Insurance Company is directed to comply with the aforesaid order within two months from today failing which it would render itself liable to penalty under Section 27 of the Act.

IN the result, the complaint is allowed to the extent indicated above. Complaint allowed with costs.