Oriental Insurance Co. Ltd. vs SARASWATI

THIS is an appeal under S.15 of the , which by order dated 23.2.2005 in Complaint No. 79/2004 by District Consumer Disputes Redressal Forum, Durg (hereinafter called the ''District Forum'' for short), has been put under challenge.

DECEASED Dhronacharulu was an employee of Bhilai Steel Plant and had obtained Group Janta Personal Accident Insurance Policy (hereinafter called the ''Janta Policy'' for short), covering the risk of his life for the period from 9.1.1999 to 8.1.2011. The said policy was obtained in pursuance of memorandum of understanding between Steel Workers Union (INTUC), Bhilai and appellant insurer. It is also not in dispute that the dead body of the insured Dhronacharulu was found lying near railway line on 24.9.2003. There were several injuries on the body. The complainant lodged claim for payment of assured amount under the Janta Policy issued by appellant/insurer. However, the claim was repudiated by the appellant/insurer by their letter dated 4.3.2004, on the ground that the policy was cancelled by them w.e.f. 26.11.2000 and intimation thereof was given to Steel Workers Union. Aggrieved, the complainant approached District Forum and filed the complaint. The appellant/insurer resisted the complaint ''inter alia'' on the ground that the insured committed suicide and, therefore, the claim under the Janta Policy was not payable. It was also averred that the policy was already cancelled by the appellant/insurer by their letter dated 4.3.2004 addressed to Steel Workers Union.

District Forum by the impugned order repelled the defence version as above of the appellant/insurer and held that it has not been established that the deceased committed suicide. It was accordingly held that the appellant/insurer committed deficiency in service by repudiating the complainant''s claim. Accordingly, it was directed that appellant/insurer shall pay to the complainant Rs. 5,00,000 together with interest @ 9% p.a. from 19.3.2004.

WE have heard the learned Counsel for the parties and record perused. As noticed earlier, repudiation of the claim by the appellant/insurer by their letter dated 4.3.2004 was on the ground that the policy was cancelled by them by their letter dated 26.11.2000 addressed to Steel Workers Union. It is clear that the deceased insured was never informed about the cancellation of the policy, which was necessary for its cancellation, as per terms thereof. That being so, even if the appellant/insurer wrote a letter dated 26.11.2000 to Steel Workers Union, the same would not have the effect of cancellation of the policy. Reference in the above connection may be made to the decision of this Commission in The Oriental Insurance Co. Ltd. v. Smt. Sushila Bai, Appeal No. 576/2004; Oriental Insurance Co. Ltd. v. Mariamma Koshi & Ors., Appeal No. 1282/2003 and many other similar appeals.

THE next contention of the learned Counsel for appellant/insurer was that as the deceased committed suicide, the claim under the said policy was not payable in view of condition Nos. 4(a) and 4(d) of the Janta Policy. It was submitted that the complainant had deliberately tried to cross the railway line and committed breach of law and had committed suicide. It may be pointed out that there is no material to support the contention as above. Learned Counsel for appellant/insurer referred to the report of the investigator. However, the report by itself, without any material to support it would not in any way substantiate the allegations as above. Moreover, in the said report the investigator has only expressed his doubt about the circumstances of the death of the deceased and has opined that there was the possibility of deceased having committed suicide. However, such a report, which is not even supported by the affidavit of the investigator cannot be relied upon. Post-mortem report clearly indicates multiple abrasions all over the body of deceased which are indicative of accidental death of the deceased insured. In view of above finding of the District Forum that the deceased died due to accident is justified and is affirmed. Therefore, the appellant/insurer was liable to pay to the complainant/respondent the assured amount under the policy, as has been directed by the District Forum. No interference in the impugned order is called for. This appeal has no substance. It is accordingly dismissed. The appellant/insurer shall bear its own cost of this appeal and shall pay that of the complainant/respondent, which is quantified at Rs. 1,000 (Rupees one thousand) only. Appeal dismissed.