Padmabati Behera vs ORIENTAL INSURANCE CO LTD

BOTH the cases have been filed under Section 12 of the Consumer Protection Act, 1986 in short C.P. Act, by two different complainants for deficiency in service of the Oriental Insurance Company Ltd. represented through its Sr. Divisional Manager, and Branch Manager, Oriental Insurance Co. Ltd., Mochisahi Square, Puri, hereinafter be called as opposite party Nos. 1 and 2 respectively, in settling the death claim of late Biranchi Narayan Behera.

A common judgment is passed in both the cases for convenience, as the cases are heard analogously in one day. The fact of the case in brief is that, undisputedly opposite party No. 3 of C.D. Case No. 78 of 2002, who is the complainant in C.D. Case No. 76 of 2002, is a company registered under the Companies Act, whose work is to distribute and supply electricity in the Western region of Orissa. This opposite party No. 3 has employed number of employees for smooth distribution and supply of electricity and Biranchinarayan Behera as such was working as a helper under opposite party No. 3. The Oriental Insurance Co. Ltd. is a subsidiary Company of General Insurance Corporation of India in short G.I.C.I and is doing business of fire and accident insurance for rendering service to the consumers. The opposite party Nos. 1 and 2 are the Officers of the Oriental Insurance Co. Ltd. in short O.I.C. They are responsible for settlement of claim, interest and damage due to accidental death and injuries in respect to insured under the Group Personal Accident Insurance Scheme of the O.I.C. The opposite party No. 3 adopted such Group Personal Accident Insurance Scheme for its employees for the period of insurance from 28.2.2000 to 27.2.2001, sum insured per person Rs. 3,00,000 (three lakh) by paying premium from its own fund. Biranchi Narayan Behera (since dead) who is the husband of Padmabati Behera, the complainant in C.D. Case No. 78 of 2002, was an insured member under said policy No. 345309/2000/41. Opposite party No. 3 has paid the periodical premium for and on behalf of the employees including said Biranchi.

THE specific case of Padmabati Behera and opposite party No. 3 is that the Group Personal Accident Insurance Scheme in short G.P.A.I.S. assures the family members of the insured to give 3 lakh rupees on event of death of an insured. Said Biranchi met with an accidental death due to electric shock on 19.12.2000 at 11 a.m., when he was discharging his duty in repairing the electric line under the Budhapal Electrical Section of Deogarh Electrical Sub -Division, Deogarh. After this matter was reported at Kundaigola Police Station, U.D. Case No. 3 of 2000 was registered and post mortem on the dead body was conducted through a doctor and evidence of witnesses was recorded by the police. Ultimately, the police submitted final form with information that accidental death occurred to Biranchi due to electric shock while connecting fuse in the Palrama Feeder and there is no suspicion of foul play. The opposite party No. 3 submitted claim on behalf of said Padmabati before opposite party Nos. 1 and 2 on 9.2.2001 which is expected to be settled within seven days from the receipt of the claim. But, opposite party No. 1 vide its letter dated 11.10.2001 (Annexure -3) requested opposite party No. 3 to provide the viscera report of Biranchi for finalizing the claim as the Final Form submitted by police discloses that Biranchi was in drunken state and died on sheer negligence. Though the Medical Officer in short M.O.H.C. Chhedeipada, C.H.C., Dist. Angul vide his letter (Annexure 4) dated 22.11.2001 and A.S.I., Kundaipali out post vide his letter (Annexure 5) dated 12.11.2001 in reply to the further inquiry by opposite party No. 3 about the cause of the death of Biranchi, reported that the cause of death of Biranchi is not due to his own negligence but due to electric shock for which the viscera was not sent for examination yet, opposite party Nos. 1 and 2 knowing about the same sat over the matter for long time. Ultimately, opposite party No. 2 rejected the claim vide letter dated 25.2.2002 (Annexure 7) on the ground that Biranchi died due to his drunkenness for which the claim cannot be settled in view of the exclusion clause of the scheme. But there was no cogent and satisfactory evidence before opposite party No. 2 to form such opinion. Therefore, each of the complainant of both these C.D. cases claimed the insured amount of 3 lakh, interest @ 24% per annum on the insured amount from 19.12.2000, Rs. 1,08,000 towards mental agony and harassment of family members of Biranchi, expenses towards journey and correspondence and cost of litigation in total Rs. 6,38,000 and Rs. 6,33,000 respectively, to which complainant Padmabati Behera is entitled.

AS per the written version, opposite party Nos. 1 and 2 have stated that after examining the matter in details, they have taken the decision of repudiating the claim. So they have not caused any laches, negligence and deficiency in service. According to them, assuming in the worst case that Biranchi met with an accidental death and it is revealed from the final report (Annexure 2) submitted by the police that Biranchi had fallen down due to his sheer negligence as he was in drunken state. Therefore, in view of the exclusion Clause 6(b) of the said policy (Annexure 1 series) the claim is repudiated. Besides this Padmabati is negligent in prosecuting her claim in not providing opposite parties the viscera examination report and Annexures 4 and 5 is meaningless to them as the same are internal communication between the employer with different authorities. Thus, they claim for dismissal of both the C.D. cases which have also been filed beyond the prescribed period of limitation. We have heard both sides and perused the documents and materials on record.

THE Risk Covered and Scope of Cover under the said policy No. 345309/42/2000/41, Annexure 1 not disputed by the opposite parties, provides under the policy to the insureds assignee or nominees or his legal personal representatives as the case may be the sum insured in case of death solely and directly from accident caused by external violent and visible means. But the sum insured is not available to the insureds assignee or nominees and others as aforesaid in case the insured dies being under the influence of intoxicant liquor or drugs in view of ''Exclusions or Exceptions'' Clause 6(b) of the said policy.

AS the opposite parties claim that the claim has been repudiated in view of said Clause 6(b), the crux of the point is as to whether Biranchi died an accidental death in view of the ''Risk Covered'' or died due to his negligence being under the influence of liquor. As a matter of fact, opposite party No. 3 Company adopted the G.P.A.I.S. of the opposite party Nos. 1 and 2 for its employees including Biranchi by paying periodical premium from its own fund on behalf of its said employees. So he has every locus standi to file a C.D. case and is also a necessary party in respect to the settlement of claim. In such circumstance as well as in the circumstance in which Annexures 4 and 5 were issued by the said M.O. and A.S.I. respectively, have much bearing to the present cases. The final form (Annexure 2) submitted by Kundheigala Police Station discloses that the cause of death of Biranchi is due to accidental electric shock while connecting fuse in the palrama feeder and no suspicion of foul play. Said final form also speaks about the post mortem examination report that the cause of death is due to electric shock. Opposite party No. 2 asked opposite party No. 3 vide letter dated 11.10.2001 (Annexure 3) to supply viscera report for finalisation of claim as on scrutiny of the final report of the police, he observed that the employee was in drunken state and died due to sheer negligence. But no where in the report, Annexure 2, the investigating officer has stated that after necessary investigation he was satisfied that Biranchi was under the influence of intoxicants or liquor when he was connecting the fuse and due to his own negligence Biranchi had fallen down from the feeder and died. His report only discloses that Prafulla Samal, line man had told that Biranchi was on drunken state. But his statement is not before us. Neither his statement is brought before us at the instance of opposite parties nor opposite parties have made any attempt to adduce his evidence in this case. Police report discloses that thre other line man had gone to that spot including Prafulla Samal, whereas police has not examined them. There are no other material in support of the fact that Prafulla Samal told before the police that Biranchi was under the influence of liquor at that time. The post mortem report also does not disclose that he was under the influence of liquor. Therefore, had Biranchi was under the influence of liquor or any intoxicants at the relevant time on 19.12.2000, the said police would not have filed the final report stating therein the cause of death of Biranchi is due to accidental electric shock and there is no suspicion. In this end of the view, opposite party No. 2 is not justified to suspect the police report and to call for the viscera examination report from opposite party No. 3.

MOREOVER , after receipt of said letter, Annexure 3 from opposite party No. 2, opposite party No. 3 made further inquiry and correspondence with the aforesaid police and the M.O. as a result of which Annexures 4 and 5 were received. Vide Annexure 5, the A.S.I. has specifically reported that during inquiry the witnesses and others did not disclose that Biranchi had taken alcohol before death or died due to negligence. He sticked to his report as per the final form that Biranchi died due to electric shock while discharging his duty. The M.O. has also sticked to the cause of his death due to electric shock as per Annexure 4. He has also reported that as police did not feel necessary for the examination of the viscera, the viscera is not examined. There is nothing to suspect the reports, Annexures 4 and 5 which are relevant to the point under dispute. Therefore, the net conclusion would be that the death of Biranchi is under the Risk Covered of the said police and opposite party Nos. 1 and 2 cannot escape from liability as his death does not come under Clause 6(b) of Exclusions or Exceptions of the said policy. Undisputedly, complainant Padmabati Behera is the wife of deceased Biranchi. Therefore, she is entitled to the assured sum in the said policy and interest at a reasonable rate on the said amount with compensation for mental agony and harassment and expenses and cost of litigation, opposite party Nos. 1 and 2 having caused considerable delay unnecessarily in settling her claim.

IN the result, both the cases are allowed on contest against opposite party Nos. 1 and 2, but necessary order is being passed in C.D. Case No. 78 of 2002 for the purpose of execution and compliance of orders. The opposite party Nos. 1 and 2 are hereby directed to pay to Padmabati Behera, the complainant, the insured amount of Rs. 3 lakh with interest @ 9% per annum from 9.2.2001 which is the date of filing of the claim, within 8 weeks from the date of the receipt of the copy of this order failing which 12% interest will be charged after 8 weeks. It is further directed that opposite party Nos. 1 and 2 would pay Rs. 10,000 as compensation towards mental agony and harassment and Rs. 1,000 towards litigation expenses to said Padmabati Behera. Mr. Subash Mahtab, Member -I agree. Complaints allowed. -