ORIENTAL INSURANCE CO. LTD. Vs. SHYAMKALI

JUDGEMENT

(1.) THIS appeal is directed against order dated 5.11.2011, passed by District Consumer Disputes Redressal Forum, Baikunthpur Korea (hereinafter called District Forum for short) in complaint case No.106/2009, whereby the complaint of respondent Nos. 1 &

(2.) HEREIN has been allowed and the appellant Insurance Company has been directed to pay Rs.5,00,000, the sum assured under Group Janta Personal Accident Insurance Policy on account of death of the insured Shyam Sundar Panika by drowning. 2. Briefly stated the facts of the case are that the deceased Shyam Sundar Panika was working with respondent No.3 & 4 as an employee and was insured by the appellant Insurance Company under Group Janta Personal Accident Insurance Policy for the period between 16.10.1999 to 15.10.2009 and premium of the policy was being deducted from his salary. In the terms of the insurance policy in case of accidental death an amount of Rs. 5,00,000 and in case of loss of limb or eye some less amount was payable.

(3.) AS per the case of the complainant before District Forum, the deceased died on account of drowning on 22.5.07, while taking bath in a pond. The matter was reported to the police, postmortem of the dead body was conducted and claim was preferred before the Insurance Company, which has been repudiated by the Insurance Company on the ground that there was delay in preferring claim and that the deceased was guilty of violation of terms of the policy as he consumed alcohol and thereafter died on account of drowning, so his death comes in the exclusion clause of the policy. This defence was also taken by the Insurance Company that insurance cover was not available on the date of death of the deceased as the policy was already cancelled by returning pro rata premium of the policy to the employer of the insured. However the employer has supported the case of the respondent Nos. 1 & 2 /complainants.