ILABEN KIRITBHAI SHETH Vs. ORIENTAL INSURANCE CO

JUDGEMENT

(1.) The complainant No.1, Mrs. Ilaben K. Sheth, widow of deceased Kiritbhai R. Sheth in her personal capacity as well as guardian of two minor children Ronak and Ripal and the complainant No.2, M/s. Cadila Laboratories Limited, employer of Kiritbhai Sheth have claimed the amount of Rs.3,71,000/- which include the insurance amount of Rs.1,50,000/- under Table I of the policy and Rs.1,50,000/- under table III of the insurance policy and Rs.36,000/- for the interest and Rs.30,000/- for mental shock and Rs.5,000/- cost of the litigation. Deceased Kiritbhai Sheth was employee of the complainant No.2 M/s. Cadila Laboratories Limited which had taken group personal accident insurance policy for 1050 employees including Kiritbhai Sheth. According to the complainants Kiritbhai Sheth had to attend duty till late evening as he had to contact the medical practitioners, stockists etc. and on February 16, 1991 when he was returning from duty on his scooter he met with the accident and serious injuries were caused to him. Some strangers took Kiritbhai Sheth to his residence in rikshaw and family Doctor Amlani was called and then was taken to the nursing home of Dr. Prakash Shah and Dr. Prakash Shah was called. Before Dr. Shah could examine Kiritbhai Sheth he succumbed to the injuries. The No.2 vide letter dated February 19,1991 informed the opposite party Insurance Company of the death of Kiritbhai due to the accident. Vide letter dated 14.3.91, the complainant No.2 forwarded several documents regarding the death and submitted the claim form. The Insurance Company insisted for the post mortem note and the police report but the post mortem was not carried out and police complaint was not filed and, therefore, the complainants could not furnish those documents and, therefore, the opposite party vide letter dated January 2,1992 informed the complainant No.2 that in the absence of FIR and post mortem report, the claim was repudiated and the file was closed at the end of the Insurance Company. The complainants have therefore filed this complaint for the above referred amount.

(2.) The opposite party vide written reply (Exh.7) denied the various contentions in the complaint and also denied the death of Kiritbhali Sheth by accident and asserted that in absence of the post mortem note and police complaint it was not possible for the opposite party to accept the fact that the death occurred due to the accident and accordingly asserted the right to repudiate the claim. It is alleged that the claim is false and frivolous and the complainants are not entitled to the amount claimed.

(3.) The fact that Kiritbhai Sheth was an employee of the complainant No.2 and was getting the monthly basic pay of Rs.4,425/- and HRA Rs.700/- and accordingly was getting Rs.5,175/- as remuneration and was in employment at the time of the accident is established by documentary evidence and there is no dispute to that fact. As such complainant No.2 which is a business concern has no reason to state false facts in favour of the complainant No.1. Immediately the letter was written by complainant No.2 to the opposite party stating the facts regarding accidental death of Kiritbhai Sheth. The establishes the anxiety of the company for getting the compensation to the employee who was covered under the group insurance. Shri Shekhar, the witness examined by the opposite party has admitted that Kiritbhai was covered under the policy as employee of Cadila Laboratories. In view of that it should be accepted that the deceased Kiritbhai was the employee of the complainant No.2 and was covered under the group insurance which was in force at the time of the accident.