Bhagmati Bai Verma W/o Shri Thanuram Verma vs Branch Manager The Oriental Insurance Co. Ltd.

THIS order shall decide two above said cases, which are between the same parties and entail similar questions of facts and law.

SHORTLY stated, the facts of these two cases are these. Shri Thanuram Verma, since deceased was an employee of Chhattisgarh Co-operative Credit Society Limited, Bhilai. The Group Janta Personal Accident Insurance Policy was taken by Chhattisgarh Co-operative Credit Society Limited and his membership number was 8960. Shri Thanuram Verma obtained two policies issued by the insurance company. Insurance policy no. 152503/2009/526 was for Rs. 1,00,000/- and the period of policy was valid from 17th June, 2008 to 16th June, 2009. The second insurance policy no. was 152503/2009/91 was for a sum of Rs.1,00,000/- and the period of policy was valid from 26th February, 2008 to 26th June, 2009. He was employee of BSP. Shri Thanuram Verma died on 15th December, 2008 by drowning in a pond, which was an accidental death. Thus, the claim was preferred before the insurance company and intimation was also given to the Police Station. The insurance company repudiated the claim of the claimant. Thereafter, the complainant filed the complaint before the District Forum and claimed the amount of insurance policy of Rs.1,00,000/- each. The District Forum allowed the complaint of the complainant and directed the opposite party to pay amount of Rs.50,000/- each, total being Rs. 1,00,000/- along with interest and compensation for mental harassment and cost of suit. The appeal was preferred before the State Commission but the State Commission also dismissed the appeal.

It may also be mentioned here that in reply insurer took the defense that deceased was intoxicated at the time of accident and died of consuming an intoxicated substance but could not bolster this defense with evidence before the Forum and the Forum held that the death took place due to accident.

WE have heard counsel for the petitioner. The principal argument urged by the counsel for the petitioner was that he had collected information from the RTI, wherein, it transpired that the insurance company had given the benefit of Rs. 2,00,000/- in similar cases. Our attention was also drawn towards the RTI report. This argument is devoid of merit. Both the Fora below have rightly held that a person, who is insured by the insurance company under two different Group Janta Personal Accident Insurance Policies and as per Exclusion Clause 3 of the policy, benefit of 100% can only be provided and not more than that. Both the Fora below have placed reliance upon judgment of the State Commission in case reference of Oriental Insurance Company Ltd. Vs. Anika Thakur & Ors. in Appeal No. 371/2008 dated 19th August, 2009, wherein it was held by this Commission "As the insurance cover was provided to the employer of the deceased for minimum sum of Rs.1,00,000/-, therefore only that much sum is payable to the LRs of the deceased. Policies have been obtained from two different Insurance Companies and both the policies are having such term regarding limit of maximum benefit, which can be provided in a particular claim, then in such a case liability be shared by both Insurance Companies, so that total benefit to the LRs of the deceased may not be more than the sum assured under the Personal Accident Insurance Policy."

TURNING to the argument regarding RTI information, if the insurance company commits a mistake, that mistake is not to be followed in other cases. We have to take a down to earth view. The petitioner has in vain tried to make bricks without straw. Consequently, we see no force in both these petitions and dismiss the same.