WADHEL WATER PROOFING COMPANY vs UNITED INDIA INSURANCE CO

THE complainant claimed in this complaint an amount of Rs. 1,06,002/- with interest for the settlement of insurance claim. THE facts of the complaint are that the complainant obtained an insurance policy from the opposite party for indemnifying the insurance received by their workers during the course of employment with the complainant. THE complainant carries on business of water proofing with the help of their employees. THE complainant obtained the insurance policy for the period between 11.4.1990 to 10.10.1990 after payment of Rs. 1216/- towards the premium. According to complainant in an incident occurred on 13.5.90 their employee Sonabhai Oza died in an accident while working with the complainant Company during the course of his employment. His age was 32 years. It is the allegation of the complainant that he paid Rs. 1,06,002/- to the legal heirs of the deceased Sonabhai as per the direction of the Commissioner for Workmen''s Compensation. THE Complainant further alleged that their claim lodged with the O.P. for payment of insurance claim remained unsettled. According to complainant, the opposite party by letter dated 11.2.91 refused the claim on the ground that the complainant had not complied with certain provisions of Maharashtra Factories Rules, 1963. THE complainant, therefore, claimed the aforesaid amount towards the settlement of the insurance policy together with the interest at the rate of 18% p.a. THE Opposite Party filed the written version and denied the claim of the complainant. Inter alia, it has been submitted by the opposite party that they have not committed any act of deficiency in their service except stating that the claim has been rejected. It is further submitted that the rejection of claim does not amount to a deficiency within the meaning of Section 2(g) of the C.P. Act, 1986. THE O.P. does not have any quarrel about the death of complainant''s employee in question. THE only dispute is that the complainant has not complied with statutory requirement.

WE have heard both the sides through their respective Advocates and also perused the affidavits documents and the pleadings of both the parties. The following few points arise for our consideration. (1) Whether the complaint is maintainable? (2) Whether there has been deficiency in the service of the opposite party? Whether the complainant is entitled to receive compensation due to the deficiency in the service of the opposite party?

As regards the first point, we are of the view that the complaint is maintainable as the opposite party rendered necessary service to the complainant in relation to his insurance requirement within the meaning of Section 2(o) of the C.P. Act. Thus, we find that the complaint is maintainable.

The ground to reject the complainant''s claim is solely on the basis of condition No. 3 in the insurance policy. We have perused the insurance policy placed on record. The condition No. 3 is as under:- "The insured shall take reasonable precaution to prevent accident and disease and shall comply with all statutory obligations."

THE page 3 of the policy lays down legal conditions. THE condition bearing on the insurance policy is quoted below:- "W.C. Act, 1923 & subsequent amendments of the said Act, prior to the date of issue of the policy,"

"THE Fatal Accidents Act, 1955," Beside the aforesaid two conditions there is no other statutory obligation binding the complainant. THE dispute, therefore, boils down to the obligation that minimum of reasonable precautions has to be taken to prevent accident appearing in Condition No. 3. According to complainant they had taken all the reasonable care of their workers while doing the work of water proofing. It is the case of the complainant that they are doing the business of water proofing, roof repairing, A.C. Sheet fixing, repairing etc. for various customers. It is, therefore, submitted that they are conversant with the risk in their business and they had obtained the policy to cover the loss of their employees during the employment. It is, therefore, submitted that complainant had taken all the necessary and reasonable care to protect the life of their employees. The reason for rejection of the claim of the complainant given by the opposite party in their letter dated 18.2.91 is that the complainant contravened Rule 73F(a) of Maharashtra Factories Rules, 1963. If there is violation of the aforesaid Factories Rule, then it does not find place on page 3 showing the conditions in the policy. On the contrary, the case of the opposite party is the; the complainant has violated Condition No. 3 attached to the policy. In absence of the mention of the Maharashtra Factories Rules, 1963 as the legal condition on page 3 of the policy condition we a re of the view that the claim of the complainant cannot be rejected by the opposite party for a condition which does not find place among the written conditions on page 3 of the policy. In any case, the condition No. 3 mentioned in the policy and Maharashtra Factories Rules, 1963 cannot be read together in absence of mention of the Maharashtra Factories Rules, 1963 on page 3 of the policy. Under these circumstances, we are of the view that there is deficiency in the service of the opposite party that their legitimate claim has been wrongly rejected for no reasons and thus caused loss to the complainant due to their negligent working. Hence, we find that there is deficiency in the service of the O.P.

THE complainant has, therefore, clearly demonstrated that they were required to pay to the legal heirs of the deceased employee an amount of Rs. 1,06,002/- on the basis of decision of the Commissioner for Workmen''s Compensation since the complainant has been put to the loss for that amount. THE opposite party is required to compensate that loss of the complainant by settling the insurance claim. THEre cannot be any dispute about the quantum of compensation since it has been arrived at by the competent authority. THE complainant is also justified to receive interest at the rate of 18% p.a. on the aforesaid amount towards compensation. Hence, we allow this complaint and pass the following order:- ORDER The complaint is allowed. The opposite party is directed to pay to the complainant an amount of Rs. 1,06,002/- together with interest at the rate of 18% p.a. from the date of payment made to the employee''s legal heirs by complainant till payment is made by the opposite party. Complaint allowed.