If Accidental Death Is Proven, Can't Reject Claim Based On Unnecessary Risk Taking, Maharashtra State Commission Holds Universal Sompo Insurance Co. Liable

The State Consumer Disputes Redressal Commission, Aurangabad (Maharashtra) bench comprising Dr Nisha A. Chavhan (Member) and Nagesh C. Kumber (Member) held Universal Sompo General Insurance Company liable for wrongfully repudiating the claim for 'Gopinath Mundhe Farmers Insurance Scheme' held by a deceased daily wage worker. The State Commission held that once accidental death was proven, insurance companies couldn't reject the claim based on the deceased's perceived unnecessary risk-taking. Brief Facts: Janardhan Bapurao Warked, who was an agriculturist and daily wage labourer, had purchased the 'Gopinath Mundhe Farmers Insurance Scheme' from Universal Sompo General Insurance Company (“Insurance Company”). He was working with a private contractor to change a distribution box and cable wire. Unfortunately, while performing this task, Janardhan suffered an electric shock which resulted in his death. The incident was registered under section 174 of the Cr.P.C. at the Mantha Police Station, and a post-mortem was conducted. Smt. Kantabai (“Complainant”), as the nominee of the deceased, attempted to claim insurance benefits through the Taluka Krishi Adhikari, but the claim was neither processed nor disbursed. Feeling aggrieved, she filed a consumer complaint in the District Consumer Disputes Redressal Commission, Jalna, Maharashtra (“District Commission”). She alleged that the Insurance Company had committed a deficiency in service by failing to process the insurance claim. The Insurance Company contested the complaint, arguing that Janardhan's death was due to his unauthorized climbing of the pole without consent or permission from the Maharashtra Electricity Distribution Company (MSEDCL), which violated the terms and conditions of the insurance policy. Consequently, it repudiated the claim, asserting that no deficiency in service was committed towards the Complainant. The District Commission dismissed the complaint after hearing both sides. Dissatisfied with the order of the District Commission, the Complainant filed an appeal in the State Consumer Disputes Redressal Commission, Aurangabad Bench, Maharashtra (“State Commission”). Observations by the Commission: The State Commission noted that the main point of contention revolved around the Insurance Company's repudiation of the claim, citing the deceased's unauthorized climbing of the pole without consent from Maharashtra Electricity Distribution Company Limited (MSEDCL). This action was considered a violation of exclusion clauses in the insurance policy, according to the Insurance Company. The State Commission further noted that the deceased possessed knowledge of electrical work and that it was common practice in rural areas for local labourers and electricians to assist MSEDCL or private contractors without verifying permissions. These labourers often assumed that the necessary permissions had been obtained by the contractors or MSEDCL. The Commission emphasized that the responsibility to obtain permissions lay with the contractors or MSEDCL, not the labourers themselves. Referring to a Government Resolution (G.R.) dated 19.09.2019, the State Commission highlighted that insurance companies were bound by the directions and guidelines outlined in the G.R. Notably, Clause 19 of the G.R. stated that once accidental death was proven, insurance companies couldn't reject the claim based on the deceased's perceived unnecessary risk-taking. Ultimately, the State Commission found that the District Commission had erred in not considering important facts presented by the complainant, including relevant judgments and the benevolent nature of the 'Gopinath Mundhe Farmers Insurance Scheme'. Consequently, the State Commission allowed the appeal and set aside the order of the District Commission.

If Accidental Death Is Proven, Can't Reject Claim Based On Unnecessary Risk Taking, Maharashtra State Commission Holds Universal Sompo Insurance Co. Liable

Smita Singh

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