IN THE HIGH COURT OF JUDICATURE AT MADRAS DATED: 21.12.2011 CORAM THE HONOURABLE MR.JUSTICE D.HARIPARANTHAMAN W.P.No.9611 of 2011 and M.P.No.1 of 2011 Smt.Valli ... Petitioner Versus 1.The Divisional Manager, United India Insurance Company, Divisional Office, Tarapore Tower, 7th Floor, No.826, Anna Salai, Chennai-600 002. 2.The Secretary, Tamil Nadu Construction Workers Welfare Board, No.8, Valluvarkottam High Road, Nungambakkam, Chennai-600 031. ... Respondents PRAYER: This Writ Petition is filed under Article 226 of the Constitution of India praying for issue a Writ of Mandamus seeking for a direction to the 1st and 2nd respondents to sanction the insured amount of Rs.1 lakh to the petitioner together with interest at the rate of 12% p.a. from the date of death till the date of payment. For Petitioner : Mr.R.Ramesh For Respondents : Mr.S.K.Krishnamurthy for R-1 Mr.RM.Muthukumar for R-2 Govt. Advocate O R D E R The petitioner is a young widow. Her husband was a construction worker. 2. In exercise of powers conferred under Section 6 of the Tamil Nadu Manual Workers (Regulation of Employment and Conditions of Work) Act, 1982 (Tamil Nadu Act 33 of 1982), the Government of Tamil Nadu https://hcservices.ecourts.gov.in/hcservices/ constituted a Board namely "Tamil Nadu Construction Workers Welfare Board" on 30.11.1994 to execute the Scheme and to maintain and administer the Manual Workers General Welfare Fund of Tamil Nadu Construction Workers Welfare Board and to provide welfare measures for the construction workers engaged in the construction industry. The following welfare measures are provided in the scheme for the workers, who have registered in the second respondent Board and the husband of the petitioner registered his name with the second respondent Board. i) Creches ii) Personal Accident Relief iii) Provident Fund and Employee' Insurance Scheme. iv) Pension Scheme v) Assistance for the Funeral Expenses on the death of a Registered Manual Worker. vi) Assistance for the Education of the son or daughter of Registered Manual Worker. vii) Assistance for Marriage of self and the son/Daughter of a Registered Manual Worker. viii) Assistance for the Delivery of a Child or for the Miscarriage of pregnancy or for the Termination of pregnancy, by a Registered Women Manual Worker. ix) Assistance for the natural Death of a Registered Manual worker. x) Spectacles. 3. While, the petitioner's husband was working in the sand quarry at Chinnamathur Maduvu, Chennai – 68, on 18.10.2003 at about 5.00 p.m., he was accidentally buried under the sand, due to sliding of sand. Immediately, a complaint was given to the G-2, Madhavaram Milk Colony Police Station and FIR was registered in Crime No.135/2003 under Section 174 of Cr.P.C. on 19.10.2003 at about 11.00 a.m. that the death of the petitioner's husband took place in suspicious circumstances. On 19.10.2003, post-mortem was conducted in Government Stanely Hospital. After the post-mortem, a certificate was issued by the Doctor stating that cause of the death of the petitioner's husband was the accident. Thereafter, the body was handed over to the petitioner. https://hcservices.ecourts.gov.in/hcservices/ 4. According to the petitioner, her husband is covered by a group insurance policy scheme of the first respondent and, therefore, she is entitled to the benefits of the group insurance scheme due to the death of her husband in the accident on 18.10.2003. 5. But, the second respondent issued a letter dated 28.07.2004 sanctioning a sum of Rs.12,000/- by treating the death of the petitioner's husband as natural death, instead of accidental death. The petitioner refused to receive the said sum of Rs.12,000/- and she made a representation to the second respondent seeking to get her insurance amount of Rs.1,00,000/- from the first respondent, for the accidental death of her husband. 6. Subsequently, the petitioner made representations dated 21.09.2006 and 07.05.2007 to the second respondent to get her insurance amount. The second respondent sent a reply dated 15.05.2007, directing the petitioner to produce the post-mortem certificate. Accordingly, the petitioner submitted a letter dated 16.07.2007 enclosing the post-mortem certificate. 7. While so, the second respondent addressed a letter in E1/58045/06 dated 02.08.2007 to the first respondent requesting them to grant the insurance amount to the petitioner due to the death of her husband in the accident on 18.10.2003. The second respondent enclosed the relevant documents mentioned therein. The first respondent sent a letter dated 04.03.2010 to the second respondent directing them to give various documents mentioned therein and also to explain the reason for delay in submitting the claim. Under the said circumstances, the first respondent sent a letter dated 16.04.2010 to the second respondent stating that on scrutiny of papers, the first respondent found out that the claim was made after the delay of 4 years and therefore they are not in a position to entertain the claim after such a lapse. In the said letter, the first respondent wanted to know the reason for delay. 8. Thereafter, the first respondent wrote another letter dated 23.06.2010 to the second respondent stating that as per the policy condition, the claim must be made immediately within one calendar month from the date of death. Since the claim was made to the first respondent on 06.08.2007, after the delay of 4 years, the first respondent was not able to entertain the claim. 9. The second respondent sent a letter dated 20.07.2010 to the first respondent stating that the first respondent was not correct in repudiating the claim on the ground of delay and in the terms and conditions of the policy, nowhere reference as to time limit has been mentioned. The second respondent requested the first respondent to reconsider the repudiated claim for insurance payment to the petitioner due to the death of her husband in the accident. In the said factual background, the petitioner has filed the present writ https://hcservices.ecourts.gov.in/hcservices/ petition seeking for a direction to the 1st and 2nd respondents to sanction the insured amount of Rs.1 lakh to the petitioner together with interest at the rate of 12% p.a., from the date of death of her husband till the date of payment. 10. The first respondent has filed a counter affidavit stating that without challenging the order dated 23.06.2010 repudiating the claim of the petitioner, the writ petition seeking for the issuance of mandamus is not maintainable. It is further stated that since question of facts has arisen for consideration, the writ petition is not maintainable. On merits, it is stated that the death could have been intimated to the first respondent immediately, with full particulars, by way of notice, in order to get the same verified by the licensed professional investigator, by the first respondent . It is further stated that after the lapse of four years from the date of death of the petitioner's husband, the question of deputing the investigator, would not serve the purpose. It is also averred that the death was not at all proved beyond doubt and the claim was not made immediately after the accident, in accordance with the policy condition. 11. The second respondent filed a counter affidavit supporting the claim of the petitioner. It is stated that the first respondent shall admit the claim of the petitioner, as no time limit for making such a claim, had been prescribed in the conditions of policy. 12. Heard both sides. 13. The petitioner's husband was a construction worker. He registered with the second respondent Board. A group insurance policy was taken by the first respondent in No. 011600/47/03/00001. It is not in dispute that as per the policy condition, for the death of a person covered under the policy in an accident, the first respondent is liable to pay a sum of Rs.1,00,000/-. 14. The petitioner's husband was working in the sand quarry at Chinnamathur Maduvu, Chennai-600 068. On 18.10.2003 at about 5.00 p.m., the accident took place and the petitioner's husband was buried under the sand, due to sand slide, which resulted in his death. Immediately, a complaint was given by one of the co-workers, who was also involved in sand quarrying, to the G-2, Madhavaram Milk Colony Police Station and FIR was registered in Crime No.135/2003 under Section 174 of Cr.P.C., on 19.10.2003 at about 11.00 a.m. The relevant portion of the First Information Report is extracted hereunder:- "new;W 18/10/2003 md;W khiy Rkhh; 5 kzp ,Uf;Fk; rpd;dkhj;J}h; kLtpy; ehDk; rpd;dkhj;J}iu nrh;e;j fnzrd;. Kdpahz;o kw;Wk; Kj;J Mfpnahh; nrh;e;J ,uz;L khl;L tz;oapy; kzy; Vw;wpf;bfhz;L ,Ue;njhk;/ fnzrd; kziy File;J J}f;fpf; bfhz;L te;J vd;dplk; bfhLj;jhh;fs; https://hcservices.ecourts.gov.in/hcservices/ ehd; mij th';fp tz;oapy; nghl;Lf;bfhz;oUe;njd;/ me;j ,lj;jpy; nkny Ie;jo cauj;jpw;F btUk; fspkz;zhf ,Ue;jJ mjw;F fPnH kzy; ,Ue;jJ/ fnzrd; me;j kziy File;J ms;sp bfhz;oUf;Fk;nghJ nkny cs;s kz; rhpe;J tpGe;J fnzrid kz; K:otpl;lJ/ mg;nghJ Kdpahz;o md;dhh; Tilia jiyapy; J}f;fp;f; bfhz;lhh;/ mth; kPJ kz; tpHe;jnghJ mz;zhh; Tilapy; tpGe;J Kdpahz;of;F rpuha;g;g[f;fhak; Vw;gl;L ka';fpa epiyapy; , Ue;jhh;/ ehDk; Kj;Jt[k; fnzrid J}f;f Kad;wnghJ v';fshy; J}f;f Koatpy;iy/ clnd ehd; CUf;Fs; xote;J Fkhh; O filapy; epd;W bfhz;oUe;j Mapuk; kw;Wk; tp$pia miHj;Jf;bfhz;L brd;W kz;iz js;sptpl;L fnzrid J}f;fpg; ghh;j;njhk;/ fnzrd; ,we;Jtpl;lhh;/ gpnujj;ij khl;L tz;oapy; J}f;fp nghl;Lf;bfhz;L te;J fnzrd; tPl;oy; nghl;Ltpl;nlhk;/ eh';fs; vd;d bra;tJ vd;W bjhpahky; ,Ue;J tpl;nlhk;/ , J nghyP;!; nf!; vd;W Chpy; cs;s bghpath;fs; brhd;dhh;fs;/ Mifahy; fhty; epiyaj;jpw;F ,d;W g[fhh; bfhLf;fpnwhk;/ 15. Thereafter, the Inspector of Police, G-2, Madhavaram Milk Colony Police Station handed over the body of the husband of the petitioner to the Government Stanely Hospital, Chennai for post- mortem. On 19.10.2003, post-mortem was conducted by a Doctor and Post-Mortem Certificate was issued. The relevant portion of the post-mortem certificate is extracted hereunder:- "The body was first seen, by the undersigned at 2.15 on 19.10.2003 its condition then was Rigor Marks present all over the body post-mortem commenced at 2.15 p.m. at 19.10.2003. Appearance found at the post-mortem moderately wounded body of a male." The opinion of the Doctor is that the deceased would appear to have died of cervical spinal injury. 16. The Doctor, who was working in Government Stanely Hospital, gave a death report to the Inspector of Police. In the death report, the cause of death is shown as accident. The death report is also extracted hereunder:- DEATH REPORT DR.S.BALASUBRAMANIAN G2, M.M.Colony PS.No.135/2003 M.B.B.S. D.C.H. U/s. Suspicious Death 1. Name in full : Ganesan 2. Sex : Male 3. Nationality Caste : Hindu-Adi Dravidar 4. Age : 36 5. Date of death : 18.10.2003 6. Cause of Death : Accident(Suspicious Death) 7. Duration of deceased : 8. Usual Residence : No.3/266, Perumal Koil Street, https://hcservices.ecourts.gov.in/hcservices/ Chinnamathur. 9. Place of Death : Chinnamathur Maduvu 10.Social Condition : --- 11.Occupation : Coolee 12.Corps to be burried/burnt : Burnt 13.Name of burial ground : Chinnamathur Burial Ground 17. A Chemical Analysis report dated 10.11.2003 was given by the Assistant Director, Forensic Sciences Department, Chennai wherein it is stated that five articles were examined viz., 1) Stomach and contents, 2)Intestine and contents, 3)Liver and Kidney, 4) Blood, 5) Preservative. But Alcohol or other poison was not detected in any of them. The opinion of the Assistant Chemical Examiner is that the deceased would appear to have died of cervical spinal injury. 18. The aforesaid materials placed before this Court make it clear that the husband of the petitioner, a construction worker, died on 18.10.2003, due to the accident, while he was working in the sand quarry. The aforesaid documents are public documents and the contents of the documents are not in dispute. Even the learned counsel appearing for the first respondent is not disputing the aforesaid materials and the contents contained therein. The contention of the first respondent is that as per the condition of the policy, the claim should be made within a month from the date of death. The learned counsel appearing for the first respondent relied on the condition No.1 of the policy which is extracted hereunder:- " Upon the happening of any event which may give rise to a claim under this policy, written notice with full particulars must be given to the company immediately. In case of death, written notice also of the death must, unless reasonable cause in shown, be given before internment, cremation and in any case, within one calendar month after the death and in the event of loss of sight or amputation of limbs written notice thereof must also be given with one calendar month after such loss of a sight or amputation." 19. Admittedly, as per the condition of the policy, the claim shall be made within a period of one month from the date of death. The first respondent shall not refuse to entertain the claim mechanically in all cases, whenever there is a belated claim, particularly when there are enough materials to suggest that the claim is based on accidental death, otherwise the very purpose of the insurance scheme would get frustrated. The purpose of the Scheme framed by the second respondent Board is to provide welfare measures to the construction workers, who are registered with them. The list of welfare measures are stated above. One of the werfare measures is relating to the personal accident relief. Pursuant to the same, the group insurance policy was taken by the second respondent. The group https://hcservices.ecourts.gov.in/hcservices/ insurance policy provides for payment of insurance amount, in the event of accidental death of a construction worker, covered under the policy. It is not in dispute that the husband of the petitioner is covered under the group insurance policy. But it is stated that the claim was made belatedly and therefore, the same could not be entertained. 20. As stated above, the first respondent, being a Central Government Organisation, shall act fairly and shall not reject the claim technically, on the ground of limitation, particularly when there are overwhelming materials in support of the claim. In this case, as stated above, originally first information report was registered under Section 174 of Cr.P.C. for suspicious death of the husband of the petitioner. The post-mortem was conducted immediately. The First Information Report, Death Report, Post- Mortem Certificate and Chemical Analysis Report indicate that there was an unfortunate accident resulting in the death of the husband of the petitioner. It is a different matter, if the matter was not reported to the police immediately and post-mortem was not conducted, then it could be difficult for the first respondent to ascertain the truthfulness of the claim. 21. The first respondent has stated in the counter affidavit that since there is a delay, no purpose would be served by deputing an Investigator to investigate on the bonafide of the claim. Para 5 of the counter affidavit is extracted hereunder:- "5. I humbly submit that as per the contract of insurance, the insured upon happening of any event which may give rise to a claim under the policy, written notice with full particulars must be given to the insurer, the purpose of immediate notice is to allow the insurer to investigate whether the loss/claim is bona fide, whether the loss/claim within the scope of the policy, whether or not warranties/conditions have been complied by appointing licensed Professional Investigator and obtaining Investigation Report, which forms the base document for processing the claim. To be precise the question of deputing the Investigator after a lapse of 4 years from the date of death of Mr.Ganesan will not serve the purpose for which the investigators were appointed." 22. According to the first respondent, appointment of Investigator would not serve the purpose, at this distant point of time. However, the first respondent has not disputed the materials viz., First Information Report, Post-Mortem Certificate, Death Certificate and Chemical Analysis Report. No investigator appointed https://hcservices.ecourts.gov.in/hcservices/ by the first respondent would go beyond the aforesaid documents and reports. Therefore, in my view, the first respondent shall not refuse to settle the claim payable due to the death of the husband of the petitioner. 23. I am not in agreement with the submissions made by the learned counsel appearing for the first respondent that the disputed question of fact has arisen for consideration. In my view, except vaguely stating that the disputed question of fact has arisen, the learned counsel appearing for the first respondent, is not able to state in detail, about the disputed question of facts. As a matter of fact, the facts are very clear and the documents would speak for itself. In fact, if the claim is not based on those documents, I could not have entertained the writ petition. 24. The other submissions about the maintainability of the writ petition also does not arise. When the whole issue is whether the first respondent is liable to pay the insurance amount based on the group insurance policy, the first respondent could not take a technical stand that instead of seeking to quash the order dated 23.06.2010 repudiating the claim, the petitioner could not maintain this writ petition seeking issuance of a direction to the first respondent to pay the amount to the petitioner under the group insurance policy. 25. In the letter dated 23.06.2010, the first respondent stated that they could not entertain the claim due to the delay of four years in making the claim. But in their letter dated 04.03.2010, they requested the second respondent to send the following papers to enable them to process the claim. 1) Claim form, 2) FIR, 3)ID Card, 4)P.M. Report, 5) Death certificate, 6)Inquest Report, 7)Ration Card, 8)Legal Heir Certificate, 9)Final Investigation Report, 10)Chemical Analysis Report, 10) Reason for delay in submission of claim. All the 9 documents as required by the first respondent, were submitted. The second respondent, while submitting the documents, established that the death was an accidental one. However, the first respondent sent a letter dated 23.06.2010 that they could not entertain the claim after 4 years of delay. In my view, the first respondent was not correct in refusing to entertain the claim, particularly, when 9 documents as sought for by them were submitted by the second respondent. Though, the second respondent is not correct in stating that there was no prescription of time limit, the first respondent is also not correct in refusing to entertain the claim solely based on the delay, particularly, they themselves directed the seond respondent to submit certain documents and that the same were also submitted. 26. For all these reasons, I am of the view that the writ petitioner is entitled to succeed and thus a direction is issued to the first respondent to pay the amount of Rs.1,00,000/- (Rupees one https://hcservices.ecourts.gov.in/hcservices/ lakh only) to the petitioner, pursuant to the death of her husband in the accident on 18.03.2003, within a period of eight weeks from the date of receipt of a copy of this order. Since the second respondent failed to take immediate steps to get the amount from the first respondent, they are solely responsible for the delay and therefore, the second respondent is directed to pay interest at the rate of 6% p.a. on Rs.1,00,000/- from the date of death, till this date. 27. The Writ Petition is disposed of with the above observations and directions. No costs Consequently, connected M.P. is closed. Sd/ Asst. Registrar /true copy/ Sub Asst.Registrar rrg To 1.The Divisional Manager, United India Insurance Company, Divisional Office, Tarapore Tower, 7th Floor, No.826, Anna Salai, Chennai-600 002. 2.The Secretary, Tamil Nadu Construction Workers Welfare Board, No.8, Valluvarkottam High Road, Nungambakkam, Chennai-600 031. + 1 cc to Mr. R. Ramesh, SR.77921 + 1 cc to Mr.S.K. Krishnamoorthy, Sr.77960 W.P.No.9611 of 2011 RJ(CO) Eu 23.12.11 https://hcservices.ecourts.gov.in/hcservices/