Sri G.Nagaraju, President
1. The complainant had filed this Complaint Under Section 12 of the Consumer Protection Act,1986 praying this Commission to direct the Opposite Parties to pay sum assured amount of Rs.2,00,000/-, to pay Accidental death benefits i.e. equal to sum CC 438/2018 Page No.2 assured of Rs.2,00,000/-, to pay interest on Rs.4,00,000/- @24% P.A. from the date of death i.e. 10-12-2016 to 01-10-2018 for Rs.1,73,333.33, to pay Rs.50,000/- towards compensation for mental agony and legal expenditure of Rs.10,000/- with all other attendant benefits with costs.
2. The brief contention of the complaint herein is that the complainants husband by name T.Mondaiah was an Account holder vide A/c.No.1047447083 in Andhra Pradesh Grameena Vikas Bank of Tekumatla Branch, which is insured with Opposite Party No.1 i.e. SBI General Insurance Company Policy on payment of Rs.100/- as Premium from his Account and policy was issued vide Master policy bearing No.149844-0000-00 and the said policy is valid from 19-11-2016 to 18-11-2017. On the unfortunate day i.e. 10-12-2016 when life assured was going on his Motor Cycle/Bike, fell down on the road and died on the spot, on which a case in Crime No.253/2016 was registered U/Sec.304 (A) of IPC by Police, Chityala. The Police Authorities after thorough investigation filed Charge Sheet and also filed Inquest Report and Postmortem Examination Report. Inspite of sending those documents along with claim and several requests to the Opposite Parties, they failed to settle the claim. Hence, filed this complaint.
3. On Notices, the Opposite Party No.1 had filed Written Version and Additional Written Version and Opposite Party No.2 was set exparte on 14-03-2019. The contention of the Written Version by Opposite Party No.1 herein is that the sum assured amount of Rs.2,00,000/- and the policy was commenced from 18-11-2016 to 17-11-2017 and further submitted that the claim was never repudiated. Inspite of several intimations/letters from 20-03-2017, 04-04-2017, 02-06-2017, 08-06-2017, 13-06-2017, 12-07-2017, 09-11-2017, 24-11-2017, 04-12-2017, 17-01-2018, 01-02-2018, 22-03-2018 & 06-04-2018 required documents were not sent by the complainant. Therefore the claim was not processed by stating that the claim cannot be kept open for too many long days, hence closed the claim. The Opposite Party No.1 further alleged that there is no Accidental Death Benefit. Sum Assured amount of Rs.2,00,000/- is only entitled by the complainant. As there are two reports, the Opposite Party No.1 had requested the report of Viscera/Chemical Analysis by the hospital/Police Authority. The Opposite Parties further contended that the deceased himself was driving the vehicle without any type of valid driving licence thereby violated the terms and conditions. The vehicle was driven without valid driving licence, therefore the company is not liable to pay as there is no deficiency of service on the part of Opposite Party No.1. Hence, prayed to dismiss. CC 438/2018 Page No.3
4. The complainant had filed Affidavit and Additional Affidavit and repeated the contents of the complaint and got marked Ex.A-1 to A-17 and on behalf of Opposite Party No.1 Mr.Leo John had filed Affidavit and got marked Ex.B-1 to B-11. The Opposite Party No.1 filed Written Arguments.
5. The following Points are emerged for Consideration by this Commission out of the pleadings of both parties.
i) Whether there is any deficiency of service on the part of Opposite Parties? ii) Whether the complainant is entitled for any relief? iii) If so, for what Relief?
6. APPRECIATION OF EVIDENCE AND DISCUSSION: - The undisputed facts that are evident from the record are that the deceased Late T.Mondaiah was an Account holder vide Bank Account No.1047447083 in A.P.Grameena Vikas Bank, which is evident vide Ex.B-1 on deducting the premium amount of Rs.100/- and the policy was issued and same was inforce from 19-11-2016 to 18-11-2017. It is also an undisputed fact that there was a lot of correspondence between the Opposite Party No.1 and complainant with regard to the request of furnishing of documents vide Ex.B-3 to B-11. Only disputed point that emerged for adjudication herein is, according to the Opposite Parties, the documents were not sent so also at the time of accident the deceased life assured T.Mondaiah was not having valid driving licence, apart from further contending that there is dispute in the cause of death/nature of death, therefore Visceral Examination Report is required. Per contra, the contention of the complainant herein is that it is an accidental death, which was occurred on 10-12-2016 and Postmortem Examination was also conducted vide Ex.A-10 i.e. Schedule of Observations A-General. On thorough investigation the Police Chityala filed Final Report U/sec.173 of Cr.P.C. stating therein that the deceased Mondaiah himself fell down on road along with his motor cycle and died on the spot and treated the case as Action Abated and the said document i.e. Ex.A-14 suggest that there is no suspicion in the cause of death of Mondaiah. Therefore seeking Visceral Report by the Opposite Parties is unwarranted. So far as the driving licence of Mondaiah is concerned, it is evident from the MVI Report vide Ex.A-12 at Column No.17 it is specifically mentioned that D.L. not produced. The policy herein is personal accident insurance policy, which is evident vide Ex.B-1 and conditions annexured does not stipulate possession of any licence since it is a personal accident and there was no condition with regard to the subsistence of valid driving licence as the contract was between the Opposite Party No.1 and the Opposite Party No.2 and life assured was privy to that contract. Apart from that there is no specific condition CC 438/2018 Page No.4 with regard to the possessing valid driving licence in personal accident insurance coverage.
7. The learned counsel appearing for Opposite Party No.1 during the course of arguments relied on the decision reported in 2019 (2) TAC 851 (NCDRC) in Liberty General Insurance Ltd. Vs. Pranali Popat Suryavanshi (R.P.No.3363 of 2018 decided on 10-04-2019), wherein the said Judgment, the fact was that the farmer died without having valid driving licence, whose life was covered under several schemes by Government At Para-5 in the said referred case insurance policy certain executions was incorporated at Para-III stating that that the company shall not be liable under the policy for driving any vehicle without any valid driving licence as observance to the said Judgment. The said Citation is not applicable as because in the present policy there is no term or condition with regard to the subsistence valid driving licence apart from that the insured is not a Party to the said contract and also there are no conditions with regard to driving licence. Therefore the said judgment is not applicable. In the above stated facts and circumstances the case is fit to be allowed as there is deficiency of service on the part of Opposite Parties. So far as the liability is concerned, though the complainant had pleaded accidental death benefits etc. i.e.Rs.2,00,000/- which is not mentioned in any document in A Series, the Opposite Party No.1 fairly admitted that only sum assured amount is entitled i.e. Rs.2,00,000/-, which is evident vide Ex.B-1. Therefore this Commission is inclined to grant sum assured amount of Rs.2,00,000/- with interest from the date of filing of the complaint @7.5% P.A. with costs of Rs.10,000/-.
8. In the result the complaint is partly allowed and directed the Opposite Parties
1 & 2 are jointly and severally directed to pay sum assured amount of Rs.2,00,000/- (Rupees Two lakhs only) with interest @7.5% p.a. from the date of filing of the complaint i.e. 03-10-2018 to till the date of its realization along with Rs.10,000/- (Rupees Ten thousand only) towards compensation for mental agony including costs to the complainant within one month from the date of receipt of the order. (Dictated to Stenographer, transcribed by her, corrected and pronounced by us in the open Commission on this 25th day of February,2021). MALE MEMBER LADY MEMBER PRESIDENT CC 438/2018 Page No.5 APPENDIX OF EVIDENCE WITNESSES EXAMINED On behalf of Complainant On behalf of Opposite Parties Affidavit of PW1/complainant filed. Affidavit of Opposite Party No.1 filed EXHIBITS MARKED ON BEHALF OF COMPLAINANT Ex.A-1 is the letter dt: 01-02-2018 addressed to the complainant from the Opposite Party No.1. Ex.A-2 is the Copy of Death Certificate of the deceased T.Mondaiah. Ex.A-3 is the Attested copy of First Information Report of the deceased T.Mondaiah. Ex.A-4 is the Attested copy of document dt:11-12-2016 In the Court of Addl.Judicial First Class Magistrate at Parkal from Sub-Inspector of Police, Chityala. Ex.A-5 is the Attested copy of letter dt: 10-12-2016 from to the complainant to the Sub-Inspector of Police, Chityala. Ex.A-6 is the Attested copy of Inquest Report of the deceased T.Mondaiah. Ex.A-7 is the Attested copy of Schedule of Observations A-General of the deceased T.Mondaiah. Ex.A-8 is the Certified photo copy of First Information Report of the deceased T.Mondaiah. Ex.A-9 is the Certified photo copy of Crime Detail Form of the deceased T.Mondaiah. Ex.A-10 is the Certified photo copy of Schedule of Observations A-General of the deceased T.Mondaiah. Ex.A-11 is the Certified photo copy of Inquest Report of the deceased T.Mondaiah. Ex.A-12 is the Certified photo copy of Accident Report from Motor Vehicle Inspector Crime No.253/2016 U/s.304-A IPC of P.S.Chityala. Ex.A-13 is the Certified photo copy of Proceedings of the Sub Division Police Officer, Bhupalpally under Crime No.253/2016 U/s.304-A IPC of P.S.Chityala. Ex.A-14 is the Certified Photo copy of Final Report U/sec.173 of Cr.P.C. Ex.A-15 is the Xerox copy of Circular dt:28-06-2017 from Insurance Regulatory and Development Authority of India. Ex.A-16 is the Xerox copy of Circular dt:20-09-2011 from Insurance Regulatory and Development Authority of India. Ex.A-17 is the Xerox copy of Circular dt:28-10-2016 from Insurance Regulatory and Development Authority of India. CC 438/2018 Page No.6 ON BEHALF OF OPPOSITE PARTIES Ex.B-1 is the Xerox copy of Policy of the deceased T.Mondaiah issued by Opposite Party No.1. Ex.B-2 is the Xerox copy of letter dt:June,2017 addressed to the complainant from the Opposite Party No.1. Ex.B-3 is the Xerox copy of letter dt:08-06-2017 addressed to the deceased T.Mondaiah from the Opposite Party No.1. Ex.B-4 is the Xerox copy of letter dt: 13-06-2017 addressed to the complainant from the Opposite Party No.1. Ex.B-5 is the Xerox copy of letter dt: 12-07-2017 addressed to the complainant from the Opposite Party No.1. Ex.B-6 is the Xerox copy of letter dt: 09-11-2017 addressed to the complainant from the Opposite Party No.1. Ex.B-7 is the Xerox copy of letter dt: 24-11-2017 addressed to the complainant from the Opposite Party No.1. Ex.B-8 is the Xerox copy of letter dt: 04-12-2017 addressed to the complainant from the Opposite Party No.1. Ex.B-9 is the Xerox copy of letter dt: 17-01-2018 addressed to the complainant from the Opposite Party No.1. Ex.B-10 is the Xerox copy of letter dt: 22-03-2018 addressed to the complainant from the Opposite Party No.1. Ex.B-11 is the Xerox copy of letter dt: 06-04-2018 addressed to the complainant from the Opposite Party No.1. MALE MEMBER LADY MEMBER PRESIDENT Order pronounced on : Copy made ready on : Dispatch No. and Date : Free Copy of order furnished to the complainant : Free Copy of order furnished to the Opposite Party/ies :