BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, Hon’ble Lady Member
Thursday the 1st day of February, 2007
C.C. No.117/2006
Smt. Y.Savitramma, W/o. Late Y.Rama Mohan Reddy, Aged 45 years, Hindu,
R/o. Ramireddypalli (V), Sanjamal (M), Kurnool District.
…Complainant
-Vs-
1. The Branch Manager, Life Insurance Corporation of India,
Banaganapalli Branch, Kurnool District.
2. The Branch Manager, Life Insurance Corporation of India,
Nandyal Branch, Kurnool District.
3. The Divisional Manager,
Life Insurance Corporation of India, Kadapa. …Opposite parties
This complaint coming on this day for orders in the presence of Sri. A. Prabhakara Reddy, Advocate, Kurnool for complainant, and Sri. A.V.Subramanyam Advocate, Kurnool for opposite Party and stood over for consideration till this day, the Forum made the following:-
ORDER
(As per Smt C. Preethi, Hon’ble Lady Member)
1. This consumer complaint of the complainant is filed U/S 12, of C.P. Act., seeking a direction on the opposite parties to pay accidental benefit of Rs.3,55,000/- under policy bearing No.653302418, accidental benefit of Rs.1,00,000/- under policy bearing No.652099098, with 24% interest from the date of death, costs of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainant’s case is that the complainant’s husband Y.Rama Mohan Reddy, has taken two policies for Rs.3,55,000/- and Rs.1,00,000/- with policies bearing numbers 653032418, & 652099098, the policies also covers accidental risk. On 24-06-2002 the complainant’s husband while coming from Panyam to Neravad, a tipper bearing No.AAA-7959, coming from Nandyal hit the deceased and resulted in instantaneous death of the policy holder. The death intimation was given to opposite parties and the complainant submitted claim form by submitting all required formalities the opposite party No.1 sent a cheque for Rs.3,78,075 which includes policy amount and interim bonus under policy bearing No.653032418, and opposite party No.2 sent another cheque for Rs.1,28,400/- which includes policy amount and vested bonus and interim bonus under policy bearing No.65209998. But the opposite parties did not pay the accidental benefit which is equally to sum assured. On
17-01-04 the opposite party No.1 wrote a letter to the complainant requesting to submit judgment copy and the complainant through her legal notice dated:
08-07-05 submitted judgment copy and opposite party No.1 written another letter dated:19-08-05 requesting the complainant to submitted Driving License of the policy holder for settling the claim. The complainants submits that Driving License is in no way required for settlement of claim and opposite parties are purposely delying in settling the claim and it is unfair trade practice. Hence, complainant was constraint to file this complainant before this forum for redressal.
3. In substantiation of her case the complainant relied on the following documents viz: (1) letter dated:28-01-03, of opposite parties No.1 addressed to the complainant as to the settlement of policy bearing No.65302418,(2) letter dated:28-02-03, of opposite party No.2, addressed to the complainant as to the settlement of policy bearing No.652099098,(3)letter dated:17-01-04 of opposite party No.1 addressed to the complainant(4)office copy of legal notice dated:08-07-05 issued by complainants advocate to opposite party No.1 along with speed post receipt and acknowledgement(5)intimation letter dated:14-07-05 of opposite party No.1 to the complainant (6)attested xerox copy of letter dated:
26-07-05 of opposite party No.1 addressed to the complainant and (7)letter dated:19-08-05 of opposite party No.1 addressed to the complainant, besides to the sworn affidavit of the complainant in reiteration of her complainant averments and the above documents are marked as Ex.A1 to A7 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitablely replied to the interrogatories caused by the opposite parties.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case by filing written version of opposite party No.3 and opposite parties No.1 and 2 adopted the written version of opposite party No.3.
5. The written version of opposite parties admits the complainants husband Y.Rama Mohan Reddy has taken two policies bearing numbers 653032418, and 652099098 for Rs.3,55,000/- and Rs.1,00,000/- and admits the complainant settled the claim for Rs.3,78,075/- and Rs.1,28,400/- and paid the said amount to the complainant. It further submits that as per terms and conditions of the policy in case of accidental death of the life assured the claimant should inform about the death of the life assured and produce required documents. As per terms and condition No.10 of the policy the opposite parties was not be liable to pay an additional sum if the death of the life assured resulted by committing breach of law. In the present case the life assured drove the vehicle and caused his death and the complainant was asked to produce Driving License of the life assured, inspite of several reminders the complainant failed to produce the driving license of the deceased. In order to establish whether the life assured death was accidental are not and whether the life assured was possessing a valid driving license as prescribed by the transport authorities at the time of accident the opposite party requested the complaint to produce driving license of the deceased for want of driving license the complainants claim is still pending and the opposite parties did not repudiate the claim of the complainant and there is no delay on part of opposite parties in settling the claim and there is no deficiency of service on part of opposite parties and seeks for the dismissal of complainant with costs.
6. In substantiation of their case the opposite parties relied on the following documents viz: (1)policy bond bearing no.653032418 along with terms and conditions (2)policy bond bearing no.652099098, along with terms and conditions (3)A bunch of 5 letters addressed by opposite party No.1 to the complainant and (4)A bunch of 4 letters addressed by opposite party No.2 to the complainant, besides to the sworn affidavit of the opposite party No.3 in reiteration of his written version averments and the above documents are marked as Ex.B1 to B4 for its appreciation in this case. The opposite parties caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties.:?
8. It is a case of the complainant that she is the wife of late Y. Rama Mohan Reddy who insured his life with opposite parties under policies bearing numbers 653032418, and 652099098 for Rs.3,55,000/- and Rs.1,00,000/-. On 24-06-02 the policy holder while coming from panyam to Neravad a tipper bearing No.AAA-7959, coming from opposite direction hit the policy holder and resulted in instantaneous death of the policy holder. On the claim preferred by the complainant the opposite parties settle the claim for basic amount and bonus but did not pay the accidental benefit under the said policies. The Ex.B3 are the bunch of 5 letters addressed by opposite party No.1 to the complainant dated:25-01-03, 23-11-03, 24-12-03, 17-01-04, and 11-03-04 requesting the complainant to submit final judgment copy for considering accidental benefit. The complainant along with Ex.A4 legal notice dated:08-07-05 submitted judgment copy. Thereafter, the opposite parties through their letter dated:
19-08-05 (Ex.A5) requested the complainant to submit driving license for considering accidental benefit. The Ex.B4 are the letters of opposite party No.2 to the complainant dated:09-09-02, 11-03-04, 12-08-02 and 19-08-05, there on requesting the complainant to submit the claim form and to submit the final verdict from the Court of Law and also driving license of the deceased. The complainant thereafter addressed a legal notice dated:08-07-05 (Ex.A4) expressing her inability to submit driving license and also stating that final judgment copy has nothing to do with the settlement of the claim. The opposite parties replied vide Ex.A5 stating that final judgment copy has been forwarded to their Divisional Office and replied on 26-07-05 (Ex.A6) stating that to admit the claim for accidental benefit it is necessary to produce copy of valid driving license of the deceased and request the complainant to produce driving license of the deceased. The opposite parties in their written version alleges that particulars of driving license are necessary for settling the claim as there is a proviso in the policy terms & conditions that insurance company will not be liable if the death occurred in the course of insured committing breach of law and non holding of license by the deceased policy holder amounts to breach of law.
9. So far as the facts of this case are concerned there is hardly any dispute the only question is : can the insurance company rejected a claim solely on the ground that the policy holder did not have a driving license. The opposite parties did not place any cogent relevant material on record to prove that the accident in which the policy holder died occurred due to rash and negligent driving of the policy holder and further the opposite parties failed to prove that the accident occurred at the fault Y. Rama Mohan Reddy (deceased policy holder), as there was no fault of Y.Rama Mohan Reddy (deceased policy holder) it is immaterial that the deceased was holding driving license or not. The counsel for complainant strongly relied on the decision of Supreme Court in Jithendra Kumar Vs Oriental Insurance Company Ltd and others reported in IV (2003) SLT 497 = 2003 (3) TAC.9 (SC) = 1986-2004 consumer 7828, wherein it has been laid down that the Insurance Company cannot repudiate a claim solely on the ground that the policy holder who had nothing to do with the accident did not hold a valid driving license. In the present case there is no immaterial on record to say that the accident in which the deceased policy holder death occurred was on account on any rash or negligent driving of his motor cycle. Hence, the insurance company cannot insist for driving license of the deceased policy holder.
10. Hence, in the light of above discussion and relying on the decision of Supreme Court, the insurance company cannot insist for driving license of the deceased policy holder for settlement accidental claim and thereby dodging for the settlement of claim is certainly amounting to deficiency of service on part of opposite parties.
11. To conclude, following the decision of Supreme Court and the discussions made above the complainant is perfectly remaining entitled to get the accidental benefit under the policies of her husband and the opposite parties are liable to pay the accidental benefit to the complainant.
12. In the result, the complaint is allowed directing the opposite parties 1 to 3 jointly and severally to pay to the complainant the accidental benefit under the policies bearing numbers 653032418, and 652099098 of Y. Rama Mohan Reddy with 9% interest per annum, from the date of complainant i.e., 21-08-06 till realization along with cost of Rs.2,000/- with in a month of receipt of this order.
Dictated to the Stenographer, transcribed by her, corrected and pronounced in the Open bench this the 1st day of February, 2007.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1 letter, dated:28-01-2003 addressed by opposite party No.1 to the
complainant as to settlement of policy No.65302418.
Ex.A2 letter, dated:28-02-2003 of opposite party No.2 to complainant as to
settlement of policy No.652099098.
Ex.A3 letter, dated:17-01-2004 of opposite party No.1 to the complainant.
Ex.A4 office copy of legal notice dated:0807-2005 issued to opposite party
No.1 along with speed post receipt and acknowledgement.
Ex.A5 Intimation letter, dated:14-07-05 of opposite party No.1 to the
complainant.
Ex.A6 Attested xerox copy of letter, dated:26-07-2005 of opposite party No.1
to complainant.
Ex.A7 letter, dated:19-08-2005 of opposite party No.1 to complainant.
List of exhibits marked for the opposite parties:-
Ex.B1 original policy No.653032418 along with terms & conditions.
Ex.B2 original policy bond No.652099098.
Ex.B3 A Bunch of 6 letters addressed by opposite party No.1 to the
complainant.
Ex.B4 A Bunch of forms (4) letters addressed opposite party No.2 to
complainant.
MEMBER PRESIDENT
Copy to:-
1. Sri. A.Prabhakara Reddy, Advocate, Kurnool.
2. Sri A.V. Subramanyam, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
