Before the District consumers Forum:Kurnool
Present: Sri K.V.H. Prasad, B.A., LL.B., President
And
Smt C.Preethi, M.A., LL.B., Member
Sri R.Ramachandra Reddy, B.Com., LL.B., Member
Monday the 22nd day of November, 2004
CD No.186/2003
Smt.B.Venkateswaramma,
W/o Late.B.Lakshmaiah,
R/o 24-18,
Kondapeta, Dhone,
Kurnool District. ……Complainant represented by his counsel
Sri.K.Yerukala Reddy.
-Vs-
- The Branch Manager,
LIC of India,
Dhone. …Opposite party
- The Divisional Manager,
LIC of India,
Cuddapah. …Opposite party No.2 represented by his
Counsel Sri.B.Rama Subba Reddy.
O R D E R
(As per Sri.R.Ramachandre Reddy, Member)
1. This consumer dispute case of the complainant is filed under section 12 of the C.P. Act, 1986 seeking a direction on the opposite parties1 & 2 for the payment of Rs.75,000/- towards accidental benefits of the policy with interest at 18% per annum from 25-01-2003, Rs.3,000/- which was deducted towards un paid premium, interest on 92,400/- at 18% per annum for the delayed period of the said amount, from 25-01-2003 to 17-05-2003, Rs.15,000/- towards compensation and costs of this complaint.
2. The case of the complainant is that the complainants husband Late.B.Lakshmiah (Insured) took LIC Policy No.652425331 dated 14-01-2000 for Rs.75,000/- which is an accidental benefit accidentally due to collusion of two vehicles. On the date of accidental death of insured the policy was in force and as per the terms of the said polic, the LIC has to pay double the sum assured amount with all benefits. After the accidental death of the insured the nominee i.e., complainant submitted all the documents along with the claim form, claiming amount under the said policy. Then on 04-05-2003 the opposite parties have paid Rs.92,400/- towards sum assured amount and bonus thereon only after deducting so called unpaid premium of Rs.3,000/- through cheque to the complainant, but the same was received under oral protest by the complainant, as the opposite party No.1 assured that they would pay the accidental benefits under the policy after getting clearance for paying the same from the opposite party No.2. So the complainant with fond hope that the opposite parties would pay the accidental benefits after some time was waiting for the payment. But to her surprise she received a letter dated 26-10-2003 from the opposite party no.2 in which it is informed that they had indisputable proof to show that the deceased, insured committed breach of law by driving the vehicle in a rash and negligent manner and he was responsible for the accident, as there was no willful violation of terms and conditions of the policy or law on the part of the insured. Opposite parties have illegally deducted Rs.3,000/- towards unpaid premium. Hence the conduct of the opposite parties, in not settling of the claim of the complainant , by showing untenable grounds amounts to deficiency in service and liable to pay the accidental benefits of the policy of rs.75,000/- with interest at 18% per annum from 25-01-2003, Rs.3,000/- which was deducted towards unpaid premium, interest on 92,400/- at 18% per annum for the delayed period of the said amount from 25-01-2003 to 17-05-2003, Rs.15,000/- towards compensation and costs of this complaint.
3. The complainant in support of her case encloses to the complaint the documents and they are marked as Ex.A1 and Ex.A2 and also filed sworn affidavit of 3rd party of Ella Ramudu, who was the cleaner of the said accident lorry No.AP 21 V 2901, the reply given to the interrogatories of the opposite party No.2 on the affidavit of Ella Ramudu and on behalf of the complainant filed interrogatories to the opposite party No.2 for their appreciation. The sworn affidavit of the complainant reiterates the complainant’s case on the above documents.
4. While the opposite party No.1 remained absent without participating in the proceedings in this case and filing any written version and set exparte.
5. The written version of the opposite party No.2 besides questioning the justness and maintainability of the complaint in facts and law and denied all the allegations mentioned in the complaint of the complainant, except the double accidental benefits under the said policy scheme and the complainant husband opted to pay quarterly premium Rs.1,000/- and nominated Smt.B.Venkata Lakshmamma, the complainant as the beneficiary, the deceased Sri.Lakshmiah was a private driver and did not work under any employer as per the proposal dated 12-01-2000. The proposal dated 12-01-2000 and office copy of the policy bearing No.652425331 is filed. It is further submitted that complainant informed the opposite party No.1 that her husband Sri.B.Lakshmanna died on 25-01-2003 in an accident and requested for the claim forms. She had submitted Claim Form-A and discharge voucher duly completed for the full and final settlement of the claim in respect of the said policy on 05-05-2003. The opposite parties settled the claim in favour of the complainant on receipt of claim form by paying Rs.92,400/- vide cheque No.952624 dated 17-05-2003 which includes basic sum assured Rs.75,000/- and bonus Rs.20,400/- after deducting three quarterly premium dues i.e., 4/2003, 7/2003 and 10/2003 Rs.3,000/- in terms of the policy condition No.2. The complainant was called upon to submit attested copies of FIR, PIR, PMR and final report of the police on 02-06-2003 for the consideration of accident benefits. The complainant did not deliberately produced these documents to suppress the fact that her husband died on account of his own rash and negligent driving and did not really die in an accident as reported. The opposite parties received first information report in Crime No.9/2003 dated 25-01-2003 Registered Under 304-A and 337 and the Police Inquest Report, Postmortem Report, Case Dairy in the said Crime of the Peddapadu Police Station. It is established from the said reports that the deceased life assured being the driver of the vehicle No.AP 21 V 2901 drove the said vehicle in the rash and negligent manner and dashed incoming lorry No.AP 27 U 7349 as a result of which he died. Thus the deceased was responsible for the accident and the resulted cause of death. He has thus committed breach of law by his own negligent and rash driving. The accident resulting from the breach of law, is excluded in the policy conditions 10(2) (b) (IV). The relevant portion of the condition is re produced hereunder.
“The Corporation shall not pay the additional sum referred, if the disability or the death of the life is assured shall:
(IV) Result from the life assured committing any breach of Law”
6. As such the accident benefit claim was reject by a speaking order dated 26-10-2003. The said benefit was covered under the relevant policy condition accepted by the deceased and the complainant has not right to question the veracity of the policy contract for covering the accident benefits. As there is no deficiency of service on the part of the opposite parties since the basic claim amount of Rs.92,400/- was settled on 17-05-2003 within 15 days from the date of intimation dated 02-05-2003. The last requirement for consideration of the A.B. was submitted by the complainant on 03-09-2003. The said accident benefit was rejected within 26 days and seeks the dismissal of the complaint with costs.
7. The opposite party No.2 taken on reliance besides to the sworn affidavit of the opposite party No.2 on the documentary record which is marked as Ex.B1 to Ex.B6 and also filed replied to the interrogatories of the complainant and even interrogatories to the 3rd party affidavit of the Ella Ramudu for his reply for their appreciation.
8. Hence, the point for consideration is whether the complainant is entitled to the reliefs sought for?
9. The Ex.A1 is the letter dated 07-05-2003 addressed by the opposite party No.2 to the complainant enclosing a Cheque for Rs.92,400/- towards the settlement of the claim of the insured. The Ex.A2 is the letter dated 26-10-2003 addressed by the opposite party No.2 to the complainant as to the repudiation of all the liability of the accident benefits under the said policy as they have indisputable proof to show that the deceased (Insured) committed breach of law by driving the vehicle in a rash and negligent manner and he is responsible for the accident. The accident benefit is excluded as per the policy conditions and privileges No.10-2 (b) (IV). As this relevant portion of the conditions is reproduced in the written version of the opposite party No.2, which reads as “result from the life assured committing any breach of law”. Whether any breach of law was committed by the insured as alleged by the opposite party No.2 as to the repudiation of the accident benefit which covers under the said policy as to be seen in the light of the documentary evidence produced by the opposite party No.2 to substantiate his plea.
10. As per the lenor of the written and the sworn affidavit of the opposite party No.2 filed the cause of the repudiating the claim (Ex.A1) is that the opposite parties have indisputable proof to show that the deceased (Insured) committed breach of law by driving the vehicle in a rash and negligent manner and he is responsible for the accident. As per the policy conditions and privileges No.10-2(b) (IV) the said accident benefits is excluded. The said policy condition reads as “result from the life assured committing any breach of law”. Hence the crux is that whether the rash and negligent driving comes under breach of law. The meaning of breach as per “Compact (New) OXFORD Dictionary, Thesaurus &Words power guide” is infringement, Schism, contravention, quarrel, rift etc., Hence in this case insured not committed any offence within the meaning of breach of law and in support of the above facts the opposite party No.2 relied on Ex.b1 which is the discharge of death claim under the policy No.652425331 dated 14-01-2000 issued by the LIC through the Form No.3801, the Ex.B2 which is a original policy. The Ex.B3 is an attested Xerox copy of the case dairy part-II under the crime No.9-2003 which envisages that the accident was due to rash and negligent drive by the insured. The Ex.B4 is an attested Xerox copy of FIR in Crime No.9/2003 dated 25-01-2003 of Peddapadu Police Station. The Ex.B5 is an attested Xerox copy of the Panchanama Report of the dead body of the insured and Ex.B6 is an attested Xerox copy of case dairy (Part-I) of the Peddapadu Police Station in Crime No.9/2003 of West Godavari District, an offence under section 304-A, 337, 338 IPC which is a final report case dairy treating the case as abated dated 30-05-2003. The sworn affidavit of the Ella Ramudu the cleaner of the said accident lorry No.AP 21 V 2901 also reveals that the death of the insured was due to accident, but the insured was not responsible for the accident, but the opposite vehicle No.AP 72 U 7349 driver and its owner with intent to escape from the civil and criminal liability made the Police to file a false case against the insured who was no more (Ex.B6). The interrogatories to the sworn affidavit of the Ella Ramudu by the opposite party No.2 and its replies by the counsel of the complainant could not make out any much worthy material to consider in this case, other than the accident which occurred due to collusion of the above said both the vehicles. Hence, absolutely there is not cogent material on the record in support of the contentions of the opposite party No.2 in repudiating the claim. For want of substantiating material in support of the opposite party No.2’s contentions except by mentioning the policy conditionNo.10-2(b)(IV), the act of the repudiation of the claim of the insurance by the opposite party No.2 as is remaining without any justifiable excuse, the said conduct of the opposite party No.2 is certainly amounting to failure on the part of the opposite party No.2 in performing the statutory duty in repudiating the claim and there by amounting to deficiency of service and there by entitling the complainant to the claim as the bonafidies of the complainant’s claim or not otherwise disturbed.
11. In the result, and in sum up of the above discussion, the complaint is allowed directing the opposite party No.2 to pay Rs.75,000/- towards accidental benefits of the policy with interest thereon at 9% per annum from 25-01-2003 along with costs of Rs.2,000/- within a month from the date of the receipt of this order.
Dictated to the Stenographer, typed to the dictation, corrected by us, and pronounced in the Open Court this the 22nd day of November, 2004.
Sd/- Sd/- Sd/-
MEMBER PRESIDENT MEMBER
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant:- Nill For the opposite parties:- Nil
List of Exhibits marked for the complainant:-
Ex.A1 Letter dated 07-05-2003 addressed by opposite party No.2 to the complainant.
Ex.A2 Letter dated 26-10-2003 addressed by opposite party No.2 to the complainant as to the repudiation of claim.
List of Exhibits marked for the opposite parties:-
Ex.B1 Discharge of death claim policy No.652425331 issued by LIC authorities under Form No.380 dated 14-01-2000.
Ex.B2 Policy No.652425331 of the deceased.
Ex.B3 Attested copy of statement of P.Ramulamma in Crime No.9/2003.
Ex.B4 Attested copy of FIR No.9/2003 dated 25-01-2003 of Peddapadu Police Station.
Ex.B5 Attested copy Inquest Report.
Ex.B6 Attested Xerox copy Final report (Case Dairy).
Sd/- Sd/- Sd/-
MEMBER PRESIDENT MEMBER
// Certified free copy communicated under Rule 4 (10) of the A.P.S.C.D.R.C. Rules, 1987//
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