::BEFORE THE DISTRICT CONSUMER DISPUTES  REDRESSAL COMMISSION AT BIDAR::

                                                                       C.C. No.14/2022.

                                                                                                                                      Date of filing: 28.01.2022.

                                                              Date of disposal: 28.11.2023.

P R E S E N Ts:-    

                                (1) Shri. Mabu Saheb H.Chabbi,                                                                                                               B.Com.,LL.B.,(Spl.),

                                                                               President.,  

                                (2) Kum. Kavita,

                                                               M.A.,LL.B.,(Spl.),  

                                                                         Member.                               

COMPLAINANT/S                    1.   Sri.Gopal Reddy S/o Prabhu Reddy,

                                                      Age: 56 years, Occ: Agriculture,
                                                       R/o Vithalpur, village Post Meenkera 
                                                       Tq:Humnabad, Dist:Bidar-5850227. 

                                                      (By Sri.Sanjay Kumar., Advocate.)           

                                          V/s

OPPONENT/S                             1.  Authorised Officer/Policy Service Office, 
                                                       COCO By NAVI GENERAL INSURANCE,
                                                       (formally know as DHFL General Insurance),
                                                        H.No.402, 403 & 404.  A&B Wing, 4^th Floor,
                                                        Fulcrun, Sahar Road, Next to Hyatt 
                                                        Regency, Andheri (East),                                                       

                                                        Mumbai-4000, Maharastra.                                                   

                                                     (By Sri.S.Wilson., Advocate.)

                                                                                    ::  J U D G M E N T  ::

By. Sri. Mabu Saheb H.Chabbi,. President.

The complaint is filed by the complainant under section 35 of the Consumer Protection Act, 2019, against the opponent for the deficiency of service caused by not settling the insurance claim by the OP to the complainant, hence following judgment is passed. 

Brief facts of the complaint.

The brief facts of the complaint are as follows: -

2.         The complainant is Father of deceased Mr. Giridhar Reddy who died in an incident, the said deceased person was working as conductor Cum Driver in NEKSRTC Depot.  During his survival he had purchased the bike Honda Motorcycle and Scooter its registered in RTO Office, bearing registration no; KA-39/R8622, in the name of deceased Giridhar Reddy and said motorcycle full insured for period of five years along with P.A. for Owner -Driver covered and deceased insured paid all the premiums as per policy from Respondents under COCO By Navi General Insurance its Product name COCO Ride Two-Wheeler Package policy-Navi General Insurance, therein specifically stated P.A. for Owner Driver i.e Compulsory Personal Accident Cover for owner driver for Rs. 15,00,000/- per person its Policy No;21000022488/00/000000/0 period own Damage-00.00 Hours on
11-9-2019 to Midnight 10-09-2024 liability And 00.00 Hours on 11-9-2019 to Midnight 10-09-2024 Compulsory PA Cover for owner driver only -00.00 hours on 11-09-2019 to midnight 10-09-2020, UIN No:IRDAN155RP0050V01201819 Policy issued date: 10-1-2020, and the deceased policy holder was paid total premium package of Rs. 7.010.00/- the said policy is in active force, and as per Scheduled and Certificate of insurance of the policy nominee of the said policy holder is his father Sri. Gopalreddy S/0 Prabhureddy R/o.Vithalpur Village in Humnabad Taluka District Bidar and on the date of incident policy was in force/active.  The OP insurance agent by impressed showing green grass and the benefits of obtaining such policy which would cover full protection to the third party, own damage, owner and drivers & etc, agreed to payment of said benefits in case of death of said owner cum drivers, & OP company issued the certificate of insurance to deceased, hence on the date of incident spread over the pandemic decease of coived-19,. That, said policy holder owner /driver Mr. Giridhr Reddy was died due to accident on 1-6-2020, the concerned Traffic Police registered case u/s 279, 338, & 304(A) of IPC in crime no:44/2020 issued FIR to jurisdictional Magistrate and subsequently submitted final report, thereafter the nominee of deceased policy holder Gopalreddy was intimated to OP office within time even under the period of pandemic deceased covid-19, and as per instructions of OP officer /authorized person the nominee submitted photocopy of policy of Deceased Life assured and etc,. through courier & submitted death certificate and FIR and Complainant along with request letter to pay the P.A. for Owner -Driver, and its claim registered PA owner Driver Claim No; 40700002027 with OP office, but surprisingly on technical ground repudiated P.A. for Owner -Driver through mail. I.e Reads: "Closure of your claim under Non Admissibility PA owner Driver Claim No;40700002027, in claimed policy; 210000 22488/00/000000/0, policy holder: Giridhar reddy S/o Gopal reddy; Vehicle no;KA39R8622."  and further OP after keeping long time stated that Driving licence of Deceased was not valid, hence by stating that escaping the liability of deceased policy holder benefits of death claim alleging fake allegations in fact the deceased complainant father not permitted by police to search the D.L over dead body of deceased Giridhar Reddy due to pandemic covide-19, and also done funeral by government officials and Gram Panchayat Development officers, therefore complainant is unable to search the same D.L and four Wheelers D.L. is Different from Two wheeler vehicle and the said deceased Giridhar Reddy having Valid DL of motor Cycle licenses but it was not traced, being helpless uneducated agriculture labour facing great in convinance, hence OP caused deficiency in service by repudiating claim of complainant by technically.  Hence, this complaint is filed by the complainant against Ops. 

Gist of Written Version.

3.         The OP appeared through his counsel before this commission after due service of notice from this commission and filed his written version and the gist of the written version of OP is as below.    

The contention of the complainant that he is the father of deceased Mr. Giridhar Reddy who was working as Conductor cum Driver in NEKSRTC Depot is not known to this O.P., hence, the complainant may kindly be put to strict proof. The further contentions that, Giridhar Reddy had purchased the bike bearing registration no. KA 39 R 8622 and the same is fully insured for period of five years along with P.A for owner-driver by this O.P and the policy number and the period of coverage, name of nominee etc. is admitted as true. But, the coverage of the policy is subject to terms and conditions contained in the policy and strict adherence to the provisions of law by the insured.  The contentions of Para no.3 that, the insured Giridhar Reddy met with an accident and died succumbing to the injuries and Police Traffid has registered FIR in this regard are true. The further contention that, the nominee had filed the claim to recover the P.A. coverage, but the same was repudiated owing to violation of condition of policy on the point of no D.L. is true. The contentions that, the police did not allow the father of the deceased/insured to search for the D.L over the dead body and the funeral was done by the government officials and Gram panchayat PDO, therefore, the complainant was unable to search for the D.L. and that, the D.L. for four wheeler is different from the Two wheeler and the deceased was having the valid D.L. to ride the motor cycle and that, the complainant being helpless uneducated agriculture labour cannot trace the D.L., hence facing great inconvenience, hence the O.P. has caused deficiency in service by repudiating the claim are false, wrong and unreasonable, hence, denied. The complainant himself has filed the copy of the D.L. of the deceased/insured, hence, the contention of not able to trace the D.L. falls flat on its nose and the further contention that, the deceased held two D.L separately, one for two wheeler and another for four wheeler is absurd, hence denied. The copy of D.L provided to the O.P. clearly does not carry the endorsement for driving the Two Wheeler, which in turn clearly proves the violation of the condition of policy, which mandates that, the rider of the vehicle should possess the valid and effective D.L. to ride the insured vehicle and in the present case the insured himself was riding the m/c without possessing the valid and effective D.L., hence, the O.P has rightfully repudiated the claim owing to violation of condition of policy. Hence, the complaint is devoid of merits therefore, liable to be dismissed with costs.

Evidence of complainant.

4.         The complainant himself got examined as P.W.1 and another witness one Mr.Chandrakanth S/o Bheemsha Pujari, examined as P.W.2 by filing his evidence affidavit and complainant got marked Ex.P.1 to Ex.P.14 documents and those are as below.

1.   Ex.P.1- Online Copy of Repudiation of claim of the complainant
          dt:23.09.2020.

2.   Ex.P.2-Copy of title page of JMFC Court Bidar in CC No.734/2020 
          along with FIR copy with complaint.

3. Ex.P.3-Copy of Crime details Form conducted by police dt:02.06.2020.
4. Ex.P.4-Copy of order sheet of JMFC Court.
5. Ex.P.5-Copy of inquest Panchanama conducted by Traffic Police.
6. Ex.P.6- Copy of P.M. report dt:02.06.2020.
7. Ex.P.7-Copy of Motor Vehicle accident report dt:06.06.2020.
8. Ex.P.8-Copy of Insurance policy Schedule and certificate of insurance.
9. Ex.P.9-Copy of RC Card.
10. Ex.P.10-Copy of LMV DL of Giridhar Reddy.
11. Ex.P.11-Copy of Aadhar Card of complainant.
12. Ex.P.12-Copy of PAN Card of complainant.
13. Ex.P.13-Copy of Membership Card issued by Co-operative Society NEKSRTC.
14. Ex.P.14- Copy of ID Card of Giridhar Reddy  issued by NEKSRTC.

Evidence of OP.

5.         One Sri Kalpit Sharma, is examined as R.W.1 on behalf of OP by filing his evidence affidavit and no document got marked on OP side.   

Points/Issues.

6.         Learned counsel for the parties argued on merits of the case.  From the pleadings and documents produced by the parties, the points that, arose for the consideration are as below. 

1. Whether the complainant proves that, he is consumer to the OP and further proves the deficiency of service from the OP? 

2. Whether the complainant proves any entitlement of claim of insurance from the OP?

3. What order?  

7.         Our answers to the points raised above are as follows: -

1. In the negative.
2. In the negative.
3. As per the final order.

Points No.1 and 2.

8.         In order to decide the said issues, since the points/issues No.1 and 2 are having inter related subject matter and point No.1 and 2 are discussed together as follows. 

9.         The complainant and OP have filed their respective evidence affidavit as per P.W.1 and R.W.1.  The complainant examined one witness Mr.Chandrakanth S/o Bheemsha Pujari, as P.W.2, and reiterated the facts of their respective pleadings in their evidence affidavit. The complainant got marked Ex.P.1 to Ex.P.14 documents to establish his case.  The OP has not produced any documents on his side.  

10.       The case of the complainant is that his son Giridhar Reddy has purchased one Motor Cycle bearing its Reg.No.KA.39/R/8622 and he has purchased an insurance policy vide No.21000022488/00/000000/0, having its validity from  11.09.2019 to midnight 10.09.2024.  Son of the complainant paid premium package of Rs.7,010/- towards the compulsory P.A. covering the period of 11.09.2019 to 10.09.2020 (owner driver) to the OP.  The insured Sri.Giridahr Reddy son of complainant died on 01.06.2020 due to accident during the period of Covid-19 pandemic disease.  The Traffic Police Bidar registered a case in Cr.No.44/2020 for offence punishable u/s 279, 338, and 304(a) of IPC.  The complainant being the nominee of the policy had intimated the death intimation to the OP.  Further the complainant submitted claim with required documents to the OP.  But the OP repudiated the claim of the complainant stating that, the deceased was not having any valid D.L. to ride his Motor Cycle which was insured with the OP. 

11.       To substantiate the case of the complainant the complainant has produced Ex.P.2 the Title page  of JMFC Court Bidar in CC NO.734/2020 with FIR in Cr.No.44/2020 of Bidar Traffic Policy for offence punishable u/s 279,338, 304(A) of IPC against the deceased Giridhar Reddy, Ex.P.3 Spot panchanama, Ex.P.4 Order sheet in CC No.734/2020, Ex.P.5 inquest panchanama, Ex.P.6 P.M. report pertaining to Giridhar Reddy, Ex.P.7 Motor vehicle accident report pertaining to vehicle KA.39/R-8622, which have been not disputed by the OP.  The OP has not denied the accident incident and the cause of death of deceased Giridhar Reddy.  The complainant produced Ex.P.8 the insurance policy schedule purchased by deceased Giridhar Reddy from OP company for personal accident claim coverage.  Ex.P.9 is the registration certificate pertaining to the deceased Motor Cycle.  The OP is not disputed with regard to Ex.P.8 and Ex.P.9.  further the OP is admitted the fact of the deceased possessing the LMV D.L. for the period 05.02.1989 to 20.12.2029, but the OP denied that, the deceased does not possess any valid D.L. for his two wheeler vehicle as on the date of accident.

12.       The OP has repudiated the claim of the complainant as per Ex.P.1 online message copy.  The complainant tried to prove his case contending that, the deceased Giridhar Reddy possessed D.L.  for his two wheeler Motor Cycle.  During the Covid-19 period when the deceased was admitted to the Hospital for his treatment to the injuries sustained due to accident the DL and other valuable documents were in his packet and the relatives were not allowed to see and cremate the dead body of Giridhar Reddy with rituals and hence, the body was cremated along with all the documents by the officials.  But, this contention cannot be accepted because the guidelines during Covid-19 period produced by the complainant which allows the hospital authority as well as relatives of the deceased to cremate the body, within the frame of Covid-19 guidelines, even as per inquest conducted by Police under Ex.P.5, no documents found from deceased personals.  Assuming for the discussion even if the deceased had valid D.L., the complainant could get another copy of D.L. from the competent authority and produce the same before this commission for adjudication of this case.  But, the complainant did not try to get and produce the valid D.L. from the competent authority.  The mere production of Ex.P.10 the LMV D.L. pertaining to deceased, without any endorsement regarding the two wheeler Motor Cycle D.L. this commission cannot accept that, the deceased possessed the valid D.L. as on the date of accident. 

13.       The OP contended that, riding of a Motor Cycle by the deceased without valid D.L. which violates GR 36 conditions of the policy and violates the provisions of IMV Act, hence the OP claim that the repudiation of the insurance claim is in accordance with law.

14.       On going through the above discussion made by this commission, the deceased Giridhar Reddy, is not having particular category of D.L. to ride his motor cycle and hence, the claim of the insurance cannot be allowed to claim by the complainant in this case, though the complainant proved to be a consumer to the OP.  In view of the above discussion the complainant fails to prove his case for claiming the benefits under insurance policy purchased by his son Giridhar Reddy.  Accordingly, we answered point No.1 and 2 in the negative as against complainant and proceed for pass following.

::ORDERS::

The complaint filed by the complainant U/sec 35 of consumer protection Act 2019 as against OP is hereby dismissed.  No order as to cost.              

            Intimate the parties accordingly.                         

 (Typed to our dictation then corrected, signed by us and then pronounced in the open Commission on this   28^th day of November-2023).

Documents produced by the complainant.

1. Ex.P.1- Online Copy of Repudiation of claim of the complainant
          dt:23.09.2020.

2.   Ex.P.2-Copy of title page of JMFC Court Bidar in CC No.734/2020 
          along with FIR copy with complaint.

3.   Ex.P.3-Copy of Crime details Form conducted by police dt:02.06.2020.

4. Ex.P.4-Copy of order sheet of JMFC Court.

5. Ex.P.5-Copy of inquest Panchanama conducted by Traffic Police.

6. Ex.P.6- Copy of P.M. report dt:02.06.2020.
7. Ex.P.7-Copy of Motor Vehicle accident report dt:06.06.2020.
8. Ex.P.8-Copy of Insurance policy Schedule and certificate of insurance.
9. Ex.P.9-Copy of RC Card.

10.Ex.P.10-Copy of LMV DL of Giridhar Reddy.

11. Ex.P.11-Copy of Aadhar Card of complainant.
12. Ex.P.12-Copy of PAN Card of complainant.
13. Ex.P.13-Copy of Membership Card issued by Co-operative Society NEKSRTC.
14. Ex.P.14- Copy of ID Card of Giridhar Reddy  issued by NEKSRTC.

Document produced by the Opponent.

-Nil-

Witness examined.

Complainant.

P.W.1- Sri.Gopal Reddy S/o Prabhu Reddy,   (complainant).   

P.W.2- Mr.Chandrakanth S/o Bheemsha Pujari

Opponent.

R.W.1- Sri Kalpit Sharma,