Date of Filing 19.04.2023

                                                                                                             Date of Disposal: 18.11.2023

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION

THIRUVALLUR

BEFORE TMT. Dr.S.M. LATHA MAHESWARI, MA. ML, Ph.D (Law),                                         …….PRESIDENT

               THIRU.P.VINODH KUMAR, B.Sc., BL,                                                                                ……MEMBER-I

CC.No.39/2023

THIS SATURDAY, THE 18^th DAY OF NOVEMBER 2023

1.Mrs.A.Vijaya,

   W/o.Angamuthu,

2.Mr.D.Angamuthu,

    S/o.  Duraisamy,

   No.4/556B, Main Road,

   Thaneerkulam Village,

   Kakkalur Post,

   Thiruvallur Taluk & District.                                                               ......Complainant.

                                                                              //Vs//

The Branch Manager,

IFFCO TOKIO General Insurance Company Limited,

No.28, (Old No.195),

North Usman Road,

T.Nagar, Chennai 600 017.                                                                  .…..Opposite Party.

Counsel for the complainants                                : M/s.S.Kamalakkannan, Advocate.

Counsel for the opposite party                              : Mr.A.Naveen Kumar, Advocate.

This complaint coming before us on various dates and finally on 09.11.2023 in the presence of M/s.S.Kamalakkannan, counsel for the complainants and Mr.A.Naveen Kumar, counsel for the opposite party and upon perusing the documents and evidences of both sides this Commission delivered the following:

ORDER

PRONOUNCED BY TMT.Dr.S.M. LATHA MAHESWARI, PRESIDENT

1. This complaint has been filed by the complainants u/s 35 of the Consumer Protection Act, 2019 alleging deficiency in service against the opposite party with regard to repudiation of insurance claim of the complainants for the death of their son along with a prayer to pay a sum of Rs.15,00,000/- towards untold sufferance due to the deficiency in service and negligent act of the opposite party and to pay a sum of Rs.5,00,000/- towards compensation for the mental agony and hardship caused to the complainants along with cost of the proceedings to the complainants.

Summary of facts culminating into complaint:-

2. The complainants’ son met with an accident on 14.08.2022 while travelling in a two wheeler and after taking treatment in Government Medical Hospital, Thiruvallur died on 14.08.2022.  Complainants’ lodged complaint and registered Criminal complaint No.202/2022.  The deceased was 22 years old and was earning Rs.20,000/- per month.  When Personal Accident Owner cum Driver insured amount of Rs.15,00,000/- was claimed, the claim was repudiated by the opposite party citing the reason that the coverage was only for a period of one year i.e., from 17.10.2020 to 16.10.2021.  Thus aggrieved the present complaint was filed to direct the opposite party to pay the insured amount a sum of Rs.15,00,000/- towards the untold sufferance due to the deficiency in service and negligent act of the opposite party and to pay a sum of Rs.5,00,000/- towards compensation for the mental agony and hardship caused to the complainant along with a cost of the proceedings to the complainants.

The crux of the defence put forth by the opposite party:-

3. The opposite party remind absent and was set exparte on 07.07.2023.  However, after preferring RP.No.108/2023 the exparte order was set aside by the Appellate Authority and they appeared before this Commission and had filed written version, Proof Affidavit with documents.

4. The opposite party denies the complaint allegations contending interalia that the claim was repudiated as the complainants were not eligible to maintain the personal Accident Claim as there was no valid Personal Accident coverage at the time of accident and hence the complainants claim was not maintainable.  Further, it was submitted that the coverage with respect to the personal accident was only for the period of 17.10.2020 to 16.10.2021 and that the policy was subject to terms and conditions.  It was submitted that only as per the option of the policy holder the policy was granted for one year coverage.  Thus they sought for the complaint to be dismissed.

5. On the side of complainants proof affidavit was filed and documents marked as Ex.A1 to Ex A11 were submitted. On the side of opposite party proof affidavit was filed and documents marked as Ex.B1 & Ex.B2 were submitted.

Points for consideration:-

1)   Whether the repudiation of Personal Accident Cover claim for the death of the complainants’ son caused due to the accident of two wheeler insured with opposite party amounts to deficiency in service?

2) If so to what reliefs the complainant is entitled?

6. Point No.1:-

The following documents were filed on the side of complainants in support of their contentions;

1. Insurance Policy copy dated 17.10.2020 was marked as Ex.A1;
2. Driving License was marked as Ex.A2;
3. R.C. Book was marked as Ex.A3;
4. FIR copy dated 14.08.2022 was marked as Ex.A4;
5. Post Mortem Examination Report was marked as Ex.A5;
6. Death Certificate was marked as Ex.A6;
7. Legal heir certificate was marked as Ex.A7;
8. Letter issued by the complainant to the opposite party dated 02.01.2023 was marked as Ex.A8;
9. Reply notice of the opposite party dated 23.01.2023 was marked as Ex.A9;
10. Aadhaar card of the 1^st complainant was marked as Ex.A10;
11. Aadhaar card of the 2^nd complainant was marked as Ex.A11;
12.  

On the side of opposite party the following documents were filed in proof of their defence;

13. Insurance Policy copy dated 17.10.2020 was marked as Ex.B1;
14. Reply notice of the opposite party dated 23.01.2023 was marked as Ex.B2;

            7. Heard both learned counsels appearing for both parties in an extensive manner.  The only argument advanced by the learned counsel appearing for the complainants is with regard to the coverage of the personal accident cover.  It is the submission that the policy document Ex.A1 provides that the period of insurance was from 17.10.2020 to 16.10.2025 as provided under the liability section.  He submitted that for Personal Accident Owner Driver the premium collected was Rs.350/- and hence on the date of accident the Personal Accident Cover very well was in existence and hence the opposite party was liable to pay the insured amount of Rs.15,00,000/-.  Thus he sought for the complaint to be allowed.

8. On the other hand, the learned counsel appearing for the insurance company argued that the coverage was only for one year, citing the same document Ex.A1 wherein it has been stated that based on the option the Personal Accident Cover to Owner cum Driver was only for one year. Thus he argued that as there was no personal accident cover on the date of death of accident causing death of deceased, no claim could be honoured. Hence he sought for the dismissal of the complaint.

9. On perusal of the entire pleadings and materials this Commission could find that in the policy documents it has been specifically mentioned that,

“Based on your option, the personal accident cover to Owner-Driver is granted for 1 year from the date of inception of the policy.  You need to renew it before expiry for continuation of the cover.

This policy of type ‘New Vehicle without NCB’ with age of vehicle ‘0’is issued as a brand new vehicle and if it is otherwise, this benefits under the present policy will stand forfeited.  For this New Vehicle ‘TN/NEW/6458’ is a system generated number for internal Reference only.  Client needs to contact nearest IFFCO-TOKIO Branch for inclusion of Registration number issued by RTO within 60 days of policy inception”.

10. This Commission also found that in the first page of the document Ex.A1 under the liability section, the period of insurance was stated to be from 17.10.2020 to 16.10.2025.  However, we could find that the “Liability” and “Coverage “could be interpreted by giving different meaning though both appears to be synonymous.  Liability coverage is for injuries and damage to others when the insured is at fault.  However, coverage for Personal Accident implies that period of liability coverage.  In the said facts and circumstance the interpretation by the opposite party/insurance company that though the period of insurance was given for 5 years from 17.10.2020 to 16.10.2025 the personal accident cover to Owner cum Driver is granted for only one year on the option of the policy holder assumes significance and has to be taken into account.  It is clearly mentioned in   Ex.A1, that the “personal accident cover to Owner-Driver is granted for 1 year from the date of inception of the policy.  You need to renew it before expiry for continuation of the cover”.

11. Thus the policy was taken on 17.10.2020 and it has to be presumed that the period of insurance for Owner cum Driver (Personal Accident Cover) was from 17.10.2020 to 16.10.2021 and therefore when the death had occurred on 14.08.2022 as rightly pointed out by the opposite party there was no Personal Accident Cover for the insured vehicle.  In such facts and circumstances we hold that the repudiation of the claim made by the opposite party is justified.

12. Even as per the IRDA Guidelines on Standard Personal Accident Insurance Product Reference No. IRDA/HLT/GDL/MISC/036/02/2021 under the policy terms and conditions clause 6 provides that the policy tenure of the standard product shall be for a period of one year.  Thus we have no hesitation to dismiss the complaints holding that deficiency in service as alleged by the complainants was not proved against the opposite party in the matter of repudiation of insurance claim. Thus we answer the point accordingly in favour of the opposite party and as against the complainants.

Point No.2:-

13. As we have held above that the complainants had failed to prove that the opposite party had committed any unfair trade practice and deficiency in service, they are not entitled to any relief in this complaint.  Thus we answer the point accordingly.

In the result, the complaint is dismissed.  No order as to cost.    

Dictated by the President to the steno-typist, transcribed and computerized by him, corrected by the President and pronounced by us in the open Commission on this 18^th day of November 2023.

     -Sd-                                                                                                                       -Sd-

MEMBER-I                                                                                                           PRESIDENT

List of document filed by the complainants:-

List of documents filed by the opposite party:-

     -Sd-                                                                                                                     -Sd-

MEMBER-I                                                                                                         PRESIDENT