Per Sri A. Hazarath Rao, President:-   The complainant filed this complaint under section 12 of the Consumer Protection Act seeking Rs.1,00,000/- being the accidental benefit assured under the policy No.675269117; Rs.50,000/- as damages besides costs of Rs.10,000/-.       

2.   The averments of the complaint in brief are as follows:

          One Nallapati Sambasiva Rao insured his life with the opposite party by taking insurance policy bearing No.675269117 for Rs.1,00,000/- and it covered accident benefit also.   On 10-09-11 at about 4.30 pm the said Sambasiva Rao met with an accident while traveling on a tractor bearing No.AP7L 5075 and died on the spot.  The SHO, Pedanandipadu PS on report registered the said accident as Crime No.55 of 2011 u/s 174 Cr.P.C.   The complainant is the wife of the said Sambasiva Rao besides nominee under the said policy.   The complainant after the death of her husband approached the opposite party for payment of accident claim benefit under the said policy.   The opposite party on 16-07-12 informed the complainant that claim arising out of accident benefit is rejected.   The opposite party did not explain the reasons for rejecting complainant’s claim.  On 04-08-12 the complainant got issued a legal notice claiming amount under the said policy.   But the opposite party failed to pay the same.   The complainant suffered a lot mentally and financially due to the said attitude and behaviour of the opposite party and it amounted to deficiency of service.   The complaint therefore be allowed.      

3.      The contention of the opposite party as mentioned in version-cum-affidavit in brief is hereunder:

          The complainant is not a consumer and there is no consumer dispute and as such this Forum has no jurisdiction to entertain.  The opposite party processed the claim of the complainant and communicated its decision promptly and as such did not commit any deficiency of service.   The opposite party paid Rs.1,13,500/- by settling the claim for the basic sum assured along with bonus.   Subsequently, the opposite party referred the file to the Divisional Office for consideration of accident benefit.  The deceased/insured was in drunken state and sat on the mudguard by the side of the tractor driver and had accidentally fell down on the black topped road due to jolts on account of small pits and the life assured succumbed to injuries after falling from the tractor.   The drunken state of the deceased resulted in his death.   The complainant’s accident benefit claim came under the purview of exceptions and as such the opposite party rightly repudiated that claim.  The complaint therefore be dismissed.  

4.  Exs.A-1 to A-9 and Exs.B-1 to B-5 were marked on behalf of complainant and opposite parties.

5.  Now the points that arise for consideration are:

1. Whether there is a deficiency of service on the part of opposite parties?
2. Whether the complainant is entitled to compensation?
3. To what relief?

6.      Admitted facts in this case are these:

          a. One Nallapati Sambasiva Rao took insurance policy for                                 Rs.1,00,000/- vide policy No.675269117.

        b. The said policy got additional accident claim benefit.

        c. The insured died on 10-09-11 while traveling on tractor

                (Ex.A-4 and A-5).

        d. The opposite party settled basic claim with bonus and paid                   Rs.1,13,500/-.

        e. The complainant on 04-08-12 got issued a notice for which                   the opposite party gave reply (Exs.A-6 to A-8= B4 & B5). 

          f. The SHO, Pedanandipadu registered the said accident as                               Cr.No.55 of 2011 and issued final proceedings as action                   dropped (Ex.A-9=B3).      

        g. The deceased/insured was subjected to post mortem in                                Guntur Medical College, Guntur (Ex.A-5).

7.   POINT NO.1:-   The controversy now revolves regarding the payment of additional benefit i.e., accident benefit claim.  Burden is on the opposite party to support the repudiation.  The opposite party relied on clause 10(b) of conditions and privileges of the said policy (Ex.B-1) and the report given to police regarding accident (Ex.B-2) and final report of police (Ex.B-3).  

8.     Clause 10 (b) of Ex.B-1 deals with accident benefit resulting in death of life assured and it reads as follows:

        “Death of life assured:  to pay an additional sum equal to the sum assured in lumpsum under this policy, if the life assured shall  sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of its occurrence solely, directly and independently of all other causes result in the death of life assured.   However, such additional sum payable in respect of all policies taken under the plan shall not exceed Rs.50 lakh.

                The Corporation shall not be liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of Life assured shall:-

1. be caused by intentional self injury, attempted suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic, or
2. take place as a result of accident while the life assured is engaged in aviatio or aeronautics in any capacity other than that of a fare-paying, part-paying or non-paying passenger in any aircraft which is authorized by the relevant regulations to carry such passengers and flying between established aerodromes, the life assured having at that time no duties on board the aircraft or requiring decent there-from; or
3. be caused by injuries resulting from riots, civil commotion, rebellion, war (whether war be declared or not), invasions, hunting, mountaineering, steeple chasing or racing of any kind; or
4. result from the Life assured committing any breach of law; or
5. arise from the employment of the life assured in the armed forces of military service of any country at war (whether war be declared or not).

The extra premium for this benefit will not be built to be paid after all premiums under this policy have been paid or on and after the policy anniversary on which the age nearer birthday of the life assured is 70 years which ever is earlier.”  

9.     In Ex.B2 the defacto-complainant mentioned that number of persons were traveling in the ill fated tractor bearing No. AP 7L 5075, a person sitting by the side of tractor driver fell down due to jolts of tractor on account of pits on the road who later succumbed to injuries.   Ex.B-2 further revealed that the SHO, Pedanandipadu registered the said report as Crime No.55 of 2011 u/s 154 of Cr.P.C.  

10.   Ex.B-3 is copy of final CD dated 24-03-12 (as action dropped).  In Ex.B-3 the investigating officer after investigation mentioned the following:  

            “The deceased was the native of Vengalayapalem village of Guntur Rural Mandal.  In search of livelihood deceased along with his wife L.W.2 migrated to Ravipadu village of Pedanandipadu Mandal long back and living by doing coolie works.   On 10-09-11 afternoon, Ravipadu villagers taken out procession for the immersion of “vinayaka idol” on the 9^th day of “vinayaka chaviti” at Suryalanka of Bapatla Mandal.   Along with the villagers, deceased also boarded Tractor bearing No.AP 7L 5075 driving by LW5 and sat on his right side on mud guard.   On the way to Bapatla, around 4.30 pm, when the tractor reached near Bus Stop, Nagulapadu village on PN Padu, Bapatla-Road, deceased who was in drunken state that was sat on the mud guard by the side of tractor driver has accidentally fallen down on the black topped road due to jolts of tractor because of small pits on the road which were formed due to removal of speed breakers and during the process deceased who sustained fatal internal injury over his rear side of head and also abrasions over elbow, loin and left thigh has died on the spot with in short time.  Then the persons in the tractor has brought back the dead body to the house of deceased and informed the wife of deceased about the occurrence.  Subsequently Pedanandipadu police visited the house of deceased and removed the dead body to GGH, Guntur and kept the same in mortuary.  No foul play is suspected. This was happened accidentally and unfortunately”.   

11.   Ex.B3=(A-9) revealed that the deceased was in drunken state and was sitting on the mudguard by the side of the tractor driver, accidentally fell down on BT road due to jolts of tractor because of small pits on the road.  Ex.B-2 revealed that the insured alone sustained head injury though some other passengers were traveling on the ill fated tractor.   The averments of Ex.B-3 revealed that the deceased fell down as sat on the mudguard by the side of tractor driver that too in a drunken state. 

12.   The learned counsel for the opposite party relied on the decisions reported in [2008 ACJ 2215 and 2012 (1) ALT 273.                      In Manager, Oriental Insurance Company Limited vs. Vallabhani Surya Rao and others 2008 ACJ 2215 it was held that no liability can be fastened on the insurance company in respect of the risk of unauthorized passengers traveling in a goods vehicle relying on the principles laid down by the Supreme Court in National Insurance Company Limited vs. Bommithi Subbhayamma (2005 ACJ 721 SC) and in New India Assurance Company Limited vs. Vedavathi                          (2007 ACJ 1040 SC).  The decision reported in United India Insurance Company Limited represented by its Divisional manager, Kurnool and Balaswamy and others 2012 (1) ALT 273 is also to that affect.  

13.   The contention of the learned counsel for the complainant is that the above decisions were not applicable as the claimants were third parties against the insurance company.   The said contention of the learned counsel for the complainant is having considerable force.   The insurance company is exempted from liability by paying accident benefit causing death if it resulted from the life assured  committing any breach of law as seen from clause 10 (b) of Ex.B-2.  

14.   The ratio in the above decisions is that any tractor is a goods carriage and traveling on a tractor is unauthorised.   It is not the case of the complainant that he was a labour under land owner who possessed the tractor.   

15. The insured fell down while traveling on a tractor sitting on mudguard by the side of tractor driver that too in drunken state and thus the insured/deceased committed breach of law.   It is the only insured who sustained injury from out of the passengers traveling on the tractor as seen from  Ex.B-3.  Under those circumstances, the opposite party repudiating the accident benefit claim is justified.   We therefore answer this point against the complainant.               

16.  POINT NO.  2  :  In view of findings on point No.1 the complainant is not entitled to any damages and answer this point also against the complainant.

17. POINT No.3:-   In view of above findings, in the result the complaint is dismissed without costs.

Typed to my dictation by Junior Stenographer, corrected by me and pronounced in the open Forum dated this the 25^th day of February, 2013.

MEMBER                                                                 PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite party:

                                                                                   PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.