By Sri. MOHANDASAN.K, PRESIDENT

1.The complaint in short is as follows:

      The husband of the complainant Mr. Kurian was the registered owner of Vehicle No. KL-10-AK-2030 Tavera Car.   The vehicle was insured with the opposite party vide Motor Secure Private Car Insurance Comprehensive Policy No.2015–V3573411-FPV dated 16/02/2015 valid from 18/02/2015 to 17/02/2016.  The opposite party issued policy on 16/02/2015 in favour of Mr. Kurian, Kulangarath-House, Chulliyode-PO, Malappuram-Dt.

2.     On 29/12/2015 at about 00.15 hours the vehicle was met with an accident at Kallamoola, Cheriyama Palam, Public Road, in the limits of Kalikavu Police Station. The registered owner of the vehicle Mr. Kurian died in the accident and his wife, the complainant sustained grievous injuries.  The complainant filed a petition before the Motor Accidents Claims Tribunal, Manjeri for getting compensation and was allowed an amount of Rs. 2,25,000/- as full and final settlement.  The opposite party issued a cheque of Rs. 2,25,000/- to the complainant on 20/12/2018.  Their grandson Mr.Ebin was the driver of the vehicle at the time of accident.  Kalikavu police registered a crime as FIR No. 839/2015 against him as accused.   Thereafter charge sheeted before the Judicial First Class Court, Manjeri against Mr.Ebin.  The RC owner Mr.Kurian was not having driving license to drive the vehicle.

3.      The vehicle had insured with the opposite party as Motor Secure Private Car Insurance Comprehensive Policy and having right to get comprehensive compensation Rs. 2,00,000/- to the legal heirs of the deceased RC Owner.  The complainant, the wife of the deceased demanded the opposite parties to grand comprehensive compensation of Rs.2,00,000/-.  On 22/08/2016 the opposite party demanded the details of the vehicle through a letter.  On 01/11/2016 the opposite party again demanded the driving license of the RC owner.  On 15/11/2016 the complainant sent a letter to the opposite party stating that the RC Owner having no driving license to drive the vehicle.  The driving license of the RC owner is not necessary to get comprehensive policy compensation from the insurance company.  The demand of opposite party to surrender the driving license of the RC owner is illegal and improper. On 31/01/2019 the complainant send a lawyer notice demanding the comprehensive policy compensation. On 04/02/2019 the opposite party received the registered notice.  Despite receipt of notice the opposite party did not issue comprehensive policy compensation of Rs.2,00,000/-.The policy is beyond with comprehensive coverage of RC owner of a private car. The opposite party not so far paid compensation amount to the legal heir as wife of the RC owner, hence this complaint.

4.     The complainant alleges the approach of the opposite party is highly improper and illegal.  The opposite party is liable to compensate the complainant to the tune of Rs.2,00,000/-with interest at the rate of 12% per annum from 29/12/2015 to till payment and liable to pay Rs. 25,000/- as compensation for the mental agony and hardship suffered by the complainant. Hence the complainant prays for the insured sum of Rs.2,00,000/- with 12 % interest and compensation of Rs. 25,000/- along with cost of Rs.2,000/-. 

5.      On admission of the complaint notice was issued to the opposite party and on receipt of notice the opposite party filed version denying the entire averments and allegations in the complaint. 

6.      The opposite party admitted that the cause of action for the complaint arouse on 29/12/2015. But the lawyer notice was sent to the opposite party only on 31/01/2019 and so the complaint is barred by limitation. 

7.     The opposite party admitted that the vehicle No. KL-10-AK 2030 was insured by the opposite party during the relevant period vide Policy No.2015 –V-3573411-FPV.  An insurance policy is a contract and the rights and liabilities of the parties are governed by the terms and conditions of the contract.  It is further submitted that the wordings for all Motor Vehicle Insurance Contracts of Insurance are approved by the IRDAI, the statutory body for insurance matters.  The wordings in the policy are India Motor Tariff, Generals Regulations 36 IMT GR 36.  The wordings of the IMTGR 36 are submitted as follows: “GR.36. Personal Accident (PA) cover under Motor Policy (Not applicable to vehicles covered under section E, F and G of Tariff for Commercial vehicles). 

A. Compulsory Personal Accident Cover for Owner- Driver

        Compulsory personal accident cover shall be applicable under both liabilities only and package policies.  The owner of insured vehicle, holding effective driving license is termed as owner-driver for the purposes of this section.  Cover is provided to the owner-driver whilst driving the vehicle including mounting into/dismounting from or travelling in the insured vehicle as a co-driver.  It is further submitted that this provision deals with personal accident cover and only the registered owner in person is entitled to the compulsory cover where he/she holds an effective driving license.  Hence compulsory personal accident cover cannot be granted where a vehicle is owned by a company, a partnership firm, or a similar body corporate or where the owner-driver does not hold an effective driving license.  In all such cases, where compulsory PA cover cannot be granted, the additional premium for the compulsory PA cover for the owner-driver should not be charged and the compulsory PA cover position in the policy should also be deleted.   Where the owner driver owns more than one vehicle, compulsory PA cover can be granted for only one vehicle as opted by him/her. 

8.    The opposite party submitted that the claim was under Section III personal accident cover for owner-driver of the policy for compensation for the death of the Insured Cum Registered owner of the vehicle, Mr. Kurian in an accident involving the vehicle.  The opposite party reproduced the conditions of the policy regarding when amount is payable as follows: -

1). This cover is subject to

1. The owner –driver is the registered owner of the vehicle insured herein
2. The owner –driver is insured named in this policy.
3.  The owner –driver holds an effective driving licence, in accordance with the Provisions of Rule 3 of the Central Motor Vehicle Rules, 1989, at the time of the accident. 

9.       The opposite party submitted that the claim is payable only when the owner/ insured is either the driver or the co-driver and holding a valid driving license. The submission of the opposite party is that the deceased in this case is neither a driver nor a co-driver and he does not have valid driving licence also.

10.   Hence, the complainant is not entitled any amount and the IMT General Regulations 36 specifically prohibits the Insurer from paying out any sum if the owner did not have a valid license.  Hence the complaint is liable to be dismissed. 

11.   The complainant and opposite parties filed affidavits and documents. The documents on the side of complainant marked as Ext. A1 to A9 and the documents on the side of opposite party marked as Ext.B1. Ext. A1 is Photocopy of RC in respect of vehicle No. KL-10-AK-2030. Ext.A2 is copy of certificate of insurance. Ext. A3 is copy of FIR 839/2015 dated 29/12/2015, Kalikavu Police Station. Ext. A4 is copy of final report in FIR No. 839/2015 dated 29/12/2015 Kalikkavu Police station.  Ext. A5 is copy of letter issued by the opposite party to the complainant.  Ext. A6 is copy of letter issued by the opposite party to the complainant. Ext. A7 is copy of reply for letter dated 15/11/2016. Ext. A8 is copy of lawyer notice dated 31/01/2019. Ext. A9 is copy of postal receipt and  acknowledgment. Ext. B1 is copy of certificate of Insurance–Cum–Policy schedule in respect of policy No. V3573411 valid from 18/02/2015 to 17/02/2016.

12.  Heard the complainant and opposite party. Perused affidavit and documents.  The following points arise for consideration: -

1. Whether the complaint is time barred?
2. Whether there is deficiency in service on the part of the opposite party.
3. Reliefs and cost.

13.Point No.1: -

   The opposite party contented that the complaint filed in the year 2020 and the cause of action arouse on 29/12/2015 and so the complaint is time barred one. It is admitted that the policy holder, the owner of the vehicle died in the accident on 29/12/2015 at about 00.15 hours while he was travelling in his vehicle.  The complainant herein is the wife of the policyholder who approached the opposite party for the benefit under the personal accident insurance coverage.  But the opposite party neither denied the insurance benefit nor allowed the claim as prayed.  The documents shows that the complainant approached several times for the benefit, but the opposite party in all the occasions demanded the driving license of the deceased policy holder who was not having driving license.  It is also an admitted fact that he was not driving the vehicle at the relevant time of accident.  Ultimately the complainant caused lawyer notice to the opposite party on 31/01/2019 and there also no proper response from the opposite party.  The opposite party produced one and only document is the Certificate of insurance cum policy schedule, which does not reveal whether the opposite party repudiated the claim of the complainant or not.  In the absence of proper document for the repudiation of the claim we treat the cause of action as continuing one and we don’t find merit in the contention of opposite party that the claim is time barred one and we answer the first point accordingly.

14.Point No.2: -

          The opposite party did not allow the personal accident insurance benefit to the complainant stating that the deceased owner of the vehicle was not holding the driving license at the time of accident and so the contention of the opposite party is that the complainant is not entitled to the benefit under the  insurance policy. The opposite party produced Ext. B1 certificate of Insurance Cum Policy Schedule- Form 51 of the Central Motor Vehicle Rules 1989 along with Future Secure Motor Insurance – (Private car)policy wordings. The wordings Section III Personal accident cover  for  owner –driver  is as follows:- “ the company  undertakes  to pay compensation as per the following scale for bodily injury/death sustained by the owner  of the vehicle, in direct connection with the vehicle insured or whilst  mounting  into /dismounting  from the vehicle  insured  or whilst  travelling in it  as a co-driver, caused  by violent accidental external and  visible means which independent of any other cause  shall within six  calendar months of the occurrence  such injury result  in :

1. Compensation shall be payable under only one of their items(i) to (iv) above in respect of the owner –driver arising out of anyone occurrence and total liability of the insurance shall not in the aggregate exceed the sum of Rs. 2,00,000/-during any one period of insurance.
2. No compensation shall be payable in respect of death or bodily injury directly or indirectly wholly or in part arising or resulting from or  traceable to (a) intentional self-injury suicide or attempted suicide physical defect or infirmity or (b) an accident  happening whilst such person is under the influence of intoxicated liquor or drugs.
3.  Such compensation shall be payable directly into the insured or to his/her legal representative whose receipt shall by the full discharge in respect of the injury insured.

This cover is subject to

1. The owner-driver is the registered owner of the vehicle insured herein,
2. The owner –driver is the insured named in this policy.
3. The owner-driver holds an effective driving license in accordance with the provisions of Rule 3 of Central Motors Vehicles Rules 1989, at the time of the accident. 

    The wordings of section3 that the owner driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motors Vehicles Rules 1989, at the time of the accident lead the opposite party not to allow the insurance benefit to the complainant. But the policy produced by the opposite party Ext. B1 document provides coverage for the owner-driver as personal accidents insurance coverage.   The complainant produced Ext. A2 Motor Secure – Private Car Insurance – Comprehensive Policy which reveals the details of premium collected from the insured as follows: -

B- Liability

Basic premium including premium for TPPD Rs. 4,109/-

Add: compulsory PA to owner –driver - Rs. 2,00,000/- Rs. 100/-

Add: legal liability to paid driver /cleaner/employees Rs. 50/-

No. persons 1

Total liability premium (B) Rs. 4,259/-.

Total premium for the policy period Rs. 14,529/-

Service tax (including cess) Rs. 1,797/-

Total premium (rounded off) Rs.  16,326/-.

The perusal of Ext. A2 shows that the opposite party collected premium of Rs.100/- for personal accident risk coverage to owner –driver worth Rs.  2,00,000/-.  It is also revealing the opposite party collected premium to cover legal liability to paid driver /cleaner /employee also. Now what can be inferred from the perusal of Ext. A2 is that the opposite party collected insurance premium from the insured, the owner of the vehicle towards compulsory personal accidents to owner-driver.  The opposite party did not produce any document to show that while collecting the premium the owner of the vehicle was holding an effective  driving license  in accordance with the provisions of the Central Motors Vehicles Rules 1989, as  contended  in section III, personal accident cover for  owner-driver  provided in the  future Secure Motor Insurance  (Private Car) policy wordings.  So, it is an admitted fact that the opposite party collected premium for the   personal accident insurance coverage from the policy holder, the owner of vehicle. Ext.B1 document shows that it is a declaration as stated in the schedule which shall be the basis of the contract of the insurance which is applicable to company for the insurance and the premium paid in the schedule as considered for such insurance in respect of accidental loss or damage occurring during the period of insurance.   So, that also reveals the policy holder was not duly acknowledged the conditions in Ext B1 declaration.

15.    The Commission finds that it is relevant to verify the object of insurance coverage of a personal accident for owner-driver of the vehicle.  The object of a personal accident cover was to benefit the owner for any losses and injuries that could occur due to an accident. The intent behind personal accident cover for owner-driver is to ensure that insured vehicle owner does not have to burden medical expenses in case of any major injuries of permanent disablement. Moreover, vehicle owner can rest assured that in case of their demise due to a motor accident, their families will receive a death benefit.  The Motor Vehicles Act or any other statute does not necessitate holding an effective driving licence for being the owner of a vehicle.  A person who is not holding a driving license can also be an owner of the vehicle. The driving license is provided as per Motor Vehicle Act to drive a motor vehicle and not as the qualification to own a vehicle. Physically disabled person is not deprived from holding a motor vehicle. At the same time, he may not be qualified to hold a valid driving license.  The section III also stated the owner -driver is entitled for the benefit whilst mounting into /dismounting from vehicle.  Moreover, in case the owner of the vehicle travels in the vehicle as a co-driver, is also entitled as per the personal accident insurance coverage.  Hence, the denial of insurance benefit after receiving insurance premium from the owner of the vehicle cannot be justified at all.  The denial of personal accident insurance benefit to the injured owner of the vehicle while he was travelling in his vehicle under a qualified driver, cannot be justified and we find that the complainant is entitled to the benefit of the insurance under Personal insurance Accident coverage Ext. A2 and B1 documents. There is no case for the opposite party that the owner of the vehicle was travelling in his vehicle while driving a person who do not hold a valid driving license as provided under motor vehicles act. Hence, the denial of the insurance coverage to the complainant is an unfair trade practice and deficiency in service.  If there is any ambiguity in the policy condition regarding the personal accident coverage of owner-driver, it is to be looked in to by the appropriate authority. There is no justification for the denial of insurance coverage after receipt of premium from the owner of the vehicle and the insurance company is liable to pay the insurance benefit.

16.Point No:3: -

       The claim of the complainant is that to pay a sum of Rs. 2,00,000/- with 12% interest per annum from 29/12/2015 till payment along with Rs.25,000/- as compensation towards the mental agony and hardships suffered by the complainant due to unfair and deficient service from the part of opposite party and Rs. 2,000/- towards legal notice.  In addition, the complainant prays the cost of the proceedings.  In this complaint, the registered owner of the vehicle who is the policy holder died in the accident on 29/12/2015 at about 00.15 hours. Though the complainant approached the opposite party for the insurance benefit the opposite party did not allow the claim to the complainant.  Ultimately on 31/01/2019 the complainant caused lawyer notice demanding compensation as per the policy.  Though the opposite party received notice, there was no proper response from the side of opposite party.  Hence, the complainant filed this complaint on 09/03/2020 seeking the insurance benefit. The opposite party is liable to settle the claim of the complainant within a reasonable time of cause faction. It appears there is inordinate delay in settling the claim. So, the complainant is entitled insurance benefit with interest from the date of filing this complaint that is from 09/03/2020 onwards.  The complainant also claimed compensation of Rs. 25,000/- which appears as reasonable amount. The opposite party is liable to pay Rs. 25,000/- to the complainant on account of deficiency in service and unfair trade practice from the side of opposite party.  Complainant is entitled Rs. 10,000/- as cost of the proceedings. 

17.   In the light of above facts and circumstances, we allow this complaint as follows:

1. The opposite party is directed to pay the personal accident insurance coverage of Rs. 2,00,000/-(Rupees Two lakh only) to the complainant with interest at the rate of 9% per annum from the date of filing this complaint i.e.  09/03/2020 to till date of payment. 
2.  The opposite party is directed to pay Rs. 25,000/-(Rupees Twenty five thousand only) as compensation on account of deficiency in service and unfair trade practice from the side of opposite party and thereby caused inconvenience and hardship to the complainant.
3. The opposite party is directed to pay Rs. 10,000/- (Rupees Ten thousand only) as cost of the proceedings.

The opposite party shall comply this order within one month from the date of receipt of copy of this order, failing which the complainant is entitled interest at the rate of 9% per annum for the above entire amount from the date of filing this complaint to till date of payment.

Dated this 30^thday of March, 2023.

MOHANDASAN K., PRESIDENT

PREETHI SIVARAMAN C., MEMBER

MOHAMED ISMAYIL C.V., MEMBER

APPENDIX

Witness examined on the side of the complainant                      : Nil

Documents marked on the side of the complainant                    : Ext.A1to A9

Ext. A1 : Photocopy of RC in respect of vehicle No.KL-10-AK-2030.

Ext.A2 : Copy of  certificate of insurance.

Ext. A3 : Copy of FIR 839/2015 dated 29/12/2015, Kalikavu Police Station.

Ext. A4 : Copy of final report  in FIR No. 839/2015 dated 29/12/2015 Kalikkavu Police

                Station.

Ext. A5: Copy of letter issued by the opposite party to the complainant.

Ext. A6: Copy of letter issued by the opposite party to the complainant.

Ext. A7: Copy of reply for letter dated 15/11/2016,

Ext. A8: Copy of lawyer notice dated 31/01/2019.

Ext. A9: Copy of postal receipt and  acknowledgment.

Witness examined on the side of the opposite party                      : Nil

Documents marked on the side of the opposite party                    : Ext. B1

Ext. B1 : Copy of certificate of Insurance –Cum- Policy schedule in respect of policy

                No. V3573411 valid from 18/02/2015 to 17/02/2016.

MOHANDASAN K., PRESIDENT

PREETHI SIVARAMAN C., MEMBER

MOHAMED ISMAYIL C.V., MEMBER