BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION AT BANGALORE (URBAN)

DATED 30^th DAY OF JANUARY 2024

ORDER

SMT. K. ANITA SHIVAKUMAR, MEMBER

Complainant filed this complaint U/S 35 of Consumer Protection Act 2019, seeking direction to OP to pay Rs.15,00,000/- with interest at 18% p.a. from the date of death of deceased till payment  and cost of litigation.

2. Brief facts of this case are as follows:-

The complainant stated that she is the wife of the deceased Shabaz. C and she is only the legal heir succeeding the estate of the deceased Shabaz. C and also having 3 minor childrens are depending upon the income of their deceased father. The complainant stated that the OP is the General insurance company had issued the Insurance Policy bearing No.3005/-2011488164/00/0000005653, and period of Insurance is from 21.08.2020 to 20.08.2021, to the Motor cycle bearing registration No. KA-14-EU-8632, and collected the premium of Rs.375/- and copy of the policy was issued for the same, as per the policy schedule, and liability of coverage, compulsory of personal accident to owner/driver to the liability of Rs.15,00,000/-.

3. The complainant further stated that on 21.12.2020 at about 7.30 p.m the deceased Shabaz. C was riding the Motor Cycle bering registration No.KA-14-EU-8632, along with pillion rider Noushad on NH-206 road, at Hosahalli Gate, Nittur Hobli, Gubbi Taluk from Tumkur towards Shivamogga, at that time, one unknown vehicle was dashed to the Motorcycle, as a result of which, both were fell down and sustained grievous injuries and succumbed to death at the spot, immediately the deceased Shabaz. C was shifted to Govt Hospital, Tumkur, and the post mortem was conducted and the body was handed over to complainant, and she has performed the last rites and rituals and spent a sum of Rs.1,50,000/- towards medicine, treatment and transportation of dead body and for the last rites and rituals of the deceased Shabaz. C. The complainant stated that the Gubbi Police was registered case in crime No.268/2020 regarding the accident in question.

4. The complainant further stated , she is only the legal heirs succeeding the estate of the deceased Shabaz.C, died at the age of 25 years, and he was hale and healthy and he was frugal in his habits and he was maintaining good health. Complainant further stated that on the date of accident the deceased was a Labourer, by occupation and he was earning Rs.25,000/- per month, and he was only the sole bread earner of his family, and the entire of his income was given to the complainant, after the death of deceased, she has put great financial loss, and loss of dependency, loss of estate, loss of love and affection, etc,. The complainant and her minor childrens are fully depending upon the income of deceased Shabaz. C due to the sudden death the complainant and her minor children’s are suffering for their livelihood, maintenance and dependency.

5. The complainant stated that, the OP has issued the insurance policy, as per the condition of the policy referred above the complainant is entitled to receive compensation as stipulated in law a sum of Rs.15,00,000/- plus other incidental expenses with interest thereon at the rate of 18% p.a., from the date of accident till realization, and hence she has approached through the application, and issued the legal notice through her counsel, to pay the claims as contemplated under the policy, and in spite of repeated requests and demands the OP not paid the claims till this date. The same has been repudiated in repudiation letter dated 17.10.2022. The complainant submit that, the OP is deliberately and willfully and in order to defeat claims of the complainant, the OP have not paid the claims, it amounts to the deficiency of service, so that the complainant left with no other alternative, have filed the complaint. The complainant alleged that, the OP is liable to pay compensation under the liability of coverage, compulsory of personal accident to owner/driver to the liability of Rs.15,00,000/- and also liable to pay the interest at the rate of 18% p.a. from the date of death to till the date of payment and the complainant are also entitle cost of his proceedings.

6. On the basis of issuance of notice, OP represented through its counsel and filed statement of objections. OP contends in its version that the OP, M/s. ICICI Lombard General Insurance Company Limited is a company engaged in General Insurance having its registered office at Bengaluru and this version is filed through the registered office of the OP located at Bengaluru through its authorized signatory-cum-Legal official. At the outset it is humbly submitted that the present complaint is not maintainable either on legal grounds or on factual basis.

7. It is stated that the present complaint is false, malicious and incorrect and is filed with mala-fide intention. OP further states that there has been no negligence or deficiency of service whatsoever, on the part of the OP in dealing with the concerned policy. The policy of insurance is the evidence f the terms of the agreement between the insured and insurer. The OP admits that the vehicle of deceased was insured and the said insurance was valid from 21.08.2020 till 20.08.2021 and the liability of this OP is limited to the terms and conditions of the policy of insurance. The OP stated that the complainant herein has intimated regarding the personal accident claim to this OP dated 25.03.2022 stating that insured vehicle has met with an accident 21.12.2020 and the insured died in the accident. This OP has duly registered the claim vide claim No.MOT12086563.

8. It is further stated that after the receipt of the claim form the OP has registered the claim and it was found that the incident has taken place on 21.12.2020 and the claim intimation was received on 25.03.2022, which is almost 18 months from the date of incident, this is violation of policy terms and conditions, wherein it is duty of the nominee to immediately inform the insurance regarding the incident and lodge the claim, however there is enormous delay of 18 months in reporting the claim to this OP.

9. It is stated that after the receipt of the claim this OP has sought for the following documents from the complainant vide letter dated 19.07.2022, 16.08.2022, 01.09.2022 and letter dated 15.09.2022, however the complainant has failed to provide the below documents to process the claim:

i) DL of the Insured

ii) Nominee details and bank details of the Nominee

iii) RC copy of the vehicle

iv) NOC of all legal heirs

v) KYC form filled and signed by the Nominee along with AML documents i.e., Aadhar and PAN of Nominee.

10. It is submitted that the OP, despite several reminders vide letters dated 19.07.2022, 16.08.2022, 01.09.2022 and letter dated 15.09.2022, however the complainant has failed to provide the below documents to process the claim, hence with no other option this OP has closed the claim of the complainant for Non-submission of the afore said documents vice their letter dated 17.10.2022. Hence, this OP has neither committed any deficiency of service nor adopted any unfair trade practices while dealing with the complainant. Accordingly, the complaint of the applicant is legally not tenable or maintainable.

11. The complainant has failed to make out a prima facie case against the OP insurance company and the complainant be put to strict proof of the same. Hence, prays to dismiss the complainant with cost.

12. After the stage of version, complainant adduced her evidence by way of affidavit and filed 26 documents, which are marked as Ex.P.1 to Ex.P.26. One Samridhi Mukesh, legal manager of OP company filed affidavit evidence along with 2 documents which are marked as Ex.R.1 and Ex.R.2. We perused the documents on record. Both counsels not argued, despite sufficient time granted. Hence, argument taken as heard and proceeded to pass the order on merits.

13. On the basis of above pleadings for our consideration are as follows:-

i) Whether the complainant proves the deficiency of service on the part of OP?

ii) Whether complainant is entitled for the relief?

iii) What order?

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

Point No.1:- Affirmative.

Point No.2:- Partly Affirmative.

Point No.3:- As per the final order.

                      REASONS

15. Point No.1&2:- These points are inter-connected to each other and for the sake of convenience, to avoid repetition of facts, these points are taken up together for common discussion.

16. After perusal of the pleadings of both parties, it is admitted that complainant’s husband got insured his vehicle bearing registration No. KA-14-EU-8632 in vide policy No.3005/2011488164/00/000000/5653. The said policy was valid from 21.08.2020 till 20.08.2021 which is at Ex.P.1. As per the documents Ex.P.1, complainant has paid Rs.5,533/- towards premium, out of which Rs.375/- is specially for the benefit of P.A cover for owner/driver of Rs.15,00,000/-. It is also not disputed that on 21.12.2020 at about 7.30 p.m deceased Shabaz. C their riding insured motor vehicle along with pillion rider Noushad on NH 206 road at Hosahalli Gate, Nitturu Hobli, Gubbi Thaluk from Thumkur towards Shivamogga. One Unknown vehicle was dashed to insured motor vehicle as a result on which both fell down and sustained grievous injuries and succumbed to death, both at the spot. Immediately the deceased Shabaz. C was shifted to Government Hospital, Tumkur and obtained post mortem report which is at Ex.P.11. The same was registered police complaint before Gubbi Police Station which is at Ex.P.6. The FIR at Ex.P.5 and the other inspection report and mahazar report which is at Ex.P.9 and 10 respectively. Complainant also produced Ex.P.13 pertains to the deceased death certificate issued by concerned authority. After the death of deceased Shabaz. C at the age of 25 years, complainant suffered lot of financial and mental crisis to lead her livelihood along with minor children. Hence complainant submitted the claim form to OP company claiming for a personal accident insurance benefit which is at Ex.P.15 on 25.03.2022.

17. It is pertinent to notice that after the receipt of claim form OP has sent letter to complainant to produce necessary/required documents for processing the claim on 18.07.2022, at Ex.P.17. Complainant was supposed to submit the DL copy of deceased, cancelled cheque, nominee KYC and photographs of 2 passport size photographs, Aadhar copy, PAN card etc, copy to process the claim, claimed by complainant. In spite of sufficient time complainant has not produced necessary required documents. In the absence of receipt of the above mentioned documents, as per IRDAI regulations 2016, OP repudiated the claim of the complainant and sent the intimation through rejection letter dated 17.10.2022 which is at Ex.P.18. Aggrieved by the repudiation of the claim, complainant approached this commission for redressal of her grievance. She filed Aadhar card, PAN card of deceased and complainant herself along with ration card which exhibits the information about 2 minor children’s and the documents pertains to family of deceased by way of affidavit which are from Ex.P.19 to Ex.P.26.

18. By perusing the evidence filed by OP No.1 it has taken contention that complaint is not maintainable on legal grounds and factual basis and complainant has filed this complaint malafide intention, OP company has sought the documents namely DL of insured nominee details, bank details of nominee, RC copy of vehicle, NOC of legal heirs, KYC form filled and signed by nominee in vide letter dated 19.07.2022, 16.08.2022, 01.09.2022 and 15.09.2022. Further complainant failed to provide the above mentioned required documents for honoring the claim. It shows OP has not caused any deficiency in honoring the claim of the complainant. In the absence of necessary documents OP is not any position to materialize the claim as per the terms and conditions of the policy and IRDAI guidelines.

19. Though the OP has taken stand that complainant caused delay in claiming the insurance amount and personal accident benefit of Rs.15,00,000/-. Here we can observe that the accident taken place on 21.12.2020 at 7.30 p.m but the complainant claimed the insurance claim on 25.05.2022 which means there is delay of 18 months from the date of accident which is violation of terms and conditions of policy. Even though OP taken the contention of delay, submission of proposal form they repeatedly requested complainant to provide the necessary/required documents. OP submitted Ex.R.1, reveals that the report of insurance for own coverage is from 21.08.2020 to 20.08.2021. In case of 3^rd party, is from 21.08.2020 to 20.08.2025. With regard to the personal accident of owner/driver benefit is from 21.08.2020 to 20.08.2021. When OP received Rs.375/- as premium for personal accident benefit of Rs.15,00,000/-, OP has to honor the claim of personal accident benefit, since the policy was in force.

 20. Considering the complaint filed by relative of deceased with regard to the accident, both Gubbi Police Station, FIR, Mahazar report, deceased Shabaz. C was succumbed by grievous injury resulted from the accident. OP company has no dispute about accident, his death and the above mentioned FIR, police complaint and the other documents which speaks deceased was using the insured vehicle caused death due to the grievous injuries by the accident. OP has to consider all these and deceased is entitled to get personal accident benefit. When the death due to accident, his legal heirs are entitled for the claim of the insured amount/personal benefit. Complainant has already submitted the family tree by way of affidavit, which reveals that complainant is wife of deceased, having 3 minor children. For their livelihood, complainant no doubt might have facing financial problems after the death of Shabaz. C, who was only bread earner of the family.

21. Here in our considered view OP has produced letters dated 26.04.2022, 13.06.2022, 28.06.2022 and 02.09.2022 which are at Ex.R.2. Even after several reminders complainant has not produced any documentary evidences to prove the required documents submitted to OP. Hence considering the documents produced by OP and no co-gent evidences filed by complainant about the production of all necessary/required documents to OP, in our considered view OP has not caused any deficiency in its service. OP was ready to materialize the claim, if complainant produced documents. Hence OP sought documents. In the absence of the necessary documents, obliviously OP cannot honor the claim of the complainant. With the above discussion we are of opinion that complainant is directed to submit all the necessary and required documents as OP instructed along with claim form immediately after this order. Further OP is directed to honor the claim of the complainant reveals the personal accident benefit of Rs.15,00,000/- to complainant without interest, within 30 days from the date of submission of claim form along with necessary documents. On the above discussion we answer Point NO.1&2 in affirmative and partly affirmative.

22. Point No.3:- In view of the discussion referred above, we proceed to pass the following:-

                                   ORDER

1. Complaint filed by the complainant U/S 35 of Consumer Protection Act, is hereby allowed in part.
2. OP shall pay Rs.15,00,000/- towards personal accident insurance amount to the complainant within 30 days after the receipt of proposal form along with required documents, failing which OP shall pay interest at the rate of 8% p.a. from the date of order till realization.
3. OP further shall pay Rs.10,000/- towards cost of litigation to the complainant.
4. Furnish the copies of the order and return the extra copies of pleadings and documents to the parties, with no cost.

(Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open Commission on this 30^th day of JANUARY, 2024)

Documents produced by the Complainant-P.W.1 are as follows:

Documents produced by the representative of opposite party – R.W.1;