COMPLAINT FILED ON: 13.04.2010

DISPOED ON: 27.12.2010

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

DATED THIS THE 27^TH DECEMBER 2010

  PRESENT:-  SRI. B. S. REDDY                            PRESIDENT

                     SMT. M. YASHODHAMMA               MEMBER                   

                     SRI. A. MUNIYAPPA                         MEMBER   

COMPLAINT No.817/2010

O R D E R

SRI. B.S. REDDY, PRESIDENT

The complainant filed this complaint U/s. 12 of the Consumer Protection Act of 1986, seeking direction against the Opposite Parties (herein after called as O.Ps) to settle the claim the accident benefit under the ‘Life Time Gold Insurance Policy’ of her deceased son with interest at 24% p.a. and to pay compensation of Rs.5,00,000/- with litigation costs on the allegations of deficiency in service on the part of the OPs.

2.      The case of the complainant is to be stated in brief is that:

The complainant’s son Mr. Rajesh Kumar De had taken Life Time Gold Insurance Policy from OP for the sum assured Rs.15,00,000/- with accident and disability benefit rider of Rs.10,00,000/- and waiver of premium rider benefit of Rs.35,000/-. The date of commencement of policy was with effect from 19.01.2008. The annual premium of Rs.35,000/- was regularly paid. The complainant is nominated to the said insurance policy. The complainant’s son Rajesh Kumar De met with road traffic accident on 14.08.2008 at about 9.45 a.m. and succumbed to the fatal injuries during treatment. The complainant being nominee submitted claim form along with necessary and relevant documents for settlement of claim in terms of the policy. OP after considering the claim and documents submitted was pleased to release the sum of Rs.15,00,000/- towards basic plan only, but failed to settle the accident benefit of Rs.10,00,000/- in terms of the insurance policy. The complainant continued communications to OP for the settlement of the claim under accident benefit, OP failed to settle the claim and at last asked to furnish the copy of the driving license of her son. The complainant expressed her inability to furnish the copy of driving license, since the driving license along with the wallet and some valuables of her son were lost in the accident as per the report of the police. The complainant is not having copy of driving license and unable to obtain certified copy of driving license from the concerned RTO and furnish the same to the OP. There is no specific condition imposed in the policy that the policyholder must possess driving license and the production of driving license is a condition precedent to process the settlement of accident benefit under the policy. On the date of accident, the complainant’s son was traveling from Bangalore to Hyderabad with original driving license and the license was lost in the accident along with other belongings. Further from the record, it is clear that the accident took place due to the negligence of the lorry driver. Therefore insisting upon the complainant to furnish the driving license of the deceased is not relevant. OP is illegally withholding the settlement of claim under accident benefit to the complainant, without any valid reason. The conduct of OP in non-settling the accident benefit in terms of policy amounts to gross deficiency of service and as a result, the complainant has suffered mental agony, hardship and inconvenience. The complainant got issued legal notice on 23.10.2009 to OP to settle the claim, OP neither replied for the said notice nor complied with the demand. Hence the complaint.   

3.      OPs though appeared through the counsel, not filed the version.

4.      In order to substantiate the complaint averments, the complainant filed affidavit evidence. OPs have not filed any affidavit evidence.  

5.      Complainant filed written arguments, heard from complainant’s side. OPs side was taken as heard.  

6.      From the complaint averments and affidavit evidence of the complainant and written arguments submitted it becomes clear that the complainant is the mother of Rajesh Kumar De who died in road traffic accident which took place on 14.08.2008 at about 9.45 a.m.; while he was traveling from Bangalore to Hyderabad on National Highway No.7, near Parvatha Devarappalli Village Bus Stop, Kaganapalli Mandal, Andhra Pradesh. The complainant has produced the insurance policy with terms and conditions. After going through the terms and conditions of policy it is crystal clear that the complainant’s son Mr. Rajesh Kumar De had taken Life Time Gold Insurance Policy from OP, the policy No.07426726  for the sum assured Rs.15,00,000/- with accident and disability benefit rider of Rs.10,00,000/- and waiver of premium rider benefit of Rs.35,000/-. The date of commencement of policy was with effect from 19.01.2008. After the death of complainant’s son the complainant submitted claim form along with all the necessary and relevant documents for settlement of claim in terms of the policy. OP after considering the claim and documents submitted, was pleased to release the sum of Rs.15,00,000/- towards basic plan only, but failed to settle the accident benefit of Rs.10,00,000/- to the complainant in terms of insurance policy on the ground that complainant failed to produce the driving license of her deceased son Rajesh Kumar De.

7.      The complainant has produced the certified copy of FIR with English translation; copy of charge sheet filed in respect of the said accident in which, the complainant’s son met with road traffic accident. After going through the charge sheet filed against the driver of the lorry in respect of the said accident it becomes clear that the accident in question had taken place due to the rash and negligent driving of the lorry bearing No.AP-15 X-2446. Thus it cannot be said that the accident was on account of the rash and negligent driving of the motor cycle bearing No.KA-01 EJ-7597 by the deceased Rajesh Kumar De, the son of the complainant. The terms of policy does not contain the fact of possessing driving license and the same being condition precedent for settlement of the policy. When the accident in question had taking place on account of the rash and negligent driving of the lorry by its driver, OP was not justified in demanding the driving license of the deceased Rajesh Kumar De for settlement of the claim. The complainant being the nominee under the policy and the mother of deceased was made to suffer in not settling the claim. In the reply for settlement of the claim OP has stated that to enable them to examine the claim under accident and disability benefit rider a copy of the valid driving license of the life assured is required. For the legal notice, the reply has been sent on 07.12.2009 stating that the company would be in a position to examine the claim under the accidental and disability benefit rider only on the receipt of a valid driving license of the life assured. In 2006 ACJ 2319 K.S. Usha Vs. L.I.C. of India the Hon’ble High Court wherein the claim was repudiated on the ground of non production of driving license it was held that when the accident is due to rash and negligent driving of other vehicle involved LIC could not repudiate the claim for want of driving license of the assured. At para – 3 of the said judgement it is stated that:

“When the petitioner is not in a position to produce such documents, when the accident has not occurred due to rash and negligent driving of the deceased policyholder, respondent cannot repudiate the claim of the petitioner only on the ground of non-production of driving license. Arguments of the learned counsel for the respondent that L.I.C. cannot honour the claim of the petitioner in the absence of the production of driving license could have been appreciated by this court provided the accident had been caused due to rash and negligent driving of the deceased Jagadeesh.”

          In the above said case also the L.I.C. repudiated the claim on the ground that the wife of the deceased failed to produce the driving license of her deceased husband who died in the motor vehicle accident. The principles laid down are aptly applicable to the facts of the case. As in the instant case from the charge sheet filed it becomes clear that the accident had taken in place due to rash and negligent driving of the other vehicle i.e., lorry. Under these circumstances we are of the considered view that the OP was not justified in not settling the claim on account of non production of the driving license of the deceased Rajesh Kumar De. The act of OP in not settling the claim without application of mind amounts to deficiency in service on the part of the OPs. The terms of policy provides the accident and disability benefit rider to an extent of Rs.10,00,000/-. The complainant being nominee and the mother of deceased is entitled for the said amount; OP is liable to settle the claim.

8.      OP by its letter dated 06.10.2008 acknowledged the receipt of necessary documents for processing the claim. OP accepted the claim towards the basic plan and enclosed the cheque dated 30.09.2008 towards basic plan claim payment of Rs.15,00,000/-. Further it is stated that the policy also cover accident disability benefit rider, the life assured expired due to a road traffic accident, but copy of driving license has not been submitted and requested to submit the copy of the driving license obtained from concerned RTO for settling the claim. Further in the letter dated 11.09.2009 OP demanded the copy of the driving license. In the legal notice dated 23.10.2009, the complainant has clearly stated that the production of driving license is not a condition precedent to process the settlement of accident benefit under the policy and OPs have illegally withholding the settlement of claim without any valid reason. Inspite of that notice OP by its reply dated 07.12.2009 demanded the production of the copy of valid driving license. Therefore we are of the view that OP was not justified in not settling the claim on the ground of non-production of copy of valid driving license of the deceased. OP is liable to pay interest on the said claim from January – 2010 at the rate of 9% p.a. till the date of payment. Accordingly we proceed to pass the following:               

                                      O R D E R

The complaint filed by the complainant is allowed in part. OPs are directed to settle the claim in respect of policy bearing No.07426726 for the sum assured of Rs.10,00,000/- with regard to accident and disability benefit rider and pay the same to the complainant with interest at 9% p.a. from January – 2010 till the date of payment and pay litigation cost of Rs.3,000/- to the complainant.  

This order is to be complied within four weeks from the date of this order.

          Send copy of this order to both the parties free of costs.

(Dictated to the Stenographer and typed in the computer and transcribed by him, verified and corrected, and then pronounced in the Open Court by us on this the 27^th day of December – 2010.)  

PRESIDENT

MEMBER                                                      MEMBER 

 Snm: