F.A.No.583/2008 AGAINST C.C.No.94/2007, DISTRICT FORUM, ANANTAPUR

Between:

1. The Branch Manager, LIC of India,

    Hindupur, Anantapur District.

2. The Divisional Manager,

    Life Insurance Corporation of India,

    Kadapa.                                                                                                  Appellants/

                                                                                                                   Opp.parties

          And

Smt.P.Vasundara W/o.late V.S.N.Kumar

Occ:Service, C/o.Working in B.C.Girls Hostel,

A.P.Residential School, Tekelodu,

R/o.Chilammethur Village & Mandal

Anantapur District.                                                                                             Respondent/                                                                                                                                                                             Complainant

Counsel for the Appellants: Hari Rao Lakkaraju

Counsel for the Respondent: Mr.N.Aswartha Narayana

QUORUM:   THE HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT

AND

SMT.M.SHREESHA,  MEMBER

.

TUESDAY, THE TWENTY THIRD DAY OF NOVEMBER,

TWO THOUSAND TEN

Oral Order: (Per Hon’ble Justice Sri D.Appa Rao, President)
***

This is an appeal preferred by the insurance company against the order of the District Forum directing it to pay Rs.5,00,000/-  being the accident benefit amount covered under the four policies from 09-8-2005 till the date of realization together with compensation of Rs.30,000/- and costs of Rs.5,000/-.

        The case of the complainant in brief is that she is the wife of late V.S.N.Kumar.  While he was alive he took four policies for an amount of Rs.35,000/-, 25,000/-, 100,000/- an Rs.50,000/- respectively  and he died on 29-7-2001 in an accident.  A case was registered by police in Crime No.90/2001 followed by post mortem examination.  When a claim was made the insurance company had paid the assured amount without paying the accidental benefit, though the nominee was entitled for the same under law.  Therefore, she claimed Rs.4,00,000/- towards accidental benefit together with interest, Rs.20,000/- towards compensation and costs of Rs.5,000/-.

        The insurance company resisted the case while admitting the issuance of the policies, it alleged that the accident benefit is equivalent to the sum assured and the maximum accident benefit is around Rs.2,10,000/- under all policies put together.  When the complainant was asked to file the driving license of the assured, she did not file and as such only the assured amount was paid.  Therefore, she was not entitled to the amount claimed and prayed for dismissal of the complaint with costs.

The complainant in proof of her case filed affidavit evidence and

got marked Exs.A1 to A4 while the opposite parties filed affidavit evidence of the Manager and filed Exs.B1 to B6. 

        The District Forum after considering the evidence on record, directed the insurance company to pay Rs.5,00,000/- being the accident benefit amount covered under the said policies together with interest at 9% p.a. from 09-8-2005 till the date of realization together with compensation of Rs.30,000/- and costs of Rs.5,000/-.

        Aggrieved by the said order, the insurance company preferred the appeal contending that the District Forum did not appreciate the facts in correct perspective.  It ought to have seen that unless the complainant proves that the deceased was having driving license, she was not entitled to the accidental benefit amount.  She filed the complaint belatedly after receiving the amount covered under the policies.  Therefore, they prayed that the appeal be allowed.

        The point that arises for consideration is whether the order of the District Forum is vitiated by mis-appreciation of fact or law in that regard?

        It is an undisputed fact that the complainant is the widow of the deceased, V.S.N.Kumar, who had taken four insurance policies, Exs.B1 to B4.  In the very counter, they had admitted the issuance of the policies with accident benefit namely entitled to the sum equivalent to the sum assured.  Though the learned counsel for the insurance company contended that they by mistake, it was stated that the accident benefit is covered which in fact is not, however in the light of the fact that such a benefit is covered under the policies, we are not in agreement with his contention.  Despite the fact that the amounts were paid under the policies, they did not extend the accidental benefit  to the complainant on the ground that the driving license was not filed.  The complainant is admittedly a widow and despite her vigorous search, she could not trace out the license.  The insurance company which was having surveyors, investigators and others did not try to find out whether the deceased was having driving license or not.  The complainant cannot be asked to file the driving license of the deceased when the insurance company could verify the fact.  Simply on the ground that the complainant did not produce the driving license, the accident benefit cannot be denied.  It may be stated herein that the insurance company is fully aware that the accidental benefit is covered for all the policies.  Since admittedly the death was by accident, ex-facie the insurance company ought to have settled the accident benefit on the ground that the assured died in an accident without insisting for driving license.  It is not as though he was an accused in the case registered by the police evidenced from the recitals in F.I.R., Ex.A4.   However, the District Forum ought not to have awarded Rs.5,00,000/-,  in fact, the complainant was entitled to Rs.2,10,000/- being the sum equivalent to the sum assured.

        In the result the appeal is allowed and the order of the District Forum is modified and the insurance company is directed to pay Rs.2,10,000/- being the accident benefit amount with interest at 9% p.a. from 09-8-2005 till the date of realization.  The amount granted by the District Forum towards compensation and costs are confirmed.  Time for compliance four weeks.

Sd/-PRESIDENT.

                                                                                                        Sd/-        MEMBER.

JM                                                                                                             Dt.23-11-2010