The factual matrix of this case, briefly stated, are that the deceased husband of the complainant took an insurance policy being no. 439450588 from the OP nos. 2 & 3 on 20-02-2008. The husband of the complainant died of a road accident while driving a vehicle; but the OPs refused to provide accidental death benefit to the complainant and feeling aggrieved by such illogical act on the part of the OPs, the complainant preferred the instant case for getting necessary relief under the law.
In support of her claim, the complainant submitted photocopies of policy certificate, letter of repudiation of claim issued by the OP no. 2 dt. 30-09-2011, Driving License of the complainant’s deceased husband, FIR, P.M. Report, Seizure list etc.
On being noticed, the OPs resisted and contested the complainant by submitting written version as well as WNA. They also took a positive part in the entire proceeding. The OPs in their joint reply strongly opposed the material allegations as raised by the complainant. By their written version, it is stated inter alia by the OPs that they repudiated the claim of the complainant on account of suppression of material fact. It is stated by the OPs that the complainant’s husband that at the time of taking the insurance policy stated his profession as ‘Car Driver’. However, they came to know from the police report that the life assured was driving a Truck carrying Goods with National Permit. It is further stated by the OP insurance company that had the said information been disclosed to them, the life assured would be liable to pay 2% extra premium. Thus, they prayed for dismissal of the case against them.
Points for determination
We frame the following issues to arrive at a decision.
- Whether the case is maintainable in its present form?
- Whether there is any deficiency in service on the part of the OPs?
- Whether the complainant is entitled to any relief/reliefs as prayed for?
Decisions with reasons
Point no. 1, 2 and 3
All these points are taken up collectively for the sake of convenience of discussion.
We have heard learned counsels for the parties and have carefully perused the materials on record.
Admittedly, the deceased insured was a policy holder under the OPs. There is no dispute that the accident took place within the validity period of the policy in question. It is also admitted fact that the complainant was the nominee of the policy in question. Therefore, there can be no dispute as regards maintainability of the instant case before this forum.
It is alleged by the OPs that the deceased insured took the policy in question by suppressing material fact as regards his nature of occupation/profession i.e. the deceased insured did not disclose the fact that he used to drive heavy motor vehicles/Truck which required him to pay 2% extra premium than what he actually paid but he had shown his profession in the proposal form as ‘car driver’. According to the OP there was no illegality in their action to repudiate the claim of the present applicant as to death benefit.
On perusal of the proposal form, it transpires that the deceased insured declared himself as a ‘Car driver’. Although the OPs have accused the deceased insured of suppression of material fact, but still fact remains that the photocopy of driving license of the deceased insured, filed on record on behalf of the complainant, goes to show that he possessed driving license of motor vehicle other than transport vehicle. That being so, we do not find any suppression of material fact on the part of the deceased insured at the time of taking policy, as alleged by the OPs. Therefore, in our opinion,, the OPs objection in this respect is not tenable.
However, on perusal of the photocopy of driving license of the deceased insured, as submitted by the complainant, it appears that the deceased insured was not authorized to drive transport vehicle while it transpires from the photocopy of FIR that prior to his death the insured, Sukdev Jana was driving a gas tanker which was a transport vehicle. It goes to show that the deceased insured was driving the vehicle in question bearing no. NL 02G 2166 in contravention of the terms and conditions of the driving license as shown in the proposal form. If someone ventures in any unlawful activity and any mishap occurs out of such activity, a Court of Law cannot help such a party. Therefore, in our considered view, the complainant is not entitled to get any accidental benefit out of the insurance policy in question for the action of her deceased husband by driving transport vehicle which was not the subject matter of the aforesaid insurance policy.
These points are disposed of accordingly.
Hence, it is
O R D E R E D
that the CC case no. 03/2012 be and the same is dismissed on contest against the OPs. Parties do bear their respective cost.
Dictated and corrected
by me
President
S.S. Ali A.K. Bhattacharyya
Member President
