BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
FA 360 of 2012 against CC 88/2009, Dist. Forum, Srikakulam
Between:
1) The Branch Manager
ICICI Lombard General Insurance
Company Ltd.
Rama Lakshmana Junction
Srikakulam.
2) The Manager
ICICI Lombard General Insurance
Company Ltd.
Dwaraka Nagar, Visakapatnam
Through Legal Manager
ICICI Lombard General Insurance
Company Ltd.
D.No. 6-3-352/1, Osman Plaza
Road No. 1, Banjara Hills
Hyderabad. *** Appellants/
Opposite Parties
And
Susheela Patnaik
W/o. Late Krishna Rao Patnaik
Bonamali Village
Kanchili Mandal
Srikakulam Dist. *** Respondent/
Complainant
Counsel for the Appellant : M/s. S. Sravan Kumar
Counsel for the Respondent: M/s. A. Rama Rao.
CORAM:
SMT. M. SHREESHA, PRESIDING MEMBER
&
SRI S. BHUJANGA RAO, MEMBER
THURSDAY, THE FIFTH DAY OF SEPTEMBER TWO THOUSAND THIRTEEN
ORAL ORDER: (Per Smt. M. Shreesha, Member)
***
1) Aggrieved by the order in C.C. No. 88 of 2009 on the file of Dist. Forum, Srikakulam, the opposite parties preferred this appeal.
2) The brief facts as stated in the complaint are that the complainant’s husband Sri Krishna Rao Patnaik got his tractor & trailer insured with Op2 covering the period from 18.8.2007 to 17.8.2008 and also paid an amount of Rs. 100/- towards personal accident covering the risk of the owner of the vehicle for an amount of Rs. 2 lakhs. While so, on 3.11.2007 the life assured died in a road accident while he was proceeding in the said vehicle on the NH5 at Kanchili village of Srikakulam District. The complainant submits that she immediately intimated about the death of her husband to Op2 on 30.11.2007. She alleges that in spite of several approaches and legal notice got issued by her on 22.9.2009 there is no response from the Ops nor settled the claim. Hence this complaint seeking directions to Ops to pay Rs. 2 lakhs covered under the policy together with interest, compensation and costs.
3) Op2 filed counter denying the allegations made by the complainant and contended that the Dist. Forum has no jurisdiction to entertain the matter. They contend that the complainant did not furnish the particulars of intimation and claim form in order to settle the claim. At the time of accident the driver was not having the valid driving license to drive the vehicle in question and that the assured sat on the vehicle beside the driver contrary to the terms of the policy. The opposite parties have not repudiated the claim and therefore there is no deficiency of service on their behalf. As the life assured had violated the terms of the policy, the insurance company is not liable to indemnify the complainant.
4) The Dist. Forum based on the evidence adduced i.e., Exs. A1 to A8 and the pleadings put forward allowed the complaint directing the Ops to pay Rs. 2 lakh covered under the policy with interest @ 9% p.a., from the date of claim till the date of realization together with costs of Rs. 2,000/-.
5) Aggrieved by the said order, the opposite parties preferred this appeal.
6) The point for consideration is whether the complainant is entitled to personal accident benefit of Rs. 2 lakhs covered under the policy?
7) The only contention of the opposite parties is that the complainant did not furnish the information immediately nor filed any claim form. They also contended that at the time of accident the driver was not holding the valid driving license to drive the tractor & trailer, and that there is violation of terms of the policy as the vehicle was occupied by more than one person, and therefore not liable to pay any compensation.
8) We observe from the record that the life assured late Krishna Rao Patnaik got his tractor & trailer insured with Ops by paying premium of Rs. 7,753/- in respect of his vehicle. So also covered his life under personal accident insurance by paying additional premium of Rs. 100/-. Here, we are not dealing with vehicle insurance but only with regard to personal accident covered under the policy. The life assured was exclusively covered under personal accident for an amount of Rs. 2 lakhs on payment of premium of Rs. 100/-. In case of his death in an accident the insurance company is liable to pay an amount of Rs. 2 lakhs to the nominee. In the instant case, the death of the life assured is not in dispute. Exs. A2 to A4 establish that he died in an accident. It is pertinent to note that the opposite parties did not choose to file any documents nor filed the conditions of the policy with respect to Personal Accident. Ex. A1 Photostat copy of the policy filed by the complainant shows that in case of death of the life assured in an accident the insurance company is liable to pay Rs. 2 lakhs to the nominee. The case on hand has nothing to do with the vehicle coverage. The subject matter is
only with regard to personal accident coverage. As stated earlier in case of death of the life assured in an accident the insurance company is liable to pay an amount of Rs. 2 lakhs under the policy to the nominee. The appellant/insurance company could not establish by way of documentary evidence that the life assured did not die in an accident nor that there is any violation of terms of the policy. We do not find any reasons to interfere with the well-considered order of the Dist. Forum. We do not see any merits in the appeal.
9) In the result this appeal is dismissed. No costs. Time for compliance four weeks.
1) _______________________________
PRESIDING MEMBER
2) ________________________________
MEMBER
*pnr 05/09/2013
UP LOAD – O.K.
