( Passed on dated 20^th  November, 2015 )

Per Shri Atul D. Alsi – Hon’ble President.

              The complainant No.1 is widow and complainant Nos. 2 to 4 are children of deceased Motiram s/o. Maniram Pardhi.  The deceased Motiram Pardhi was the agriculturist and having agricultural land at Owara, Gat N. 425, 427, 426, 428, 453, 447, 449, 446, 445 and 444.  The deceased was insured as per the said scheme and entitled to be benefited by the O. Ps.  Thus, the deceased was insured at the time of accident under the said scheme with O. P..

2.            The husband of complainant No.1 i.e. Motiram s/o.Maniram Pardhi, who died on 28/09/2012 in road accident. The deceased was proceeded towards village Mulla P.H.C. for medical treatment of Indubai.  But unfortunately, one vehicle No. MH-35/H-7176 which was driven by Akash s/o. Shivchand Sakhare dashed to the vehicle of Motiram Pardhi.   Due to said accident, the Motiram Pardhi is died on 08/12/2012 at Medical Hospital, Nagpur.  The report of such accident came to be lodged to Police Station, Deori and registered an offence p/u/s.279, 338, 304(a) of I.P.C. vide crime No. 60/2012 against Akash s/o. Shivchand Sakhare.

3.            For getting the benefit of such scheme the complainant has submitted a claim form along with all requisite documents.  On 19/03/2014, the O.P. sent letter to the complainant and refused the claim of complainant on the ground of non supply of driving licence.  It is pertinent to state here that the deceased Motiram Pardhi was lost driving licence in that accident.  In that respect, the complainant No.1 had solemnly affirmed and executed an affidavit before Executive Magistrate, Deori.  The said affidavit is also submitted by the complainant to the O. P..  The deceased was the Karta and only earning member of his family and the whole family is depends upon deceased Motiram.

4.            The complainants praying to direct the opposite parties to pay sum assured of Rs.1,00,000/- towards compensation along with interest 24% from the date of accident and also praying to direct the O.P. to pay Rs.20,000/- towards mental and physical agony and stress.

5.            After receiving the notice issued by this Forum, the O. P. No.1 is not appeared though served the notice before this Forum hence proceeded ex-parte against him on dated 18/06/2015, the O. P. No. 2 has filed his written statement by post and he denied all the contentions of the complainant & the O.P. No. 3 has appeared through his counsel and filed his written statement before the forum. 

6.            In their reply, O. P. No. 3 stated that, the deceased was not holding valid license to drive the motor vehicle.  It is false and hence denied that the license of deceased was lost.

7.            In his special pleading the O. P. No.3 further submitted that, it is learnt that the deceased did not know the driving that thus the deceased could not drive the motor cycle in proper way and dashed the upcoming vehicle but there is no driving license placed on record for claim settlement.  Hence, the claim was rightly repudiated that the deceased was died due to his own negligence.  The death of husband of complainant is self inflicted injury which is not covered under the terms and conditions of the agreement. 

8.            The complainant has filed Copy of refusal letter issued by O. P. No.3  at page no. 11,  original  7/12 extract  at page no.12,  original Gav Namuna 8A- Jama Bandi Patrak  at page no. 13, copies of police papers i.e. F.I.R., Spot Panchanama, Inquest Pancanama, P.M.report etc. at page No.41 to 51 on record.

9.            The learned counsel for complainant Mr. S. B. Dahare argued that the opponent is fully aware that it is the group insurance policy like the one under which claim has arisen does not specify such a condition.  He cited First Appeal No. A/10/947 (ICICI LOMBARD VS. RANGRAO PATIL + 1) in that case, the Hon’ble Commission held that license is not at all a necessary condition to settle the insurance claim under group insurance policy.

              He mentioned another citation of Hon’ble State Commission, Mumbai in First Appeal No. 1009/07 (ICICI LOMBARD –VS.- SINDHUBAI KHAIRNAR) in that case also, the insurance company insisted for driving license.  In that case, the Hon’ble Commission held that license is not at all a necessary condition to settle the insurance claim.  It is grave negligence and deficiency of opponent party i.e. Insurance Company.  The said scheme is floated by Maharashtra Government for the benefit of farmer’s dependent which is unfortunate death.  But the insurance company is avoided this liability which is totally illegal.

10.                   The counsel for O.P. No.3 Adv. Mrs. Indira Baghele filed her written notes of argument.   In her written argument she has submitted that, the deceased was not holding valid license to drive the motor vehicle.  It is evident that the deceased was not holding license and with malafied intention to obtain unlawful claim the complainant has taken wrong plea.  The O.P. No.3 has rightly rejected the claim of complainant on the ground for not finding the driving license.  Hence, the complaint is liable to be rejected with cost. 

11.                   As per petition and arguments and documents filed on record following points came for consideration:-

REASONING & FINDINGS

12.                    The complainant filed 7/12 extract and field survey No. 445 at Mauze Owara, Tal. Deori, Dist. Gondia at page No. 12 & 13. Therefore, the deceased was farmer and necessary entries of mutation were carried in Revenue record.  

13.                   The police officer of Police Station, Deori registered offence P/U/s. 279, 338, 304(A) of I.P.C. against the offending vehicle who dashed the vehicle of deceased.  Therefore, the deceased was not negligent in driving vehicle.

14.                   As per Judgment of Hon’ble State Commission, Mumbai, in First Appeal No. A/10/947 (ICICI LOMBARD VS. RANGRAO PATIL + 1)  and as per referred Judgment in case between ICICI LOMBARD –VS.- SMT. SINDHUBAI KHAIRNAR, the Hon’ble National Commission held in appeal No. 1009/07 ruled that “Farmer group insurance policy, which is issued to extend insurance cover to large group of persons, driving license is not at all a necessary condition to settle the claim”.

15.                   Hence, rejection of claim for want of license by Insurance Company is a deficiency of service hence complainant’s claim is partly allowed as per following order:-            

-: ORDER :-

1.            The complaint is partly allowed.

2.            The O. P. No.3 is directed pay sum  of Rs.1,00,000/- towards compensation under “Shetkari Janta Accident Insurance Scheme” with interest at the rate of 9% p.a. from the date of admission of complaint i.e. from 24/03/2015 till its realization.

3.            The O. P. No.3 is directed to pay Rs.5,000/- to the complainant for mental torture and mental agony along with Rs.5,000/- towards cost of litigation.

4.            The O.  P. No. 3 is directed to comply the above order within 30 days from the date of receipt of this order.

5.            No order passed against O. P. Nos. 1 & 2.