Per Sri A. Hazarath Rao,  President:-

        The complainants filed this complaint u/s 12 of the Consumer Protection Act seeking insured amount of Rs.1,00,000/- together with interest @12% p.a.,; Rs.10,000/- as compensation; Rs.10,000/- towards mental agony and Rs.10,000/- towards legal expenses.

2.   In short the averments of the complaint are hereunder:

The complainants 2 and 3 are children of the 1^st complainant and one Goriparthi Venkateswara Rao (deceased). The said Venkateswara Rao had Nirbhaya Gold Savings account bearing No.NGSB/01/00050226 with the 1^st opposite party.  The 1^st opposite party insured the life of its account holders under personal accident insurance policy with the 2^nd opposite party.   The said Venkateswara Rao maintained requisite balance in his account at the time of his death.   The sum assured under the personal accident policy was Rs.1,00,000/-.  The said Venkateswara Rao died in road accident on 17-03-10 within the limits of Bhattiprolu PS.   The SHO, Bhattiprolu PS registered the said accident as Cr.No.26/10 u/s 304 A IPC against driver of the RTC bus AP10Z 3532.   The 1^st complainant submitted entire relevant documents to the 1^st opposite party in April, 2010 who in turn sent them to the 2^nd opposite party.   The 2^nd opposite party though received claim form did not settle it.   The opposite parties thus committed deficiency of service.   The complaint therefore be allowed.

3.  The contention of the 1^st opposite party is hereunder:

        The 1^st opposite party forwarded all the claim papers to the               2^nd opposite party who in turn repudiated the claim of the complainants as the deceased did not possess driving license.   The burden is on the complainants to furnish the required documents to the 2^nd opposite party for consideration.   The 1^st opposite party thus discharged its obligation of sending claim form and relevant documents submitted by the complainants to the 2^nd opposite party.    The 1^st opposite party did not commit any deficiency of service.  Rest of the allegations contra mentioned in the complaint are all false and are created for the purpose of the case.  The complaint therefore be dismissed.

4.  The contention of the 2^nd opposite party in nutshell is hereunder:

        The 1^st opposite party obtained Group Janata Personal Accident Policy from the 2^nd opposite party for its Nirbhaya Gold Account holders of various branches covering the period from 29-08-09 to     28-08-10.   Insurance coverage for each account holder was Rs.1,00,000/-.   The 1^st opposite party submitted FIR, PM Certificate and asked the 2^nd opposite party to sent claim forms.  Accordingly the 2^nd opposite party sent the claim form.   But 2^nd opposite party did not receive any information from other side.   Finally the 2^nd opposite party on 06-09-10 addressed a registered letter to the 1^st opposite party to submit a claim form along with other documents mentioned therein more particularly driving license of the deceased.  The 1st opposite party received it under postal acknowledgment.   Neither the complainants nor the 1^st opposite party submitted driving license to process the claim.   The 1^st complainant on 30-09-10 addressed a letter to the 1^st opposite party stating that the deceased Venkata Rao did not possess driving license at all who in turn forwarded the same to the 2^nd opposite party.     The 2^nd opposite party closed the file as no claim for want of driving license of the deceased and informed the same to the 1^st opposite party on                  04-11-10.   The 2^nd opposite party did not commit any deficiency of service.  The complaint therefore be dismissed.  

5.   Exs.A-1 to A-8, Ex.B-1, B-2 to B-11 on behalf of the complainants, 1^st opposite party and 2^nd opposite party were marked respectively.                   

6.     Now the points that arose for consideration are:

1. Whether the opposite parties committed deficiency of service and if so by whom?
2. Whether the complainants are entitled to compensation?
3. To what relief?

7.  POINT No.1:-    The complainants 2 and 3 are children of               1^st complainant and the deceased Venkateswara Rao as seen from        Ex.A-6.   Goriparthi Venkateswara Rao died in road accident on            17-03-10 as seen from EXs.A-3 to A-5.  The deceased Venkateswara Rao having account with the 1^st opposite party (Exs.A-1 and A-2) and his coverage under the insurance scheme (Ex.B-2) are not in dispute.  The 1^st opposite party sending claim forms along with required documents to the 2^nd opposite party (Ex.B-3 to B-8) is also not in dispute.  

8.     Ex.B-7 dated 30-09-10 said to have been addressed by the            1^st complainant revealed that the deceased Venkateswara Rao did not possess any driving license.  Under Ex.B-9 dated 04-11-10 the                 2^nd opposite party repudiated the claim of complainants for want of driving license of the deceased Venkateswara Rao.   As seen from Ex.B-9 the 2^nd opposite party did not mark a copy to the                            1^st complainant in spite of knowing addressed particulars though addressed to the 1^st opposite party.   I see no reason for the                    2^nd opposite party to communicate with the 1^st opposite party alone even after receipt of claim forms and knowing the address of claimants.  Such an attitude is not expected on the part of                      2^nd opposite party. 

9.     Ex.B-11 is the copy of agreement in between the opposite parties.  Ex.B-11 agreement is not only binding on the 1^st opposite party but also on its customers being beneficiaries.   Under Ex.B-11 the 2^nd opposite party mentioned the exceptions:

        “The company shall not be liable under this policy for

1. Any other payment after a claim under one of the clauses (a), (b), (C) or (d) has admitted and become payable
2. Any payment in case of more than one claim under the policy during any one year of insurance by which the maximum liability of the company in that period would exceed the sum payable under sub-clause (a) of this policy.
3. Payment of compensation in respect of death, injury or disablement of the insured person.
   1. From intentional self injury, suicide or attempted suicide
   2. Whilst under the influence of intoxicating liquor or drugs.
   3. Whilst engaging in aviation or ballooning or whilst mounting into dismounting from or traveling any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standards type of air craft anywhere in the world.
   4. Whilst racing on wheels or horseback.
   5. Whilst big game hunting, mountaineering engaged in winder sports, skying or ice hockey.
   6. Directly or indirectly caused by veneral diseases, insanity.
   7. Arising or resulting from the insured committing any breach of the laws with criminal intent.

1. Payment of compensation in respect of death, injury or disablement of the insured person due to or arising out of or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, capture, arrests restraints and detainments of all kings, princess and people of whatsoever.    
2. Payment of compensation in respect of death or bodily injury or any disease or illness to the insured person (a) directly or indirectly caused by or contributed to by or arising from ionizing radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel.  For the purpose of this exception combustion shall include any self-sustaining process of nuclear fission (b) directly or indirectly caused by or contribution to by or arising from nuclear weapons material.  Provided also that the due observance and fulfillment of the terms and conditions of this policy (which conditions and all endorsements nercon are to be read as part of this policy) shall so far they relate to anything to be done or note to be done by the insured person be a condition precedent to any liabiliuty of the company under this policy.
3. The insurer under this policy shall not extend to cover death or disablement resulting directly or indirectly caused by contributed to or aggravated or prolonged by childbirth or pregnancy or in consequences thereof”.

10.   The same were incorporated in the pass book supplied by the 1^st opposite party to its customers (Ex.B-1).  Clause VIII (c) of Ex.B-11 enumerated the documents to be submitted to the company in case of death claims and they are:

1. Post-mortem report
2. Final investigation report
3. Death Certificate
4. Name of the nominee
5. Claim form (issued by the company on intimation of death)
6. Any other documents.

11.   Ex.A-3 revealed that the accident took place on 17-03-10 while the deceased was proceeding on TVS moped due to hit by RTC bus.    It is not the case of the complainants that the deceased Venkateswara Rao got driving license.  One should possess an effective driving license to drive a vehicle as rightly contended by the 2^nd opposite party.   The 2^nd opposite party is not liable to pay the insured amount in case of death arising or resulting from the insured committing any breach of law with criminal intent as seen from the exceptions.   No doubt the deceased had violated the provisions of MV Act in driving TVS Moped without driving license.  It is not the case of the 2^nd opposite party that the deceased was driving his moped without driving license with criminal intent.   Mere violation or breach of law itself is not sufficient to repudiate the claim unless it was with criminal intent.   Without incorporating such condition specifically the 2^nd opposite party cannot advance such type of contention.  Rejecting the claim of the complainants for want of driving license without such condition being incorporated under Ex.B-11 by the 2^nd opposite party in our considered opinion amounted to deficiency of service.  

12.   The 1^st opposite party discharged its obligation by sending claim form and required documents to the 2^nd opposite party.  Therefore we opine that the 1^st opposite party did not commit any deficiency of service and the complainants are entitled to the insured amount of Rs.1,00,000/- from the 2^nd opposite party.  We therefore answer this point accordingly.

13.  POINT No.2:-   The complainants claimed compensation of Rs.10,000/- and Rs.10,000/- towards mental agony.   No doubt the attitude of the 2^nd opposite party did cause mental agony to the complainants.  Awarding Rs.5,000/- towards compensation and mental agony in our consideration opinion will meet ends of justice.  We therefore answer this point accordingly.

14. POINT No.3:-   In view of above findings in the result the complaint is partly allowed as indicated below:

1. The 2^nd opposite party is directed to pay Rs.1,00,000/- (Rupees one lakh only) together with interest @9% p.a., from 04-11-10 (the date of repudiation) till realization to the complainants.
2. The 2^nd opposite party is directed to pay Rs.5,000/- (Rupees five thousand only) to the complainants towards compensation.
3. The 2^nd opposite party is directed to pay Rs.1,000/- (Rupees one thousand only) towards costs to the complainant.
4. The claim against 1^st opposite party is dismissed without costs.
5. The amounts ordered above shall be paid within a period of six weeks from the date of receipt of the copy of the order.

          Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 5^th day of July, 2012.

MEMBER                                             MEMBER                                         PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:

                                                                                                            PRESIDENT