2. The Manager,

    Chaitanya Godavari Grameena Bank,

    Head office : Raghu Mansion,

    4/1, Brodiepet, Guntur.

3. The United India Insurance Company Ltd.,

    Rep. by its Divisional Manager,

    Main Road, Brodiepet,

    Guntur.                                                     … Opposite parties 

                This Complaint coming before us for final hearing on       08-07-11 in the presence of Sri N.Srinivasa Rao, advocate for complainant and of Sri P.Siva Rama Prasad, advocate for opposite parties 1&2, Sri Paladugu Venkateswarlu, advocate for 3^rd opposite party, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following: -

O R D E R

Per Sri A. Hazarath Rao,  President:-

                The complainant filed this complaint under section 12 of the Consumer Protection Act, 1986 seeking assured amount of Rs.1, 00,000/- covered under Nirbhaya Gold Scheme together with interest and for costs.

2.      The averments of complaint in brief are as follows:

                One Komaragiri Venkateswarlu i.e., the husband of complainant had savings bank account with the 1^st opposite party bearing account No.50397 under Nirbhaya Gold Scheme.  The account holder should maintain minimum balance for coverage of accidental benefit.  The said Venkateswarlu on 02-07-09 at about 4 pm died in an accident due to hit by the lorry bearing No.AP03Y 8379.  The complainant sought for payment of Rs.1, 00,000/- i.e., death benefit covered under Nirbhaya Gold Scheme.  The 1^st opposite party had tie-up with the 3^rd opposite party to cover the insurance under the said scheme.  The complainant submitted all relevant documents to opposite parties 1 and 2 for payment of the benefit.  The opposite parties 1 and 2 did not choose to see to get payment through the 3^rd opposite party.  The accident occurred due to negligent driving of driver of the said lorry.  The complainant is the nominee under the said policy.  The opposite parties 1 and 2 received notice and gave reply seeking driving license of the deceased.  Driving license of the deceased is not required to settle the death benefit.  Driving license was lost in the accident and it could not be traced.  The complaint therefore be allowed.          

3.                The 2^nd opposite party filed memo adopting the version of 1^st opposite party and the contention of opposite parties 1 & 2 in brief is hereunder:

            One Komaragiri Venkateswarlu had account bearing No.50397 under Nirbhaya Gold Savings.  The 1^st opposite party received information regarding the death of said Venkateswarlu on 03-07-09.  The complainant is nominee under the account.  The 1^st opposite party informed the fact of death of account holder to 2^nd opposite party on 03-07-09.  On 24-07-09 the 2^nd opposite party furnished the claim forms to complainant.  On 08-09-09 the 2^nd opposite party forwarded the claim forms copy of FIR, postmortem report, death certificate to the 3^rd opposite party (mistakenly typed as 2^nd opposite party). The 1^st opposite party on 03-04-10 received letter from 3^rd opposite party asking for driving license of the deceased.  The opposite parties thus did not commit any deficiency of service.  The complaint therefore be dismissed.

4.      The contention of 3^rd opposite party in brief is hereunder:

                The 3^rd opposite party issued group Personal Accident Insurance Policy No.150804/47/08/61/00000255 under Nirbhaya Gold Scheme to the account holders of 1^st opposite party.  The risk under the said group will cover those who are under the age of 70 years.  The deceased was also included in the said group insurance policy.  The policy will be issued basing on the oral and bonafide information, good faith furnished by the 1^st opposite party.  The insured died leaving behind the complainant, two sons and one daughter.  The complainant through 1^st opposite party claimed compensation. The 3^rd opposite party appointed investigator to submit his report.  The deceased himself was driving the motorcycle and he has no driving license and it amounts to violation of policy terms and therefore repudiation is justified.  The complaint therefore be dismissed.

5.             Ex.A1 to A6 on behalf of complainant and Ex.B1 to B10 on behalf of opposite parties 1 and 2, Ex.B11 to B16 on behalf of 3^rd opposite party were marked.

6.      Now the points for consideration are

1. Whether the opposite parties have committed deficiency of service?

1. To what relief?

7.      Undisputed facts in this case are these:

1. The insured was covered under Janatha Personal Accident Policy bearing No.150804/47/08/61/00000255.

1. The insured had account with the 1^st opposite party under Nirbhaya Gold Saving Scheme (Ex.B1).

1. On the date of accident the insured maintained minimum balance (Ex.B2).

1. The 1^st opposite party sent claim forms to 3^rd opposite party (Exs.B3, B4 and B5)

1. The 3^rd opposite party repudiated the claim of the complainant on 10-03-10.

8.      POINT No.1

                Ex.B13 dt.10-03-10 reads as follows:

                “RE: JPA Death claim of your NGSB A/c. holder,                                                    K.Venkateswarlu (50397)

                   In ref. to the above, we have written to you for Driving License of the deceased on 19-01-2010, which is essential for processing claim. But so far we have not heard anything from you.  Since the deceased was reportedly driving the motorcycle when the accident was occurred, we cannot further proceed with the claim unless the valid D.L. is submitted.  Hence please comply with the requirement within 15 days of the receipt of this letter i.e., on or before 25-03-2010 otherwise the claim will be closed construing that there is NO CLAIM.”

9.             The 3^rd opposite party repudiated the claim as insured had no driving license at the time of accident. Ex.A2 is Xerox copy of FIR in crime No.120/09 on the file of Macherla PS (T) and it reads as follows:

10.           Ex.A2 revealed that death of insured took place due to rash and negligent driving of lorry driver bearing No. AP03Y 8379.    Ex.A2 further revealed that the said lorry and the motorcycle bearing No.AP16 AP 3203 driven by the insured-cum-deceased were in motion. The death of the insured in accident is not in dispute. Under Ex.B11 it was mentioned that the company should not be liable for policy

1. ______
2. _________
3. _________
4. Payment of compensation in respect of death, injury or disablement of the insured from (a) intentional self-injury, suicide or attempted suicide. (b) Whilst under the influence of intoxicating liquor or drug. (c) Whilst racing on wheels, hunting Big Games Shooting, Mountaineering or hills engaged in winter sports, skiing & ice hockey. (d) Directly or indirectly caused by insanity. (e) Arising or resulting from insured committing any breach of the law criminal intent.     

11.           It is for the insurer to prove that the insured committed any breach of law with criminal intent.  The policy in question is not for the claim on account of insurance of the motor vehicle. Driving a motorcycle with out licence did not amount to breach of law with criminal intent in our considered view.  Under those circumstances, we are of the view that the complainant is entitled to have accidental benefit and the repudiation made by the opposite parties is not justified.

12.           Since the opposite parties failed to settle the claim within reasonable time, the complainant is entitled to have interest.  In view of the aforementioned discussion, we hold that the opposite party committed deficiency of service in rejecting the claim for want of driving licence of the insured /deceased under the said policy.

13.    POINT No.2

                In view of the above findings, in the result, the complaint is allowed in part in terms as indicate below:

1. The 3^rd opposite party is directed to pay Rs.1, 00,000/- (Rupees one lakh only) to the complainant together with interest at 9% p.a. from the date of repudiation i.e., 10-03-10 till the date of payment.
2. The 3^rd opposite party is further directed to pay costs of Rs.1000/- to the complainant.
3. The complainant is directed to furnish ‘No Objection Certificate’ from her children namely Sai Kumar, Subrahmanya Chari and Sai Sukanya to the 3^rd opposite party under acknowledgement.
4.  The claim against opposite parties 1 and 2 is dismissed without costs.
5. The amounts ordered above shall be paid within a period of six weeks from the date of receipt of copy of this order, failing which, the amount ordered in point No.2 shall also carry interest at 9% p.a. till the date of realization.

Dictated to the Junior Steno, transcribed by her, corrected by me and pronounced in the open Forum this the 19^th day of July, 2011.

          MEMBER                                                                PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:

                                                                                          PRESIDENT