O R D E R
(BY Sri. Ganesh Jadhav, President)
1. THIS IS A COMPLAINT FILED U/SEC.12 OF Consumer Protection Act, 1986.
2. The brief facts alleged in the complaint are that complainant Nos. 1 and 2 are father and mother and complainant No.3 is wife of deceased N. Rakesh Goud respectively, and they are the permanent residents of Ashoknagar, Kamareddy, Dist. Nizamabad
The deceased N. Rakesh Goud during his life time subscribed the policies viz 642972851, 602603169 and 602599125 for sum assured Rs. 1,00,000/- each. As per the conditions of policy the opposite parties should pay the sum assured along with accident benefit, if the policy holder died accidently. It is alleged that N. Rakesh Goud died on 3-10-2010 at about 9.00pm while on the way to Kamareddy as in the opposite direction several vehicles with fully toured head were coming due to which he lost control over his vehicle and fell down near the turning of Maisamma temple situated at outskirts of Ugrawai village, due to which he sustained serious grievous injuries to head and died on the spot and the pillion rider Karri Shiva Kumar received injuries. On receiving the information the complainant No.1 herein lodged a complaint before the Police Devanpally in which PS limits the accident occurred. On receipt of the complaint the Police Devanpally registered a case in FIR No. 210/2010 dt:4-10-2010 U/s 304A and 337 of IPC and sent dead body of N. Rakesh Goud for postmortem wherein detailed examination was done by duty doctor who opined in PME report that the death was due to Haemorrhage, shock and Head injury.
The above facts were intimated to opposite parties and also submitted all relevant documents which are needed for claiming of the policy amount by the complainants, and also started visiting the opposite party No.1’s office and corresponded with the opposite parties 1 & 2 and despite several visits the opposite parties have settled the claim to the extent of sum assured only and repudiated the claim for accident benefit. As a bolt, the opposite parties 1 & 2 sent a letter by creating their own opinion that the deceased was in a state of intoxication and due to which only the accident took place and repudiated the claim of the complainants for accident benefit vide a letter dt. 04-03-2011 and paid the sum assured only. But surprising thing is that the doctor being a technical personal, there is not even a single word to show that the deceased N. Rakesh Goud consumed the liquor and if at all it is true it should be detected by the duty doctor in his PME report, but it is not so, then the reason for repudiation of the claim for accident benefit is erroneous, fictitious and have no value.
The complainant Nos. 1 and 2 being the parents and the complainant No.3 being the wife of the deceased are entitled for accident benefit of Rs. 1,00,000/- each under the above said three policies and the opposite parties are liable to pay the said policies accident benefit amount of Rs. 3,00,000/- with interest at the rate of 24% per annum and also damages Rs. 1,00,000/- Hence this complaint and they prayed to allow the same.
3. The opposite party No.2 filed his written statement and the same is adopted by Opposite party No. 1. It is stated that the Opposite Parties are not aware of the relationship of the complainants with the deceased N. Rakesh Goud and their residence and put the complainants to strict proof of the same. It is admitted that Sri. N. Rakesh Goiud during his life time secured Life Insurance Policy Nos. 602603169 & 602599125 for a sum assured of Rs. 1,00,000/- each with accident benefit payable equal to the sum assured. It is denied that Sri. N. Rakesh Goud secured the policy No. 642972851 with accident benefit. In fact he has taken the policy which commenced from 15-11-2011 when he was minor at the age of 16 years old with annual premium of Rs. 4,931/-and he being minor the accident benefit was not applicable to him. Even though he was informed to pay additional amount of Rs. 100/- towards accident benefit from the date of commencement of the policy i.e from 15-11-2009 onwards along with regular premium of Rs.4,931/-. He has not chosen to pay an amount of Rs. 5031/- which includes additional amount of Rs.100/- towards accident benefit but he has paid only regular premium @ Rs. 4931/- and during his life time he has not paid consideration amount towards accident benefit and without paying consideration amount towards accident benefit the Opposite Parties are not entitle to pay the accident benefit of Rs. 1,00,000/- towards policy No. 642972851. It is stated that Opposite Parties are not aware of all the facts stated in para 3 of the complaint pertaining to the particulars of accident, lodging of complaint and registering of FIR by the Police Devanpally etc and put the complainants to strict proof of the same. It is admitted that the Corporation settled the basic sum assured under the policies, but denied that the Corporation rejected the accident benefit claim under the policies without any genuine reason. In fact the subject accident benefit was rejected basing on receipt of the Police Final Report dated 31-12-2010 of Devanpally Police Station of Nizamabad District. Further it is stated that as per their official record the life assured was driving under the influence of liquor and hence the incident in which he lost his life cannot be treated as an accident. The claim for accident benefit was rejected invoking policy condition 10 ( b)(i) which reads as follows:
“ The corporation shall not be liable to pay the additional sum assured in case if accident caused by whilst the life assured is under the influence of intoxicating liquor, drug or narcotic.”
It is further stated that the decision of competent authority of rejection of accident benefit claim under the said policies was informed to the complainant through their letter dated 04-03-2011. Further the complainant approached their Zonal Authorities at Hyderabad in which retired Judge is also a member who had also upheld the decision of rejection of the accident benefit claim and the same was also informed to the complainants vide their letter Ref. Claims/SCRC/5252 ( AB) dated 15-10-2012. It is untenable to mention that the accident benefit is rejected without any evidence but it is rejected on a full proof as stated supra.
It is further stated that all the facts mentioned in the para 5 of the complaint are false and incorrect. It is denied that the complainants are entitled to accident benefit of Rs. 3,00,000/- and also Rs. 1,00,000/- as damages. The Opposite parties prayed to dismiss the complaint against them with costs in the ends of justice and equity.
4. During the enquiry, the complainant No.1 N. Ramchander Goud filed his Affidavit in lieu of his evidence as PW1 and got marked Ex.A1 to A8 on behalf of complainants. On behalf of opposite parties 1 & 2 their Manager ( L & HPF) Sri. V. Vijaya Saradhi filed his Affidavit in lieu of his evidence as RW1 and got marked documents Ex.B1 to B5.
5. Heard arguments of both sides.
6. The points for consideration are.
- Whether there is deficiency in service on the part of Opposite parties in repudiating the accident benefit claim of the complainants under the policies?
- Whether the complainants are entitled for any reliefs as prayed for?
- To what relief?
7. Point No.1 & 2 :
Admitted facts are that Sri. N. Rakesh Goud during his life time secured the LIC policy Nos. 602603169 and 602599125 for a sum assured of Rs. 1,00,000/- each with accident benefit payable equal to the sum assured. The fact that Sri. N. Rakesh Goud during his life time also secured the LIC policy No. 642972851 for a sum assured of Rs. 1,00,000/- is not disputed. The dispute raised in respect of this LIC policy No.642972851 is that it was secured by Sri. N. Rakesh Goud while he was minor at the age of 16 years with annual premium of Rs. 4931/- and he being the minor the accident benefit was not applicable to him. Even though he was informed during his life time to pay additional amount of Rs. 100/- towards accident benefit from the date of commencement of the policy but he has not chosen to pay an amount of Rs. 5031/- which includes additional amount of Rs. 100/- towards accident benefit and that he has paid only the regular premium of Rs. 4931/- and during his life time he has not paid the consideration amount towards accident benefit and without paying consideration amount towards accident benefit the Opposite Parties are not liable to pay the accident benefit Rs. 1,00,000/- towards policy No. 642972851. Further admitted facts are that the Opposite Parties settled the basic sum assured under these three LIC policies bearing Nos. 642972851, 602603169 & 602599125 but repudiated the claim of complainants to the extent of accident benefit on the ground that the deceased was under influence of alcohol at the time of riding the motor bike and met with road accident leading to his instantaneous death. Therefore as per the terms and condition of the policy clause 10 (b)(i) Accident Benefit is not payable.
8. The contentions of the complainants are that Opposite Parties having settled the basic sum assured under the three policies obtained by deceased N. Rakesh Goud, had repudiated the claim of Accident Benefit on the untenable grounds that the deceased was under influence of alcohol at the time of riding the motor bike and met with road accident leading to his instantaneous death. According to the complainants the Final Report Ex.B1 of Devanpally Police Station relied by the Opposite Parties no doubt disclosed that the deceased was under influence of alcohol but it does not give any details about actual amount of alcohol if consumed or type of intoxicants consumed. Further their contention is that if really the deceased had consumed liquor and he was under influence of alcohol the doctor would have traced the contents of the said alcohol during the post mortem examination and he would have mentioned the same in the PME report Ex.A3. But the said PME report did not disclose the contents of alcohol. Finally the complainants contended that the opposite parties have not produced any credible evidence to sustain their contentions. In order to prove the versions of the complainants they filed the evidence affidavit of complainant No.1 as PW1 and got marked Ex.A1 to A8 documents on their behalf.
The contentions of the opposite parties are that the Accident Benefit was rejected basing on the Police Final Report dt : 31-12-2010 of Devanpally Police station of Nizamabad District pertaining to the accident in Cr.No.210/2010 dt: 04-10-2010, U/s. 304A and 337of IPC in which the N. Rakesh Goud died. The attested copy of the said report is marked as Ex. B1 which disclosed that the insured consumed liquor and expired due to lost his control over his motor cycle. Therefore, according to the Opposite parties the deceased violated the terms and conditions of the insurance policies and thereby the company is not liable for any compensation and rightly repudiated the claim of accident benefit of the complainants under policies and as such there is no deficiency on their part. To substantiate the versions of opposite parties the affidavit of their Manager (L&HPF) Sri. V. Vijaya Saradhi is filed in lieu of his evidence as RW1 and got marked Ex.B1 to B5 documents on their behalf.
9. In the present case the Opposite Parties simply relied on the Final Opinion Report ( Ex.B1 ) filed by Sub Inspector of Police Devanpally in Cr.No.210/2010 dt: 04-10-2010, U/s. 304A and 337of IPC in which the N. Rakesh Goud died. Basing on this report the claim of Accident Benefit of the complainants under the LIC polices is repudiated on the ground that deceased was in intoxication condition while driving the motor bike and met with an accident and died on spot. The Final Report Ex. B1 no doubt disclosed that the deceased had consumed liquor and was in drunken condition but it does not give any details about the actual amount of liquor if consumed or the type of intoxicants consumed. Even if this final report is accepted, this is not adequate proof that the deceased was intoxicated, in the absence of any evidence regarding the quantity of alcohol consumed. Except this piece of evidence there is no other evidence to show that the deceased N. Rakesh Goud was in drunken condition and was under the influence of alcohol. If at all the deceased had consumed alcohol as revealed from the Final Report Ex.B1 and as contended by the opposite parties, the doctor who conducted the Post Mortem over the dead body of the deceased and who issued the PME report Ex.A3 would have traced the contents of alcohol during the post mortem examination and would have mentioned in his PME report Ex.A3. The PME report Ex. A3 of the deceased N. Rakesh Goud shows that the death of the deceased is due to “Hemorrhage shock due to head injury”. No where the contents of alcohol is disclosed in Ex.A3. Therefore we are of the considered opinion that PME Report Ex. A3 negatives the contents of Ex. B1 the Final Report which does not inspire much confidence in view of the PME report Ex.A3. The Opposite Parties have not appointed any investigator nor investigated as to the circumstances under which accident took place. Onus is on the Opposite Parties to produce some tangible evidence to substantiate their case. The opposite party has not able to produce any credible evidence to show that the deceased N. Rakesh Goud was intoxicated which resulted in his death. In this circumstance and in the light of observations made by the Hon’ble National Commission in a case between “National Insurance Company Ltd., V/s. Soma Devi and others” reported in CPR June 2012 part at page 467, we are of the considered opinion that the contentions of the Opposite parties that the deceased was under the influence of alcohol at the time of driving the motor bike are not sustainable and hence cannot be accepted. Therefore we are of the considered opinion that there is a deficiency of service on the part of the opposite parties in repudiating the claim of the complainants in respect of two policies i.e policy Nos. 602603169 & 602599125 which were admittedly secured by Sri. N. Rakesh Goud during his life time for a sum of Rs.1,00,000/- each with accident benefit payable equal to the sum assured.
10. Regarding the repudiation of Accident Benefit of the complainants under the policy bearing No.642972851 the contentions of the Opposite Parties are that Sri. N. Rakesh Goud has taken this policy while he was minor at the age of 16 years old with annual premium of Rs. 4931/- and being the minor the accident benefit was not applicable to him. Even though he was informed during his life time to pay premium of Rs. 5031/- including Rs. 100/- towards accident benefit, he has not chosen to pay an amount of Rs. 5031/- but he has paid only the regular premium Rs. 4931/- and during his life time he has not paid the consideration amount towards accident benefit and without consideration amount towards accident benefit, the Opposite Parties are not liable to pay the accident benefit for a sum of Rs. 1,00,000/- towards policy No. 642972851. At the initial stage the opposite parties have not raised this ground for repudiation of the accident benefit in their repudiation letter Ex. A8. But subsequently they have raised this ground for repudiation in their counter. No doubt, this ground of repudiation is raised subsequently in their counter but the Opposite Parties have adduced the evidence of RW1 in this regard who clearly stated that this policy bearing No. 642972851 was taken while N. Rakesh Goud was minor when he was 16 years old and he being a minor accident benefit was not granted to him. RW1 further stated that even after agreeing to pay premium of Rs. 5031/- including addition of Rs.100/- towards accident benefit from 15-11-2009 he has paid an amount of Rs. 4931/- only and during his life time he has not paid the consideration amount towards accident benefit and without consideration amount towards accident benefit the opposite parties are not entitled to pay the accident benefit of Rs. 1,00,000/- towards the policy No. 642972851. The proposal form Ex.B3 disclosed the date of birth of the life assured i.e N. Rakesh Goud is 24-03-1986 and he was 16 years old at the time of proposed the said policy. At Serial No.7 there are 6 columns amongst which there is a column for “Is Accident Benefit required?” and this column is kept blank. In another column “Sum Proposed”, and in this column Rs. 1,00,000/- is mentioned, and in another column “ Amount deposited” and in this column Rs. 4931/- is mentioned, Ex.B4 is History premium transactions towards policy No. 642972851 this shows the payment of premium @ of Rs. 4931/- only, Ex. B5 is the endorsement of granting Double Accident Benefits(D.A.B) towards policy No. 642972851. All these documents Ex.B3 to B5 supported the evidence of RW1 which establishes the fact that no additional amount of Rs. 100/- towards accident benefits in respect of the policy No. 642972851 was paid. This evidence of RW1 supported by Ex. B3 to B5 was not rebutted by the complainants. In these circumstances we are of the considered opinion that the complainants are not entitled to claim the accident benefit under the policy bearing No. 642972851. And that the complainants are only entitled to claim the accident benefit under the policy Nos. 602603169, 602599125. Therefore it is held that the act of repudiating the claim of the complainants in respect of these two policies amounts the deficiency in service on the part of Opposite Parties.
The complainants have not filed any record for the relief of compensation of Rs. 1,00,000/- claimed by them towards pain and suffering and mental agony. As such they are not entitled for the said relief. Accordingly the Point Nos. 1 and 2 are answered infavour of the complainants and against the Opposite Parties.
11. POINT No.3.
Having considered the entire facts and circumstances of the case and in view of the aforesaid discussions and findings, we are of the considered opinion that the opposite parties 1 & 2 are liable to pay Rs. 1,00,000/- each in respect of the LIC policy Nos. 602603169 and 602599125 towards Accident Benefit with 9% interest per annum from the date of repudiation i.e. 04-03-2011 with cost.
12. IN THE RESULT, the complaint is allowed in part as under.
- The Opposite parties 1 and 2 are directed to pay an amount of Rs. 1,00,000/- ( Rupees one lakh only) each in respect of the policies bearing Nos. 602603169 and 602599125 towards accident benefit total Rs. 2,00,000/- under both the said policies with 9% interest per annum from the date of repudiation i.e. 04-03-2011 till the date of realization.
- The Opposite parties are also directed to pay Rs. 2000/- ( Rupees two thousand only ) to the complainants towards cost of the complaint.
Typed to my dictation, pronounced by us in the open Forum on this the 31st day of October 2014.
