Judgment & Order  dt. 11.07.2017

            Repudiation of the complainants’ claim for insurance money by the OPs, i.e. National Insurance Company Ltd. has galvanized the complainants to file the instant case u/s 12 of the C.P. Act, 1986, alleging deficiency in service against the OPs. The quintessence of the facts leading to the filing of the instant case by the complainants may be described as follows.

            The complainants are wife and minor daughters of the deceased Raju Dey. Raju Dey died in an accident on 13.5.2015 while he was driving his own motorcycle, bearing registration No.WB-62A/6717. The deceased had a Personal Accident policy covers from the National Insurance Company Ltd. i.e. the OP Nos. 1 & 2. After the death of the deceased, the complainants are entitled to get the policy amount from the OPs, but the OPs did not make any arrangement for payment of policy amount in favour of the complainants. The complainant No.1, i.e. the wife of the deceased, knocked at the door of OP No. 1 on several times, but to no effect. Last of all, on 28.9.2015 it was informed by the OP No. 1 to the complainant No.1 that they are not entitled to get any amount from the insurance company, as the deceased had no personal accident cover. Having got the said letter, the complainants have filed the instant case, praying for payment of Rs.2 lakh as the policy amount, Rs.50,000/- as compensation for mental and physical pain and agony, Rs.10,000/- as litigation costs. Hence, the case.

            The OP Nos. 1 & 2 have filed a written version of them to contest in the case, wherein it is submitted inter alia that the deceased had an insurance policy from the OPs, that he died in an accident within the valid period of insurance policy. But he did not pay any additional amount for personal accident coverage and therefore, the complainants are not entitled to get any amount as claimed for. According to them, the complainants have no cause of action to bring the instant case and therefore, the case should be dismissed in limini with cost.

            Upon the averments of both the parties the following points are formulated for proper adjudication of the case.

Issues:

1. Whether the OPs are liable for deficiency in service by repudiating the claim of the complainants for policy amount?
2. Are the complainants entitled to get policy amount as clamed for?

Evidence of the parties

            The affidavit-in-chief has been filed on behalf of the complainants and same is kept in the record. The documents filed by them as per firisti are also kept in the record. On the other hand, the OPs have also filed affidavit-in-chief with some documents as per firisti and these are also kept in the record for consideration.  

DECISION  WITH  REASONS

Issue Nos. 1 & 2:

            Both the points are taken up for consideration at a time for the sake of convenience.

            It is contented on behalf of the insurance company that the deceased did not pay any additional amount for personal accident cover and as such the complainants, who are legal representative of the deceased, are not entitled to get the policy amount from the insurance company. Ld. Lawyer appearing for the complainants has argued that the insurance policy was a package policy; it was a comprehensive policy and the insurance company has also received premium from the deceased covering any kind of personal damage including owner-cum-drivers damage and therefore, the complainants are entitled to get policy amount for death of the deceased.

            Perused the evidence on record and also documents filed on behalf of the parties. Considered all these along with submissions of canvassed on behalf of the parties.

            In the face of submissions of the parties as pointed out above, it is to be seen whether the insurance policy purchased by the deceased was an “Act Policy” or a “Comprehensive Policy”/ a “Package Policy”. The policy of the deceased was not ‘Act policy’; it was a ‘Package Policy’ and it is so admitted by the OPs in the affidavit-in-chief as filed by them. It has also been stated therein that there is a guideline of I.R.D.A. that the insurance company can take premium to cover the life risk of the insured owner-cum-driver, but it is not mandatory. According to the submission of the insurance company, no premium whatsoever has been paid by the deceased to cover the life risk of him. Let us now see whether the insurance policy covers the life risk of the deceased or not; or, in other words, whether any premium has been paid by the deceased in order to cover the life risk of him or not. The deceased died on 13.5.2015 and this date is covered within the policy No.150730/31/14/6200014692. There is a schedule i.e. “schedule of premium” in the copy of the insurance policy which has been filed herein. There are 2 parts of this schedule –(A) ‘own damage’ and (B)’liability’. In the portion of ‘own damage’ the gross amount of Rs.117/- has been received to cover the liability of the owner-cum-driver (OD). In another part titled “liability” a gross amount of Rs.414/- has been received from the deceased as premium. There is also a “limit of liability clause” on the same policy and it mentions that the personal accident cover u/s 3 for owner-cum-driver is Rs.1 lakh. Another document is filed on behalf of the National Insurance Company Ltd. showing the rate of tariff premiums to be charged on different types of vehicles w.e.f. 1.4.2015. There is a table for two-wheelers tariff on that document and it is reproduced as follows:-

TWO WHEELER TARIFF (Sec.-3)

ZONE –B, (Rest of India)

N.B. Owner Driver risk is compulsory for both Package & Liability Policy.

            A perusal of the above table reveals that the risk of owner-cum-driver is compulsory for both package and liability policy. It has already been mentioned that the policy of the deceased was package policy and this being so, the said policy must compulsorily cover the risk of owner-cum-driver. It has already been found that in the insurance policy itself that the deceased has paid premium to cover the risk of personal damage. Personal damage includes within it the death of the insured. Regard being had to the legal provisions as discussed above and also evidence on record as pointed out above, we are of the opinion that the insurance policy was a package policy and as such it covers compulsorily the death of owner-cum-driver of the motorcycle as to the amount of Rs.1 lakh only as mentioned in the insurance policy. The insurance company has not rightly repudiated the claim of the complainants and therefore, they have been guilty of deficiency in service for not allowing the claim of the complainants. The complainants are entitled to get the insurance money to the extent of Rs.1 lakh only.

            Ld. Layer for the complainant has argued that the OPs should have taken the meager amount of Rs.50/- from the assured to cover personal accident of him. It is their duty to get the insured informed about that facility and the deceased would have been able to pay the said paltry sum, had it been so informed.

            The insurance policy is a package policy. In case of such policy, owner-driver risks is to be compulsorily borne by the insurer. It is obligatory on the part of the insurer to inform the insured of the necessity of payment of the paltry sum by the insured to cover personal accident. That obligation is not discharged by the insurer and here also arises the deficiency in service on their part.

            It has been further contended on behalf of the insurance company that the complainant No.1 has received payment of Rs.1 lakh in full and final settlement of her claim under another policy of Janata Personal Accident claim, bearing policy No.150703/47/12/9600000180 and as such they are not entitled to any claim as made by them. Their contention appears to have no substance at all. A person is entitled to get same kind of benefit under different policies, provided the policies are all valid and effective.

            In the result, the case succeeds in part.

Hence,

                                                O R D E R E D

          that the complaint case be and the same is allowed on contest against the OPs-Insurance Company with cost, which is quantified at Rs.2,000/- only.

            The OP Nos. 1 & 2 are directed to make payment of Rs.1 lakh only as policy money / amount and Rs.2,000/- as litigation costs, totaling of Rs.1,02,000/- (Rupees One Lakh Two thousand) only to the complainants by issuing separate account payee cheques of equal amount in the individual names of the complainants within a month of this order, failing which the policy amount will carry interest @ 12% p.a. till the date of full realization of the said amount.

            Let a free copy of this order be supplied or sent to the parties concerned free of cost.