Tamil Nadu

StateCommission

FA/652/2012

VIJAYA - Complainant(s)

Versus

THE BRANCH MANAGER, NATIONAL INSURANCE COMPANY LIMITED - Opp.Party(s)

C. KULANTHAIVEL

23 Sep 2015

ORDER

 

BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION,CHENNAI

BEFORE :   THIRU.A.K.ANNAMALAI                          PRESIDING JUDICIAL MEMBER

                                                      TMT.P.BAKIYAVATHI                               MEMBER

                                                                                        F.A.NO.652/2012

(Against the order in CC.No.44/2010, dated 02.02.2012 on the file of DCDRF, Namakkal)

DATED THIS THE 23^rd DAY OF SEPTEMBER 2015

Tmt.Vijaya,

W/o.Late Raja,

197/ S.F.Pannakkadu,

Suriyampalayam Post,                                           M/s.C.Kulanthaivel

Tiruchengode Taluk,                                    Counsel for appellant / Complainant

Namakkal District.

-vs-

The Branch Manager,

National Insurance Company Limited,                   M/s.Nageswaran & Narichania

81-Chetti Street, Opp Bus Stand,                   Counsel for Respondent /Opp.party

Tiruchengode,

Namakkal District.   

          The Appellant is the complainant filed a complaint before the District Forum against the opposite party praying certain relief.  The District Forum allowed the complaint.  Against the said order, the appellant / complainant filed this appeal praying for to set aside the order of the District Forum in CC.No.44/2010, dated 02.02.2012.   

          This appeal coming before us for hearing finally on 31.08.2015, upon hearing   the arguments on both sides, perusing the documents, lower court records, and the order passed by the District Forum, this commission made the following order.

A.K.ANNAMALAI,  PRESIDING JUDICIAL MEMBER

          The complainant is the appellant.

2.       The complainant’s deceased husband availed as owner of the lorry No.TN-34-F-5466  as  comprehensive policy for his own and also availed two more policies as Group Personal Accident policy and Group Traffic Accident Policy and from his lorry owner’s association and while the policies are in force he met with an accident on 16.9.2009 in the State of Assam and expired.  When the complainant as legal heirs claimed the policy amounts and the claim was not settled alleging still it was under investigation.  Hence the consumer complaint came to be filed.

3.       The opposite party denied the allegations before the District Forum contending that the cause of death of the policy holder was not proved as it is stated that while alighting from the parked lorry the said policy holder Raja fell down and died and since the cause of death was not clearly known the investigation was made which is pending and thereby no deficiency on their part.

4.       The District Forum after an enquiry on the basis of materials allowed the complaint in part directing the opposite party to pay a sum of Rs.2,00,000/- only under the policy Ex.B1 with interest at the rate of 6% per annum  and to pay Rs.2000/- as costs and dismissed the claim in other two policies under Ex.B2 and B3 without costs.

5.       Aggrieved by the impugned order the complainant has come forward with this appeal contending that the District Forum erroneously dismissed the complaint for the claim against the other two policies when it was holding that the policy holder sustained injury and subsequently expired due to that injury, it is proved that the said Raja died in a motor vehicle accident and thereby the appeal is to be allowed.

6.       We have heard both sides arguments and perused the materials carefully.  It is the admitted case of both sides that the complainant deceased husband being the lorry owner cum driver availed three policies one comprehensive against his own and two more group insurance policies from the lorry owner’s association and on the basis of the same the claims were made.  It is also not in dispute that the policy holder died while on the vehicle at Assam.  The opposite parties admitted the policy claims under Ex.B1 to B3 policies.  The District Forum having considered the materials of both sides came to the conclusion that under Ex.B1 alone the policy holder entitled for the claim of Rs.2,00,000/- and not entitled to get the amounts under Ex.B2 and B3 since the deceased Raja sustained injury in the accident not directly caused by external violent accident and visible means and therefore the complainant cannot enforce the two policies under Ex.B2 and B3.  For this when we perused the policies under Ex.B2 and B3 the Ex.B2 it was taken as group policy covering the risk traffic accident insurance policies for 1952 members anywhere in India as per policy conditions and on perusal of the conditions under the definitions pointing “Road Accident”- Accident caused by or arising out of use of motor vehicle as defined in the Motor Vehicles (Amendment) Act, 1994 as amended upto date under Ex.B2 policy and Ex.B3 with the same details covering for 1952 persons of Lorry Urimaiyalargal Sangam in which it is pointed out “If the insured shall sustain any bodily injury resulting solely and directly from Accident caused by outward violent visible means then the company shall pay to insured the sum hereinafter set forth ………”

From these two policies it is clear that the coverage for causing of death or injury due to accident while using the vehicle shall pay the amount to the policy holder / nominee.  But in this case the opposite parties claimed that the accident causing no visible outward the claim cannot be considered and the District Forum for this relied upon the rulings reported in 2005 CTJ (SC)1 Polymat India Pvt.Ltd and another –v-s National Insurance Co.Ltd and others and 2006 CTJ (SC) 625 Life Insurance Corporation of India and another vs- Smt.S.Sindhu…. and in view of the terms and conditions of the policy and construed that the amount could be paid only for accident only by way of violation outward visible means.  The learned counsel for the appellant contended that whether the accident is to be considered an incident which become as accident to be taken for consideration and in this case the policy holder while on the vehicle falling down from the lorry sustained injury and subsequently died in the hospital which was not disputed and thereby the death was in the course of employment while on the vehicle and for this they relied upon the precedent reported in  R.P.828/2010, dated 9.1.2015 National Consumer Disputes Redressal Commission, New Delhi in the case of Mrs.Ajmeri khatun –vs- General Manager, National Insurance Company Ltd and others in which it is observed that the policy holder died due to snake bite which was considered as accident death and the District Forum allowed the same against which the appeal was filed before the State Commission and the State Commission set aside the order and dismissed the complaint against which the National Commission allowed the Revision petition in this case by accepting the contentions of the District Forum and also the appellant relied upon two more order of this Commission passed in F.A.No.461/2011 dated 23.7.2013 and in F.A.No.672/2011, dated 25.6.2014 touching the same point and the  accident occurred  due  to snake bite and Scorpion stinging in which an incident caused treated as accident and also relied upon “2007 (2) CPR 260 (NC), 2007 CTJ 257 (CP) (NCDRC) and 2008 CTJ 917 (CP) Supreme Court” in which it is held as follows:

          “The Supreme Court held that the Insurance companies being in a dominant position, often act in an unreasonable manner and after having accepted the value of a particular insured good, disown that very figure, on one pretext or the other when called upon to pay compensation.  This ‘take it or leave it’ attitude is clearly unwarranted not only as being bad in law but also ethically indefensible”.

In view of the same in this case also we are of the view that liberal interpretation to be given for the terms of accident and  in this case the deceased in the course of employment while on vehicle and thereby falling from the vehicle become unconscious and sustained injury and got admitted in the hospital and subsequently died.  As per the report under Ex.A1 in which it was stated

          “During investigation I/O of the case ASI K.Nath visited the P.O. and examined the compliant and witnesses and found that the truck owner N.Raja on way to Guwahati from Manipur taking water ¾ times, while the truck stopped at Khatkhati Roma Kant truck parking the truck owner N.Raja trying to get down from the truck.  At that time he fall down from the truck and found unconscious and immediately the complainant along with truck parking owner and staff shifted to Bokajan C.H.C for treatment but the doctor declared that he was died.  As per formalities the dead body was inquest and sent to the Diphu Civil Hospital for P.M. examination and after collection of P.M. examination and doctor opined that the cause of death is due to shock and hemorrhage.

          This is for favour of information and necessary action.”

Hence we are of the view that as per the definition under Ex.B2 Road Accident-“Accident caused by or arising out of use of motor vehicle”.  This incident happened which is nothing but an accident and thereby the complainant is entitled for the benefits of the policy coverage under Ex.B2 and B3 and on behalf of deceased husband and thereby the order of the District Forum by dismissing the claim for the same is hereby to set aside and accordingly

          In the result, the appeal is allowed and the complaint is allowed by setting aside the order of the District Forum dismissing the claim against Ex.B2 and B3 policies and

1. the opposite party is directed to pay a sum of Rs.1,00,000/- each towards policies under Ex.B2 and B3 and apart from the sum of Rs.2,00,000/- under Ex.B1 already awarded by the District Forum with 6% interest from the date of complaint till the date of realization to the complainant for herself and on behalf of the legal heirs mentioned under Ex.A4 and

2. confirming the costs of Rs.2000/- already awarded by the District Form.

          3. No separate order as to costs in the appeal.

          4. Directions shall be complied within a period of 6 weeks from the date of this order.

 

P.BAKIYAVATHI                                                         A.K.ANNAMALAI

    MEMBER                                                       PRESIDING JUDICIAL MEMBER

 

INDEX; YES/ NO

VL/D;/PJM/INSURANCE