Karnataka

Gadag

CC/8/2015

Renuka N Arear - Complainant(s)

Versus

The Branch Manager, Oriental Insurance Co. & others - Opp.Party(s)

A.F.Rayappanavar,

08 Dec 2015

ORDER

JUDGEMENT DELIVERED BY SMT.C.H.SAMIUNNISA. ABRAR PRESIDENT:

The complainant has filed this Complaint against the Opposite Parties (herein after referred in short as OPs) u/s 12 of Consumer Protection Act, 1986 alleging deficiency in service claiming a sum of Rs.1,00,000/- towards the personal accident cover for the deficiency in service rendered by the Ops and interest at the rate of 18% p.a. along with litigation expenses. 

2.    The brief facts of the case are that the Complainant is the wife of deceased Ningappa S/o Venkappa Arear. The husband of the Complainant met with an accident in his motor cycle Bajaj Discover coming from Koralahalli towards Mundaragi of Gadag District on 14.10.2012. The Complainant submits that the husband of the Complainant was the Owner of the Bajaj Discover Motor Cycle bearing registered No.KA-26-R-8795 registered on 18.01.2012. The above said vehicle was insured under the OP No.2’s-Company bearing Policy No.471101/31/2013/7524 and further Complainant submits that deceased had a valid Driving Licence to drive the said vehicle D.L. bearing No.2084.

 

3.      Further, the Complainant submits that the claim application under personal accident cover on 22.08.2014 claiming the insured amount of RS.1,00,000/- along with all required documents such as FIR, Complaint, IMA Report, D.L., R.C. Book, Legal Heir Certificate, Death Certificate. The OP No.2 has endorsed the Application on 22.08.2014. It is further submitted that the Complainant visited the Office of the OP No.2 several times, but OP had not responded to settle the claim. Finally, the Complainant issued a legal notice through her counsel on 27.11.2014 to pay the claim personal accident claim cover under the Policy, within 7 days from the date of receipt of this notice. Further, the Complainant submits that inspite of settling the claim the OP No.2 through his counsel replied on 22.12.2014 that this Complainant has not submitted required documents such as, FIR, Complaint, P.M.Report,Death Certificate etc. along with Claim Form and further contents in notice that there is a delay in informing and submitting the claim Application. Hence, the claim is rejected. Claims stating that “in view of violation of policy condition of your claim is not entitled to claim amount under the P.A. Cover” and further the Complainant submits that the Ops intentionally avoided to settle the claim benefit to the Complainant. Hence, OP had made deficiency in service on his part, the Complainant prayed to ordered to settle the insured amount of Rs.1,00,000/- along with 18% interest and litigation charges.

 

4.      Version notice served to the Ops by RPAD, Opposite Parties have appeared through their counsel and filed a Version. OPs have contended their version as follows:

 

The Complaint is not tenable either in law or in facts. Hence, the Complaint is to be dismissed inlimine. The OP No.1 is only the extension counter foil issuing policy none other activities are carried in the counter there is no any cause of action against the OP No.1. Complainant is untenable against the 1^st OP and has been drag to this Forum malafidely. Hence, Complaint deserves to be dismissed the entirety.

 

  5.    The OP No.2 admitted that the Complainant husband hold a policy and submits that the issuance of the policy between the insurer and insured represent a contract between the parties, since the insurer undertake to compensate the loss suffered by the insured on account risk covered by the insurance policy. The terms of the agreement have to be strictly construed to determine the extent of liability of the Insurer that being so, the insured also had strictly in accordance with statutory limitation and terms of the policy expressly set out therein.

 

6.      Further, OPs contended that Complainant has to intimate the accident immediately and submit the claim form along with necessary documents within the six months to the Ops-Company so as to unable the OP to investigate the facts and process in accordance with the terms of the contract and prevailing law. The accident occurred on 14.10.2012 and Complainant representing herself as or a wife intimated the fact of the accident to the OP on 22.08.2014 through the notice which being the beyond the period of statutory and contractual period, such delay claim defect the indemnification. Hence, Op is not liable to pay any claim made in the Complaint. Further, Ops submits that as Complainant had filed a MVC Petition at district and Session Court and MACT Gadag and same was dismissed on the ground that the Complainant/Petitioner in MVC No.112/2012 has fail to establish that Ningappa Arear died in Accident occurred on alleged date in the manner and reasons placed on record and findings of the MACT binds to the parties of the proceedings with setting aside the finding MVC 112/2012 the present Complainant not entitled for any of the relief, further the OP had alleged that the Complainant to prove that she is the wife and entitled for the benefit of PA Coverage. For the Complainant to prove that contents of Paragraph No.2 to 5 denied and stating that for all the above reasons the Complaint is to be dismissed.

 

7.      In support of the Complaint Smt.Renuka W/o Ningappa Arear C.W.1 (Complainant) filed an affidavit reiterating what has been stated in the Complaint and got marked as Exhibit P1 to P14 . In support of OP 1 and 2 one Sri.Ravindra S/o Laxman Kalladagi, Administrative Officer of OP No.2 filed an affidavit and examined on behalf of OP No.1 and 2. Note of argument filed, heard both the sides.

 

8.      On perusal of the Complaint, allegations and version contentions, the documents on records and evidence adduced we conceive this dispute if the Complainant claiming Rs.1,00,000/- under P.A. cover policy against the OPs along with 18% interest and litigation charges, that the husband of the Complainant had obtain a P.A. Insurance Policy from the OP No.2 for his vehicle Motor Cycle Bajaj Discover bearing No.KA-26 R-8795 on 18.01.2012 at R.T.O. Gadag and husband of the Complainant while going on his above said vehicle he met with an road accident on 14.10.2012 and died on the same day. On submission of the claim the Ops Company repudiated the claim on the ground of breach in policy condition and alleges deficiency in service whereas the Opposite Parties contented that the claim is barred by limitation, the Complainant has already filed the MVC Petition, that the petition was dismissed for not establishing that Ningappa Arear died in an accident occurred on the alleged date and MACT binds the parties to the proceedings, without setting aside the findings in MVC the present Complaint not entitled for any relief. Hence, there is breach of policy condition and not liable to settle the claim, the repudiation is proper there is no deficiency in service on their part. This being the matter, the points to be decided are:-        

 

1.     2.	Whether the Ops prove that the claim is barred by limitation?   Whether there is a deficiency in service on the part of the Ops by refusing to pay the Policy benefits?
3.   4.	Whether the Complainant is entitled for the relief sought for?   What Order?

 

 

 

Our Answer to the above Points are:-

Point No.1 – Negative,

Point No.2 – Affirmative,

Point No.3 – Partially Affirmative,

Point No.4 – As per the final Order

                         

R E A S O N S

 9.  POINT NO.1 and 2:  Since point NO.1 and 2 are identical to avoid the repetition of the fact, we considered both the points to get together for discussion. The Complainant is the wife of the deceased, the deceased owns a vehicle bearing No.KA-26 R-8795 Bajaj Discover Motor Cycle for which the deceased has insured with OP No.2. The policy was covered with the personal accident coverage which is not disputed by Ops and admitted the same. The main disputed facts are that the accident was not intimated to the Ops within the statutory limitation so as to unable the Ops to investigate the facts and processing accordance with the terms and condition, the Complainant had to submit the claim form along with the necessary documents within 6 months to the OPs.  

 

      10.     The Complainant has approached District & Session MACT Gadag claiming for the compensation in MVC No.112/2013. The Hon’ble and District Judge dismissed the case by observing that the accident took place due to rash and negligent driving of the driver/deceased and order that the claimant is not entitled for compensation, to show that the Complainant has filed the Order copy of the same, such being the order, the Complainant here has filed a Complaint before this Forum claiming the personal accidental insurance. The Complainant was not aware that the Hon’ble District and Sessions Court will not award any compensation for rash and negligent driving of the deceased and the Op was also well aware that the Complainant had approach the above said Court for the compensation, if the intention of the OP was good he would have advised the Complaint to claim under personal accident claim while. That the Complainant had approached the District Court and under MVC No.112/2013 where the OPs have also came to know that the insured was died in an accident, at the same time OP had investigated the fact in accordance. The Complainant is the wife of the deceased/insured who was unaware of the process to claim of the insurance amount which led her to approach the District Court. The Complainant had sufficient cause for not filing the claim form to the Ops within a statutory period. Such being the facts the Ops cannot deny to pay the insurance amount mere for the reason not filing the claim form and not submitting the documents in the statutory limitation. The Complainant had produced the documents marked as Exhibit P1 to P13 i.e. Exhibit P1 FIR discloses that the alleged accident have been occurred on 14.10.2012 and the same was reported at Mundargi Police Station under Crime No.21/12. The other documents produced are Abate Charge, Charge Sheet, Post Mortem Report also disclose that the accident had occurred. The Complainant had produced the copy of the valid Driving Licence, Insurance Policy Certificate and Extract of the Registration Certificate (R.C.) of the vehicle, Motor Cycle bearing No.KA-26 R-8795, copy of the Death Certificate of the deceased. After perusing the documents carefully it is established that the accident had been occurred on above said date was due to rash and negligent driving of the deceased. The case filed by the Complainant in District Court MVC 112/2013 which had been dismissed by the Hon’ble Judge on the issues that the accident took place due to the rash and negligent driving of the driver. In such circumstances, the claimant is not entitled for compensation in MVC, such being the findings that the OP had failed to establish that the deceased/insured had not died in the accident. The rash and negligent driving does not binds in personal accident claim.  

 

    11.     The Complainant had insured the vehicle for the vehicle Bajaj Discover Motor Cycle bearing NO.KA-28 R-8795 paying a premium of Rs.1,125/- in which additional personal accident had been covered for which of Rs.50/- had been collected. By perusing the documents i.e. produced by the Complainant Exhibit P5, P6, P7, P11 and P12 establishes that the deceased was holding a valid driving licence to drive the Motor Cycle and Motor Cycle was registered at R.T.O. Gadag for which the deceased had insured his vehicle in Ops-Company the Complainant had produced all the documents along with the claim form to the Ops on 22.08.2014 claiming P.A. Cover benefit of Rs.1,00,000/-. Mere for the late submission of the documents, the OP cannot deny the claim, the Complainant being the house wife, the delay in submission of the claim was due to the unawareness of the Terms and Conditions of the policy. The OP had never care to reply to the claim and the OP had failed to produce any documentary evidence to show that P.A. claim had been rejected due to the late submission of the claim. It was bounded duty of the Ops to inform the Complainant whether her claim has been accepted or rejected. Only on receiving the legal notice sent through the counsel of the Complaint, the OP had replied. Hence, we consider that there is deficiency in service on the part of the Ops. Hence, the limitation cannot be treated as barred. As such we answer the Point No.1 negative and Point No.2 as affirmative.

 

   12. POINT NO.3:  In the light of the above discussion, the Complainant is the legal heir the deceased is entitled to receive the benefit, because the abrupt death of the insured will change the situation, circumstances, finance and the position of survival in every aspects, moreover the Complainant had produced her Voter I.D. Card, it proves that the Complainant is the spouse of the deceased hence she is entitled for the reliefs that we answer the Point No.3 in partially affirmative.

 

13.  POINT NO.4 :  In the light of the above findings, we proceed to pass the following:      

 

//ORDER//

          1.   The complaint is partially allowed.

2.  The OP No.2 is directed to pay an amount of Rs.1,00,000/- (Rupees one lakh) towards the Personal Accident Cover.

3.   The OP No.2 is directed to comply the Order within 30 days from this Order, failing which OP had to pay interest at the rate of 10% p.a. till realization.

4.  Claim against OP No.1 is hereby dismissed.  

 

5.  Send a copy of this Order to both the parties free of cost.   

 (Dictated to the Stenographer, transcribed by him, corrected and then pronounced by me in the Open Court 30^th day of January, 2016)

 

 

            Member                       Member                             President