D.O.F:12/01/2022
D.O.O:29/11/2024
IN THE CONSUMER DISPUTES REDRESSAL COMMISSION KASARAGOD
CC.05/2022
Dated this, the 29th day of November 2024
PRESENT:
SRI.KRISHNAN.K : PRESIDENT
SMT. BEENA. K.G : MEMBER
Premalatha P.K,
W/o Madhusoodanan,
Thanal, Perool,
Varikkachal. P.O, : Complainant
M.M. Bazar,
Mathamangalam,
Kannur District.
(Adv: Benny Jose)
And
1. The Branch Manager,
United India Insurance Co. Ltd,
Behind SBI,
City Mall, Court Road,
Payyannur.
(Adv: K Vinod Kumar)
2. The Divisional Manager,
United India Insurance Co. Ltd, : Opposite Parties
Tiger Hill Complex Floor No.2,
Muncipal Office Road, M.G. Road,
Kasaragod – 671121.
ORDER
SRI. KRISHNAN.K : PRESIDENT
Facts of the case is that the complainant is the mother of Mithun.T.M, who is died in a motor accident on 04/04/2021 while proceeding to Payyannur from Onakunnu. His bike bearing Registration No: KL – 59-Q-4175 met with an accident with a JCB. Mithun got seriously injured and on the way to Pariyaram Medical College he died the deceased Mithun was the owner of the motor bike bearing Registration No: KL – 59-Q-4175. The vehicle is insured with opposite party with valid insurance policy from the period between 15/08/2020 to 14/08/2021 the policy was having P.A death coverage. The P.A coverage is for 15 Lakhs if the owner/Driver dies in an accident his legal heir will get the said amount.
The complainant filed claim before Opposite party which is repudiated by Opposite party vide letter dated 21/12/2021 for the version that there is violation of policy condition of section III (B). that the policy condition III (B) states that the personal accident cover for owner/driver death no compensation shall be payable in respect of death or bodily injury directly or indirectly wholly or in part arising or resulting from as traceable to an accident happening whilst such person is under the influence of intoxicating liquor or drugs.
The opposite party rejected the claim for the reason attributed that in the postmortem report it is noted that smell of alcohol was present. In the repudiation letter it is also stated that the laboratory report of the deceased was not conducted in this case. Hence opposite party cannot determine the quantity of alcohol present in the body at the time of accident. Another reason stated in the final report of police it is stated that the insured was driving the vehicle in a careless and negligent manner causing damage to the public. At the same time LIC honored the death claim in respect of complainants deceased son.
The act of opposite party is highly illegal arbitrary and without any basis and against the norms of natural justice. For which complainant claims to pay a sum of Rs. 15 lakhs with interest and cost of the proceedings.
The opposite party No:1 filed written version and Opposite party No:2 filed memo adopting the version of Opposite party No:1. The opposite party admitted that the vehicle bearing registration No: KL-59-Q- 4175 having valid insurance policy at the time of accident. The claim of the complainant has been repudiated for the reason that there in violation of the policy condition under section III(B). The Opposite came to the conclusion based on the postmortem report of the deceased and also referring the final report of the police.
There is no deficiency in service from the part of opposite party. The opposite party issued policy with certain conditions, which is also accepted by the policy holder opposite party acted only as per the terms and conditions of the policy. The assumption that can be drawn from the postmortem and final report of police shows that the deceased was under the influence of alcohol at the time of accident. The Opposite party has rightly repudiated the claim as per the terms and conditions of the policy and prayed to dismiss the complaint.
The complainant filed chief affidavit and cross examined as Pw1 Ext A1 to A6 marked. The Opposite filed documents and Ext B1 and B2 marked.
Heard the respective counsels in details.
Point for consideration in the case is that:
- Whether there is any deficiency in service from opposite parties?
- Whether the complainant is entitled for relief sought in the complaint?
- If so for what reliefs?
For convenience all the points are considered together:
The case of the complainant is that her son Mithun died in a road traffic accident. At the time of accident he was riding the vehicle bearing registration No: KL-59-Q 4175. The said vehicle is insured with Opposite party and policy was owner/Driver P.A death coverage. The complainant filed claim before Opposite Party but rejected for the reason that the deceased was under the influence of alcohol at the time of accident.
The case of Opposite is that vehicle used by the deceased having valid insurance coverage of owner/driver P.A coverage, but claim rejected for the reason that there is violation of policy condition No III (B).
The documents produced by complainant are Ext A1 FIR in crime No. 155/2021 of payyannur police, Ext A3 insurance policy, Ext A4 legal heirs certificate, Ext A5 repudiation letter and Ext A6 postmortem certificate.
The complainant claims Rs. 15 lakhs as insurance benefit. The quantum amount is not disputed by opposite party. But the contention of opposite party is that at the time accident the PA coverage holder is under the influence of Alcohol and it is the violation of the terms and conditions of the policy and they rejected the claim. Further opposite party stats that they came to the conclusion based on the postmortem report of the deceased and also referring the final report of the police report. But these reports are not proved by opposite party as per the mandate of law.
So considering the nature and circumstances of the case evidence adduced by complainant we are of the opinion that the complainant is entitled for the relief claimed in the complaint.
In the result complaint is allowed in part directing the opposite parties to pay an amount of Rs. 15,00,000/- (Rupees Fifteen lakhs only) with 8% interest from the date of complaint till realization with an amount of Rs. 5000/- (Rupees five thousand only) as cost of litigation to the complainant within 30 days of the receipt of the complaint.
Sd/- Sd/-
MEMBER PRESIDENT
Exhibits
A1- First Information Report
A2- Final Report
A3- Copy of the certificate insurance policy
A4- Copy of the legal heirs Certificate
A5- Repudiation Letter
A6- Postmortem certificate
B1- Copy of the policy
B2- Postmortem Certificate
Witness Examined
Pw1- Premalatha. P.K
Sd/- Sd/-
MEMBER PRESIDENT
Forwarded by Order
Ps/ Assistant Registrar
