D.O.F: 31.07.2018

                                                                                      D.O.D: 24.02.2023

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PUDUKKOTTAI

BEFORE:

                 Thiru. K. Mohandoss, B.Sc., B.L.,                     : PRESIDENT

                 Tmt. S. Sugunadevi, M.A., M.L.,                       : MEMBER 1  

                Thiru. A. Alagesan B.E., E.P.G.D.M.,                 : MEMBER 2

                                            MEMBER 2

CC.  43 / 2018

DATED THIS THE TWENTY FOURTH DAY OF FEBRUARY ’2023

T. Anjammal,

W/o. Late A. Thangaraj,

Malligaippati Village,

Navadippatti, Kodumbaloor Post,

Illupur Taluk,

Pudukkottai District                                                              :  Complainant

                                                             Vs.,

The Branch Manager,

Life Insurance corporation of India,

Kulithalai Branch,

Vaigainallur Aghraharam,

Kulithalai, Karur District – 639 104                                      :  Opposite party

This complaint is coming for hearing before us on 10^th  day of February’2023  in the presence of Thiru.K.T. Stalin, Counsel for the Complainant, and Thiru. P. Venkatraman, Counsel for the and opposite party.   Perused the complainant and opposite party side documents, and hearing the arguments of both sides and the case having stood over to this day for consideration, this Commission passed the following:

                                                           ORDER

                    THIRU. K.MOHANDOSS,B.Sc., B.L., ; PRESIDENT

 1.The crux of the complaint is : - It is the case of the complainant that, she is the wife of deceased A.Thangaraj,  had taken two life insurance policies. On 18.10.2017 deceased Thangaraj was proceeding on motorcycle while crossing the road at that time one TN-58-AM-0216 Hundai I.10 car driver came with rash and negligent manner and gave dash to the motorcycle and he met with an accident.  The said accident occurred due to rash and negligent driving of the driver of Hundar car.  Her husband died in the said accident.  Her husband was agriculturist.  He was having agricultural land at Malligaipatti village, Godumballur Post and Pudukkottai District.  The death of the deceased occurred in the accident. Therefore, the complainant has submitted her claim proposal.  The opposite party insurance company has repudiated the claim on the ground that, her husband was not having valid and effective driving licence at the time of accident.  Therefore, due to said deficiency in service on the party of opposite party, she has constrained to file consumer complaint and claimed compensation amount of Rs.2,50,000/- along with interest from the date of complaint.  She has also claimed Rs.1,00,000/- towards mental agony and cost of proceedings.

The  opposite party has filed written version contending as follows:

     The complaint is false, fraudulent and legally unsustainable hence liable to be dismissed in limine. The complainant is put to strict proof of all those averments made in the complaint.

   The opposite party insurance company has filed its written version that, the deceased was not having effective driving license. He died while driving motorcycle without having driving license.  Hence, it is submitted that, by letter dated 28.03.2018, the opposite party insurance company informed the complainant about repudiation of the claim, for want of valid and effective driving license.  It is the contention of opposite party, that as per the insurance agreement, it is biding on the claimant to submit driving license as per terms No.10 with policy if the deceased who was driving vehicle was not having effective driving license, legal heirs of deceased or the injured claimant are not entitled for compensation towards the insurance policy.

    The opposite party has mentioned about the procedure for submitting claim and contended that, it is up to insurance company to allow or repudiate the claim.  In this case the claim submitted by complainant is repudiated as deceased was not having effective driving license.  Hence this Hon’ble District Consumer commission pleased to dismiss the complaint for non compliance of documents such as effective driving license and inquest report from policy which are the requirement as per agreement.

 On the basis of respective contentions of the parties following points arise for our determination.

     The complainant to prove his case has filed proof affidavit along 8 documents and the same has been marked as Exhibit A-1 to A-8. The first opposite party insurance company to prove their case has filed proof affidavit along with 4 documents and the same has been marked as Exhibit B-1 to B-4. 

The points for consideration are: - (1). Whether there is any deficiency in service on the part of the opposite parties ?

(2). If so to what relief the complainant is entitled for ? 

Point Nos.1&2 :- The learned counsel for complainant submitted that, complainant have submitted all requisite documents.  However, the opposite party insurance company has repudiated the death claim for want of driving license of deceased.  In fact, accident occurred due to fault on the part of driver of the Hundai –I-10 and not due to the fault on the part of deceased.  Hence, the claim cannot be rejected for non production of driving licence.  Hence the complainant is allowed death benefit of policy with compensation and cost.

   The learned counsel for complainant emphasized on the point that, though the deceased was standing along motorcycle he was not at fault.  The offence is also registered against the driver of offending vehicle.  The complaint relied upon the documents submitted along with claim proposal, the claim were settled for both the policies on 08.12.2019 through NEFT infavour of nominee Anjammal spouse of deceased A. Thangaraj for Rs.88,250/- and Rs.2,00,000/-

  The learned counsel for opposite party insurance company argued that, the deceased himself was riding motor cycle at the time accident, the complainant approached the office and the branch manager was intimated regarding the same and on production of necessary claim forms.  The claims were settled for both the policies through NEFT infavour of complainant.  When the complainant demanded accidents benefit besides policy amount. This opposite party had sent a detailed reply as the nature of death is reported as vehicle involved in road accident while crossing the road.  It was also intimated to the complainant that in order to avail the claim under accidents benefits, they require policy inquest report and driving license of policy holder of A. Thangaraj.  But the complainant was not submit the above documents till today since the nature of death is reported as vehicle accident while crossing the road.  Hence the above two documents are required by the opposite party.  Without submitting the requirements the complainant has filed this complaint is not maintainable.  The opposite party insurance company directed the complainant to produce requisite documents including driving license of deceased.  The opposite party came to know that, deceased was not having driving license and there is breach of policy condition mentioned in the agreement as per clause 10.  This fact itself was sufficient to repudiate the death claim.  Hence, in repudiating claim there is no deficiency in service on the part of opposite party insurance company.

 We have perused the documents produced by complainants along with claim proposal.  It reveals that, the complainants have complied all requisite documents to show that, deceased was agriculturist, his death is occurred in the motor  accident. However, it has come on record that deceased was not driving motor cycle but standing along it.  However, the complainant were asked to produce driving licence. Due to non compliance of said documents the death claim is repudiated. It reveals that, the accident occurred due to the fault on the part of Hundai car driver, offence is also registered against him. When the claim is repudiated for want of driving licence, the opposite Insurance Company could have inquired about driving license of deceased with RTO.

   The Learned counsel for complainant argued that,  if the claimant could not produce the valid and effective driving license of deceased who was not at fault, the claim cannot be rejected.                               .   
    We relied upon the judgment of Hon'ble High Court in 9650/2014 Bhagyashree Dhage Vs. The State of Maharashtra wherein the Hon'ble Lordship of Bombay High Court held that, clause 21 in the resolution cannot be considered as mandatory. The reliance also can be placed on judgment of Hon'ble Bombay High Court in W.P.No. 10185/2015 - Latabai Raosaheb Deshmukh Vs. State of Maharashtra & Ors. decided on 6.3.2019, which is reproduced by District Consumer Commission. Wherein the Hon'ble High Court 7 A/155/2020 Court observed that, there was nothing to infer that accident was occurred due to fault of deceased, and to reject the claim. Insurance Company has committed deficiency in service mistaken in rejecting claim. In view of the scheme introduced for benefit of farmers, as seen in GR of 2009 is binding on the insurance company. This court hold that, compensation needs to be given to the petitioner and interest also to be paid, as provided in GR of 2009.

  . Here the documents produced by complainant itself state that, the accident occurred while deceased was not riding the motor cycle, the deceased stand on near by road for crossing with motor cycle.   FIR state that, offence is registered against the driver of car on offending vehicle and not against deceased as motor cycle rider.  

    In case of death in motor accident except the death claim of  "offending" driver  all other claim of agriculturists to be settled in case of death occurred in a motor accident.  it reveals that it is necessary to furnish valid and effective driving license of the driver who met with an accident while driving the vehicle. However categorically states that except the offending driver (driver at fault) claim of all to be settled. Thus, the valid license is required in case death of 'offending' driver (i.e.driver at fault) Word  is very material in the case in hand. Because it is apparent that deceased  was though not driving motor cycle he was not at fault and there is also no nexus between driving license and cause of accident on the part of deceased.

   We have also perused which is modified or amended insurance act Wherein the categories of accident and required documents to be given, which are required while submitting claim proposal. If we read which states about documents to be submitted with claim in column at serial No.1, it is specifically mentioned that in case of road accident and rail accident, the claimant has to submit copy of FIR,  inquest  report and. Post mortem report. The main documents is silent to state that in case of death of person in motor accident and if he was driving vehicle required to produce driving license. Hence submission of driving license of deceased cannot be the mandatory requirement. Even otherwise in the case in hand the police paper, the FIR states that accident occurred due to fault on the part of driver of unknown vehicle and FIR is registered against driver of unknown vehicle . Hence, in the case in hand it is not desirable to ask the claimant to produce valid and effective driving license. Moreover, the cases wherein driving license is required, burden is on Insurance Company to prove that, deceased was not having valid driving license, at the relevant time as the person driving vehicle is not alive and hence in death benefit of policy, generally the legal heir such as widow being rustic villager is not expected to furnish such document. Moreover opposite party insurance company to prove fact of driving by deceased, at that to produce inquest report if it is in their favour.

    With the aforesaid discussion, in view of distinguishing fact and circumstances and ongoing through the cases referred by the parties we are of the opinion that the opposite party insurance company by repudiating the death claim has caused deficiency in service on the part of opposite party.

     In the result, the opposite party insurance company shall pay the amount of Rs.2,50,000/- towards death claim for two policies along with 12% interest from date of filing till date of realization and to pay Rs.20,000/- towards mental agony with cost of Rs..5000/-

This order is dictated by the President to the Steno-Typist, transcribed, typed by her and corrected, signed and pronounced by us in open Commission, today on this 23^rd  day of February’2023.

(Sd*******)                               (Sd*******)                                      (Sd********)

MEMBER:2                               MEMBER:1                                       PRESIDENT

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE COMPLAINANT

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE OPPOSITE PARTY

(Sd*******)                              (Sd*******)                                       (Sd********)

MEMBER:2                               MEMBER:1                                       PRESIDENT