Date of Filing : 24.03.2010
Date of Order : 08.06.2011
BEFORE THE II ADDITIONAL DISTRICT CONSUMER
DISPUTES REDRESSAL FORUM,
SESHADRIPURAM, BANGALORE – 560 020
Dated 8th JUNE 2011
PRESENT
Sri. S.S. NAGARALE, B.A., LL.B. (SPL) …. President
Smt. D. LEELAVATHI, M.A., LL.B. …. Member
Sri. BALAKRISHNA V. MASALI, B.A., LL.B.(SPL) …. Member
COMPLAINT NO. 944 / 2010
Smt. Krupa.K.N.
W/o. Renuka Reddy,
R/o: No. 24/5, 4th Cross,
Near Church, Pipeline Road,
Vijayanagar,
Bangalore – 560 040. ……. Complainant
V/s.
1. The Manager,
Bajaj Allianz,
GE Plaza, Airport Road, Yerawada,
Pune – 411 006.
2. Team Life Care Co. (I) Pvt. Ltd.,
“Sri Vasam”, 1-B, 1st Floor,
No. 15, 1st Cross, Pampa Layout,
Hebbal Kempapura,
Bangalore – 560 024. …… Opposite Parties
ORDER
(By the President Sri. S.S. Nagarale)
This Complaint is filed by the Complainant u/s. 12 of the Consumer Protection Act, 1986.
2. The facts of the Complainant’s case are that the husband of the Complainant Sri. Renuka Reddy had obtained Policy bearing No. 111471978 from OP1. On 15.03.2009, the insured died on account of accidental gas burst on which date the policy was in force. Complainant being a nominee submitted necessary documents to the OP for claiming death benefits of her husband. As per the claim made by the Complainant, OP accepted the same and paid a sum of Rs.2,50,000/-. As the death occurred due to accident, the Complainant is entitled for another Rs.2,50,000/- under the Policy as accidental death benefit. Hence, she made a claim with OP for the same. But, OP has rejected the said claim on the ground that insured was running unauthorized gas agency resulting in breach of law and death as a result of the same is excluded under the accidental death benefit as per the policy terms & conditions. Hence, she filed the Complaint.
3. OP1 has filed its version admitting the issue of the Policy to the husband of the Complainant bearing No. 111471978 dtd. 18.10.2008 and the death of the insured due to accident and when the claim made by the Complainant, a sum of Rs.2,50,000/- has been paid to the Complainant as per the policy terms & conditions. OP has rejected the claim of the Complainant with respect to accidental death benefit on the ground that insured had indulged in an unauthorized transfer of Liquefied Petroleum gas from one cylinder to another cylinder and was carrying on the unauthorized business of selling the LPG cylinders of lesser weight for commercial purpose. The insured was the one of the owner of the M/s. Monica Gas Agency who was supplying the domestic cooking gas. The insured along with others were refilling the domestic gas unauthorizedly without taking any sort of safety measures and the same were sold unauthorisedly. At the time of refilling the cylinders unauthorizedly the insured sustained severe burns due to accidental gas burst. Claim made by the Complainant claiming the accidental death benefit was repudiated as per the exclusions clause of the policy conditions i.e., “Death occurs as a result of the insured person committing any breach of Law”. On submission of the claim form by the complainant, the same has been honoured and paid a sum of Rs.2,50,000/- to the Complainant. Since the death of the life assured caused due to his involvement of an activity committing breach of law, Complainant is not entitled for accidental death benefit. Hence, OP prayed for dismissal of the Complaint.
4. Affidavit evidences are filed. Documents are produced. I have gone through the pleadings, documents and affidavit evidence.
5. Arguments are heard.
6. Points for consideration are as follows:
(i) Whether Complainant proves deficiency of service on the part of OP?
(ii) Whether the Complainant is entitled for the relief as sought for?
REASONS
7. It is an admitted case that the deceased Renuka Reddy had insured his life with OP for sum assured Rs.2,50,000/- and Accidental Death benefit is Rs.2,50,000/-, total benefit given is to the tune of Rs.5,00,000/-. It is also an admitted fact that the OP Company had paid Rs.2,50,000/- towards sum assured under the Policy to the Complainant who is the nominee. Death Certificate and proposal form of Renuka Reddy are produced. Complainant has written a Letter to the OP on 30.04.2009 stating that her husband Renuka Reddy had taken life insurance Policy and he died in an accident and requested the OP to give the benefits under the Policy. Medical Attendant Certificate of the deceased Renuka Reddy is also produced. It is also an admitted fact that Renuka Reddy died in LPG Gas Cylinder burst accident.
8. The only defence taken by the OP is that Renuka Reddy was running unauthorized Gas Agency resulting in breach of law and such death is excluded under the accidental death benefit as per the policy terms & conditions. OP has relied on exclusion clause (a) of the policy. Exclusion clause states that “in the following cases, the death benefit shall be paid, but the accidental death benefit shall not be paid (a) death occurs as a result of insured person committing any breach of law”. Relying on this clause, OP had denied accidental death benefit to the Complainant.
9. Now we have to see whether the OP is justified in Law to deny the accidental death benefit to the Complainant. Bare & bald defence taken by the OP does not amount to proof of the defence. The OP has not produced any documents or proof or any evidence to substantiate their defence. How can the OP say that the deceased had committed breach of Law and his wife is not entitled for accidental death benefit. Admittedly, against Renuka Reddy no case was booked by any Authority during life time for any breach of law. The Gas Agency was not at all running by the deceased Renuka Reddy. It is the case of the OP that Renuka Reddy is one of the owner of M/s. Monica Gas Agency and supplying the domestic cooking gas. But, in order to prove that Renuka Reddy was one of the owner of the Gas Agency, no document is produced by the OP. On the other hand, Complainant has produced Trade Licence Certificate issued by the BBMP, Health Department, Bangalore. As per this Certificate, the Gas Agency was in the name of K.N. Geetha Jayarama Reddy. The BBMP had issued licence to her to run Gas Agency. Therefore the question of Renuka Reddy running unauthorized Gas Agency does not arise at all. There is no question of running of Gas Agency by breach of Law. Renuka Reddy is not at all concerned with the Gas Agency ownership. As per the Complainant, her husband was working in the Gas Agency as a Helper in the said Monica Gas Agency. Therefore, the defence of the OP that deceased committed breach of Law does not arise at all. There is no question of breach of Law in this case. What is breach of Law committed by the deceased is not explained or proved by the OP. On the other hand, the Gas Agency being run under the licence issued by BBMP, Bangalore, in the name of K.N. Geetha Jayarama Reddy and in that Agency deceased Renuka Reddy was working as a Helper. Unfortunately, accident took place in the said shop and in the said accident deceased sustained burn injuries and succumbed to the injuries.
10. Under these circumstances, it is a clear case of the accidental death. OP is bound to pay the accidental death benefit to the wife of the deceased who is the nominee. OP without any just, legal & fair reasons, repudiated the claim of the Complainant. This trend on the part of OP is not proper. OP as per their commitment & obligation should have paid death benefit along with accidental death benefit to the Complainant. The OP without any lawful reasons has repudiated the genuine claim of the Complainant. This attitude on the part of OP cannot be appreciated. Complainant who is a widow of the deceased is definitely entitled to get accidental death benefit of Rs.2,50,000/- from the OP. OP has committed grave deficiency of service in not paying the accidental death benefit to the Complainant. In the result, Complaint deserves to be allowed. OP shall have to be directed to pay accidental death benefit of Rs.2,50,000/- to the Complainant. For the above reasons, I proceed to pass the following:
ORDER
Complaint is allowed. OP is directed to pay Rs.2,50,000/- towards accidental death benefit to the Complainant within 30 days from the date of this Order.
In the event, non compliance of the Order within 30 days, above amount carries interest @ 9% P.A. from the date of filing the Complaint till the date of payment. Complainant is also entitled for Rs.2,000/- as costs of the present proceedings from the OP.
Send the copy of this Order to both the parties free of cost immediately.
Pronounced in the Open Forum on this 8th June 2011.
Order accordingly
PRESIDENT
We concur the above findings
MEMBER MEMBER
