(Sri D. Shankar Rao, Member)

1.  This is a complaint filed by the complainant under section 12 of Consumer Protection Act, 1986 seeking a direction to the opposite party to pay a sum of Rs.1,00,000/- along with interest @ 18% p.a., Rs.50,000/- towards pain and suffering and Rs.25,000/- towards mental agony besides  costs of the complaint.

2. The brief facts set out in the complaint are that the husband of the complainant namely K. Bhaskar was Group Policy holder in Janatha Personal Accident Policy No.051104/47/12/61/00000122 issued by OP for a period of 5 years from 22-6-2012 to 21-6-2017, covering 50 members of electrical contractors with accidental benefit of Rs.1,00,000/- each. The husband of complainant died on 26-12-2012 in a road accident. The complainant being wife and nominee made requisition to OP with required documents for payment of her husband accidental death claim under the policy.  But the OP sent a letter dated 13-6-2013 to complainant, stating that her claim was closed on account of non-compliance of required documents and the deceased K. Bhaskar not having valid and effective driving license. The Group Policy is insured for personal accident, but holding of valid driving license is not the condition of the said policy.  Hence closing of policy claim is illegal and arbitrary.  The complainant got issued legal notice on 29-9-2013 to OP for payment of the policy claim. The OP did not choose to give any reply to the complainant. The facts are clearly established that the acts of OP are unfair trade practice and deficiency of service in closing the claim. The OP is liable to pay the claim of Rs.1,00,000/- under the policy with 18% interest along with Rs.50,000/- towards pain and suffering and Rs.25,000/- towards mental agony to the complainant besides costs of the complaint.

3. The OP filed its counter and stated that the deceased K. Bhaskar was Group Policy holder.  The claim was closed on account of non-compliance of required documents and the deceased K. Bhaskar not having valid and effective driving license at the time of accident. The OP has closed the claim under the policy.  The OP has acted as per the terms and conditions of the policy and repudiated the claim of complainant through a letter dated 13-6-2013.  The OP has denied all other allegations. Therefore the claim of the complainant is liable to be dismissed with costs.  

4. During enquiry, the complainant filed her affidavit as evidence and got marked Exs.A-1 to A-6 documents and closed her evidence. The OP filed the affidavit of one M.P. Vinil Kumar, Assistant Manager of Company at Kurnool Branch as evidence and closed its evidence.

5.  Heard arguments.

6.  The points for consideration are:-  

     (i) Whether there is any deficiency of service on the part of OP in  

          repudiation of claim?

     (ii)  To what relief?

7. Point Nos.1 and 2:- There is no dispute that the husband of the complainant namely K. Bhaskar was Group Policy holder in Janatha Personal Accident Policy No.051104/47/12/61/00000122 issued by OP in Ex.A-1. The complainant is a nominee to the Group Policy holder K. Bhaskar also not in dispute. The accidental death benefit is Rs.1,00,000/- for each policy holder under the Group policy also not in dispute.  It is also not disputed that the Group Policy holder K. Bhaskar died on 26-12-2012 in a road accident and the Group Policy in Ex.A-1 is subsisting as on the date of accident.  

8.  The fact in issue is that the deceased K. Bhaskar not having valid and effective driving license at the time of accident. Therefore the OP has repudiated the claim of the complainant through a letter dated 13-6-2013 in Ex.A-2.

9.  The version of the complainant is that the Insurance of Group Policy is meant only for personal accident, as such holding of driving license is not required. Therefore the repudiation of claim under Group Policy is illegal and arbitrary.      

10.  In order to prove the case, the complainant filed her own affidavit as evidence and she relied upon Exs.A-1 to A-6 documents supporting her case.

11.  The OP filed the affidavit of M.P. Vinil Kumar, Assistant Manager of their company at Kurnool branch as its evidence supporting their case.

12. The learned counsel for the complainant filed written arguments, reiterating that the holding of driving license is not required in a Group Personal Accident Policy.  The OP did not file the terms and conditions of the Group Policy showing that there is a such condition with regard to the driving license of the Group Policy holder. 

13.  We have also heard the oral arguments of learned counsel for the parties and gone through the entire case record and also perused the exhibits in Exs.A-1 to A-6 documents. Ex.A-1 is showing Group Janatha Personal Accident Policy Schedule with the names of 50 members including the name of deceased K. Bhaskar in Sr.No.1. Ex.A-2 is a letter dated 13-6-2013 issued by OP showing the repudiation of claim.  Ex.A-4 is a legal notice issued to OP. Ex.A-3 is a postal receipt of Ex.A-4 legal notice. Ex.A-5 is the postal acknowledgement of Ex.A-4 legal notice.  Ex.A-6 is a letter addressed to OP regarding the accident of her husband K. Bhaskar.   

14. Admittedly the Group Policy holder K. Bhaskar was died on  26-12-2012 in a road accident.  Ex.A-6 is disclosing that the accident was happened on 25-12-2012 due to the tyre of Travera was burst while it was going from Hyderabad to Gadwal when the deceased K. Bhaskar was returning from Yerravalli to Gadwal. Thereafter the deceased K. Bhaskar was taken to Gadwal area hospital and then to Kurnool area hospital and then also to Hyderabad. The deceased K. Bhaskar was succumbed with injuries at 3:30 p.m. on 26-12-2012 while he was taking treatment at Osmania Hospital in Hyderabad. Ex.A-6 is addressed to OP on 22-3-2013.  There is no acknowledgement from the OP to show that the Ex.A-6 was served.  The contents of Ex.A-6 are not showing in the complaint as well as in the legal notice in Ex.A-4 except contended that the deceased Group policy holder K. Bhaskar was died on 26-12-2012 in a road accident. However, the death of Group policy holder K. Bhaskar in a road accident on 26-12-2012 was not denied by OP, but they pleaded that the said deceased Group policy holder K. Bhaskar was not having valid and effective driving license at the time of accident. Further the learned counsel for OP vehemently argued that the deceased K. Bhaskar should have possessed the valid and effective driving license as per Sec.3 of M.V. Act while he was driving the vehicle caused for the accident as per terms and conditions of the Group policy.  Ex.A-1 is not appended its terms and conditions.  The OP has not filed the Group policy terms and conditions to the case record supporting its plea that the deceased Group policy holder should have possessed the valid and effective driving license. The fate of entire case swirls around the possessing of valid and effective driving license.  The OP has repudiated the claim on two counts.  One is, that the complainant has not submitted required documents inspite of letters/reminders have been sent to her and another one is, that the deceased Group policy holder K. Bhaskar not having valid and effective driving license at the time of accident. Therefore the onus to prove the same shifted to OP. Except self explanatory affidavit filed as evidence, which is nothing but replica from the counter, the OP has not adduced any piece of evidence supporting its plea that the deceased Group policy holder should have possessed valid and effective driving license at the time of accident. The OP has also not placed any record when and what purpose the letters/reminders have been issued to the complainant. It is pertinent to note here that how the OP had come to conclusion that the deceased K. Bhaskar not having valid and effective driving license without verification of required documents. Hence the repudiation of claim on two grounds in Ex.A-2 are contradictory with each other. Therefore in the absence of such required evidence of terms and conditions of the Group policy, we are not inclined to accept the version of the OP in repudiating the claim of complainant on two grounds showing in Ex.A-2. 

15.  Further the evidence in Ex.A-6 is not rebutted by OP through any rebutting evidence. Hence we are of the opinion that the deceased Group policy holder K. Bhaskar was died in a road accident on 26-12-2012 due to Travera tyre was burst, caused for the accident.  

16. Viewing in any angle, we are of the considered view that the repudiation of claim in Ex.A-2 under Group policy is not correct and proper.  There is deficiency of service on the part of OP in repudiating the claim of complainant in Ex.A-2 under the Group policy.  Therefore the OP is liable to pay the accidental death claim of Rs.1,00,000/- with 9% p.a. interest from the date of repudiation i.e., on 13-6-2013 till realization to the complainant with costs of Rs.1,000/-.

17.  The complainant has not adduced any piece of evidence that she is entitled any sum compensation under the heads of pain and sufferings and mental agony.

18.  IN THE RESULT:-  The complaint is allowed in part as under:-

    1) The OP is directed to pay Rs.1,00,000/- towards accidental death claim under Ex.A-1 Group policy with 9% interest p.a. from the date of repudiation on 13-6-2013 till realization to the complainant.

   2)  The OP is also directed to pay Rs.1,000/- to the complainant towards costs of the complaint.