O R D E R
(By Sri D.Shankar Rao, Member)
1. The brief facts set-out in the Complaint are that the husband of complainant Enugupatla Vittal was obtained Group Personal accident Insurance Policies Nos 050700/47/22/61/00000187 under JPA (Janata Personal Accidnet) and 0500700/47/11/43/00000186 under KCC (Kisan Credit Card) from opposite party No.2 by virtue of his KCC account in the Society of opposite party No.1. The sum assured is 1,00,000/- each of the Policies. The policy holder Enugupatla died on 24-05-2011 in a road accident. The complainant being wife & Nominee has claimed the policies sum assured with the opposite parties. The opposite party No.2 has repudiated the claim on 05-11-2012 on a ground that the policy holder was physically handicapped prior to taking policies and the said material fact was not disclosed as such the claim is not admissible. The opposite parties 1 & 2 have failed to react positively which amounts to deficiency of service.
2. The Opposite party No.1 Society remained exparte throughout the proceedings.
3. The Opposite party No.2 filed its counter briefly stated that they have issued a Group KCC Scheme policy and Janata personal Accident Policy Nos 050700/47/11/43/00000186 and 050700/47/11/61/00000187 valid from 01-05-2011 to 30-04-2012 covering to KCC holders of opposite party No.1 society. The sum Insured under the policy is Rs.1,00,000/- (Rs.50,000/- under KCC Scheme plus Rs.50,000/- under JPA Scheme but not Rs.1,00,000/- each scheme as pleaded by complainant). In this case Insured Person Enugupatla Vittal was driving a Motor Cycle No.AP-25-R-0473 with his brother –in-law Kummari Sailoo as Pillion rider from Birkur to Bodhan to attend Handicapped meeting and after while they were returning to their Village and that on the way, driver of RTC Bus No. AP-11Z-2209 drove it rash & Negligent manner and gave dash to Motor Cycle as a result of which the Insured died. The deceased Insured person was orthopedically handicapped having 70% disability as such he was unfit person to drive any kind of vehicle. This fact was suppressed while obtaining the policy and payment of sum insured is excluded as per terms & Conditions of the policy. Therefore the opposite party No.2 has repudiated the claim which is legally valid & correct. The deceased insured Person did not hold a driving license and had no knowledge of driving any vehicle. Hence he died due to willful voluntary and authorized acts, as such the opposite party is not liable for payment of sum Insured and any compensation under the policy.
4. During enquiry the complainant filed her evidence affidavit as pw1 and got marked exhibits A1 to A6 documents and closed her evidence.
The opposite party No.2 filed the evidence affidavit of their Assistant T.Rajendra Sharma as Rw1 and got marked exhibits B1 to B15 documents and closed their evidence.
5. Heard Arguments.
6. The Points for Consideration are:-
1) Whether there is any deficiency of service on the part of opposite parties 1 & 2 in repudiation of claim under the policy?
2) To what Relief?
7. Point No. 1 & 2: There is no dispute that the opposite party No.2 has issued a Group Personal accident Insurance Policy Under KCC Scheme bearing Policy No. 050700/47/11/43/00000186 and JPA Scheme bearing Policy No. 050700/47/11/61/00000187 both valid from 01-05-2011 to 30-04-2012 covering to KCC holders of opposite party No.1 society. It is also not disputed that the deceased Enugupatla Vittal was an account holder of KCC Scheme with the opposite party No.1 society. The complainant is the Nominee of the Policy also not in dispute. The Policy holder Enugupatla Vittal was died in a road accident on 24-05-2011 also not in dispute.
The dispute is that the policy holder Enugupatla Vittal has suppressed the Material information regarding his deformity of his Right Lower limb while taking the Group policy.
Further disputed that the policy holder Enugupatla Vittal beaing orthopedically handicapped with 70% disability was unfit person to drive any kind of vehicle and he did not hold a driving license.
In order to prove the case the complainant filed her own evidence affidavit as pw1 and she relied upon exhibits A1 to A6 documents. On the other hand the opposite party No.2 also filed the evidence affidavit of their Assistant T.Rajendra Sharma as Rw1 evidence and they also relied upon exhibits B1 to B15 documents Supporting to their contention.
In this case, the Plea taken by opposite party No.2 that the Policy holder Enugupatla vittal had suppressed his deformity while taking policy and payment of sum Insured is excluded as per the terms & Conditions of the policy. Therefore the onus against opposite party No.2 to prove the same.
Ex.A1(B3) is the claim repudiation letter issued by opposite party No.2. Ex.A2 is the intimation of repudiation letter dated 20-11-2012 issued by opposite party No.1 society. Ex.A3(B12) is the FIR No.105/2011 issued on 24-05-2011 by Varni Police. Ex.A4(B14) is the Inquest report dated 24-05-2011. Ex.A5(B15) is the Postmortem examination report dated 24-05-2011. Ex.A6(B13) is the Charge sheet dated 29-11-2011 filed by Varni Police.
Ex.B1 is the KCC/JPA Scheme Policy terms & Conditions in general Ex.B2 is the KCC Scheme master Policy Scope & Cover in general. Ex.B4 is the claim intimation letter dated 18-06-2011 issued by opposite party No.1 Society. Ex.B5 is the letter dated 11-07-2011 showing that the deceased policy holder Enugupatla Vittal was an account holder of KCC member in opposite party No.1 society. Ex.B6 is the claim form submitted by complainant through opposite party No.1 Society. Ex.B7 is the medical certificate of physically handicapped Pertaining to deceased policy holder Enugupatla Vittal showing 70% deformity. Ex.B8 is the Medical Certificate of Physically handicapped pertaining to the deceased Enugpatla Vittal. Ex.B9 is the Death Certificate dated 30-05-2011 issued by Gram Panchayat Birkur. Ex.B10 is the Dependent Certificate issued by Tahsildar Birkur. Ex.B11 is the House hold Card.
We have heard the arguments of counsel for the parties and perused the exhibits on both sides and also verified the entire record. The opposite party No.2 has not adduced the proposed form of the Group policy of deceased policy holder Enugupatla Vittal to show that he had suppressed his deformity of physically handicapped. No doubt the exhibits A3(B12), Ex.A4(B14), Ex.A5(B15), Ex.A6(B13), Ex.B7 & Ex.B8 are showing that the deceased policy holder Enugupatla Vittal was a physically handicapped Person. But no evidence is shown that he had suppressed the information regarding his deformity at the time of taking policy. Hence we are not inclined to accept the version of opposite party no.2 that the deceased policy holder had suppressed the information in respect of his deformity while taking policy.
Ex.B1 and Ex.B2 are not at all reflecting that the physically handicapped persons are not eligible for taking Group Personal Accident Insurance Policy under KCC/JPA Schemes. Further the Ex.B2 is reflecting that the Policy will cover the KCC holders upto the age of 70 years and whose names are declared by banks and in respect of whom the premium is paid by the banks to the Insurance Company. Hence we are of the view that the deceased policy holder Enugupatla Vittal who being a KCC account holder with the opposite party No.1 Society as confirmed in Ex.B4, B5 & B6 would not get disentitlement disqualified from the membership of Group Personal accident Insurance Policy under KCC/JPA Schemes on a ground of disclosed deformity in view of scope & Coverage of KCC Scheme matter policy in Ex.B2.
It is seen from the contents of Ex.A3(B12), & Ex.A6(B13) that the accident occurred due to rash and negligent of the driver who drove the RTC bus bearing No.AP-11Z-2209 as a result of which the policy holder died on the spot. Hence we are of the opinion that the policy holder died on 24-05-2011 in a road accident due to rash and negligent of RTC driver. Therefore we are not inclined to accept the version of opposite party No.2 that the policy holder died due to his willful, voluntary and unauthorized acts and he did not hold the driving license and had no knowledge of driving any vehicle.
The opposite party No.1 is the Society and facilitator of the Group Personal accident Insurance Policy under KCC/JPA Schemes for their KCC account holders. The job of opposite party No.1 Society is only facilitator. Hence the opposite party No.1 Society is not liable to pay sum Insured under Group Policy.
In view of aforesaid discussions and findings, we are of considered view that the Complainant being wife and Nominee of the deceased policy holder Enugupatla Vittal is entitled for sum Insured under Group Personal accident insurance policy under KCC/JPA Schemes and the opposite party No.2 is liable to pay the same.
There is total sum Insured Rs.1,00,000/-(Rs.50,000/- under KCC Scheme plus Rs.50,000/- under JPA Scheme) to each member of Group Personal accident Insurance Policy bearing KCC No.050700/47/11/43/00000186 and JPA No.050700/47/11/61/00000187 valid from 01-05-2011 to 30-04-2012 issued by opposite party No.2.
Therefore, we are of the considered view that the complainant is entitled sum Insured Rs.1,00,000/- under Group Personal accident Insurance Policy for KCC/JPA Schemes with interest and costs of the complaint.
The complainant is not entitled for any Compensation as she failed produced evidence how she is entitled.
8. IN THE RESULT the complaint is allowed in part as under:-
1) The opposite party No.2 is directed to Pay sum Insured 1,00,000/- under KCC & JPA Schemes of Group Personal accident Insurance Policy pertaining to deceased Enugupatla Vittal with 9% interest P.A from the date of claim repudiation in Ex.B3 dated 26-10-2012 till realization to the Complainant.
2) The opposite party No.2 further directed to Pay Rs.2000/- to the Complainant towards costs of the Complaint.
3) The Complaint is dismissed against opposite party No.1 without costs.
Typed to dictation, corrected and pronounced by the Member in Open Forum on this the 27th day of November 2014.
