C.C.NO.77/2008
Between:
1. Smt. Kuntimall Kalavathi,
Late K.Ramesh,
2. Kuntimalla Prasanna Kumar,
S/o Late K.Ramesh,
3. Kuntimalla Gowthami Priya,
D/o Late K.Remesh,
2 & 3 Minors being rep. by Guardian,
& Next Friend 1st complainant K.Kalavathi,
4. Kuntimalla Venkata Swamy,
S/o K.Rama Swamy,
5. Smt.Kuntimalla Varalakshmamma,
W/o K.Venkata Swamy,
All are residing at D.No,.4/878,
Siva Nagar, Dharmavaram,
Anantapur District. … … Complainants.
Vs
The Divisiona Manager
United India Insurance Company Limited,
Subash Road,
Anantapur. … Opposite party.
This case coming on this day for final hearing before us in the presence of Sri P.Venkata Narayana, Advocate for the complainant and Sri A.G.Neelakanta Reddy, Advocate for the opposite party and after perusing the material papers on record and after hearing the arguments of both sides, the Forum delivered the following:
O R D E R
Sri C.Thyagaraja Naidu, President: - This complaint has been filed by the complainants under section 12 of the Consumer Protection Act, 1986 against the opposite party claiming compensation of Rs.2,30,000/- for the death of the deceased K.Ramesh in the Motor Accident under personal accident coverage policy.
2. The brief facts of the complaint are that: - The 1st complainant is wife, the complainants 2 & 3 are children and the complainants 4 & 5 are parents of the deceased K.Ramesh (herein after referred to as the deceased), who died in the Motor accident. The deceased had insured his Motor Cycle bearing No.AP-02-4691 with the opposite party under policy bearing No.051001/31/05/01045 which covers personal accident to the owner and driver of the Motor Cycle and it was valid from 25.10.2005 to 24.10.2006. The deceased died on 24.02.2006 at about 10.30 P.M. while going on the Motor Cycle from Anantapur to Dharmavaram met with an accident and died on the spot near Yerraipalli Village Anantapur Bathalapalli Road. A case has been registered in Crime No.21/06 of Bathalapalli P.S. under section 304-A I.P.C. After the death the complainants have made oral requests for settlement of the claim with the opposite party under the cover of personal accident clause. But the opposite party has not settled the same. The complainants are the legal heirs of the deceased and as per the terms and conditions of the policy the complainants are entitled for Rs.2,00,000/- under personal accident clause for the death of the deceased Since the opposite party did not settle the claim of the complainants. Hence, the complainants got issued legal notice to the opposite party on 02.05.2008 and the same was served on them on 05.05.2008. But the opposite party did not give any reply to the complainants and did not settle the claim of the complainants. Thus there is deficiency in service on the part of the opposite party. Hence, the complainants have filed this complaint against the opposite party claiming insurance amount of Rs.2,00,000/-, for causing mental agony Rs.25,000/- and towards costs of the complaint Rs.5,000/- and prayed to direct the opposite party to pay the said amount to the complainants.
3. The opposite party filed counter and contended that the complaint is barred by limitation. The accident took place only due to the rash and negligent driving of Motor Cycle A.P.02.4691 by the deceased himself. If it is proved that the complainants are entitled to compensation under the Insurance policy for personal accident, the liability of the opposite party is limited to Rs.1,00,000/- only as peer the terms and conditions of the policy. The driver of the Motor Cycle did not possess valid driving license at the time of accident as such, this opposite party is not liable to pay any compensation to the complainants. The opposite party has denied the other averments mentioned in the complaint and contended that the complaint filed by the complainants is available to be dismissed with costs.
4. Basing on the above pleadings the following points that arise for consideration are:-
1. Whether the repudiation by the opposite party in respect of the insurance claim of the complainants for the death of the deceased in the Motor Cycle Accident amounts to deficiency in service or justified?
2. To what relief?
5. In order to prove the case of the complainants, the 1st complainant filed her evidence on affidavit and Exs.A1 to A8 were marked basing on the evidence on affidavit of the 1st complainant. On behalf of the opposite party, the opposite party filed his evidence on affidavit. No documents were marked on behalf of the opposite party.
6. Heard both sides.
7. POINT NO.1:- The evidence on affidavit of the 1st complainant goes to prove the fact that her husband, the deceased died on 24.02.2006 at 10.30. P.M. near Yerraipalli Village Anantapur while going on his Motor Cycle bearing No. A.P.02.4691 from Anantapur to Dharmavram. Her husband was the owner of the said Motor Cycle and he had insured the same with the opposite party. The opposite party had issued Insurance Policy bearing No.051001/31/05/01045 and same was valid from 25.10.2005 to 24.10.2006. The opposite party had also collected the premium of Rs.771/- including Rs.50/- towards compulsory personal accident to the owner and driver of the Motor Cycle. After the death of the deceased the case was registered as crime No.21/2006 by Bathalapalli P.S. under section 304-A I.P.C. The complainants are the legal heirs of the deceased and they requested the opposite party to pay the insurance amount of Rs.1,00,000/- under personal accident clause for the death of the deceased and also got issued legal notice to the opposite party on 02.05.2008 and the same was served on them on 05.05.2008. But the opposite party did not give any reply. Hence, they filed this complaint claiming compensation from the opposite party as the opposite party repudiated the claim without any basis, which amounts to deficiency in service of the opposite party.
8. On perusal of Ex.A1 certified copy of F.I.R. in crime No.21/2006 of Bathalapalli P.S. it goes to prove the fact that on the complaint given by the 4th complainant K.Venkata Swamy a case has been registered under section 304-A I.P.C. for the death of the deceased in the Motor Cycle Accident. Ex.A2 certified copy of the inquest report in respect of the inquest conducted over the dead body of the deceased and Ex.A3 certified copy of the P.M. report relating to the deceased goes to prove the fact that the deceased died in the Motor Cycle Accident. Ex.A4 is the certified copy final report submitted by the S.I.Police Bathalapalli P.S. wherein it is stated that even after sincere and sustained efforts the identity of the accused and crime vehicle could not be traced and no foul play was suspected in the death of the deceased. The case was treated and un-detectable. Thus the evidence on affidavit of the 1st complainant and Exs.A1 to A4 clearly goes to prove the fact that the deceased died in to Motor Cycle Accident on 24.02.2006 at 10.30 P.M. near Yerraipalli Village, Anantapur.
9. As seen from Ex.A7 Xerox copy of the insurance policy issued by the opposite party in favour of the deceased, it goes to prove the fact that United India Insurance Company Limited i.e., opposite party has issued insurance policy in the name of the deceased which is valid from 25.10.2005 to 24.10.2006. The said policy also covers the personal accident to the owner cum driver for Rs.1,00,000/- for which the opposite party has collected Rs.50/- and in all Rs.771/- was collected towards the insurance premium for the above said period by the opposite party from the deceased..
10. As seen from Ex.A5, it is goes to prove the fact that the complainants got issued legal notice through an advocate to the opposite party on 02.05.2008 stating that the deceased died in the Motor Cycle Accident on 24.02.2006 at 10.30 P.M. near Yerraipalli Village. Anantapur and requested the opposite party to pay a sum of Rs.1,00,000/- under the personal accident benefit covered under the insurance policy which was obtained by the deceased from the opposite party. Ex.A6 is the postal acknowledgment of the opposite party in respect of receiving the notice under Ex.A5 from the complainants. The opposite party inspite receiving the said notice neither settled the amount nor gave any reply to the complainants. Therefore, considering the said facts it can be presumed the opposite party has repudiated the claim of the complainants with out any valid reasons.
11. The contention of the counsel for the opposite party is that the complainants ought to have filed this complaint before this tribunal with in two years from the date of the accident i.e., from on 24.02.2006. But this complaint has been filed on 09.07.2008 i.e., with the delay of 136 days. Therefore the complaint filed by the complain filed by the complainants is barred by limitation as per section 24 (A) of the Consumer Protection Act, 1986. The said contention hold no good because alongwith the complaint the complainants have filed I.A.159/09 to condone the delay of 136 days in filing the complaint and the said petition was allowed by this tribunal on 05.08.2008. Therefore, the complaint filed by the complainants is not barred by limitation.
12. The next contention of the counsel for the opposite party is that the complainants are not the consumers. Therefore, the complaint filed by the complainants is not maintainable. The said contention holds no good because the 1st complainant is the wife, the complainants 2 & 3 are the children and complainants 4 & 5 are parents of the deceased. Ex.A7 copy of the Insurance Policy issued by the opposite party in favour of the deceased also covers for personal accident. When the deceased died in the Motor Cycle Accident he cannot be expected to file the complaint as a Consumer. His legal heirs alone are the entitled for the benefit under the said insurance policy and they have to be treated as Consumers. Therefore, the complainants being the legal heirs of the deceased are entitled to file this complaint as consumers.
13. The next contention of the counsel for the opposite party is that the deceased had no valid driving license at the time of the accident when he was driving the Motor Cycle. Therefore, the complainants are not entitled for the amount claimed in the complaint. The said contention also holds no good because the complainants have filed Ex.A8 Xerox copy of the driving license of the deceased issued by R.T.A. Anantapur. As seen from Ex.A8 it goes to prone the fact that the R.T.A. Anantapur issued licence to the deceased on 28.10.200, which is valid up to 30.06.2021. The said license covers for LMV and MCWG.
14. The next contention of the counsel for the opposite party is that the complainants have only informed about the death of deceased by notice dt.02.05.2008, which was served on them 05.05.2008. Thus there was a delay in giving the information to the opposite party with regard to the death of the deceased. Therefore, on that ground the complainants are not entitled for the amount claimed in the complaint. In support of the said contention he placed reliance in the reported decisions.
1. IV (2008) CPJ 276 Majarashtra State Consumer Disputes Redressal Commission, Mumbai. New India Assurance Company Limited Vs. Chandrakant Motichand Kandle. Wherein it was held that:- “Consumer Protection Act,1986 section 15-Insurance- Terms and conditions violated – Janata Personal Accident Policy- Claim to be preferred within one month from happening of event – Complainant sustained injuries on 17.07.2000- Sent intimation to insurer on 08.11.2002- Delay of more than 2 years in giving first information to Insurance Company – Direct breach of Policy condition very much fatal –No just and sufficient cause shown for inordinate delay in intimating insurer – Delay not to be condoned – No relief entitled’. (para.11).
2. II (2008) CPJ 168 (NC) National Consumer Disputes Redressal Commission, New Delhi. Sasanka Mohapatra Vs. New India Assurance Company Limited. Wherein it was held that:- “Consumer Protection Act, 1986 –Section 21(b) – Insurance –Janata Personal Accident Policy- Insured met with accident, suffered disability- Claim inordinately delayed – Repudiated by Insurance Company- Complaint allowed by Forum – Hence appeal – State Commission held, direction regarding payment of compensation after holding that Insurance Company not guilty of deficiency in service, not legal – Order of Forum set aside – No interference required in revision”. (paras 4 & 5).
15. On perusal of the above decisions the above decisions do not apply to the facts of this case because in the above decisions the complainants sustained injuries and there was abnormal delay in informing the insurer with regard to the accidents and their claim. Where as in this case it is death of the deceased and immediately after the death of the deceased 4th complaint has been given report to the police and the same was registered as crime and there after P.M. examination was conducted and Doctor who conducted P.M. has issued P.M. certificate. Merely because there is a delay in informing about the death of the deceased to the opposite party it can not be said that the opposite party has been prejudiced in any way. Therefore, considering the said facts the said contention of the Counsel for the opposite party cannot be accepted.
16. The next contention of the counsel for the opposite party is that in this complaint the issues which involve disputed factual questions should not be adjudicated and interpretation of the policy. Therefore, it should be adjudicated only by civil Court and not by this Forum. In support of his contention he placed reliance in the reported decisions.
1. 2006 (7) SCJ 225 between Oriental Insurance Company Limited Vs. Munimahesh Patel. Where in it was held that: - “Proceedings before the Commission are essentially summary in nature and adjudication of issues which involve disputed factual questions should not be adjudicated’.
2. 1999 CCJ 949 (SC) Saushish Diamonds Limited Vs. National Insurance Company Limited. Where in it was held that: - Consumer Protection Act, 1986 section 2 (1) (c) - Complaint Maintainability of –National Commission relegated complainant to civil action – Contention that in view of the policy undertaken by the insurance company relief should have been granted Interpretation of the Policy itself is a subject-matter of dispute – Whether National Commission has rightly rerlegated the parties to civil action – Held: yes.
3. IV (2008 CPJ 128 (NC) National Consumer Disputes Redressal Commission, New Delhi: - Durga Enterprises Vs. Oriental Insurance Company Limited. Where in it was held that:- “Jurisdiction – Summary- Insurance - Verification of claims – Disputed factual questions not adjudicable by Consumer For - Appellant if wants to support his claim by leading further evidence, to settle disputed questions, any For a other than Consumer For a can be approached – Time spent before Consumer For a to be excluded for computation of limitation.
17. On perusal of the above decisions the above decisions do not apply to the facts of this case because in this case the issue involved is where the complainants are entitled in respect of personal accident benifit of the deceased covered under the policy issued by the opposite party. Repudiation of the same by the opposite party amounts to deficiency in service or justified is the issue which has to be decided basing on the documentary evidence placed by both parties and no issues are involved with regard to the disputed factual questions and also interpretation of the policy itself to be decided by this forum. Therefore, the said contention of the contention of the Counsel for the opposite party cannot be accepted.
18. On considering entire evidence on affidavit of the 1st complainant, Exs.A1 to A8 and the entire facts and circumstances of the case,it clearly proves the fact that the deceased died in the Motor Cycle Accident on 24.02.2006 at 10.30 P.M. near Yerraipalli Village, Anantapur.. Therefore, the opposite party is liable to pay Rs.1,00,000/- with interest @ 9% p.a. from the date of the complaint till the date of realization to the complainants under personal accident policy of the deceased since the opposite party in spite of receiving the notice under the original of Ex.A5 did not pay the amount covered under original of Ex.A7 policy, which amounts to deficiency in service of the opposite party. Since the complainants are grated interest @ 9% p.a. from the date of the complaint till the date of realization on the said amounts of Rs. 1,00,000/-. Hence, the complainants are not entitled for the amount claimed under heading mental agony of Rs.25,000/-. Accordingly this point is answered.
19. POINT NO.2. In the result the complaint is allowed. The opposite party is to direct to pay a sum of Rs.1,00,000/- with interest @ 9% p.a. from the date of the complaint till the date of realization to the complainants within one month of the date of this order. Out of the said amount the complainants are entitled for equal share. The opposite party is also liable to pay cost of Rs.2,000/- to the complainants.


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