APPEAL NO: 254/2009


1. United India Insurance Co.Ltd.

through its Chairman/Managing Director

Regd.office 24, White's Road,Chennai

2. Br.Manager, United India Insurance Co.Ltd.

Br.office Palechha Mansion,Opp.Municipal

Council Stadium, Sanganer, Jaipur.

3. Br.Manager, United India Insurance Co.Ltd.

Br.office Fort Road, Nagaur (Raj.)

Through


Regional Manager, United India Insurance Co.Ltd.

Regional office, Sahara Chambers,Tonk Road,Jaipur.


Opposite parties-appellants


Vs.


1. Smt.Radha Devi Alias Sunita Devi

r/oSandas, Teh. Ladnu, Distt. Nagaur.

Complainant-respondent

2. Swapan Sakar Insurance Consultant

& Marketing Services Pvt.Ltd.,

C/o Chairman/Chief Managing Director

Head office- C-26,First and Third floor,

New Vidhan Sabha Road, Lalkothi, Jaipur.

Opposite party no.1-respondent


Date of judgment 27.7.09


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Before:


Mr.Justice Sunil Kumar Garg-President

Mrs.Vimla Sethia-Member


Mr.Ram Kalyan Sharma counsel for the appellants

Mr.Dinesh Heda counsel for respondent no.1

None present for respondent no.2


BY THE STATE COMMISSION


This appeal has been filed by the appellants which were opposite party no. 2 to 4 before the District Forum against order dated 15.11.08 passed by the District Forum, Nagaur in complaint no. 152/07 by which the complaint of complainant respondent no.1 was allowed against the appellants in the manner that the appellants were directed to pay a sum of Rs. 1 lac the amount of the accidental policy alongwith interest @ 10% p.a. w.e.f. 28.3.07, the date on which the claim was repudiated and further to pay a sum of Rs. 3000/- as costs of litigation.


2. It arises in the following circumstances-


That the complainant respondent no.1 had filed a complaint against the appellants as well as respondent no.2 before the District Forum,Nagaur on 15.9.07 inter alia stating that her husband Shyamdas Swami, now deceased had taken a Rural Accident Package Policy

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from the appellants through respondent no.2 bearing no.141301/47/06/99/00000040 for a sum of Rs. 1 lac and the policy was for the period 8.8.2006 to 7.8.2010 and as per terms and conditions of the policy if the insured dies in an accident his relatives would be entitled to a sum of Rs. 1 lac. It was further stated in the complaint that on 22.11.06 the deceased had died in an accident at Mahendragarh Distt. Koria ( Chhatisgarh) and thereafter claim was preferred by the complainant respondent no.1 being the wife and nominee of the deceased before the office of the appellants but that claim was repudiated by the appellants through letter dated 28.3.07 in the following manner-


" Sh. Shyam Das Swami not having driving licence and Ins. of vehicle at the time of accident , so claim is repudiate.

We absolve ourselves from any further liabilities, arising out of this claim, which please note."


Thereafter the present complaint was filed by the complainant.


A reply was filed by the appellants before the District Forum, Nagaur on 25.11.08 and in the reply they have taken the same pleas which were taken by them in the repudiation letter dated 28.3.07. It was further stated in the reply that as per terms and

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conditions of the policy which were printed on the back of the policy, in sub-clause 6 of condition no.2 it was mentioned that no amount was payable if the deceased had committed any breach of law with criminal intent and therefore, in the present case the appellants were entitled to the benefit of exclusion clause and it was prayed that complaint be dismissed.


After hearing the parties, the District Forum, Nagaur through impugned order dated 15.11.08 had allowed the complaint of the complainant respondent no.1 inter alia holding that in the policy it was not mentioned that at the time of accident if the deceased was not having any valid licence or if at the time of accident the vehicle was not insured, the claim was not payable and therefore that would not be a sufficient ground for repudiation of claim of the complainant respondent no.1 and thus sub-clause 6 of condition no.2 would not come to help to the appellants in the present case and the appellants were not justified in repudiating the claim of the complainant respondent no.1 and it had amounted to deficiency in service on the part of the appellants.


Aggrieved from the said order dated 25.11.08 passed by the District Forum, Nagaur this appeal has been filed by the appellants.


3. In this appeal the main contention of the learned counsel

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for the appellants is that since at the time of accident the deceased was not having a valid driving licence , therefore, claim was not payable in view of the sub-clause 6 of condition no.2 of the policy and thus the claim of the complainant respondent no.1 was rightly repudiated by the appellants through letter dated 28.3.07 and the District Forum had committed serious error and illegality in decreeing the claim of the complainant respondent no.1. Hence the impugned order could not be sustained and liable to be quashed and set aside and this appeal deserves to be allowed.


4. On the other hand the learned counsel for the respondent no.1 has supported the impugned order passed by the District Forum, Nagaur.


5. We have heard the learned counsel for the appellants as well as for respondent no.1 and have gone through the entire materials available on record.


6. There is no dispute on the point that deceased had taken a Rural Accident Package Policy from the appellants through respondent no.2 bearing no.141301/47/06/99/00000040 for a sum of Rs. 1 lac and the policy was for the period 8.8.2006 to 7.8.2010.


7. There is also no dispute on the point that the deceased had died on 22.11.06 in an accident at Mahendragarh Distt. Koria ( Chhatisgarh).


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8. Thus, in the facts and circumstances just narrated above, the question for consideration is whether the findings recorded by the District Forum by which complaint was allowed could be sustained or not and whether the repudiation of the claim of the complainant respondent no.1 by the appellants was justified or not.


9. For convenience sub-clause 6 of condition no.2 is quoted here-


" Any breach of law with criminal intent."


10. It may be stated here that in the present case when the fact that the deceased had died in an accident is not in dispute, therefore, in such circumstances it could not be said that he had made any breach of law with any criminal intent and when the deceased had died in an accident and the policy was covering the risk of accident, therefore, denial of claim on the ground of that clause just quoted above was not justified at all.


11. For the reasons stated above, the appellants were not justified in repudiating the claim of the complainant respondents no.1 on the ground of driving licence and the appellants have repudiated the claim of the complainant respondent no.1 without any basis and on wrong assumption and in an arbitrary manner and in view of this, the findings of the District Forum decreeing the claim of the complainant respondent no.1 are liable to be confirmed as they are based on correct appreciation of entire materials and evidence

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available on record and they do not suffer from any basic infirmity, illegality or perversity and this appeal deserves to be dismissed on merits.


On point of interest


12. In this case the District Forum had awarded interest @ 10% p.a. on the decreetal amount w.e.f. 28.3.07, the date on which the claim was repudiated by the appellants.


13. In our considered opinion, the rate of interest awarded by the District Forum appears to be on higher side and looking to the entire facts and circumstances of the case, we deem it proper to award interest at the rate of 9% p.a. instead of 10% p.a. and that too from the date of filing of the complaint i.e. 15.9.07 and to that extent, the impugned order of the District Forum is liable to be modified.


Accordingly, this appeal filed by the appellants on merits is dismissed. However, the complainant respondent no.1 would get interest on the decreetal amount at the rate of 9% p.a. instead of 10% p.a. from the date of filing of the complaint i.e. 15.9.07 and to the above extent on point of interest , the impugned order of the District Forum, Nagaur dated 25.11.08 stands modified accordingly.



Member President