State Consumer Disputes Redressal Commission
United India Insurance Company vs Smt. Pasumarthi Rama Devi on 29 August, 2012
BEFORE THE A BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. FA 686 of 2011 against C.C. 203/2010, Dist. Forum-I, Visakapatnam Between: The Branch Manager United India Insurance Company Gajuwaka, Visakapatnam. *** Appellant/ . O.P. And 1) Smt. Pasumarthi Rama Devi W/o. Late P. Eswara Rao 2) Pasumarthi Nagendra Pratap S/o. Late P. Eswara Rao 3) Pasumarthi Sravani D/o. Late P. Eswara Rao All are R/o. Gavarapalem Anakapalle, Visakapatnam *** Respondents/ Complainants Counsel for the Appellant: M/s. N. Mohana Krishna Counsel for the Respondents: M/s. M. Hari Babu CORAM: HONBLE SRI JUSTICE D.APPA RAO, PRESIDENT SMT. M. SHREESHA, MEMBER & SRI S. BHUJANGA RAO, MEMBER WEDNESDAY, TWENTY NINETH DAY OF AUGUST TWO THOUSAND TWELVE ORAL ORDER:
(Per Honble Sri Justice D.Appa Rao, President ) ***
1) This is an appeal preferred by the opposite party insurance company against the order of the Dist. Forum directing it to pay Rs. 1 lakh covered under the policy with interest @ 9% p.a., from the date of order till the date of realization.
2) The case of the complainant in brief is that late P. Eswara Rao, husband of the first complainant and father of second and third complainants during his life time insured his Hero Honda motor cycle with the appellant insurance company for a sum of Rs. 1 lakh covering the period from 15.3.2008 to 14.3.2009. While so, on 9.5.2008 when he was proceeding to Gajuwaka he met with an accident when a scooterist coming in opposite direction dashed against him. He suffered head injury and was shifted to KGH hospital, Visakapatnam, and while undergoing treatment he died. Later she sent a letter to the insurance company along with documents, however, they did not respond. Therefore, they filed the complaint claiming a sum of Rs. 1 lakh covered under the policy together with compensation of Rs. 50,000/- and costs of Rs. 10,000/-.
3) The appellant insurance company resisted the case. The complainants are not entitled to the benefits covered under the policy as they had violated Section-III condition No. 1 of the policy. The claim had to be made immediately to the insurance company in writing.
The deceased owner-cum-driver was not holding valid driving license at the time of accident. No compensation would be payable when the death or injury caused in an accident while he was under the influence of intoxicating liquor or drugs. It alleged that the complainants never approached them nor made any claim nor received any legal notice. No documents were filed in order to scrutinize the claim. Therefore it prayed for dismissal of the complaint with costs.
4) The complainants in proof of their case filed the affidavit evidence of first complainant and got Ex. A1 to A8 marked while the insurance company did not let in any evidence.
5) The Dist. Forum after considering the evidence placed on record opined that the complainants were not entitled to compensation since the claim was belatedly made and opined that there was no deficiency in service on the part of insurance company disallowed compensation and costs, however directed the insurance company to pay Rs. 1 lakh covered under the policy with interest @ 9% p.a., from the date of order till the date of realization.
6) Aggrieved by the said order, the insurance company preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that the complainants did not make any claim, and for the first time two years after the accident they filed the complaint. In fact, the deceased had no valid driving license at the time of accident, and the driving license which he was having was expired before the date of accident, and therefore prayed that the complaint be dismissed with costs.
7) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?
8) It is an undisputed fact that the complainants are legal heirs/representatives (LRs) of the deceased P. Eswara Rao who had obtained insurance policy for a sum of Rs. 1 lakh covering the period from 15.3.2008 to 14.3.2009 vide Ex. A4 policy. He met with motor cycle accident on 9.5.2008 and succumbed to injuries while undergoing treatment in KGH hospital, Visakapatnam evidenced under FIR Ex. A1, inquest report Ex. A3 and post-mortem examination report Ex. A2.
9) The complainant sent registered lawyer notice on 30.4.2010 about two years after his death alleging that they could know that the deceased had taken a policy. The insurance company denied having received the said notice. The fact remains that the complainants did not file acknowledgement in order to show that the insurance company has received the same.
10) Be that as it may, the insurance company repudiated the claim on two grounds (i) that the complainants did not intimate the accident immediately as per condition No. 1of the policy (ii) the deceased was not having valid and effective driving license at the time of accident.
Condition No. 1 reads as follows:
Notice shall be given in writing to the company immediately upon the occurrence of any accidental loss or damage and in the event of any claim and thereafter, the insured shall give all such information and assistance as the company shall require. Every letter, claim, writ, summons, and/or process or copy thereof shall be forwarded to the company immediately on receipt by the insured. Notice shall also be given in writing to the company immediately the insured shall have knowledge of any impending prosecution inquest or fatal injury in respect of any occurrence which may give rise to a claim under this policy.
It may be stated herein that the complainants are LRs of the deceased. They are not insured. This stipulation of notice to the company immediately on occurrence is for the insured to give such notice in case of accident.
Since the complainants are not parties to the insurance policy and they being beneficiaries being LRs of the deceased by no stretch of imagination said condition could be mulcted on the complainants. The condition squarely placed burden on the insured to give such a report. When they are not parties to the insurance contract, the stipulation of time, if any, cannot be mulcted on them, and non-adherence of such condition cannot be taken against them.
11) Yet another contention is that the deceased was not having requisite driving license, and therefore the complainants are not entitled to the amount being contrary to conditions of the policy. It may be stated that the insurance company except taking such a plea did not obtain any certificate from the Regional Transport Authority to prove that the deceased was not having valid and effective driving license at the time of accident. The insurance company could have filed the report of the Motor Vehicles Inspector to prove the said fact. Taking wild pleas without proving the said fact would not be sufficient to dismiss the claim made by the complainants. Since the claim was made within the period of limitation, they being LRs, they are entitled to the claim irrespective of the fact whether they are nominees under the policy or not. The complainants did not prefer any cross-appeal against the order of the Dist. Forum while disallowing compensation and costs. The insurance company at least after receiving notice in the complaint could have taken steps to find out whether the deceased was having valid and effective driving license or not in order to repudiate the claim. Therefore, we do not see any mis-appreciation of fact or law by the Dist. Forum in this regard. We do not see any merits in the appeal.
12) In the result the appeal is dismissed with costs computed at Rs. 5,000/-.
Time for compliance four weeks.
1) _______________________________ PRESIDENT
2) ________________________________ MEMBER
3) ________________________________ MEMBER 29/08/2012 *pnr UP LOAD O.K.