State Consumer Disputes Redressal Commission
The Oriental Insurance Company Ltd. vs Smt. Neelam Sharma. on 22 November, 2023
H. P. STATE CONSUMER DISPUTES REDRESSAL
COMMISSION SHIMLA.
First Appeal No.: 211/2023
Date of Presentation: 22.09.2023
Reserved on: 16.11.2023
Date of Decision: 22.11.2023
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The Oriental Insurance Company Ltd., Direct agents
Branch, SCO No.45, Sector 20-C, Chandigarh (U.T.),
through its Incharge/ Manager, TP hub, Divisional
Office, 3rd Floor, ISBT, Tutikandi, Shimla-171004.
.......... Appellant/Opposite Party
Versus
Smt. Neelam Sharma W/o Sh. Rakesh Sharma, R/O
House No.270, Sector-2, Shivalik Nagar, Baddi, Tehsil
Baddi, District Solan, H.P.
.....Respondent/Complainant.
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Coram
Hon'ble Justice Inder Singh Mehta, President.
Hon'ble Mr. R.K. Verma, Member.
Whether approved for reporting?1 Yes
For the Appellant: Mr.P.S. Chandel, Advocate.
For the Respondent: Mr.O.C. Sharma, Advocate.
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Per R.K.Verma, Member
O R D E R:
Present appeal is preferred against the order dated 07.06.2023 of learned District Commission, Solan, in 1 Whether Reporters of the local papers may be allowed to see the order? Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 consumer complaint No. 162/2022 titled Smt. Smt. Neelam Sharma vs. The Oriental Insurance Company Ltd. whereby, the complaint filed by the complainant was partly allowed. Brief facts of the Case:
2. Briefly, case of the complainant is that the complainant is mother and legal heir of the deceased Ms.Priyanka, who was owner of vehicle (Moped) No.HP-
12E-8637. This vehicle was insured with the appellant/insurance Company for the period from 22.07.2020 to 27.07.2021. The deceased had also taken PA cover for owner-driver in the sum of Rs.15,00,000/-. On 24.07.2021, the deceased Ms. Priyanka was going on her vehicle to Bhojiya Vidyapeeth School from her house. The vehicle was driven by Yaksh, brother of the deceased. The vehicle met with an accident and deceased Ms.Priyanka received grievous multiple injuries and she was rushed to Civil Hospital Baddi, from where she was referred to the PGI Chandigarh, where she was declared brought dead. The DD report of her death was recorded with the Police of Police Station Baddi vide DDR No.35. Information with regard to the death of Ms. Priyanka was given to the opposite party/insurance company and complainant lodged claim for personal accident and 2 Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 requested to release the claim of Rs.15,00,000/- as covered in the policy. The complainant requested so many times to the opposite party for paying the due claim, despite submitted all required documents, but the opposite party failed to pay the claim. There is deficiency in service. Hence, this complaint
3. Opposite party/Insurance company resisted and contested the complaint by filing reply. It is submitted that on receipt of intimation, claim of the complainant was registered. The Opposite Party/Insurance Company issued letter and reminder dated 07.09.2021 and 27.09.2021, respectively to the complainant asking her to submit the requisite documents including driving license of late Ms. Priyanka, if any, authorizing her to drive a two wheeler as the same was necessary for further processing of her claim, but the complainant failed to do so. From the letters and documents submitted by the present complainant, it was found that Miss Priyanka daughter of late Shri Rakesh Kumar, the owner/insured was not holding and possessing any driving license. For this reason, the claim of the complainant on account of the death of Miss Priyanka was not payable under the Terms and Conditions of the Insurance Policy and the Rules of 3 Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 claim settlement. A prayer for dismissal of complaint was made.
4. The complainant filed rejoinder denying the contents of the reply filed by opposite party and reiterating those of complaint
5. Thereafter, the parties led evidence in support of their respective pleadings.
6. After hearing the parties, learned District Commission partly allowed the complaint of the complainant.
7. Feeling aggrieved by the order of learned District Commission, the appellant/ Insurance Company has preferred the instant appeal before this Commission.
8. We have heard learned counsel of the parties and have also gone through the record carefully.
9. Learned counsel of the appellant/ insurance company has submitted that the impugned order is bad in law on the ground that the vehicle in question was registered in the name of insured deceased Ms.Priyanka, who was not holding a valid driving license at the time of accident. He further submitted that the complainant should 4 Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 have fulfilled three conditions for the P.A. claim. Firstly, the vehicle should be in the name of the insured. Secondly, she must have valid and effective driving license at the time of accident. Thirdly, insurance certificate must show her name as insured. The deceased was not having driving license at the relevant point of time. Therefore, her LR is not entitled to any claim under the policy. He prays that the appeal of the appellant be allowed.
10. On the other hand, learned counsel of the respondent/complainant has supported the impugned order and submitted that the same does not require any interference by this commission. He prays for dismissal of this appeal.
FINDING
11. The admitted facts which have emerged on record are deceased Ms. Priyanka, was owner of vehicle (Moped) No.HP-12-E-8637 which was insured with the appellant-Insurance company. She had also taken personal accident cover for registered owner-cum-driver in the sum of Rs.15,00,000/- from the appellant/insurance company. She died during the period when the insurance policy was 5 Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 in force. At the time of the accident, the deceased was not having a driving license to drive the vehicle in question.
12. The learned District commission below found the appellant/ insurance company deficient in service and relying on the judgment of the Hon'ble National Commission in the case of United India Insurance Co. Ltd. vs Pushpa Devi Mantri, Revision Petition No.2681 of 2011 decided on 8th February, 2017 partly allowed the complaint and awarded 50% of the insured amount to the complainant on the ground that the appellant/ insurance company had received premium for PA without ensuring that the insured was having driving license or without informing the insured that PA cover was available only if the owner/driver was having valid driving license.
13. Section 6 of the Indian Motor Tariff which deals with the personal accident cover for owner-driver stipulates following three conditions to the cover :-
(a) the owner-driver is registered owner of the vehicle insured;
b) the owner driver is the insured named in this policy;
(c) the owner driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicle Rules,1989, at the time of the accident.6
Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023
14. A perusal of the provisions contained under section 6 (ibid) would reveal that only the registered owner who is holding a valid driving license is entitled to PA cover to owner-driver. Therefore, it is incumbent upon the insurance company to ensure at the time of receiving extra premium for PA cover that the insured owner-driver is holding a valid driving license to drive the insured vehicle.
15. In the present case, there is no material on record to show that at the time of receiving extra premium for PA cover, the appellant/insurance company had made inquiry from the deceased about possession of a valid driving license to drive the insured vehicle. There is also no evidence on record to show that the appellant/insurance company had even informed the deceased that this cover was available to her only, if she was holding a valid driving license to drive the insured vehicle. It is also not the case of the appellant insurance company that at the time of taking the policy the deceased had misrepresented to them that she was holding a valid driving license. Therefore, the appellant insurance company was grossly negligent in not informing the deceased that she was entitled to the PA cover only in case she was holding a valid driving license. 7
Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023 This has denied the opportunity to the deceased/insured of having some other personal policy insuring her as the owner. This omission on the part of appellant/insurance company amounts to deficiency in service.
16. The Insurance Company having accepted the extra premium for PA cover without verifying that the insured was having a valid driving license to drive the vehicle in question, which was sine qua non for this cover, is also precluded at this stage to raise the plea that the deceased was not holding a valid driving license at the time of the accident. In these circumstances, we are of the considered view that the learned District Commission below has committed no illegality or material irregularity to hold the appellant/insurance company guilty of deficiency in service.
17. In view of the above stated facts, we do not find any infirmity in the order passed by learned District Commission below and same does not require any interference. Accordingly, appeal of the appellant fails and same is hereby dismissed.
18. Parties are left to bear their own costs. 8
Oriental Insurance Company Ltd. vs. Smt. Neelam Sharma F.A. No.211/2023
19. Certified copy of order be sent to the parties and their counsel(s) strictly as per rules. File of District Commission alongwith certified copy of order be sent back and file of State Commission be consigned to record room after due completion. Appeal is disposed of. Pending application(s), if any, also disposed of.
Justice Inder Singh Mehta President R.K.Verma Member Manoj 9