State Consumer Disputes Redressal Commission
National Insurance Co. Ltd., vs 1.Tekam Sudha Rani on 5 January, 2024
1
aBEFORE THE TELANGANA STATE CONSUMER DISPUTES
REDRESSAL COMMISSION:HYDERABAD
(ADDITIONAL BENCH)
FA. No. 115/2019 AGAINST ORDERS IN
CC.No. 12/2013 ON THE FILE OF DISTRICT
CONSUMER COMMISSION, ADILABAD.
Between :
National Insurance Company Ltd.,
DAB, Branch Palika Bhavan, First Floor,
R.K.Puram, New Delhi-110 066. ...Appellant/
Opposite party no.4
And
1.Tekam Sudha Rani, W/o.late Venkati, 35 years, House wife, Kannepalli Village, Bheemini Revenue Mandal, Adilabad District. ... Respondent/ Complainant
2. Chandra Motors, Rep. by it's Managing Director, Dasnapur, On Old NH 7 Road, Adilabad.
3. Hero Motors Corporation Ltd., 34, Basanth Lok, Vasanth Vihar, New Delhi -110 057.
4. Hero Good Life Programme Centre, C/o.Result Services Pvt. Ltd., 8, Balaji Estate, Guru Ravi Das Marg, Kalkaji , New Delhi. ... Respondents/ Opposite parties 1 to 3.
(Respondents 2 to 4 are not necessary Parties to this appeal).
Counsel for the Appellant : M/s. V.Sambasiva Rao Counsel for the Respondent : M/s.Praveen Kumar Challa-R1.
QUORUM: Hon'ble Sri V.V.Seshubabu, M ember (M -J), & Hon'ble Smt.R.S.Rajeshree, M ember (N-J).
FRIDAY, THE FIFTH DAY OF JANUARY, TWO THOUSAND TWENTY FOUR.
Order : (Per Hon'ble Smt.R.S.Rajeshree, M ember (N-J) **** 2
01). This appeal is filed u/s. 15 of Consumer Protection Act, 1986 by the opposite party no.4 being aggrieved by the orders passed in C.C.No.12/2013 dated 26.11.2018, wherein the District Commission had passed the following orders :
"In the result, the complaint is allowed. The case against opposite parties no.1,2 & 3 is dismissed as they are the formal parties to this case and the opposite party no.4 is directed to pay Rs.1,00,000/- (Rupees One lakh only) towards policy covered amount, and Rs.2,000/-(Rupees Two thousand only) costs of this proceedings with interest @ 7% p.a. till realization within four weeks from the date of this order failing which the complainant is at liberty to proceed against the opposite party no.4 u/s. of 25/27 of C.P.Act,1986".
02). For the sake of convenience the parties are described as complainant and opposite party as arrayed in the complaint.
03). The case of the complainant is that her deceased husband had purchased a Hero Motorcycle from opposite party no.1, Chandra Motors and at the time of purchase, the opposite party no.1 had collected separate premium towards group insurance (personal accident policy) on his life for Rs 1,00,000/- and the same was valid for a period of three years; that the policy holder died on 07.03.2012 due to electrocution and a crime was registered u/s. 304 (II) of IPC and while the policy was in subsistence her husband died due to accident; hence she being the nominee has made a claim before the opposite party no.4 claiming the insurance amount but however the opposite party no.4 had neither honoured the claim nor rejected the same, as such having no other alternative she has approached the District Commission with the complaint.
04). Before the District Commission the opposite party nos.1 and 4 filed their written versions whereas opposite party number 2 and 3 remained exparte.
The opposite party no.1 while admitting the purchase of vehicle by one Tekam Venkati, so also the issuance of policy no. 35100731116201809363 by op.no.4 but however denied issuing any policy vide no. 351804/42/09/820002 and had further expressed its unawareness with regard to the death of the insured and registration of criminal case and had pleaded that the 3 complainant had never informed regarding the death of the insured nor there was any claim application made to it by the complainant and further pleaded that it is not a party to the insurance agreement entered between insured and opposite party no.4 as such it is not liable for any deficiency of service. Further pleaded that since the policy is issued by opposite party no.4, it is the dispute between the complainant and opposite party no.4.
05). The opposite party no.4 filed the written version while expressing their unawareness with regard to the purchase of the vehicle by one Tekam Venkati and also unaware about the purchase of policy by the vehicle purchaser and also expressed their unawareness with regard to the complainant being the nominee of such policy nor were they aware of the any criminal case being filed u/s. 304 Part-II of IPC and further pleaded that they did not receive any claim being submitted by Opposite party no.1 or the complainant, as such the question of avoiding the claim on false and baseless reasons does not arise that the opposite party never received any claim from the complainant and it further pleaded that the death of the deceased did not occur due to motor vehicle accident but has occurred due to electrocution.
06). Before the District Commission, the complainant filed proof affidavit as PW.1 and got marked Exs.A1 to A8. Opposite party no.1 filed proof affidavit as RW.1 and got marked Exs.B1 and B2. Opposite parties 2 & 3 remained exparte. Opposite party no.4 did not choose to file proof affidavit and documents.
07). Being aggrieved by the orders passed by the Dist. Commission as stated in para no.1 the app/op.no4/insurance company had filed the present appeal on the following grounds:
That the District Commission grossly erred in allowing the complaint awarding compensation, costs and interest instead of dismissing the complaint ; The District Commission failed to see that the appellant insurance company issued the insurance policy in the name of deceased T.Venkati on the New Motor Cycle by covering the risk of Rs.1 lakh under compulsory personal accident coverage for the owner 4 cum driver, if the insured dies while he was riding the motor cycle at the time of accident provided if he was holding an effective driving licence, but the insured died due to electrocution and he is no way concerned with the insurance policy issued under the Motor Vehicles Act,198 and he is not entitled for the compensation;
The District Commission erroneously dismissed the complaint against the opposite parties 1 to 3 instead of dismissing the complaint against the appellant/insurance company;
The District Commission failed to see that as per the FIR lodged by the complainant stating that while her husband was attending the work on electrical pole one Jammishetti Shankar intentionally put on the electrical supply and accordingly the crime was registered and hence the death of the insured is not an accidental one and it is a planned murder. Based on the above grounds, the appellant/opposite party no.4 prayed that the appeal be allowed by setting aside the order of the District Commission.
08). Heard the appellant counsel.
09). Now the point for consideration are:
i. Whether the impugned order as passed by the
District Commission suffers from any error or irregularity or whether it is liable to be set aside, modified or interfered with in any manner?
ii. To what relief ? 10). It is the specific case of the respondent/complainant that her deceased husband had purchased a motorcycle and the
Appellant/opposite party no.4 had issued Ex.A4 "Group personal accident policy" bearing no. 351804/42/09/82000002 and the policy was valid for 3 years and as per the said policy coverage in case of death of insured, the nominee would be entitled for Rs.1 lakh; and when her husband died due to electrocution while the policy was subsisting she had made a claim before the appellant/opposite party but the appellant/opposite party had neither honoured the claim nor rejected the same.5
11). Purchase of vehicle by the deceased husband of the complainant is confirmed by opposite party no. 1 who is the dealer, appellant/opposite party no. 4 would obviously not have the knowledge as to which customer had purchased which vehicle, moreover it is not relevant here since the main dispute is
i).whether the appellant/ opposite party no. 4 has issued Ex. A 4 policy, as Appellant/opposite party no.4 had denied issuing the said policy and ii).whether when a claim was made the same was repudiated?
12). A perusal of Ex A4 re veals that it is a certificate of Insurance with a specific number and the same is issued by Appellant/opposite party no.4 which is a group insurance policy wherein 'Hero Good Life Card Member' is the insured and the details of risk coverage and sum assured is mentioned as Rs. 1 lakh and the said Ex A4 is signed by Branch Manager. Ex A5 is the cover which is addressed to the insured. When the respondent/complainant had come up with Exs.A4 & A5 in support of her case, a simple denial by the Appellant/opposite party will not suffice. It is not the case of the Appellant/opposite party that the said Exs. A4 & A5 are fake documents and have been created by the respondent/complainant. Since Ex.A4 is a group insurance policy, the respondent/complainant would not be in possession of the same, in group insurance policies only Certificate of Insurance will be given to the insured members, obviously the policy document will be in the custody of opposite party no.2. It appears the appellant/opposite party who had issued Ex.A4 had wilfully did not mention the name of the member of group insurance policy and taking advantage of the same had denied that any such policy was issued, which amounts to unfair trade practice.
Having issued Ex.A4 in a technical manner without mentioning the name of the member of group insurance and when a claim is made, based on such group insurance policy certificate, not acknowledging it and simply denying is nothing but an unfair practice adopted by Appellant/opposite party to avoid the claim. Ex A6 is the copy of claim petition submitted by the respondent/complainant to appellant/opposite party no.4. The 6 said document is also denied by appellant/opposite party no.4 and it is the argument of appellant/opposite party that no such claim has been received from the respondent/complainant, in such case the burden is on appellant/opposite party no.4 to prove that they issue acknowledgement for every claim received, without filing any rebuttal evidence to Ex.A6 a mere denial will not help. The respondent/complainant had filed Ex.A6 to prove that a claim was made to appellant/opposite party no.4. When Ex.A6 is filed, without acknowledging it or rejecting or honouring, mere denial that there was no claim filed amounts to unfair trade practice.
13). Before the District Commission, the appellant/opposite party no.4 had filed the written version with simple denials that there was no policy no.351804/42/09/8200002 issued and no claim received from respondent/complainant. But in the grounds of appeal had set up a new defence that the death of the insured was not due to accident but it was a planned murder by his co- worker Jammishetti Shanker.
It is settled principle that all defence has to be taken at first instance except in case of any subsequent developments taken place or that the same was not within the knowledge of the appellant/opposite party and in the instant case, the contention of the appellant/opposite party no.4 that the death of the insured had not occurred due to electrocution, but was a planned murder is based on Ex.A1- F.I.R. which was already filed by the respondent/complainant before the District Commission and the appellant/opposite party no.4 had the opportunity to take such defence when the written version was filed before the District Commission. the appellant/oppsotie party no.4 is estopped from making such plea at the appellate stage. Therefore, the said plea taken in the present appeal cannot be considered.
14). Having issued Ex.A4 in a technical manner without disclosing the names of members of the group insurance policy and not proving that every claim application is acknowledged ; a simple denial that no such policy was issued, no claim application was received will not suffice and it amounts to unfair trade practice Exs.A4,A5 and A6 speak for themselves.
7Based on the above discussion, we are of the considered view that only to avoid the claim, the appellant/opposite party no.4 had denied that any claim is made by the respondent/complainant. Therefore, we see no error in the order of the District Commission, but however we feel that the interest awarded can be reduced by one percent and the District Forum failed to clarify the date from when interest is awarded; therefore, we clear this ambiguity and make it clear that the respondent/complainant is entitled for the insurance amount of Rs.1 lakh with 6 % interest from the date of order of the complaint.
15). In the result, appeal is partly allowed by modifying the order of the District Commission as under:
i).Appellant/opposite party no.4 is directed to pay the insurance amount of Rs.1,00,000/- with interest @ 6% p.a. from the date of order of the complaint till realization;
ii). The costs awarded by the District Commission remain unmodified;
iii). Appellant/ opposite party no.4 is further directed to pay Rs.20,000/- towards costs of the appeal.
Time for compliance is 30 days from the date of receipt of the order.
MEMBER(J) MEMBER(NJ)
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Dated: 5.1.2024