State Consumer Disputes Redressal Commission
H.D.F.C Ergo General Insurance Co.Ltd & ... vs Smt. Lalmuni & Anr. on 18 September, 2024
Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
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miHkksDrk fookn Áfrrks"k vk;ksx] iaMjh] jk;iqj lafLFkr fnukad&22-12-2023 vafre rdZ fnukad&29-07-2024- vkns"k fnukad&18-09-2024- vihy Øekad&FA/2023/342 1- ,pMh,Qlh bxksZ tujy ba";ksjsal daiuh fyfeVsM] r`rh; ry] pkoyk dkEiysDl] nsosUnz uxj jksM] lkabZ uxj jk;iqj] iksLV o ftyk&jk;iqj ¼N-x-½ 492001 2- ,pMh,Qlh bxksZ tujy ba";ksjsal daiuh fyfeVsM] izFke ry] ,pMh,Qlh gkÅl 165@166 csxcs fjDyses"ku] ,p- Vh- ikjs[k ekxZ] ppZ xsV eqEcbZ 400020 }kjk&fof/kd izca/kd] f}rh; ry] Mh- ,e- VkWoj] U;w iykfl;k] bankSj] iksLV o ftyk bankSj ¼e-iz-½ ¼}kjk Jh ih- ds- iky] vf/koDrk okLrs vihykFkhZx.k½
------------vihykFkhZx.k@fo:} i{kdkj dz-&2 ,oa 3- fo:) 1- Jherh ykyeqfu ifr Lo- lqjs"k dqekj ;kno] mez djhc&42 o'kZ fuokfluh&HksyokMhg] Fkkuk&cyjkeiqj] iksLV o ftyk&cyjkeiqj ¼N-x-½ ¼}kjk Jh iq'dj flUgk] vf/koDrk okLrs mRrjokfnuh dz-&1½
-------------mRrjokfnuh dz-&1@ifjokfnuh-
2- eks- "ke"kqn~nhu bjkdh oYn eks- vjQqn~nhu bjkdh] mez&50 o'kZ] fuoklh&edku ua-&74] esu jksM cyjkeiqj pkSdh fMiks ds ikl cklsu] rglhy o ftyk&cyjkeiqj ¼N-x-½ ¼}kjk Jh vHk; panzoa"kh] vf/koDrk okLrs mRrjoknh dz-&2½
-------------mRrjoknh dz-&2@fo:) i{kdkj dz-&1- le{k% ekuuh; U;k;ewfrZ Jh xkSre pkSjfM+;k] v/;{k- -
ekuuh; Jh izeksn dqekj oekZ] lnL;-
i{kdkjksa ds vf/koDrk vihykFkhZx.k dh vksj ls Jh ih- ds- iky] vf/koDrkA mRrjokfnuh dzekad&1 dh vksj ls Jh iq'dj flUgk] vf/koDrkA mRrjoknh dzekad&2 dh vksj ls Jh vHk; panzoa"kh] vf/koDrkA vkns'k ¼ }kjk%&izeksn dqekj oekZ] lnL; ½ vihykFkhZx.k@fo:} i{kdkj dzekad&2 ,oa 3 us ;g vihy /kkjk&41 miHkksDrk laj{k.k vf/kfu;e] 2019 ds varxZr ftyk miHkksDrk fookn izfrrks"k vk;ksx] dksfj;k] cSdq.Biqj ¼N0x0½ ¼ftls vkxs laf{kIr esa ^^lacaf/kr ftyk vk;ksx** Allowed Page 1 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
lacksf/kr fd;k tk,xk½ ds ifjokn izdj.k dzekad&87@2021 Jherh ykyeqfu fo:) eks- "ke"kqn~nhu bjkdh ,oa nks vU; esa ikfjr vkns"k fnuakd&29-09-2023 ftlds }kjk mRrjokfnuh dz-&1@ifjokfnuh ds ifjokn dks Lohdkj djrs gq, ;g vknsf"kr fd;k x;k gS fd **fo:) i{kdkj dzekad&2 ,oa 3] ifjkofnuh dks mlds ifr ds okgu pkyd jgrs e`R;q dks izkIr gksus ij izn"kZ lh&14 ,oa nLrkost vks - ih-&1 ikWfylh ds rgr 15]00]000@&¼ianzg yk[k :i;s½ chek/ku ,oa mDr jkf"k ij nkok fujLrh fnukad&07-12-2020 ls vafre Hkqxrku frfFk rd 06 izfr"kr okf'kZd dh nj ls C;kt rFkk ekufld] "kkjhfjd o vkfFkZd {kfr ds en esa 6]000@&¼N% gtkj :Ik;s½ ,oa ifjokn O;; ds :Ik esa 3]000@&¼rhu gtkj :Ik;s½ ftyk vk;ksx ds le{k tek djsxk ftls mRrjokfnuh dz-&1@ifjokfnuh dks ,dkmaV is;h psd ds ek/;e ls Hkqxrku fd;k tkosxk] vU;Fkk foyac dh n"kk esa 09 izfr"kr okf'kZd dh nj ls C;kt ns; gksxk**] ls {kqC/k gksdj izLrqr fd;k gSA 02- lacfa /kr ftyk vk;ksx ds le{k mRrjokfnuh dz-&1@ifjokfnuh dk ifjokn laf{kIr esa bl izdkj jgk gS fd mRrjokfnuh dz-&1@ifjokfnuh dk ifr Lo- lqjs"k dqekj ;kno is"ks ls okgu pkyd FkkA Lo- lqjs"k dqekj ;kno }kjk mRrjoknh dz- 2@fo:) i{kdkj dz-&1 ds LokfeRo dh okgu v"kksd yhyS.M Vªd dzekad&lhth 15 Mh,p 0498 dk pkyu fd;k tk jgk Fkk rc fnukad&16-07-2020 dks 36 eksM+] lksukouh fpjfejh esa mDr okgu dk czsd Qsy gks tkus ds dkj.k okgu [kkbZ esa fxj xbZ ftlesa mRrjokfnuh dz-&1@ifjokfnuh ds ifr Lo- lqjs"k dqekj ;kno dh e`R;q gks xbZ ftldk iqfyl Fkkuk fpjfejh }kjk exZ dzekad&32@2020 vijk/k dzekad&260@2020 /kkjk&279] 337] 304, Hkk- n- fo- ds rgr vijk/k iathc) fd;k x;kA mRrjoknh dz-&2@fo:) i{kdkj dz-&1 }kjk viuh okgu v"kksd yhyS.M Vªd dzekad&lhth 15 Mh,p 0498 dk chek fnukad&13-05-2020 ls fnukad&12-05-2021 rd dh vof/k ds fy, djk;k x;k Fkk ftldk chek ikWfylh Allowed Page 2 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
dzekad&23152033879600000 gSA mDr chek ikWfylh ds varxZr ekfyd&MªkbZoj gsrq 15]00]000@&¼iUnzg yk[k :Ik;s½ dk O;fDrxr nq?kZVuk chek Hkh vkPNkfnr Fkk ftlds varxZr mRrjokfnuh dz-&1@ifjokfnuh us chek/ku ds Hkqxrku gsrq vihykFkhZx.k@fo:) i{kdkj dzekad&2 ,oa 3 dks i= izsf'kr fd;k] fdarq vihykFkhZx.k@fo:) i{kdkj dzekad&2 ,oa 3 }kjk dksbZ dk;Zokgh ugha dh xbZ rc mRrjokfnuh dz-&1@ifjokfnuh }kjk vius vf/koDrk ds ek/;e ls vf/koDrk uksfVl izsf'kr fd;k x;k ftldk Hkh vihykFkhZx.k@fo:) i{kdkj dzekad&2 ,oa 3 }kjk uksfVl dk dksbZ tokc ugha fn;k x;k vkSj u gh chek/ku dk Hkqxrku fd;k x;k ftlds dkj.k mRrjokfnuh dz-&1@ifjokfnuh dks ;g ifjokn ykus dh vko";drk iM+h gSA vr% ifjokn Lohdkj dj chek/ku 15]00]000@&¼ianzg yk[k :Ik;s½ ,oa "kkjhfjd] vkfFkZd {kfr ds en esa 50]000@&¼ipkl gtkj :Ik;s½ o vU; vuqrks'k fnyk;s tkus dk fuosnu dh gSA 03- mRrjoknh dz-&2@fo:) i{kdkj dz-&1 dh vksj ls lacfa /kr ftyk vk;ksx ds le{k fyf[kr dFku izLrqr dj ;g cpko fy;k gS fd mRrjoknh dz-&2@ fo:) i{kdkj dz-&1 ds LokfeRo dh okgu v"kksd yhyS.M Vªd dzekad&lhth 15 Mh,p 0498 dk chek fnukad&13-05-2020 ls fnukad&12-05-2021 rd dh vof/k ds fy, vihykFkhZx.k@fo:) i{kdkj dz-&2 ,oa 3 }kjk fd;k x;k Fkk ftldk chek ikWfylh dzekad&2315203387969600000 gS ftlds varxZr ekfyd&MªkbZoj gsrq 15]00]000@&¼iUnzg yk[k :Ik;s½ dk O;fDrxr nq?kZVuk chek Hkh vkPNkfnr Fkk ftldh {kfriwfrZ ds fy, vihykFkhZx.k@fo:) i{kdkj dz-&2 ,oa 3 ftEesnkj gSaA vr% vius fo:) ifjokn fujLr fd;s tkus dk fuosnu fd;k gSA 04- vihykFkhZx.k@fo:} i{kdkj dz-&2 ,oa 3 dh vksj ls lacaf/kr ftyk vk;ksx ds le{k fyf[kr dFku izLrqr dj ifjokn&i= esa fd, x, vfHkopuksa dks Allowed Page 3 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
vLohdkj djrs gq, ;g cpko fy;k gS fd iz"uk/khu O;fDrxr nq?kZVuk chek vksuj MªkbZoj gsrq gS tks ek= okgu Lokeh ds fy, gS ftlds varxZr okgu Lokeh@chek /kkjd okgu dks pykrs le; nq?kZVukxzLr gksdj e`r gks tkrk gS rHkh O;fDrxr nq?kZVuk chek ds rgr 15]00]000@&¼ianzg yk[k :Ik;s½ dk fjLd dOgj jgrk gS] tcfd gLrxr izdj.k esa okgu gsrq fu;ksftr pkyd lqjs"k dqekj ;kno dh e`R;q gqbZ gS ftl gsrq O;fDrxr nq?kZVuk chek dk tksf[ke vkPNkfnr ugha gksrk gS vkSj pkyd miHkksDrk dh Js.kh esa ugha vkrk gS ftlds dkj.k mRrjokfnuh dz -&1@ ifjokfnuh dk nkok ekuuh; miHkksDrk vk;ksx ds le{k izpyu"khy ugha gSA vihykFkhZx.k@fo:) i{kdkj dz-&2 ,oa 3 }kjk lsok esa dksbZ deh ugha dh xbZ gSA mRrjokfnuh dz-&1@ifjokfnuh] vihykFkhZx.k@fo:) i{kdkj dz-&2 ,oa 3 ls dksbZ vuqrks'k izkIr djus dh vf/kdkfj.kh ugha gSA vr% ifjokn lO;; fujLr fd;s tkus dk fuosnu fd;k x;k gSA 05- lacfa /kr ftyk vk;ksx us mHk;i{kksa dh vksj ls izLrqr vfHkopu] "kiFk&i= ,oa nLrkosth lk{;ksa ds ifj'khyu Ik'pkr~ mRrjokfnuh dz-&1@ifjokfnuh ds ifjokn dks vkaf'kd :Ik ls Lohdkj djrs gq, Åij dafMdk&1 esa of.kZ r vuqlkj vuqrks"k iznku fd;k gS ftlds fo:} ;g vihy gSA 06- vihykFkhZx.k@fo:} i{kdkj dz-&2 ,oa 3 dh vksj ls milatkr gksus okys fo)ku vf/koDrk Jh ih- ds- iky dh vksj ls fyf[kr rdZ izLrqr dj ;g dFku fd;k gS fd iz"uk/khu okgu Vªd dz-&lhth 15 Mh,p 0498 dh chek ikWfylh dzekad&23152033879600000 esa mYysf[kr lafonk ds vuqlkj LL to Paid Driver/Conductor/Cleaner (IMT 28) Rs. 150/- okgu ds osruHkksxh pkyd@ dUMDVj@Dyhuj ds fof/k d nkf;Ro ds fufeRr izfr O;fDr 50@&¼ipkl :Ik;s½ dh nj ls 150@&¼,d lkS ipkl :Ik;s½ okgu Lokeh ds }kjk Hkqxrku izkIr fd;k x;k gS] vr% ,sls deZpkjh dks deZpkjh izfrdj vf/kfu;e ds izko/kkukuqlkj {kfr Allowed Page 4 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
jkf"k ikus dh ik=rk gS ftlds dkj.k ekuuh; vk;ksx dks ekeys dh lquokbZ dk {ks=kf/kdkj izkIr ugha gSA mRrjokfnuh dz-&1@ifjokfnuh dh ekax okgu pkyd ds fy, O;fDrxr nq?kZVuk ns;rk ds rgr gS tks fd ikWfylh esa PA Cover for Owner Driver Rs. 15,00,000/- n"kkZ;s tkus ds dkj.k nkok fd;k gS] fdarq MªkbZoj dk chek vkoj.k O;fDrxr nq?kZVuk chek vkoj.k gsrq okgu Lokeh us izkIr ugha fd;k gS ftlds dkj.k e`rd ds fy, O;fDrxr nq?kZVuk gsrq dksbZ jkf"k Hkqxrku djus ds fy, chek daiuh nkf;Rok/khu ugha gSA ekuuh; ftyk vk;ksx }kjk bafM;k eksVj VsfjQ&28 ds varxZr fofgr izko/kku ,oa bafM;k eksVj VsfjQ&17 ds varxZr fofgr izko/kku dks ,dhd`r dj i<+ fy;k gS tks fHkUu&fHkUu fo'k;&oLrq vkSj izhfe;e rFkk chek vkoj.k ds lanHkZ esa gSA orZeku izdj.k esa okgu Lokeh }kjk mlds osruHkksxh deZpkjh dk chek vkoj.k bafM;k eksVj VsfjQ IMT-17 ds izko/kku ds varxZr ugha djok;k gS ftlds dkj.k O;fDrxr nq?kZVuk vkoj.k ds en esa chek daiuh {kfriwfrZ gsrq nkf;Rok/khu ugha gSA iz"uk/khu chek ikWfylh esa vksuj MªkbZoj ds fy, O;fDrxr nq?kZVuk chek gsrq 325@&¼rhu lkS iPphl :Ik;s½ dk izhfe;e vnk dj 15]00]000@&¼iUnzg yk[k :Ik;s½ dk O;fDrxr nq?kZVuk chek vkoj.k okgu Lokeh&pkyd gsrq gS ftlds ifjikyu esa okgu ds iath;u iqfLrdk esa okgu Lokeh dk uke ntZ gksuk] chek ikWfylh esa mlh O;fDr dk uke cgSfl;r chek/kkjd gksuk vkSj mlds ikl oS/k o izHkko"khy MªkbZfoax ykbZlasl gksuk vfuok;Z "krZ gS] fdarq bl izdj.k esa iz;qDr okgu ds iath;u iqfLrdk esa e`rd lqjs"k dqekj ;kno dk uke ntZ ugha gS vkSj u gh mldk uke chek ikWfylh esa ntZ gSA vr% lqjs"k dqekj ;kno mDr okgu ds chek ikWfylh ds fy, okgu Lokeh&pkyd ugha jgk gS] fdarq mDr rF;ksa dh vuns[kh dj ekuuh; ftyk vk;skx }kjk vkyksP; vkns"k ikfjr fd;k x;k gS tks fd fLFkj j[ks tkus ;ksX; ugha gSA vr% vihy Lohdkj dj lacaf/kr ftyk vk;ksx }kjk ikfjr vkns"k dks vikLr fd;s tkus dk fuosnu fd;k gSA vihykFkhZx.k@fo:} i{kdkj dz-&2 ,oa 3 dh vksj ls vius rdZ Allowed Page 5 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
ds leFkZu esa Iffco Tokio General Ins. Co. Ltd. Through The Head (C.S.C.) Vs. Ms. Sheetalben Nileshbhai Surti 2014 (4) CPR 38 (NC) & Liberty General Insurance Ltd. (Earlier Known as Liberty Videocon General Insurance Co. Ltd.) Vs. Pranali Popat Suryavanshi 2019 (3) CPR 199 (NC) dk voyacu fy;k gSA 07- mRrjokfnuh dz-&1@ifjokfnuh dh vksj ls milatkr gksus okys fo}ku vf/koDrk Jh iq'dj flUgk us lacfa /kr ftyk vk;ksx }kjk ikfjr vkns"k dk leFkZu djrs gq, vihy vikLr fd;s tkus dk fuosnu fd;k gSA 08- mRrjoknh dz-&2@fo:) i{kdkj dz-&2 dh vksj ls milatkr gksus okys fo}ku vf/koDrk Jh vHk; panzoa"kh us laca af/kr ftyk vk;ksx }kjk ikfjr vkns"k dk leFkZu djrs gq, vius fo:) vihy vikLr fd;s tkus dk fuosnu fd;k gSA 09- geus mHk;i{k ds fo}ku vf/koDrkx.k ds vafre rdZ Jo.k fd, rFkk lacfa /kr ftyk vk;ksx }kjk izdj.k dzekad&87@2021 esa ikfjr vkns"k fnukad&29- 09-2023 rFkk ewy vfHkys[k dk voyksdu fd;kA 10- izdj.k esa ;g rF; vfookfnr gS fd mRrjokfnuh dz-&1@ifjokfnuh ds ifr Lo- lqjs"k dqekj ;kno is"ks ls okgu pkyd Fkk tks mRrjoknh dz-&2@fo:) i{kdkj dz-&1 ds LokfeRo dh okgu v"kksd yhyS.M Vªd dzekad&lhth 15 Mh,p 0498 dk pkyu dj jgk Fkk rc fnukad&16-07-2020 dks 36 eksM+] lksukouh fpjfejh esa mDr okgu dk czsd Qsy gks tkus ds dkj.k okgu [kkbZ esa fxj xbZ ftlesa mRrjokfnuh dz-&1@ifjokfnuh ds ifr Lo- lqjs"k dqekj ;kno dh e`R;q gks xbZ ftldk iqfyl Fkkuk fpjfejh }kjk exZ dzekad&32@2020 vijk/k dzekad&260@2020 /kkjk&279] 337] 304, Hkk- n- fo- ds rgr vijk/k iathc) fd;k x;k tks fd izn"kZ lh&1 ls lh&7 ls izekf.kr gSA ;g rF; Hkh vfookfnr gS fd mRrjoknh dz-&2@fo:) i{kdkj dz-&1 }kjk viuh mDr iz"uk/khu okgu dk chek fnukad&13-05-2020 ls fnukad&12-05-2021 rd dh vof/k ds fy, Allowed Page 6 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
vihykFkhZx.k@fo:) i{kdkj dz-&2 ,oa 3 ls djk;k x;k Fkk ftldk chek ikWfylh dzekad&23152033879600000 gS ,oa mDr chek ikWfylh ds varxZr Owner Driver gsrq 15]00]000@&¼ianzg yk[k :Ik;s½ dk O;fDrxr nq?kZVuk chek vkPNkfnr Fkk tks izn"kZ lh&14 ,oa izn"kZ vksih&1 ls izekf.kr gSA 11- izdj.k esa izLrqr vfHkopu] "kiFk&i= ,oa nLrkostksa ds voyksdu mijkar ge ;g ikrs gSa fd iz"uk/khu okgu dks e`rd lqj"s k dqekj ;kno }kjk pkyu fd;k tk jgk Fkk tks fd okgu Lokeh ugha gS] cfYd mRrjoknh dz-&2@fo:) i{kdkj dz-&2 }kjk fu;ksftr isM MªkbZoj gS ftldh nq?kZVuk esa e`R;q gks xbZ gS] tcfd chek ikWfylh ds vuqlkj Owner Driver gsrq 15]00]000@&¼ianzg yk[k :Ik;s½ dk O;fDrxr nq?kZVuk chek vkPNkfnr FkkA iz"uk/khu chek ikWfylh ds vuqlkj LL to Paid Driver/Conductor/Cleaner (IMT 28) Rs. 150/- dk izhfe;e izkIr fd;k x;k gS ftlds vuqlkj mRrjokfnuh dz-&1@ifjokfnuh deZpkjh izfrdj vf/kfu;e ds izko/kkukuqlkj {kfriwfrZ izkIr djus dh vf/kdkfj.kh gSA bafM;k eksVj VsfjQ&28 fuEukuqlkj gS& "IMT. 28. Legal Liability to paid Driver and/or Conductor and/or Cleaner employed in connection with the operation of Insured Vehicle In consideration of an additional premium of 50/-notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insurer shall indemnify the insured against the insured's legal liability under the Workmen's Compensation Act, 1923 , the Fatal Accidents Act, 1855 or at Common Law and subsequent amendments of these Acts prior to the date of this Endorsement in respect of personal injury to any paid driver and/or conductor and/or cleaner whilst engaged in the service of the insured in such occupation in connection with the vehicle insured herein and will in addition be responsible for all costs and expenses incurred with its written consent. Provided always that:
1) This Endorsement does not indemnify the insured in respect of any liability in cases where the insured holds or subsequently effects with any insurer or group of insurers a Policy of Insurance in respect of liability as herein defined for insured's general employees;
2) The insured shall take reasonable precautions to prevent accidents and shall comply with all statutory obligations;
3) * the insured shall keep record of the name of each paid driver conductor cleaner or persons employed in loading and/or unloading and the amount of wages and salaries and other earnings paid to such employees and shall at all times allow the insurer to inspect such records on demand.Allowed Page 7 of 9
Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
4) in the event of the Policy being cancelled at the request of the insured no refund of the premium paid in respect of this Endorsement will be allowed. Subject otherwise to the terms conditions limitations and exceptions of the Policy except so far as necessary to meet the requirements of the Motor Vehicles Act, 1988. NOTE:
*In case of Private cars (not used for hire or reward) delete this para."
12- izdj.k esa okgu Lokeh }kjk vius osruHkksxh deZpkjh dk chek vkoj.k bafM;k eksVj VsfjQ&17 ds vuqlkj ugha djok;k gS ftlds dkj.k chek daiuh Lo-
lqjs"k dqekj ;kno dh e`R;q mijkar O;fDrxr nq?kZVuk chek jkf"k vnk djus gsrq nkf;Rok/khu ugha gSA bafM;k eksVj VsfjQ&17 fuEukuqlkj gS& "IMT. 17. Personal Accident Cover to Paid Drivers, Cleaners and Conductors:
In consideration of the payment of an additional premium, it is hereby understood and agreed that the insurer undertakes to pay compensation on the scale provided below for bodily injury as hereinafter defined sustained by the paid driver/cleaner/conductor in the employ of the insured in direct connection with the vehicle insured whilst mounting into dismounting from or traveling in the insured vehicle and caused by violent accidental external and visible means which independently of any other cause shall within six calendar months of the occurrence of such injury result in :
Details of Injury Scale of compensation
i) Death 100%
ii) Loss of two limbs or sight of two eyes 100%
iii) Loss of one limb or sight of one eye 50%
iv) Permanent total disablement from injuries other 100%
than named above
Provided always that
1) Compensation shall be payable under only one of the items (i) to (iv) above in respect of any such person arising out of any one occurrence and total liability of the insurer shall not in the aggregate exceed the sum of `...............* during any one period of insurance in respect of any such person.
2) No compensation shall be payable in respect of death or injury directly or indirectly wholly or in part arising or resulting from or traceable to (a) intentional self-injury suicide or attempted suicide physical defect or infirmity or (b) an accident happening whilst such person is under the influence of intoxicating liquor or drugs.
3) Such compensation shall be payable only with the approval of the insured named in the Policy and directly to the injured person or his/her legal representative(s) whose receipt shall be a full discharge in respect of the injury of such person Subject otherwise to th terms exceptions conditions and limitations of this policy.
*The Capital Sum Insured (CSI) per person is to be inserted "
13- Iffco Tokio General Ins. Co. Ltd. Through The Head (C.S.C.) Vs. Ms. Sheetalben Nileshbhai Surti (Supra) esa ekuuh; jk'Vªh; }kjk ;g fu/kkZfjr fd;k x;k gS fd& "7. Now, the next question to be dicided in this case is as to whether deceased who was son of insured was covered under the policy or not. Perusal Allowed Page 8 of 9 Appeal No. HDFC Ergo General Insurance Co. Ltd. & Anr. Order Pronounced FA/2023/342 Vs. on-18.09.2024 Smt. Lalmuni & Anr.
of insurance policy reveals that personal accident cover for owner/driver was provided to the extent of Rs. 1,00,000/-. Section 3(c) (1) of the policy runs as under:
"This cover is subject to:
(a) The owner-driver is the registered owner of the vehicle insured herein;
(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 os Rule-3 of the Central Motor Vehicles Rules, 1989, at the time of the accident".
This proviso makes it very clear that owner-driver means, he must be registered owner of the vehicle and his name must be shown as insured in the policy and further, owner-driver must be hold effective driving licence at the time of accident. Admittedly, deceased has not been shown as owner in the insurance policy and in such circumstances, no claim under this policy was payable to him. Learned State Commission wrongly interpreted this clause and held that if owner of the vehicle is not driving the vehicle, but another person holding lawful driving licence and accident take place then also responsibility of Insurance Co. arise under the policy."
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