State Consumer Disputes Redressal Commission
The Senior Divisional Manager vs K. Shobha Rani. And Other on 26 April, 2010
FA1755 of 2007.html BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD. F.A. 1755/2007 against C.C. 62/2004, Dist. Forum, Adilabad. Between: The Senior Divisional Manager M/s. United India Insurance Company Ltd., Divisional Office, Warangal. *** Appellant/ O.P. No. 1 And 1. K. Shobha Rani. W/o. Late Krishna Age: 43 years, H.No. 2-1-2, Tarabund Secunderabad. *** Respondent/ Complainant 2. The Police Officers Association Karimnagar & Adilabad Units Rep. by its Unit President T. Padmanabha Reddy, C.I. Police, Luxettipet. *** Respondent/ O.P. No. 2. Counsel for the Petitioner: M/s. Ravinshankar Jandhyala Counsel for the Respondent: Mr. M. Ramgopal Reddy (R1&R2) CORAM: HONBLE SRI JUSTICE D.APPA RAO, PRESIDENT. & SMT.M.SHREESHA, LADY MEMBER.
MONDAY, THIS THE TWENTY SIXTH DAY OF APRIL TWO THOUSAND TEN ORAL ORDER: (Per Honble Sri Justice D.Appa Rao, President.) ***
1) This is an appeal preferred by the insurance company against the order of the Dist. Forum, Adilabad directing it to pay the amount covered under the policy
2) The case of the complainant in brief is that she is the wife of late K. Krishna, Asst. Sub-Inspector of Police, Tamsi of Adilabad district a Janata Personal Accident Insurance Policy holder issued by the appellant insurance company through R2 for a period of 10 years effective from 5.2.1999 to 4.2.2009 covering the risk for a sum of Rs. 3 lakhs in case of accidental death. While so on 14.2.2003 he died in a road accident near Degaon Project Canal Culvert on National Highway No. 7 at 6.40 a.m. On report the police registered a case in crime No. 29/2003 u/s 304(A), 338, 337 IPC against the drivers of the jeeps. They conducted inquest over the dead body. Post-mortem examination was also conducted. She had requested opposite party No. 2 the Police Officers Association to pursue the matter, however, they were evading to give reply. Since the appellant was not paying the amount covered under the policy the complainant filed the complaint for payment of the amount covered under the policy together with interest, compensation and costs.
3) The appellant insurance company resisted the case. It alleged that Police Officers Association, Karimnagar & Adilabad took Janata Personal Accident Insurance Policy (JPA) on 4.2.1998 covering the risk of 5,350 members of their association for an amount of Rs. 3 crores. The insurance company had to indemnify if the insured sustained any bodily injury resulting solely and directly from accident caused by outward, violent and visible means. The Comptroller & Auditor General of India (CAG) opined that there was no need to issue group policy since the police personnel in the state of Andhra Pradesh were covered under Group Personal Accident Policy issued by state sector branch under the control of Director General of Police. Condition No. 6 of the policy enables it to cancel the policy at any time by issuing notice and in such a case it had to return the last paid premium less prorate part thereof for the portion of the current insurance period. At any rate it had issued notice cancelling the policy intimating the same to Police Officers Association on 12.4.2002 stating that the cancellation is effective from 27.4.2002. Aggrieved by the said decision the Police Officers Association filed W.P. No. 12057/2002 questioning the cancellation and the same is pending. As the death was long after the cancellation of the policy the complainants were not entitled to any amount. There was no deficiency in service on its part, and therefore prayed for dismissal of the complaint.
4) R2 did not choose to contest the matter, and therefore it was set-exparte.
5) The complainant in proof of her case filed her affidavit evidence and got Exs. A1 to A8 marked, while the insurance company filed the affidavit evidence of its Divisional Manager and got Exs. B1 to B7 marked.
6) The Dist. Forum after considering the evidence placed on record opined that earlier in a batch of cases between the same parties this Commission in F.A. No. 62/2005 against C.C. 35/2004 opined that without issuing show because notice before cancellation of the policy is bad under law. Therefore it directed the insurance company to pay the amount covered under the policy together with interest @ 9% p.a., from the date of complaint together with costs of Rs. 200/-.
7) Aggrieved by the said decision the insurance company preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. The Dist. Forum had no jurisdiction in view of specific arbitration clause incorporated in the policy. It had already terminated the policy and the party cannot question its right to terminate the policy and that too on a reasonable cause. The rule of audi alteram partem is a principle of public law and the same cannot be invoked under private law, which is governed by terms and conditions of the contract between the parties. At any rate writ appeal W.A. No. 903/2007 has been pending before the Division Bench and therefore it prayed for dismissal of the complaint.
8) The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis- appreciation of fact or law?
9) It is an undisputed fact that late K. Krishna, Asst. Sub-Inspector of Police, Tamsi of Adilabad district, husband of the complainant was covered under certificate of JPA policy for an amount of Rs. 3 lakhs effective from 5.2.1999 to 4.2.2009 evidenced under Ex. A5 Premia were paid from out of his salary by R2 the Police Officers Association.
While admitting issuance of policy the appellant insurance company pleads that it had cancelled the policy on 27.4.2002 and informed to R2 evidenced under Ex. B3, and also refunded the pro-rata premium evidenced under Ex. B4. The cancellation of the policy was on 27.4.2002. The pro-rata premium of Rs. 13,47,906/- was paid by them to R2. The death of the deceased was on 14.2.2003. By that time the policy was not in force. Therefore they were not liable to pay any compensation.
10) R2 the Police Officers Association questioned the unilateral cancellation of the policy in W.P. No. 12057/2002. By an order Dt. 7.9.2007 the Honble High Court allowed the writ petition and declared the impugned cancellation letter Dt. 12.4.2002 as arbitrary and illegal. However, it was held that this order will not preclude the insurance company from issuing a show cause notice to the petitioners furnishing the reasons, inviting objections and taking a decision thereafter, as per law.
11) The appellant insurance company did not allege anywhere that pursuant to the order of the High Court it had issued a show cause notice to R2 Police Officers Association nor taken any decision in this regard.
In the grounds of appeal it was mentioned that W.A. No. 903/2007 has been preferred and the same is pending. It is not known as to the outcome of the Writ Appeal. The appellant did not state that any stay order was passed in the said Writ Appeal. Therefore the order in W.P. No. 12057/2002 would bind the parties. When the High Court quashed the letter cancelling the policy, necessarily the insurance company is liable to pay the amount covered under the policy, if the death attracts the conditions of the policy.
12) The terms and conditions of the policy specifically made it clear that the insurance company shall indemnify if the insured shall sustain any bodily injury resulting solely and directly from accident caused by outward, violent and visible means it would pay the amount that is to say :
(a) If such injury shall within 6 calendar months of its occurrence be the sole and direct cause of the death of the insured the capital sum stated in the schedule.
The amount payable under the clause shall be paid to the nominee show in the schedule.
(b) If such injury shall within 6 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the capital sum insured stated in the schedule.
(c) If such injury shall within 6 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot, fifty percent (50%) of the capital sum insured stated in the schedule.
(d) If such injury shall within 6 calendar months of its occurrence be the sole and direct cause of permanently, totally and absolutely disabling the insured from engaging in being occupied with or giving attention to any employment or occupation of any description whatsoever, the capital sum insured stated in schedule.
13) Admittedly the assured late K. Krishna worked as Asst. Sub-Inspector of Police, Tamsi of Adilabad district died in a road accident on 14.2.2003 evidenced under FIR Ex. A1. In Ex. A5 the post-mortem examination the doctor opined that the death was due to haemorrhage and shock due to head injury
14) Since the complainant could prove that the assured died in a road accident the complainant is entitled to the amount covered under the policy. The Dist. Forum has rightly awarded the compensation though this aspect was not considered. The record discloses that the death was due to accident and therefore the complainant is entitled to compensation. There are no merits in the appeal.
15) In the result the appeal is dismissed. No costs. Time for compliance four weeks.
1) _______________________________ PRESIDENT
2) ________________________________ MEMBER Dt. 26.
04. 2010.
UP LOAD O.K.