State Consumer Disputes Redressal Commission
Icici Lombard Gen. Ins.Co.Ltd. vs Prem Devi on 4 August, 2009
Appeal No.206/09 ICICI Lobard General Insurance Co.Ltd. V. Premdevi Before: Mr.Justice Sunil Kumar Garg-President Mrs.Vimla Sethiya-Member
Shri Jitendra Mitruka,counsel for the appellant Shri Gopal Shastri,counsel for the respondent Date of Judgement: 4.8.09 BY THE STATE COMMISSION:
This appeal has been filed by the appellant insurance company which was op before the District Forum,Tonk against the order dated 18.12.08 passed by the District Forum,Tonk in complaint no.336/08,by which the complaint of the complainant respondent was allowed against the appellant insurance company in the manner that the appellant insurance company was directed to pay Rs.17,066/- as amount of compensation for the damage to the motor cycle and further to pay Rs.1 lac as the amount for the death of the deceased in an accident as the policy in question was covering the risk of Personal Accident and further to pay Rs.5000/- as amount of compensation for mental agony.
It arises in the following circumstances:
That the complainant respondents had filed a complaint against the appellant insurance company before the District 2 Forum,Tonk on 4.8.08 interalia stating that her husband,Bhanwarlal, now deceased had purchased a motor cycle bearing no.RJ.26.SC.2497 and that motor cycle was got insured by the deceased with the appellant insurance company for the period 15.10.07 to 14.10.08 and further at the time of insurance,the risk of personal accidental benefit of the deceased as driver of the motor cycle was also got insured by the deceased with the appellant insurance company and as per the terms and conditions of the policy,if the insured dies in an accident, the appellant would pay a sum of Rs.1 lac to his dependents and for that extra premium was paid by the deceased at the time of taking the policy.
Note: These facts are not in dispute.
It was further stated in the complaint that on 21.10.07 when the deceased was riding his motor cycle, a truck bearing no.RJ.14.2 G.5241 had caused accident with the motor cycle as a result of which the deceased had died and a FIR was lodged with the police station,Sadar,District Tonk bearing FIR no.207/07 and further a challan was filed against the driver of the truck Shiv Singh for committing offences u/s 279,304 A IPC.
Note:
These facts are also not in dispute.
Thereafter a claim was preferred by the complainant respondent being the wife and nominee of the deceased with the office of the appellant insurance company,but that claim was repudiated by the appellant insurance company through letter dated 11.3.08 in the following manner:
"We regret to inform you that your claim is not maintainable and is inadmissible,since the person who was driving the vehicle at the time of accident was not holding driving license in terms of the provisions of Motor Vehicle Act. Therefore,as the damage reported to the insured vehicle is caused due to violation of the 3 provisions of the Motor Vehicles Act,1988. Hence ICICI Lombard General Insurance Company Limited shall not have any liability in respect of the captioned subject matter."
Thereafter the present complaint was filed claiming Rs.1 lac as amount of insurance for personal accident benefit and further a sum of Rs.23,661/- as amount of compensation for the damage to the vehicle.
A reply was filed by the appellant insurance company before the District Forum,Tonk on 16.10.08 and in the reply the same pleas were taken which were taken in the repudiation letter dated 11.3.08 and since the deceased was not having a licence to drive the motor cycle,therefore,in absence of that the claim was rightly repudiated in respect of both the grounds i.e personal accident benefit as well as damage to the vehicle and it was prayed that the complaint be dismissed.
The District Forum after hearing both the parties,through the impugned order dated 18.12.08 had allowed the complaint as stated above,interalia holding that since the risk of personal accident as owner of the motor cycle was got covered under the policy and since the deceased had died in an accident,therefore,the complainant respondent was entitled to a sum of Rs.1 lac and in respect of the damage to the vehicle,since the appellant in its amended reply had assessed the loss to the tune of Rs.17,066/-,therefore,this amount be ordered to be paid by the appellant insurance company to the complainant respondent in respect of damage to the motor cycle.
Aggrieved from that order,this appeal has been filed by the appellant insurance company.
4In respect of Personal Accident Claim.
In this appeal,in respect of personal accident claim, the main contention of the learned counsel for the appellant insurance company is that since the licence of the deceased was not produced by the complainant respondent and since as per terms and conditions of the policy,it was a must,therefore,findings recorded by the District Forum could not be sustained and be quashed and set aside and appeal be allowed.
On the other hand,the learned counsel for the complainant respondents has supported the impugned order.
We have heard the learned counsel for the parties and perused the record.
In this case,there is no dispute on the point that the policy in question was taken by the deceased covering the risk of personal accident and there is also no dispute on the point that the deceased had died in an accident on 21.10.07.
In file, there is a FIR which was lodged with the police station,Sadar,District Tonk bearing FIR no.207/07 on the parcha bayan of the person who was sitting on the same motor cycle alongwith the deceased and as per the contents of the FIR, the accident was caused by a truck coming from opposite direction and challan had been filed against the driver of the truck.
In the facts and circumstances just narrated above,the question for consideration is whether the repudiation of the claim of the complainant respondent by the appellant insurance company on ground of licence could be justified or not and whether the findings recorded by the District Forum by which the complaint 5 was allowed could be sustained or not;
In our considered opinion,the findings recorded by the District Forum are liable to be confirmed one as they are based on correct appreciation of evidence on record because of the following reasons:
That since in this case,the risk of personal accident was covered and that risk must have been covered after seeing the necessary papers including the licence of the deceased,therefore,after the death of the deceased,the appellant insurance company should not be allowed to agitate the question of licence.
Further in this case,the accident was caused not by the rash and negligent driving of the deceased as the deceased was driving his motor cycle and the accident was caused by the driver of the truck and the police had filed the challan against the driver of the truck and since the accident had taken place without there being any fault on the part of the deceased,therefore,in such an event the question of licence had become redundant. From that point of view also,the question of licence is irrelevant in the present case and the repudiation of the claim of the complainant respondent on ground of licence was not justified and the findings of the District Forum by which the complaint was allowed are liable to be confirmed one.
On point of damage to the Motor cycle.
The case of licence in respect of damage to the vehicle stands on different footing in case of covering the risk of personal accident. Since in this case the motor cycle was also damaged and the deceased was not having any licence,it had amounted to violation of the terms and conditions of the policy, but the 6 question is whether on that aspect,the claim could be repudiated in toto or not, in our considered opinion,in such a case when at the time of accident,no fault on the part of the driver of the motor cycle was found and challan had been filed against the driver of offending vehicle,therefore,if the deceased was not having a licence on that ground the repudiation of the claim in toto could not be justified and the claim must have been treated as sub standard and thus the complainant respondent is entitled to 75% of the amount of Rs.17,066/- that comes to Rs12,799.5 with interest @ 9% p.a from the date of filing of the complaint and to that extent,this appeal deserves to be allowed partly.
For reasons as stated above,this appeal filed by the appellant insurance company is partly allowed in the manner that that part of the order by which the appellant insurance company was directed to pay Rs.1 lac to the complainant respondent is confirmed and appeal against that amount stands rejected, but in respect of the amount of Rs.17,066/-,this appeal filed by the appellant insurance company is partly allowed in the manner that the appellant insurance company would pay a sum of Rs.12,799.5 to the complainant respondent in place of Rs.17,066/- with interest @ 9% p.a from the date of filing of the complaint. To the above extent,the impugned order 18.11.08 passed by the District Forum,Tonk is modified. Rest order is maintained.
Member President