A NAGAMMA vs Life Insurance Corporation of India

AGGRIEVED by the order in C. C. No. 158 of 2006 dated 28. 3. 2007 on the file of District Forum, Anantapur, the complainant preferred this appeal.

THE brief facts as set out in the complaint are that the husband of the complainant by name A. Chennaih obtained two insurance policies from opposite party for Rs. 25,000 and another for Rs. 1,00,000. The husband of the complainant died on 29/1/2006 in a motor accident and a case was also registered in Cr. No. 10 of 2006 of P. S. Uravakonda. After the death of the deceased, the complainant who is the nominee, approached the opposite party and requested to pay the amounts covered under the said two policies. The opposite party asked the complainant to produce the original driving licence of the policy-holder. The complainant expressed her inability to produce the driving licence as it was lost at the time of accident. The opposite party failed to pay the amount covered under the two policies. Therefore, the complainant got issued a legal notice to the opposite party and filed the complaint before the District Forum for appropriate relief. Opposite party filed counter admitting the two policies obtained by the husband of the complainant and stated that as per the FIR the life assured namely A. Chennaih died in a road accident on 29/1/2006 while driving the motor cycle and the complainant preferred claim under the said two policies. For considering accident benefit claim, the opposite party informed the complainant vide its letter dated 8/5/2006 to submit the driving licence of the deceased life assured, but the complainant has failed to produce the driving licence. Opposite party has not repudiated the claim and as soon as the driving licence is received from the complainant the claim of accident benefit will be considered by them. Hence the opposite party seeks dismissal of the complaint.

Based on the evidence adduced i. e. Exs. A1 to A6 and Exs. B1 to B3 and the pleadings put forward the District Forum dismissed the complaint.

THE learned Counsel for the appellant submitted that the deceased did not have a driving licence is violation of terms of policy is contrary to the settled principles of law and the same is liable to be set aside and that the District Forum failed to note that the accident occurred due to rash and negligent driving of the auto but not the deceased or his vehicle. Heard the Counsel for the appellant and also the respondent.

IT is the case of the appellant that the sum assured has been given but the accidental benefits have not been paid on both the policies which is amounting to Rs. 1,25,000. It is the case of the respondent that some material evidence to establish that it is an accident has to be produced by the appellant. On perusal of the material on record we observe that Ex. A3 which is the FIR with Crime No. 10/2006 was registered by Uravakonda P. S. has been filed. This establishes that it is an accident. Having paid the sum assured, the Insurance Company ought not to have withheld the accidental benefits relying on Section 10 (b) (4) which states that accidental benefits cannot be paid for any breach of law. The learned Counsel for the appellant relied on the decision in 2000 (1) ALD (Cons.) 42, in which it was held that if there is any breach of law the burden of proof lies on the Insurance Company to establish their case. In the instant case the accident has already been established. Therefore, the act of the Insurance Company in not paying the insurance amount amounts to deficiency of service. We direct the Insurance Company to pay the accidental benefits of Rs. 1,25,000 towards both the policies together with compensation of Rs. 5,000 and costs of Rs. 2,000. In the result the appeal is allowed directing the respondent/opposite party to pay Rs. 1,25,000 towards both the policies together with compensation of Rs. 5,000 and costs of Rs. 2,000. Time for compliance six weeks. Appeal allowed.