Complaint No. IO/KCH/GI/11-003-030/2012-13
Subhadra
Vs
National Insurance Co. Ltd
The complainant’s deceased son was covered under Group PA policy taken by PNYS Chit Fund. He was covered for Rs. 1 Lac under two policies. He died in a road traffic accident while riding a motorcycle. The claim for the same was repudiated by the insurer on account of non-production of driving licence of the deceased and also contended that the insured committed breach of law with criminal intent. Therefore, the complaint.
The complainant submitted that the driving licence was lost in the accident and hence could not submit the same. The deceased had not contravened any of the provisions of the MV Act or any other law. The repudiation of the claim is against policy conditions.
The insurer submitted that the deceased was not holding valid driving licence and thereby, he had contravened the provision contained in the MV Act regarding driving licence. He rode the motor cycle with criminal intent. Thereby, he had violated exception Clause 5 of the policy conditions. The repudiation is legal and proper.
Decision:- A perusal of the terms and conditions of the Group policy would reveal that there is no stipulation that the policy conditions relating to PA Insurance (Individual) “policy are made applicable as far as the impugned policies are concerned. There is no specific provision in the terms and conditions of the disputed policy that in case of road traffic accident while the insured is driving a motor vehicle, the claimants must produce the driving licence of the insured. So, the closure of the claims on that ground can not be sustained based on the terms and conditions of the disputed policies.
In other words, there is no evidence that the accident took place on account of breach of law. Even while the insurer alleges breach of law with criminal intent, the criminal intent in riding the motor cycle in violation of MV Act is not revealed by the insurer. In an almost identical situation, Hon. HC of Kerala in Binoma Vs State of Kerala, 2013(3) KLT 172, after considering the policy conditions and other relevant documents, held that what has to be considered is not the cause for drowning but the cause for the death. So, cause of accident is irrelevant and cause of death is material.
