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2008(2) CPR 239(NC)
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI
M.B. Shah, President and R.C. Jain, Member
Life Insurance Corporation of India —Petitioner
versus
Smt. Ratan Kaur —Respondent
Revision Petition No. 2522 of 2005
Decided on 29.2.2008
Counsel for the Parties:
For the Petitioner:Mr. M.P. Bendre, Advocate
For the Respondent:Mr. Manish Gvatkar, Advocate
IMPORTANT POINT
If the terms of the policy are vague, it should be interpreted for the benefit of the assured as it would serve the purpose and object of getting insurance coverage.
Headnote:Consumer Protection Act, 1986—Sections 12 and 17—Insurance claim—Double accident benefit under policy denied on ground that deceased had no driving licence at the time of accident and was driving vehicle in rash and negligent manner—Deceased insured was driving two wheeler scooter which slipped and victim sustained injuries—District Forum allowed complaint and order was upheld by State Commission in appeal—Revision—Policy clause provided that if accidental death occurred as a result of “the life assured committing any breach of law” he will not be entitled to accident benefit—Expression “committing any breach of law” was not specific and was vague—Clause could be attracted only where it has established that life assured had died pursuant to his own act of commission or omission which would have made him liable for penal offence had he survived—Concurrent findings by Forums that there was no rash and negligent driving by deceased—Deceased had valid driving licence—No reason to interfere with order. (Paras 6 to 9)
Result: Revision dismissed.
R.C. Jain, Member—This Revision Petition raises an important question in regard to the meaning and effect which is to be given to the Exclusion Clause “If the disability or death of the insured results from the Life Assured “committing any breach of Law”’ appearing in Condition No. 10.2(b)(iv) of the conditions of the insurance policy.
2. The petitioner Life Insurance Corporation of India(in short ‘Insurance Company) has filed this Revision Petition against the order dated 14th March, 2005 passed by the Consumer Disputes Redressal Commission Maharashtra State(in short the ‘State Commission’), whereby the State Commission has dismissed the appeal filed by the Insurance Company against the order dated 10th January, 2005 passed by the District Consumer Forum Amravati(in short the ‘District Forum’).
3. The facts leading to the present revision petition are in a narrow compass. One Mr. Narendra Singh Sahni(deceased) husband of Smt. Ratan Kaur, present respondent in these proceedings had taken three double benefit insurance policies in the total sum of Rs. 1,50,000/-. Mr. Narendra Singh Sahni died on 5.1.2001, when he was driving a two wheeler scooter as the scooter had slipped and he had a fall and sustained fatal head injury. Admittedly, the policy was in force on that date. Respondents lodged the claim with the insurance company. The insurance company paid a sum of Rs. 1,50,000 to the respondent, but refused to extend the double accident benefit to her primarily on the grounds that the deceased had no driving license at the time of the accident and the deceased was driving the vehicle in question in a rash and negligent manner. Dissatisfied with the stand of the insurance company, the respondent filed complaint No. 90/2001 before the District Forum. The Insurance Company resisted the complaint on the same grounds on which it had repudiated the claim earlier. However, the District Forum on a consideration of the facts, circumstances and the material brought before it, allowed the claim of the complainant-respondent with interest besides awarding Rs. 1,000/- as costs. Aggrieved by the order, Insurance Company filed appeal before the State Commission but without success, State Commission upholding the order of District Forum in its totality. Hence this revision petition.
4. We have heard Mr. M.P. Bendre and Mr. Manish Gvatkar, learned counsel for the parties, have considered their submissions and have gone through the material on record. Learned counsel for petitioner-Insurance Company has strongly contended before us that the claim of the respondent for double benefit is not tenable because it falls under the Exclusion(iv) Clause of Condition No. 10-2 relating to the Accident Benefit which reads as under:-
“10-2 Accident Benefit: If at any time when this Policy is in force for the full sum assured, the Life Assured before the expiry of the period for which the premium is payable or before the policy anniversary on which the age nearer birthday of the Life Assured is 70, whichever is earlier is involved in an accident resulting in either permanent disability as hereinafter defined or death and the same is proved to the satisfaction of the Corporation the Corporation agrees in the case of:-
(a) Disability to the Life Assured(i) to pay in monthly instalments spread over 10 years an additional sum equal to the Sum Assured under this Policy. If the policy becomes a claim before the expiry of the said period of 10 years, the disability benefit instalments which have not fallen due will be paid alongwith the claim.(ii) to waive the payment of future premiums.
The maximum aggregate limit of assurance under all policies on the same life to which benefits(i) and(ii) above apply shall not in any event exceed Rs. 5,00,000/-. If, there be more policies than one and if the total assurance exceed Rs. 5,00,000/- the benefits shall apply to the first Rs. 5,00,000/- assured in order of date of the policy issued.
The waiver of premium shall extin
