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LIC’s refusal to pay double accident benefits upheld, as the vehicle was being driven in contravention of the MV Act.

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI

REVISION PETITION NO. 1406 OF 2012
(Against the Order dated 16/12/2011 in Appeal No. 1245/2010 of the State Commission Gujarat)

BHANUBEN VALJIBHAI,
AMBALIYA MOTHER & LEGAL HEIR
OF DECEASED
DAXAY VALJIBHAI AMBALIYA ...........Petitioner(s)
Versus
LIC OF INDIA
Rajkot Divisional Officer,
Jeevan Prakash,Tagore Road,
Rajkot – 360001 Gujarat ...........Respondent(s)

BEFORE:
    HON'BLE MRS. REKHA GUPTA, PRESIDING MEMBER

Dated : 04 Dec 2017

ORDER

        The present revision petition has been filed against the judgment dated 16.12.2011 of the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad (‘the State Commission’) in Appeal no. 1245 of 2011.

2.     The facts of the case as per the original complainant/ petitioner are that the deceased Dakshay Valjibhai Ambliya had taken ‘Bima Gold Policy with double accident benefits’, from the respondent/ LIC with sum insured at Rs.5.00 lakh and the policy number was 813075506. The said policy was valid from 28.03.2006 to 27.03.2021. The deceased policy holder expired on 30.09.2006 due to injuries caused in a vehicular accident on 12.09.2006 and as the petitioner was the legal heir of the deceased policy holder, she filed a claim before the respondent seeking payment of benefits available under the aforesaid policy. The respondent had made the payment for single benefit under the said policy. However, the double benefit (i.e., accidental death benefit) was rejected vide letter dated 26.06.2007 on the ground that the policy holder had committed breach of law. The petitioner called upon the respondent/ LIC vide notice dated 23.07.2007 to pay the benefits under the said policy. However, since the respondent had shown deficiency in service by not paying the amount, accordingly, a complaint was filed before the Consumer Disputes Redressal Forum, Rajkot District with the following prayer:

•   The respondent be directed to pay Rs.5,00,000/- with interest at the rate of 18% per annum towards double benefit amount of insurance policy from the date of accident till date of payment;
•   The respondent be directed to pay Rs.50,000/- towards pain, shock and suffering suffered by the petitioner on account of not paying the genuine claim within time;
•   The respondent be directed to pay Rs.10,000/- towards the cost of the legal proceedings and advocate fees; and
•   Any other relief which District Forum may deem fit to grant.

3.     The respondent/ LIC in their written statement had stated that the deceased policy holder was holding a learning licence. At the time of the accident, the deceased was driving the vehicle in breach of the provisions of the Motor Vehicle Rules 1989. As per their defence, in terms of Rule 3 of Central Motor Vehicle Rules 1989, any person holding the learning licence was prohibited or restricted from driving vehicle except in the event when alongside any person holding a legal licence and ‘‘L’ plate is affixed on the front portion and on the rear side of the vehicle. The claim of the petitioner was rejected since the deceased policy holder was driving the vehicle without a pillion rider holding a valid legal licence and thereby committed breach of clause 10 (b) (4) of the terms and conditions of the policy. If the claim is rejected under the terms and conditions of the policy, it cannot be said to be deficiency in service and therefore, the complaint is liable to be dismissed.

4.     The District Consumer Disputes Redressal Forum, Rajkot (‘the District Forum’) vide its order dated 9th April 2010 while allowing the complaint gave the following order:

•   The present complaint of the complainants is hereby allowed;

•   The opponent is hereby ordered and directed to pay to the complainant double accident benefit in tune of Rs.5.00 lakh with interest at the rate of 9% per annum from the date of filing of the complaint, i.e., 11.06.2008 till its realisation within 30 days from the date of order;

•   The opponent is hereby further ordered and directed to pay to the complainant Rs.10,000/- towards mental harassment and Rs.5,000/- towards the cost of the complaint within 30 days from the date of order.

5.     Aggrieved by the order of the District Forum, the respondent/LIC filed an appeal before the State Commission. The State Commission while allowing the appeal has set aside the order of the District Forum and observed as under:

“There is no dispute that the policy holder, at the relevant point of time, was holding learning licence and he had expired in a vehicular accident. Learned Advocate of the opponent, at the time of his arguments, had drawn our attention towards the terms and conditions of the Bima Gold Policy wherein one such condition is that – 10 (b) (4) – if any policy holder commits breach of any law, then the company or corporation is not responsible for payment of assured sum under the policy. As aforesaid, the deceased policy holder was holding learning licence only and the same was subject to conditions mentioned in paragraph 4 thereof. It is not her case that when the deceased policy holder was driving the vehicle, there was any person holding valid licence or a pillion rider with him. The learned Forum has been carried away with the fact that the aforesaid act is not punishable under any law or M V Act. But under Section 177 of the Motor Vehicle Act 1988, if any person commits breach of any provision of aforesaid act or the rules framed thereunder, the same is punishable. In the case of United India Insurance Co. Ltd., vs Lilabhai, reported in 2007 ACJ 1534 also, the driver of the vehicle was holding learning licence and when dashed to the guard stone, the pillion rider received injuries and the said pillion rider was not holding licence and the Hon’ble Mumbai High Court held that the insurance company was not responsible for making payment of sum assured under the policy and also held that while the person holding learning licence drives the vehicle, a pillion rider holding the legal licence should accompany him. Recently, Gujarat State Commission has also take the similar view as aforesaid in Appeal no. 1373 of 2010 (Coram : Justice R P Dholakia – Decided on 17.03.2011) and when the deceased policy holder who was holding learning licence but while driving the rickshaw, was not accompanied with by a person holding permanent licence as required, the judgment rendered by the learned Consumer Disputes Redressal Forum, Kutch District was upheld.

In our opinion, the learned Forum has not taken into consideration the aforesaid facts of law and has also not considered properly the ratio decided and arrived at in the said decisions and therefore, the judgment of the learned Forum is not proper and just and since it is necessary to interfere in the same, appeal is allowed and following final order is being passed:

Order

1.   Appeal is allowed;

1.   Order dated 09.04.2010 passed in Consumer Complaint no. 150 of 2008 by the Consumer Disputes Redressal Forum, Rajkot District is hereby quashed and set aside and in the result, complaint is hereby dismissed;
2.   As per the submissions of advocate for the appellant, they have deposited with the Registry of this Commission Rs.2,57,500/- as directed by this Commission. After verifying the correctness in that regard an account payee cheque for the amount which is deposited together with interest accrued thereon shall be given to the advocate for the appellant in this case for the purpose of handing over the same to the appellant.
3.   No order as to costs of appeal”.

6.     Hence, the present revision petition.

7.     I have heard the learned counsel for the parties. Learned counsel for the petitioner has stated that the State Commission has misdirected itself to a strict construction of the said exclusion clause particularly when the said clause required a causal connection between the breach of law and the accidental death, i.e., nexus between the absence of pillion rider and the accidental death. He further stated that the exclusion clause were vague and it is therefore, void. Counsel for the respondent on the other hand drew my attention to the exclusion clause which reads as under:

“(b)   Death of the life assured: - In addition to sum assured under Basic Plan, an additional sum equal to the accident Benefit Sum assured under this policy, if the life assured shall sustain any bodily injury resulting solely and directly from the accident caused by outward, violent and visible means and such injury shall within 180 days of the occurrence solely, directly and independently of all other causes result in death of the life assured. However, such additional sum payable in respect of this policy shall not in any event exceed Rs.50 lakh taking all existing policies of the Life Assured and under individual as well as group schemes including policies with in built accident benefit taken with Life Insurance Corporation of India and other insurance companies.

The corporation will not liable to pay the additional sum referred in (a) or (b) above, if the disability or the death of the Life Assured shall:

1.   Be caused by intentional self-injury, attempted suicide, insanity or immorality or whilst the life assured is under the influence of intoxicating liquor, drug or narcotic, or ;

1.   Take place as a result of accident while the life assured is engaged in aviation or aeronautics in any capacity other than that of a fare paying, part paying or non-paying passenger in any aircraft which is authorised by the relevant regulations, to carry such passengers and flying between established aerodromes, the life assured having at that time no duties on board the aircraft or requiring descent therefrom;

2.   Be caused by injuries, resulting from riots, civil commotion, rebellion, war (whether war be declared or not), invasion, hunting, mountaineering, steeplechasing or racing of any kind or;

3.   Result from the life assured committing any breach of law; or

4.   Arise from employment of the life assured in the armed forces or military service of any country at war (whether war be declared or not) or from being engaged in policy duty in any military, naval or policy organisation.

8.     Section 3 of the Motor Vehicles Act, 1988 reads as under:

3.        Necessity for driving licence. - (1) No person shall drive a motor vehicle in any public place unless he holds an effective driving licence issued to him authorising him to drive the vehicle ; and no person shall so drive a transport vehicle [other than [ a motor cab or motor cycle] hired for his own use or rented under any scheme made under sub - section (2) of section 75] unless his driving licence specifically entitles him so to do.

(2) The conditions subject to which sub-section (1) shall not apply to a person receiving instructions in driving a motor vehicle shall be such as may be prescribed by the Central Government.

        Rule 3 of the Central Motor Vehicles Rules, 1989 reads as under:

3.     General.—The provisions of sub-section (1) of section 3 shall not apply to a person while receiving instructions or gaining experience in driving with the object of presenting himself for a test of competence to drive, so long as—

(a) such person is the holder of an effective learner's licence issued to him in Form 3 to drive the vehicle;

(b) such person is accompanied by an instructor holding an effective driving License to drive the vehicle and such instructor is sitting in such a position to control or stop the vehicle; and

(c) there is painted, in the front and the rear or the vehicle or on a plate or card affixed to the front and the rear, the letter "L" in red on a white background as under:—

Note.—The painting on the vehicle or on the plate or card shall not be less than 18 centimetres square and the letter "L" shall not be less than 10 centimetres high, 2 centimetres thick and 9 centimetres wide at the bottom:

Provided that a person, while receiving instructions or gaining experience in driving a motor cycle (with or without a side-car attached), shall not carry any other person on the motor cycle except for the purpose and in the manner referred to in clause (b).”

9.     Admittedly the deceased only had a learner’s licence and he was driving a motor cycle without a pillion rider having a regular licence. A joint reading of section 3 of the Motor Vehicles Act, 1988 and Rule 3 of the Central Motor Vehicles Rules, 1989 makes it clear that while there is an exception permitting a person who is holding an effective driving licence from driving the vehicle it is only while receiving instructions or gaining experience in driving with the object of presenting himself for a test of competence to drive. Further, as per Rule 3 (b) such a person has to be accompanied by an instructor holding an effective driving licence to drive the vehicle and such instructor should be sitting in such a position to control or stop the vehicle. In this case there was no instructor and no person holding an effective driving licence accompanying the deceased while he was driving the vehicle. There is a nexus between the violation of the Act and the Rules and the accident because as per the FIR, the deceased had been driving the motor cycle in a rash, negligent and careless manner endangering human life and had applied the brake suddenly for saving a cyclists due to which the motor cycle slipped and the deceased fell down and was dragged over the road resulting into grave cervical injuries in his neck and he died due to said injuries. In the said FIR there is no mention of any other person accompanying the deceased when the accident occurred. The FIR has been recorded by Mr Gajubha Son of Dilubha Rana, Police Head Constable, Police Station, Rajkot City.

10.    Learned counsel for the petitioner in support of his contention has drawn my attention to the judgment of this Commission in the case of LIC of India vs Ratan Kaur, decided on 29th February 2008. The facts of the case are not applicable to the case on hand.

11.    In view of the foregoing discussion, I find no jurisdictional error or material irregularity in the impugned order which may call for interference in exercise of powers under section 21 (b) of the Consumer Protection Act, 1986. Revision petition is, therefore, dismissed with no order as to costs.

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