Research › Search › Judgment

J&K High Court · body

2017 DIGILAW 466 (JK)

Ghulam Mohd. Khandey v. Oriental Insurance Co.

2017-07-27

SANJEEV KUMAR

body2017
JUDGMENT : 1. In this petition the petitioner has called in question order dated 28.01.2015 passed by the Jammu & Kashmir State Consumer Disputes Redressal Commission (hereinafter referred to as the State Consumer Commission, for short), whereby appeal preferred by the respondent-Company against the award of District Forum, Jammu dated 27.09.2012 passed in complaint titled Ghulam Mohd. Khandey v. Oriental Insurance Co. has been allowed and order of the District Forum constituted under the Consumer Protection Act, set aside. 2. Facts of the case, as narrated by the petitioner in this petition, are that the petitioner was owner of a Maruti Car bearing registration No.JK02P-3894. He had obtained an insurance policy in respect of the aforesaid vehicle i.e. Policy No.546/2005, which was valid for a period of one year w.e.f. 18.05.2005 to 17.05.2005. The petitioner claims that at the time of issuance of insurance policy, respondent-Insurance Company had charged an additional premium of Rs.100/- from the petitioner for extending personal accident cover to the petitioner. It is submitted that on 04.06.2004 when the petitioner was coming from Kishtwar to Jammu in his Maruti Car along with his PSO, which was being driven by Gh. Mohidin, the driver of the petitioner, it met with an accident near Karni Nallah By Pass resulting in damage to the vehicle as well as serious injuries to the petitioner. The petitioner was immediately shifted to Govt. Medical College, Jammu for treatment where he remained admitted till 17.06.2004. The petitioner claims that he was operated twice and remained as indoor patient for more than six months. It is further submitted that the intimation of the accident was given to the Police Station, Nagrota as well as to the respondent-Company. It is also alleged by the petitioner that on account of grievous injuries sustained by him he incurred an amount of Rs.2.50 lakh on medical and other ancillary expenses, therefore, grievance of the petitioner is that despite intimation to the respondent-Company with regard to the occurrence and the grievous injuries sustained by the petitioner, the latter did not reimburse the loss sustained by the petitioner. Feeling aggrieved of the failure of the respondent-Company to provide service and indemnify the petitioner for the loss suffered by him, a complaint was filed before the District Forum, Jammu. Feeling aggrieved of the failure of the respondent-Company to provide service and indemnify the petitioner for the loss suffered by him, a complaint was filed before the District Forum, Jammu. The District Forum, Jammu put the respondent-Company on notice and after considering the claim and counter claim of the parties to the complaint, passed its award dated 27.09.2012 whereby respondent-Company was directed to pay a sum of Rs.2,50 lakh along with interest @ 9% for the medical expenditures and Rs.10,000/- for forced litigation. The respondent-Company feeling aggrieved of the award passed by the District Forum filed an appeal before the State Consumer Commission, which was allowed by the Commission vide its order dated 28.01.2015. 3. As is apparent from the perusal of the order impugned, the appeal was accepted and the award made by the District Forum dated 27.09.2012 was set aside on the ground that the policy of Insurance only covered personal injury of owner-driver, which according to the policy specifications would mean that person injured must be the registered owner of the vehicle possessing effective driving license and that the petitioner was though registered owner travelling in the Car was not possessed of driving license and therefore, incompetent to drive. Claim of the petitioner was also rejected yet on another ground that even in case of injuries covered under the insurance policy, the insurer’s liability only extends to death or an injury causing death or loss of limb, eyes and permanent disablement within six months of the accident only, which, as found by the learned State Consumer Commission was not the case with the petitioner, who had suffered some injuries but not grievous injuries as aforesaid. On these two grounds the claim lodged by the petitioner was not found tenable. Accordingly, the appeal was allowed and the award of the District Forum was set aside. 4. The petitioner is aggrieved of the order passed by the State Consumer Commission and has assailed the same, inter alia, on the following grounds:- a. State Consumer Commission did not appreciate the applicability of GR-36-B of Indian Tariff Act, which governed the field and placed wrong reliance on GR-36-A of the aforesaid Act, which was pressed into service by the respondent-Company. The order impugned, therefore, suffers from legal infirmity, inasmuch as the State Consumer Commission has failed to appreciate the distinction between the two provisions of the Indian Tariff Act. The order impugned, therefore, suffers from legal infirmity, inasmuch as the State Consumer Commission has failed to appreciate the distinction between the two provisions of the Indian Tariff Act. b. The Insurance Policy did not contain any exclusion clause nor the same was ever communicated or disclosed to the petitioner at the time of insuring the vehicle. That being the case, respondent-Company was not entitled in law to take the plea that owner of the vehicle, not possessing valid driving license, was excluded from the personal accident cover extended by virtue of the Insurance Policy in question. 5. Per contra, learned counsel for the respondent-Company while supporting the order impugned passed by the State Consumer Commission has submitted that the personal accident cover extended by virtue of Insurance Policy in question was only for owner-driver of the vehicle insured. Learned counsel appearing for the respondent-Company, therefore, submitted that it is only the owner, who sustains injuries while driving the insured vehicle himself is entitled to be indemnified under the policy and not the owner, who was neither driving the vehicle nor was even possessed of valid driving license. The owner of the vehicle, as contended by the learned counsel for the respondent-Company, who was not himself driving the vehicle and was not possessed of any valid driving license, was not covered by the policy. Therefore, the State Consumer Commission committed no illegality in accepting the appeal of the respondent-Company and setting aside the award of the District Forum passed on totally wrong premise and without appreciating the terms and conditions of the Insurance Policy. 6. From the perusal of the order impugned, it is abundantly clear that the claim of the petitioner was found to be untenable by the State Consumer Commission on the ground that the same was not covered under the Policy of Insurance. A bare look on the policy, which has been placed on record by the petitioner himself, would reveal that besides paying premium for insurance of vehicle for its damage, Rs.100/- had been paid by the petitioner for extending personal accident cover to the owner-driver of the vehicle as well. It is not in dispute that the petitioner is owner of the vehicle insured and therefore, he was fully insured for any risk/injuries to his person, which he might incur while driving his own vehicle. 7. It is not in dispute that the petitioner is owner of the vehicle insured and therefore, he was fully insured for any risk/injuries to his person, which he might incur while driving his own vehicle. 7. That apart, Insurance Policy which refers to personal accident cover for owner-driver also makes reference to Section III of the Policy, which, inter alia, provides the terms and conditions of personal accident cover for owner-driver, which for facility of reference is reproduced hereunder:- “SECTION-III: PERSONAL ACCIDETN COVER FOR OWNER-DRIVER Name of the Nominee Age Name of the Appointee (If nominee is minor) Relationship The Company undertakes to pay compensation as per the following scale for bodily injury/death sustained by the owner-driver of the vehicle, in direct connection with the vehicle insured or whilst driving or mounting into/dismounting from the vehicle insured or whilst traveling in it as a co-driver, caused by violent accident external and visible means which independent of any other cause shall within six calendar months of such injury result in: Nature of injury Scale of compensation (i) Death 100% (ii) Loss of two limbs or sight of two eyes or one limb and sight of one eye 100% (iii) Loss of one limb or sight of one eye 50% (iv) Permanent total disablement from injuries other than named above Provided always that A. compensation shall be payable under only one of the items (i) to (iv) above in respect of the owner-driver arising out of any one occurrence and the total liability of the insurer shall not in the aggregate exceed the sum of Rs.2 lakhs during any one period of insurance. B. No compensation shall be payable in respect of death or bodily injury directly or indirectly wholly or in part arising or resulting from or traceable to (a) intentional self injury suicide or attempted suicide physical defect or infirmity or (b) an accident happening whilst such person is under the influence of intoxicating liquor or drugs. C. Such compensation shall be payable directly to the insured or to his/her legal representatives whose receipt shall be the full discharge in respect of the injury to the insured. This cover is subject to – (a) the owner-driver is the registered owner of the vehicle insured herein. (b) the owner-driver is the insured named in this policy. C. Such compensation shall be payable directly to the insured or to his/her legal representatives whose receipt shall be the full discharge in respect of the injury to the insured. This cover is subject to – (a) the owner-driver is the registered owner of the vehicle insured herein. (b) the owner-driver is the insured named in this policy. (c) the owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicles Rules, 1989, at the time of the accident." It is, thus, clear that under the policy of Insurance in question the owner-driver was extended the personal accident cover subject to certain terms and conditions viz. (a) the owner-driver is the registered owner of the vehicle insured, (b) the owner-driver is the insured named in the policy; and (c) the owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicles Rules, 1989, at the time of the accident. It also provides for personal accident cover of the accident only in cases where injuries suffered by the insured is death, loss of two limbs or sight of two eyes or one limb and sight of one eye, loss of one limb or sight of one eye, permanent total disablement from injuries other than the above named injuries. 8. Admittedly, at the time of accident the petitioner was not driving the insured vehicle, owned by him, which was being driven by another driver engaged by him for the purpose. It is also admitted that the petitioner was not holding any valid driving license and therefore, was not competent to drive the vehicle and thus, not driver in the legal sense. It is also not in dispute that the injuries suffered by the petitioner are not those, which are incorporated in Section III of the Insurance Policy obtained by the petitioner. Therefore, the State Consumer Commission was right in arriving at the conclusion that the claim put forth by the petitioner through the medium of his complaint was not covered by the Insurance Policy, therefore, untenable in law. 9. Contention of the petitioner that the State Consumer Commission did not appreciate the distinction between GR -36-A and GR-36-B is also devoid of any merit and therefore, rejected. 9. Contention of the petitioner that the State Consumer Commission did not appreciate the distinction between GR -36-A and GR-36-B is also devoid of any merit and therefore, rejected. A reference to GR-36-A would make it crystal clear that the personal accident cover for owner-driver of the insurance vehicle is compulsory and who is “owner-driver” for the purpose of this Section has also been explained by providing that the owner of the insured vehicle holding effective driving license would be termed as owner-driver. That being the position, it was GR-36-A which was attracted in the case and not GR-36-B, which provided for optional personal accident cover for persons other than owner-driver. The aforesaid fact is fully substantiated by the bare stipulation contained in the insurance policy relied upon by the petitioner. 10. Learned counsel for the petitioner relied upon a judgment of the Hon’ble the Supreme Court passed in the case of M/s Mordern Insulators Ltd. V. The Oriental Insurance Co. Ltd.; 2000(2) SCC 734 to contend that the exclusion clause, which is neither a part of the contract of insurance nor disclosed to the insured, cannot be relied upon by the Insurance-Company to deny the claim of the insured. From the facts of this case, as narrated above, the judgment aforesaid is not applicable, which has been passed by the Supreme Court in a totally different context. Here in the case in hand the respondent is not relying on any exclusion Clause, rather there is express stipulation in the Insurance Policy, whereby the personal accident cover has been extended only to the owner-driver subject to the terms and conditions contained in Section III of the Insurance Policy. 11. On the other hand, learned counsel for the respondent-Company has placed reliance upon a judgment of this Court passed in the case of Bajaj Allianz General Insurance Company Ltd. V. Balwlant Raj and others, 2017 AAC 121 (J&K), wherein similar plea, as is raised by the petitioner in this case, was rejected by this Court. In paragraph No.15 of the aforesaid judgment, this Court rejected the plea of the respondent in somewhat similar circumstances. For facility of reference paragraph No.15 is reproduced as under:- “15. The other plea is that the policy covers owner-driver and, therefore, since the deceased has stepped into the shoes of the owner, the claim is maintainable. That plea also cannot be justified. For facility of reference paragraph No.15 is reproduced as under:- “15. The other plea is that the policy covers owner-driver and, therefore, since the deceased has stepped into the shoes of the owner, the claim is maintainable. That plea also cannot be justified. “Section III-Personal Accident Cover for owner-Driver” of Insurance Policy reads as follows: “1. This cover is subject to (a) The owner-driver is the registered owner of the vehicle insured herein; (b) The owner driver is the insured named in this policy; (c) the owner-driver holds an effective driving license, in accordance with the provision of Rule 3 of the Central Motor Vehicles Rules, 1989, at the time of the accident.” 12. Viewed thus, claim lodged by the petitioner with the Insurance Company is not found covered by the expressed terms and conditions of the Insurance Policy. Therefore, the District Forum constituted under the provisions of J&K Consumer Protection Act, 1987 fell in error in allowing the claim and therefore, the judgment impugned passed by the State Consumer Commission is correct in law and does not call for any interference by this Court. 13. In view of the foregoing analysis, this petition is found to be without any merit, hence dismissed.