Dr. Inder Jit Singh, Presiding Member

This Second Appeal has been preferred by the Appellant against the impugned order dated 18.05.2023 passed by the State Commission in FA/60/2023. The State Commission dismissed the Appeal filed by the Appellant Insurance Company and confirmed the order dated 23.11.2022 passed by the District Commission in Complaint No. 133/2021.

2. The Appellant herein (hereafter referred to as Insurance Company) was Appellant before the State Commission and Opposite Party before the District Commission. The Respondent herein (hereinafter referred to as Complainant) was Respondent before the State Commission and Complainant before the District Commission.

3. The brief facts of the case, as presented by the Appellant and as emerged from the SA, orders of the State Commission, District Commission and from the Complaint are:

The Respondent/Complainant's husband Mr. Bipinbhai Natvarbhai Vasava took a Two-wheeler Policy valid for the period from 25.10.2020 to 24.10.2021 from the Appellant/Insurance Company. The said policy also provided a personal accident cover for the owner driver for a sum assured of Rs. 15,00,000/-. On 11.06.2021 the insured met with an accident and died due to the injuries sustained in the said accident. After the accident, the vehicle was stolen from the accident spot. The Complainant lodged a claim for theft of the subject vehicle, which was stolen from the accident spot. The claim was repudiated by the Insurance Company on the ground of delay in intimation of claim by 45 days to the Insurance Company and 6 days to the police and no claim was lodged with regard to the personal accident cover on account death of the insured and no documents for processing the claim were filed under the personal accident cover. Hence, the complainant/wife of insured filed consumer complaint No. 133/2021 before the District Commission.

4. The District Commission vide its order dated 23.11.2022, partly allowed the complaint No. 133/2021.

5. Aggrieved by the order dated 23.11.2022 passed by the District Commission, the Appellant Insurance Company preferred Appeal before the State Commission. The State Commission vide order dated 18.05.2023 dismissed the Appeal at admissions stage and confirmed the order passed by the District Commission.

6. The Appellant has filed the Second Appeal before this Commission on the following grounds:

                   i) The substantial questions of law arise that (a) whether the Appellant Insurance Company could be held guilty of deficiency in service in not settling the Personal Accident Claim when no claim for personal accident was lodged by the complainant and no documents were submitted for processing the said claim (b) whether the impugned judgment and order is contrary to the binding precedents of Hon'ble Supreme Court on the issues involved in the present case.

                   ii) Both the Fora below have erred in holding that the Appellant was guilty of deficiency in service. The State Commission cast the burden of proof on the Appellant Insurance Company to prove that the breach of policy condition is so fundamental so as to have contributed to the cause of accident.

                   iii) State Commission failed to appreciate that it was not only a case of breach of policy terms and conditions but the DLA did not even meet the eligibility criterial for being entitled to the benefit of Personal Accident cover.

                   iv) The State Commission has committed jurisdictional error in passing the impugned order contrary to Section III-C of the policy terms and conditions. The State Commission committed an error in not appreciating that all the three requisite conditions mentioned in under Section III-C(l) should have been fulfilled for grant of the said claim but the same were not fulfilled in the present case. It is also an admitted position on record that the DLA was not holding a valid driving license at the time of accident as was also observed by the State Commission in para 13 of its order. Hence, the claim of Personal Accident and the complaint ought to have been dismissed.

                   v) The State Commission committed error in placing reliance on the judgments mentioned in the impugned order. The said judgments are not applicable to the facts of the present case. In support of its case the Appellant/Insurance Company has relied upon the following judgments:

                   a) National Insurance Co. Ltd. Vs. Sarita Devi & Others, RP No. 2840/2010 decided on 27.01.2016 by the National Commission.

                   b) Oriental Insurance Co. Ltd. Vs. Sony Cheriyan (1999) 6 SCC 451.

                   c) Ravneet Singh Bagga Vs. KLM Royal Dutch Airlines (2000) 1 SCC 66.

                   d) SGS India Ltd. Vs. Dolphin Internal Ltd. Civil Appeal No. 5759 of 2009 decided on October 06, 2021.

7. During the hearing on 16.09.2025, the Counsel for the Appellant argued that it was a comprehensive insurance policy covering risk to the vehicle as well as personal accident cover for the owner driver. Claim filed was only with respect to the theft of the vehicle and no claim was filed with respect to personal accident. Claim with respect to the theft was also repudiated which subsequently went before the District Commission in a separate consumer complaint which was allowed and the Insurance Company have implemented that order of the District Commission. The present case pertains to claim allowed by the District Commission and Appeal filed by the Appellant herein having been dismissed with respect to personal accident claim. There is no repudiation letter with respect to this claim. Counsel representing the Appellant herein argued that there are certain conditions to be met for the claim to be eligible for personal accident cover and one of these conditions is that owner Driver should have effective driving license, which in the present case is missing. District Commission and State Commission taking into all these facts have allowed the claim on non-standard basis. Counsel for the Appellant also placed on record copies of the following judgments of this Commission:

                   a) Sharda Bai Vs. Liberty Videocon Gen. Ins. Co. Itd. and Ors- RP No. 2086 of 2016 decided on 03.03.2017

                   b) Roshani Devi and Ors. Vs. National Ins.Co. Ltd. - RP No. 4569 of 2014 decided on 15.01.2025.

8. Appellant Insurance Company raised similar issue before the State Commission also. As regard contention that no claim was filed for the personal accident and requisite documents were not submitted, State Commission observed as follows:

                   "7.3 It is true that complainant has lodged the claim for theft of vehicle and had not lodged the claim with the opponent for personal accident. The complainant has produced with the complaint panchnama of the place of accident, inquest panchnama of the deceased, the PM report of the LA, RC book of the vehicle and the insurance policy."

As regards contentions of the insured not having a valid driving license, State Commission observed as follows:

                   "8. No driving license- award on non-standaid basis

                   8.1 It is the contention of the appellant that the insured was driving the vehicle without a driving license which is a material breach of condition. There is a specific exclusion and/or exception incorporated in the policy which reads as under:

                   Section III- Personal accident cover for owner-driver

                   This cover is subject to:

                   C) the owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicle Rules, 1989, at the time of the accident.

                   Also it has been contended that the general exception, "Driving Clause" in the policy schedule reads as under:

                   "Person or classes of persons entitled to drive - Any person including the insured provided that a person driving holds and effective driving license at the time of the accident."

                   8.2 The appellant has further contended that as the LA did not have a driving license there is violation of Section 3 and 5 of the Motor Vehicles Act. The appellant has submitted that the Ld. District Commission has erred in awarding the amount on non-standard basis.

                   8.3 The appellant vide page no. 73 made application to the Commission to direct the complainant to produce valid driving license of the life assured.

                   8.4 . As per the contention of the opponent, the complainant has not been able to provide driving license of the LA and therefore there is a breach of policy condition and the complainant is not entitled to any claim.

9. On perusal of the FIR on page 24, it is stated that the LA was driving the insured vehicle GJ-16-DA-4915 and while approaching Solarizam, one long truck like vehicle hit the LA's vehicle and LA sustained severe injuries and was taken by 108 to Amod Government Hospital where the Doctor declared the LA dead. This proves that there was a collision, as two vehicles were involved in the accident."

                   Referring on various judgments[New India Assurance Co Ltd. Vs. Krishnappa on 23 June, 2020 in M.F.A. No. 7960 of 2013 (MV-D) decided by Karnataka High Court; Shri Ram Gen. Ins. Co. Ltd. Vs. Kamiesh, IV (2019) CPJ186 (NC).], the State Commission observed as follows:

                   "11. From the findings in the above referred judgments, it can be inferred that in order for the insurance company to avoid its liability, it has to prove that the breach of policy condition is so fundamental so as to have contributed to the cause of accident. In the instant case, the appellant insurance company has not led any evidence to establish this. The appellant has not been able to demonstrate a nexus between the absence of the Driving license of the LA and the accident and that the LA has driven the vehicle in a rash and negligent manner and caused the accident.

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                   13. This commission is of considered view that it is an admitted position that LA did not have a valid driving license. Thus there is a breach of the provision of the policy and of Section 3 and 5 of Motor Vehicle Act. Therefore as per the guidelines laid down in New India Assurance Company Limited vs Naraya Prasad Appaprasad Pathak (supra), the complainant is entitled to an award of 75% of the sum insured. Ld. District Commission has awarded 75% of the claim. The order of the Ld. District Commission is just, fair and reasonable and it's requires no interference. Therefore we confirm the order of the Ld. District Commission. Hence in the interest of justice, following order is passed."

9. Both the Fora below have given concurrent findings against the Appellant Insurance Company. The Scope in a Second Appeal is limited. Section 51(2) envisage a Second Appeal if it involves a substantial question of law. What constitutes substantial question of law and how it differs from mere question of law has been elaborated by the Hon'ble Supreme Court in Chandrabhan (deceased ) Through Legal Representatives and Others Vs. Saraswati and Others (2022) 20 SCC 199. We have carefully gone through the orders of State Commission, District Commission, other relevant records and contentions of the insurance Company in the light of various judgments relied upon by the State Commission and the Appellant herein and are of the considered view that State Commission has passed a well-reasoned order and we see no reason to interfere with its findings. There is no illegality or material irregularity in the orders of the State Commission. The case involves no substantial question of law. Hence, the order of the State Commission is upheld. Accordingly, Second Appeal 604 of 2025 is dismissed.

10. Pending IAs, if any, in the case also stand disposed off.