Insurer fails to prove dead man’s driving licence was fake, widow wins Rs 15 lakh cover

Rs 275 premium

• The complainants are the legal heirs of the late Trilok Nath, and he was the registered owner-cum-driver of a vehicle.
• The vehicle was fully and comprehensively insured with the National Insurance Company (opposite party) for the period starting from November 24, 2020, to November 23, 2021.
• It is averred that Trilok Nath had paid a premium of Rs 275 specifically towards Owner-cum-Driver Personal Accident (PA) cover, which carried an assured sum of Rs 15 lakh in the event of accidental death.
• On January 30, 2021, during the subsistence of the policy, the insured vehicle met with a fatal accident in which Nath sustained grievous injuries and succumbed.
• In respect of this accident, a First Information Report (FIR) was registered on January 30, 2021, at Bharmour Police Station in Chamba.
• The complainants asserted that they submitted the claim to the insurance company along with all necessary documents, including a copy of the Parivar Register, registration certificate (RC), death certificate, and FIR.
• However, the insurance company failed to settle the PA claim despite a lapse of more than three years. The complainant has filed the plea alleging deficiency in service on the part of the insurance company.

Paper licence vs smart card

The National Insurance Company contested the complaint by taking preliminary objections of maintainability, cause of action, locus standi, limitation and concealment of material facts.

The insurer placed on record a letter from its insurance investigator, Mr Viketo G Kiba, stating that all driving licences in paper format were required to be converted to smart cards by April 30, 2018, pursuant to a notification issued in supersession of an earlier notification dated August 1, 2014.

It was submitted that the complaint was premature because the complainants never formally lodged the Personal Accident claim form.

It was contended that the complainants had not lodged the aforementioned form with the company with necessary signatures and mandatory documents, thereby depriving the insurer of an opportunity to process the claim.

Trilok Nath did not hold any valid and effective driving licence to drive the vehicle at the material date and time of the accident, it was alleged.

It was submitted that during the investigation, the police added Section 181 (driving without a valid licence) of the Motor Vehicles Act, 1988, to the charges, which categorically establishes that the departed was unlicensed.

They further relied upon a verification report of the driving licence, wherein the district transport officer (DTO), Nagaland, stated that the said driving licence was not found in the official records, and therefore, conveyed an inability to provide further information or verify the genuineness of the said licence.

Insurer failed to prove licence was fake

• The consumer court noted that the complainant, who was a widow of Trilok Nath, had produced the copy of his driving licence issued by the district transport officer, Nagaland.
• The commission observed that the driving licence was renewed up to April 26, 2022, and was issued on April 27, 2017.
• The widow also annexed a document wherein the DTO, Nagaland, had issued a certificate in respect of Nath’s licence.
• The commission said that the DTO expressed an inability to trace old paper-format records within their current system. This does not automatically render the physical licence produced by the complainant as fake or fabricated.
• It reiterated that it is a settled principle of law that the onus to conclusively prove that a driving licence is fake rests heavily on the insurance company.
• It was observed that the insurer had failed to adduce any positive, certified evidence from the licensing authority, directly invalidating or cancelling the licence, and that a statement of administrative inability to verify records due to systemic transitions cannot be equated with positive proof of forgery or fraud.
• The commission also highlighted that the unverified information relied upon by the insurance company lacks the statutory hallmarks of a certified copy under the Bharatiya Sakshya Adhiniyam (BSA), 2023, as it was devoid of the mandatory certificate at the foot attesting it to be a true copy, and fails to bear the clear official title, date, and authorised seal of the custodian of records.
• Consequently, the document produced by the opposite party could not be relied upon to discharge their heavy burden of proof, and more importantly, the complainant had placed on record a certified copy of the judgment and award passed by the Motor Accident Claims Tribunal (MACT), Chamba-II, which arose out of the very same accident.

MACT had evaluated evidence

The commission noted that the tribunal had already evaluated the evidence arising out of the same accident and concluded that the insurance company failed to discharge its onus to prove that Nath’s driving licence was invalid or fake.

The same finding binds the insurance company herein under the principles of issue estoppel (which prevents a person from going back on their word or contradicting their previous actions) and judicial consistency.

It was admitted that Trilok Nath had paid the requisite premium for a Compulsory Personal Accident cover to the tune of Rs 15 lakh.

Consequent to the findings above, the departed must be deemed to have held a valid and effective driving licence at the time of the accident. Therefore, the repudiation of the claim by the insurance company amounts to a clear deficiency in service, and the present complaint deserves to be allowed.

Accordingly, the insurer is directed to pay Rs 15 lakh to the complainant within 90 days from the date of receipt of a copy of this order, failing which, it will incur interest at 9 per cent per annum from the date of complaint till its realisation.

Consumer takeaway

The ruling underscores that an insurance company cannot deprive a consumer of their right to a claim when they have produced all the documents in favour of their case.

It highlights that the insurer failed to discharge its onus to prove that the deceased’s driving licence was invalid or fake; the same finding binds the insurer under the principles of issue estoppel and judicial consistency.

In this case, the commission directed the insurance company to grant the claim amount, reaffirming the consumer’s entitlement to redress the grievance of survival.

For consumer-related grievances, individuals may contact consumer helpline in their respective states (Himachal Pradesh helpline: 1800-180-8087) or call the National Consumer Helpline at 1915 for assistance.