BEFORE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD
F.A.No.559 OF 2012 AGAINST C.C.NO.34 OF 2011 DISTRICT FORUM KARIMNAGAR
Between:
The Branch Manager,
Unique Mercantile India Pvt Ltd.,
1st Floor, Maruthi Complex, SBI Bldg.,
CVRN Road, Karimnagar
Appellant/opposite party no.1
A N D
1. Rachaveni Rajamma W/o Nambaiah
aged 44 years, Occ: Housewife
R/o Venkatraopalli Village, Julapalli Mandal
Karimnagar District
Respondent/complainant
2. United India Insurance Co.Ltd.,
Divisional Office-10, 10-5-5/4,
Crystal Plaza, 1st & 2nd Floors,
Banjara Hills Road, Masabtank
Hyderabad-28
Respondent/opposite party no.2
Counsel for the Appellants M/s K.Bhaskar Dev
Counsel for the Respondent M/s V.Gourisankara Rao(R1)
M/s N.J.Sunil Kumar (R2)
F.A.No.560 OF 2012 AGAINST C.C.NO.224 OF 2011
The Branch Manager,
Unique Mercantile India Pvt Ltd.,
1st Floor, Maruthi Complex, SBI Bldg.,
CVRN Road, Karimnagar
Appellant/opposite party no.3
A N D
1. Gopu Malla Reddy S/o G.Madhava Reddy
Aged 52 years, Occ: Agriculture
R/o Narsapur Village, Eligald Mandal
Karimnagar District
Respondent/complainant
2. The Branch Manager
MD India Health Care Service Pvt Ltd.,
Flat No.701 & 702, Topaz Building
Punjagutta, Hyderabad-54
3. The Divisional Manager,
United India Insurance Co.Ltd.,
501, Ganesh Plaza, Opp:Navarangpura
Bus Stand, Ahmedabad-009
Respondents/opposite parties No.1 & 2
Counsel for the Appellants M/s K.Bhaskar Dev
Counsel for the Respondent M/s M.Ramgopal Reddy(R1)
M/s N.Parameswara Reddy(R2&3)
F.A.No.561 OF 2012 AGAINST C.C.NO.225 OF 2011
Between:
The Branch Manager,
Unique Mercantile India Pvt Ltd.,
1st Floor, Maruthi Complex, SBI Bldg.,
CVRN Road, Karimnagar
Appellant/opposite party no.3
A N D
1. M.Laxmaiah S/o Mallaiah
aged 49 years, Occ: Agriculture
R/o Tellikunta Village, Julapalli Mandal
Karimnagar District
Respondent/complainant
2. The Divisional Manager
United India Insurance Co.Ltd.,
501, Ganesh Plaza, Opp.Navarangpura Bus Stand
Ahmedabad-009
3. The Branch Manager
MD India Health Care Service Pvt Ltd.,
Flat No.701 & 702, Topaz Building
Punjagutta, Hyderabad-54
Respondents/opposite parties no.1 & 2
4. M.Kanakamma W/o late Laxmaiah
aged 45 years, Occ:Household
R/o Tellikunta Village, Julapalli Mandal
Karimnagar District
5. M.Ajay S/o late Laxmaiah
aged 20 years, Occ: Agriculture
R/o Tellikunta Village, Julpalli Mandal
Karimnagar District
(respodnents no.4 & 5 are brought on record
as LRs)
Respondents/respondents no.4 & 5
Counsel for the Appellants M/s K.Bhaskar Dev
Counsel for the Respondent M/s N.Parameswara Reddy(R2&3)
M/s M/s M.Ramgopal Reddy(R4)
F.A.No.562 OF 2012 AGAINST C.C.NO.226 OF 2011
Between:
The Branch Manager,
Unique Mercantile India Pvt Ltd.,
1st Floor, Maruthi Complex, SBI Bldg.,
CVRN Road, Karimnagar
Appellant/opposite party no.3
A N D
1. E.Sravani D/o Rojanandam
aged 24 years, Occ:Student
R/o Q.No.P2-1033, Nagarjuna Colony
Bhupalapally Village & Mandal
Warangal District
Respondent/complainant
2. The Divisional Manager,
United India Insurance Co.Ltd.,
501, Ganesh Plaza, Opp:Navarangpura
Bus Stand, Ahmedabad-009
3. The Branch Manager
MD India Health Care Service Pvt Ltd.,
Flat No.701 & 702, Topaz Building
Punjagutta, Hyderabad-54
Respondents/opposite parties No.1 & 2
Counsel for the Appellants M/s K.Bhaskar Dev
Counsel for the Respondent M/s M.Ramgopal Reddy (R1)
M/s N.Parameswara Reddy(R2&3)
QUORUM: SRI R.LAKSHMINARASIMHA RAO, HON’BLE MEMBER
AND
SRI THOTA ASHOK KUMAR, HON’BLE MEMBER
FRIDAY THE TWENTIETH DAY OF SEPTEMBER
TWO THOUSAND THIRTEEN
Oral Order (As per Sri R.Lakshminarasimha Rao, Hon’ble Member)
***
1. The first opposite party is the appellant. All the complaints are of similar nature and identical circumstances and as such they are being disposed of by a common order. F.A.No.559 of 2012 arising out of the order in C.C.No.34 of 2011 is taken as lead case.
2. The appeal is challenge to the order of the District Forum which passed the award directing the appellant and the respondent no.2 to pay an amount of `1,00,000/- with interest @ 9% per annum and a sum of `1,000/- towards costs.
3. The son of the first respondent during his life time obtained JPA policy through the appellant and from the respondent no.2 on 16.1.2003. JPA policy bearing No.060600/47/07/61/00000121 dated 16.01.2003 was issued by the respondent no.2 for a period of 10 years from 16.1.2003 to 16.1.2013. The first respondent’s son died on 26.1.2008 and a case in Cr.No.77 of 2008 was registered by the police concerned under section 306 R/w 34 IPC. The claim of the first respondent was not settled and she got issued notice on 24.2.2011 and thereafter also the claim was not settled.
4. The appellant resisted the claim contending that it is a facilitator for obtaining of the insurance policy and settlement of the claim of the insured or his nominee by the respondent no.2. For non-settlement of claim by the respondent no.2 the appellant submitted that it cannot be held liable and there was no deficiency in service on the part of the appellant.
5. The respondent no.2 was proceeded exparte.
6. The respondent no.1 filed her affidavit and the documents, Exs.A1 to A8. On behalf of the appellant, its authorised representative Mr.Srinivasa Rao filed his affidavit and the appellant did not choose to file any documents.
7. The District Forum allowed the complaint on the premise that the son of the respondent no.1 was murdered which amounts to accidental death. It was observed that the appellant and the respondent no.2 settled the claim and they have committed deficiency in service.
8. Aggrieved by the order of the District Forum, the opposite party no.1 filed appeal contending that it is not liable to pay any amount to the respondent no.1 and its duty was discharged as soon as the amount was remitted to the respondent no.2 and the respondent no.2 alone is responsible for payment of any amount claimed under JPA policy. It is contended that the District Forum failed to see that murder is not an accident and it is not covered by the terms of JPA policy.
9. The point for consideration is whether the order of the District forum suffers from misappreciation of facts or law?
10. It is beyond any dispute that the son of the respondent no.1 during his life time obtained JPA policy from the respondent no.2 through the appellant for the period of 10 years from 16.1.2003 to 15.1.2013 and during the period the policy was in force, he died on 26.9.2008. The police concerned registered a case u/s 306 R/w 34 of IPC and the respondent no.1 claimed amount basing on the criminal case record and stating that her son was murdered and his murder is an accidental death within the scope of the terms of the JPA insurance policy.
11. The appellant has challenged the order of the District Forum on the premise of its role is limited to the role of agent of the respondent no.2 and also that murder of the insured is not covered by the terms of the insurance policy. Insofar as the contention of the counsel for the appellant as regards the murder of the insured beyond the scope of coverage of terms of the insurance policy is concerned, this Commission is not inclined to delve into the matter as the learned counsel for the appellant has not pressed it. As such the scope of the appeal is limited to the aspect whether the liability can be fastened on the appellant.
12. The learned counsel for the appellant has contended that the appellant is agent of the respondent no.2 regarding collection of premium from the insured and settlement of claim by the respondent no.2. The learned counsel for the respondent no.1 has submitted that in view of the settled legal position, the respondent no.1 has no objection for allowing the appeal of the appellant. The learned counsel has submitted that the respondent no.2 has not filed any appeal against the order of the District Forum.
13. The appellant’s role is that of facilitator and that the Janatha personal accident insurance policy covers accidental death of the person in whose favour JPA policy is issued by the respondent no.2. The appellant forwarded the claim form and the documents to the respondent no.2. The respondent no.2 had not settled the claim despite notice dated 24.2.2011 got issued by the respondent no.1 through her counsel.
14. The appellant is facilitator and its role is limited to process the claim. The appellant is mediator between the beneficiary and the insurance company and it cannot be fastened with any liability. In several decisions the Hon’ble National Commission held that the role of facilitator cannot be stretched to the extent of payment of amount under the insurance policy.
15. The Hon’ble National Commission in Road Safety Club Pvt Ltd., Vs Smt Kodi Laxminarayanamma and others “ F.A.NO.191 of 2009 dated 3.11.2009 and this commission in 1. “Manager Andhra Bank Vs Smt Shantha Kumari and others “ in F.A.No.1314 of 2004, 2. “the branch Manager Andhra Bank Vikarabad Branch Vs. Smt T.Sulochana and others “in F.a.No.1099 of 2005, 3. The Branch Manager, Vysya Bank Ltd., Ananthapur Vs Mr.Sambasiva and another in F,.A.No.923 of 2002 4. “the General Manager, M/s Road Safety Club Vs K.Ramalaxmi in F.A.No.1494 of 2008 and F.A.Nos.1383 of 2010 and F.A.No.111 of 2011 considered the scope of facilitator in the matter of insurance company issuing the insurance policies in favour of the facilitator or its members.
16. In all the aforementioned decisions the role of facilitator between the insured and the Insurance Company has been discussed and the Hon’ble National commission also held that in the absence of any stipulation in the terms and conditions of the policy as to the liability of the facilitator, no liability can be fastened on the facilitator.
17. The District Forum, as rightly contended by the learned counsel for the appellant has passed perverse order as regards the fixing liability on the appellant. The District Forum proceeded to find the respondent no,2 negligent observing having issued the JPA Policy No.060600/47/07/61/00000121 in answering the claim’ para 10 of the order.
After death of the policy holder the complainant being nominee submitted claim to the opposite parties for payment of Rs.1,00,000/- towards the sum assured by enclosing the documents. Even after receipt of claim the opposite parties failed to settle it, therefore the complainant got issued a legal notice under Ex.A6 calling upon the opposite parties to pay the amount but even after service they failed to settle the claim. Having issued the JPA Policy bearing No.060600/47/07/61/00000121 promising to pay Rs.1,00,000/- in the event of accidental death of policy holder, the opposite party no.2 miserably failed to settle the claim. Even after receipt of notices in this case also the opposite party no.2 insurance company did not choose to appear before this Forum to answer the claim of the complainant which clearly discloses the negligent attitude of opposite party no.2 in answering the claim. Admittedly the deceased policy holder joined as a member in the opposite party no.1 organisation by paying Rs.35,000/- for which opposite party no.1 provided insurance coverage to its members. It is the duty of opposite eparty no.1 to see that the sum assured is paid to the complainant. By filing criminal case records under Ex.A2 to A5 the complainant proved her case that the policy holder was murdered which amounts to accidental death and as the JPA Policy referred in Ex.A1 was in force on the date of his death, opposite parties are liable to pay Rs.1,00,000/- towards the sum assured under the policy. Since the opposite parties no.1 and 2 failed to settle the claim they have committed deficiency in service. For the foregoing reasons we hold that the opposite parties are liable to pay Rs.1,00,000/- to the complainant jointly and severally towards the sum assured with interest @ 9% p.a. and Rs.1000/- towards the costs of proceedings.
18. We find acceptable force in the contention of the learned counsel for the appellant that the finding of the District Forum that the first respondent’s son joined as a member in the appellant organization by paying `35,000/- and the appellant provided insurance coverage to its members is perverse to the facts of the case. The finding is not based on pleading or evidence. The written version filed by the appellant contains specific purpose of collection of the amount which reads as under:
“The opposite party No.1 humbly request htat they are not authorised under the law to do any insurance business since the insurance business is done by designated insurance companies i.e., LIC and GIC having its 4 subsidiaries, one of which being United India Insurance Co.Ltd., i.e., opposite party no.2 which is now under the IRDA .
19. Thus, the second respondent would provide insurance coverage to the members of the appellant company. The District Forum has not considered ExA1 which reveals that the amount of `22,750/- was received by the appellant to be paid to the respondent no.2 and Life Insurance Corporation for the purpose of obtaining certificates of insurance from them. On the reverse side of ExA1, there are two certificates of insurance issued by Life Insurance Corporation of India and the respondent no.2-insurance company. The respondent no.2 issued certificate for a sum of Rs.1,00,000/- and the Life Insurance Corporation of India issued the certificate for assured sum of Rs.20,000/-.
20. The certificate of insurance, ExA1 clearly shows that the respondent no.2 issued the same to the appellant for coverage of risk of its members who are issued cards by the appellant. Yet, the District Forum proceeded to fix liability on the appellant along with the respondent no.2. Liability is fastened on the appellant without assigning any reason. The evidence on record is thus not appreciated and inability of the District Forum to appreciate the evidence is utilized by the respondent no.2 which did not prefer appeal or pay the sum in terms of the order to the respondent no.1 basing on appeal filed by the opposite party no.1. Such circumstances as rightly contended by the learned counsel warrant requirement of a person with judicial back ground who would make not only judicious appreciation of the evidence on record and he would also instill life to the order by his sound reasoning and make it manifest that there has been application of mind to all the issues and substantial compliance of principles of natural justice.
21. No order can be passed without assessing evidence on record. Findings of the District Forum should be based on all relevant issues of the case vis-à-vis the contention and arguments of the parties, absence thereof would result in miscarriage of justice. The order passed without considering the documents placed on record is not sustainable.
22. The Hon’ble Supreme Court emphasised the need for giving reason for decision and failure to give reasons was held the order unsustainable. In “Vishnu Dev Sharma vs State of Utter Pradesh and others” 2008(10SCJ 765 the supreme Court held that right to reason is an indispensable part of a sound judicial system, reason sufficient to indicate application of mind to the matter before court .
23. The Apex Court referred to its earlier decision in “State of Orissa vs Dhaniram Luhai” (2004) 5 SCC 568 and held that” The hallmark of a judgment/order and exercise of judicial power by a judicial forum is to disclose the reasons for its decision and giving of reasons has been always insisted upon as one of the fundamentals of sound administration justice –delivery system, to make known that there had been proper and due application of mind to the issue before the Court and also as an essential requisite of principles of natural justice”.
24. The Supreme Court held in “United India Insurance Company and others vs Roshan Lal Oil Mills Ltd and others” (2000)10 SCC19 that non-consideration of documentary evidence would result in serious miscarriage of justice and vitiates the order or judgement passed by the Forum or Court.
25. The learned counsel for the respondents in F.A.Nos.560 of 2012 to 562 of 2012 has submitted that the insurance company which issued the certificates of insurance has not filed appeal and it had complied with the orders of the District Forum by depositing amount in similar cases. He has relied upon the order of this Commission in “FA No.624 to 630 of 2012” decided on 22.03.2013 wherein it held:
Heard both counsel. Counsel for respondent no.1/complainant filed memo stating that the entire decretal amount has been deposited by the Insurance Company before the District forum and therefore, these appeals have become infructuous. In view of the memo, these appeals are dismissed as infructuous.
26. There is no evidence brought on record to show the obligation of the appellant to settle the claim lodged by the nominee of the insured. In the absence of any evidence to show the responsibility of the appellant to pay the amount covered under the certificate of insurance, we are inclined to accept the contention of the appellant that it is not liable to pay the amount covered under the insurance policy to the first respondent. Accordingly the appeal deserves to be allowed by setting aside the findings recorded by the District Forum, against the appellant in regard to its liability.
27. In the result the appeal F.A.No.559 of 2012 is allowed by setting aside the order of the District Forum against the appellant/opposite party no.1. The order of the District Forum against the respondent no.2/opposite party no.no.2 is confirmed. F.A.No.560 to 562 of 2012 are allowed by setting aside the order of the District Forum against the appellant/opposite party no.3. The order of the District Forum against the respondents no.2 and 3/opposite parties no.1 and 2 is confirmed. The parties shall bear their own costs.
MEMBER
MEMBER
Dt.20.09.2013
కె.ఎం.కె*
