BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Thursday the 25th day of September, 2008
C.C.No. 7/08
Between:
Boya Malleswari,
W/o. Late Boya Maddileti,R/o. Pasupula Village,Kurnool District. … Complainant
Versus
1. Golden Multi Trust Services Club Limited,Represented by its Managing Director,
S.B. Mansion - 16 R.N. Mukherjee Road,Kolkata.
2. The Senior Divisional Manager,Represented on Behalf of National
Insurance Company Limited,
Division III 8, Exchange Place (Gr.floor) Kolkata - 700 001.
3. The Branch Manager,Represented on Behalf of National Insurance Company Limited,
Gandhi Nagar,Tula Complex,Kurnool. … Opposite parties
This complaint is coming on this day for orders in the presence of Sri. B.Chandrudu , Advocate, for the complainant, and Sri. M. Azmathulla Advocate, for the opposite party No.1 and Sri. L. Hari Hara Natha Reddy , Advocate for opposite party No.2 and 3 and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt. C. Preethi, Lady Member)
C.C.No.7/08
1. This consumer compliant of the complainant is filed U/S 12 of C.P. Act, 1986 seeking a direction on opposite parties to pay policy amount of Rs.1 lakh with interest at 12% p.a , Rs.20,000/- as compensation , Rs.10,000/- as communication charges and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s husband Boya Maddileti has taken a policy bearing No.100300/42 /02/8200012 from opposite parties 1 and 2 and the said policy commenced from 8-10-2004 to 7-10-2009 . On 17-3-2007 the policy holder Boya Maddileti died in an accident near culvert No.97/1 on National High-way -7 near Bhoothpur , Mahaboobnagar District , due to rash negligent driving of the lorry bearing No.AP 29 T 5573. In the said accident the policy holder died on the spot, thereafter the nominee made a requisition for payment of assured amount, but the opposite party did not settle the claim and addressed a letter to the complainant dated 4-8-2007 requesting the complainant to submit original policy and other documents and the same was completed by the complainant on 11-9-2007. Even though the opposite parties received the documents from the complainant, the opposite parties did not pay the policy amount. Hence, the complainant resorted to the forum for reliefs.
3. In substantiation of her case the complainant relied on the following documents viz., (1) Xerox copy of policy bearing No. 100300/42/02/8200012 , (2) office copy of legal notice dated 28-8-2007 along with postal receipt and acknowledgement ,(3) letter dated 4-8-2007 of opposite party No.1 to 2 along with postal receipt, (4) letter dated 30-8-2007 of complainant to opposite party No.2 , (5) letter dated 03-10-2007 of opposite party No.2 to complainant and (6) office copy of legal notice dated 03-10-2007 of complainants counsel to opposite party No.1 along with postal and acknowledgement, besides to the sworn affidavit of the complaint in reiteration of her complaint averments and the above documents are marked as Ex.A1 to A6 for its appreciation in this case and replies to the interrogatories exchanged.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite parties 1 to 3 appeared through their standing counsel and contested the case by filling separate written versions.
5. The written version of opposite party No.1 submits that he has obtained a group personal accident policy on behalf of its members, as per memorandum of understanding dated 2-4-2004 between opposite parties 1 and 2. The opposite party No.1 colleted premium and forwarded to opposite party No.2 & who issued an insurance certificate to that effect and as per the said certificate the opposite party No.2 is entirely liable for the insurance amount and this opposite party is nothing to do in settling the claim of the complainant. The complainants husband joined as a member of opposite party No.1 company and a policy bearing No. 100300/42/02/8200012 was issued to him and he nominated the complainant as his nominee and regarding the accident they are no personal knowledge. All the documents submitted by the complainant are forwarded to the opposite party No.1 by its letter dated 4-8-2007 and opposite party No.2 is the exclusive and sole authority to settle the claim under the policy and there is no deficiency of service on part of opposite parties No.1 and lastly seeks for the dismissal of complaint with costs.
6. The written version of opposite party No.2 admits the complainants husband Boya Maddileti has taken policy bearing No. 100300/42/02/8200012 issued by opposite party No.2 and the said policy was issued by opposite party No.2 in association with opposite party No.1 and the policy was in force on the date of accident. On 11-9-2007 the opposite party No.2 received claim form from the complainant and legal notice of complainant dated 30-10-07 was also received by to opposite party No.2 and the opposite partyNo.2 gave reply stating that the complainant gave intimation to the opposite party No.2 after 4 months 20 days from the date of death of the deceased ,as such the opposite parties are liable to pay the assured amount to the complainant. Hence, the opposite party did not settle the claim as it is a false and created claim put up by the complainant. The opposite parties further submits that the complainant has to intimate about the death of the deceased within 30 days from the date of death and to submit claim form within 90 days, but in this case the complainant intimated about the accident after 4 months and 20 days after the death of policy holder . Hence, the opposite party treated the claim as no claim and lastly seeks for the dismissal of complaint with costs.
7. The written version of opposite party No.3 submits that the policy holder Boya Maddileti joined as a member with opposite party No.1 and taken a policy bearing No. 100300/42/02/8200012 from opposite party No.2 and this opposite party No.3 did not issued any policy to the deceased and no allegation is made against this opposite party by the complainant and no legal notice was served on this opposite party and there is no contract between opposite party No.3 and the complainant . It also submits that opposite party No.1 is a service provider under agreement with opposite party No.2 and all the officers of National Insurance Company including opposite party No.3 branch submits all documents to opposite party No.2 and Kurnool office as no knowledge of the agreement between opposite parties 1 and 2 . All the records with regard to policies issued by opposite party No.2 are maintained by opposite parties 1 and 2 only and this opposite party has no concern with the case of the complainant and lastly seeks for the dismissal of complaint with costs.
8. In support of their case the opposite parties relied on the following documents viz., (1) authorization letter dated 9-2-2008 , (2) attested copy of memo with witness certificate and (3) account letter of opposite party No.1 and 2, besides to the sworn affidavit of opposite party No.1 to 3 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B3 for its appreciation in this case and replies to the interrogatories exchanged.
9. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service?
10. There is no dispute as to the deceased policy holder Boya Maddileti covered under the policy bearing No. 100300/42/02/8200012 vide Ex.A1 issued by opposite party No.2 through opposite party No.1 and the complainant was nominee under the said policy. There is no dispute as to the death of the policy holder on 17-3-2007 in an accident near Boothpur , Mahaboob Nagar District and the policy was in force on the time of accident.
11. The main contention of the opposite party No.2 is that, in case of death of policy holder written notice must be given within one calendar month from the date of accident and claim form along with all requirements should be submitted within 90 days from the date of accident as per condition No.1 of terms and conditions of the policy. In this case the complainant intimated about the death of the policy holder after 4 months 20 days after the death. Hence, the claim was not entertained and closed as “No claim” vide Ex.A5. The Ex..A5 is the letter dated 3-10-2007 of opposite party No.2 to the complainant , on perusal of it, the date of intimation was given as 4-6-2007 i.e., after a gap of 2 months 17 days and claim form was submitted on 6-8-2007 i.e., after a lapse of four months 20 days. The above condition no where envisages forfeiture of the assured amount of the deceased on failure of the nominee/ dependent not informing the death of the policy holder to the insurance company within stipulated time. In support of her case the complainant relied on the following decision of Uttar Pradesh State Commission between LIC of India Vs Rajendra Singh Gour reported in IV 2004 CPJ Pg.531, where in it was held that repudiation of claim by LIC on the ground that intimation of death was delayed, the complainant contended that he was 80 years and not able to intimate earlier, but he completed all formalities, hence , repudiation of claim was held unjustified and illegal. In the said case the policy holder died on 29-11-1994 and intimation was given by the nominee to the insurance company in June, 2003. The policy was allowed on the ground that the policy stood intact for 10 years and the complainant was nominee under the policy and the complainant alone is entitled to the policy amount.
12. Following the above mentioned decision in the present case the death of the policy holder occurred on 17-3-2007 and the same was intimated to opposite party No.2 and claim form was submitted after the stipulated time of 90 days. But the complainant along with her claim form submitted all required documents and being an illiterate woman unaware of the fact of informing the opposite party No.2 within the stipulated time, as such the complainant is showing a reasonable cause of the delay in intimating the death of policy holder and submitting the claim beyond the reasonable time of 90 days as per condition No.1 and as such there appears no fraudulent suspicion on the face in submitting the claim form after 90 days. Hence the complainants approach to this forum seeking relief is justified. The opposite party No.2 except alleging delay in submitting claim form and in all other aspects admitting the case of the complainant. The opposite party No.2 by its doscile conduct should not have repudiated the claim of the complainant and should have condoned the delay and entertained the claim of the complainant.
13. To conclude, from the above discussion and following the afore mentioned decision, the complainant except delay in intimating the opposite party No.2 and in all other aspects certainly remaining entitled to the assured amount under the policy issued by opposite party No.2 to her husband Boya Maddileti and opposite party No.2 is liable to pay the same as there is deficiency of service on part of opposite party No.2 in not paying the said amount. As no cause of action is made out against opposite party No.1 and 3 case against opposite party No.1 and 3 is dismissed.
14. In the result, the complaint is dismissed against opposite party No.1 and 3 and allowed against opposite party No.2 directing opposite party No.2 to pay to the complainant assured amount of Rs.1,00,000/- under the policy of her husband Boya Maddileti with 9% interest p.a from the date of complaint i.e, 27-12-2007 till realization along with costs of Rs.1,000/- within one month from the date of receipt of this order. In default, the opposite party shall pay the above award with 12% interest p.a from the date of default till realization .
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 25th day of September, 2008.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1. Xerox copy of policy No.100300/42/04/8200012.
Ex.A2. Office copy of legal notice dated 28-8-2007 along with postal receipt with acknowledgement.
Ex.A3. Letter dated 4-8-2007 of opposite party No.1 to 2 along wit postal receipt.
Ex.A4. Letter dated 30-8-2007 of complainant to opposite party No.2.
Ex.A5. Letter dated 03-10-2007 of opposite party No.2 to complainant in
2 papers.
Ex.A6. Office copy of legal notice dated 03-10-2007 of complainant
council to opposite party No.1 along with postal receipt with
acknowledgement.
List of exhibits marked for the opposite parties:
Ex.B1. Authorization letter dated 9-2-2008.
Ex.B2. Attested copy of memo with witness certificate.
Ex.B3. Account letter of opposite party No.1 to 2.
Sd/- Sd/-
MEMBER PRESIDENT
// Certified free copy communicated under Rule 4 (10) of the
A.P.S.C.D.R.C. Rules, 1987//
Copy to:-
Complainant and Opposite parties
Copy was made ready on :
Copy was dispatched on :
