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 30th day of October, 2008
C.C.No. 89/08
Between:
S. Yellappa, S/o. Thippanna,
H.No.2-743, Pagidyala Village and Mandal, Kurnool District. … Complainant
Versus
- GTFS Multi Services Limited,
Office No.40/384/16-17-18, III Floor, U-con Plaza, Kurnool.
2. Golden Multi Services Club Limited, Represented by its Managing Director,
S.B.Mansion, 16, R.N. Mukherjee Road, Kolkata-700 001.
3. The Senior Divisional Manager, National Insurance Company Limited,
Division-III,
8, India Exchange Place (Ground Floor), Kolkata-700 001.
4. The Branch Manager, National Insurance Company Limited,
Tula Complex, Gandhi Nagar, Kurnool … Opposite parties
This complaint is coming on this day for orders in the presence of Sri.M.Sivaji Rao, Advocate, for the complainant, and Sri.M.Azmathulla , Advocate for opposite party No.1 and Sri.P.V.Sudhakar Reddy , Advocate for opposite party No.3 and 4 and opposite party No.2 is called absent set exparte and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. K.V.H.Prasad, President)
C.C.No.89/08
1. This case of the complainant is filed U/S 11 and 12 of C.P.Act seeking direction on the opposite party to pay to the complainant Rs.50,000/- assured amount under policy – with interest at 24% p.a , Rs.25,000/- as compensation for mental agony occurred at the delayed attitude of the opposite party in repudiating the claim without any justifiability and cost of this case alleging that the deceased Sampengi Maddileti son of the complainant during his life time obtained insurance policy No.100300/ 42/04 / BZ0001Z covering the risk of his life , for an assured amount of Rs.50,000/- , for period commencing from 15-9-2004 to 14-9-2009 and during subsistence of said policy the demise of said policy holder on 17-12-2006 in road accident occurred at the out-skrits of Bangalore in the limits of P.S. Bidhadi which registered the said accidental death in its FIR.No.532/ 2006 U/S 279 , 337 and 304 A IPC and the complainant as nominee of said deceased policy holder , preferred the claim to the opposite party on the said policy of his deceased son along with all relevant record and there being any response towards settlement , causing of legal notice dated 14-3-2008 on the opposite party and there on the opposite party prejudiced and repudiated the claim on the ground of late intimation of claim which occurred on account of obtaining relevant documents from a far of place.
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant the opposite parties caused their appearance through their counsel and contested the case denying the liability to the complainants claim filling written version of opposite parties 1 and 4 and the adoption of the written version of opposite party No.4 by opposite party No.3.
3. The written version of opposite party No.1 besides questioning the justness and maintainability of the complainants case and requiring the strict proof of complaint averments submit that it as a registered club under name and style of Golden Multi Services Club covers its members ,
under Group Personal Accident Policy obtained from opposite party No.3 and in lieu of receipt of the premium of members received from opposite party No.1 the opposite party No.3 issue certificate of insurance as per the memorandum of understanding dated 2-4-2004 entered between the opposite party No.2 and opposite party No.3 holding the liability for claim and the role of the opposite parties 1 and 2 only to collect and remit premium of insurance to the opposite party No.3 and process and forward the claims to the opposite party No.3 and as discharged said functions any deficiency on its part . It justifies the repudiation as the claim is made belatedly by the complainant in violation of the stipulated condition of 30 days scheduled in the conditions of the policy and seeks dismissal of the complainants case for want of cause of action and as conditions of the policy excludes jurisdiction to this forum confirming the jurisdiction only on to Courts in Kolkata.
4. The written version of opposite party No.4 justifies the action of the opposite party No.3 in treating the claim as no claim for its belated claim after 90 days schedule for it and disputes the complainant as legal representatives of the deceased and doubts the death certificate as name of the deceased different and alleges no jurisdiction to the forum as jurisdiction of disputes is wested in Kolkata Courts as per memorandum of understanding and the case against the opposite party No.4 not maintainable for want of permission of the forum U/S 11 (2) C.P Act and so seeks dismissal of the case in the interest of justice.
5. In substantiation of the contentions while the complainant side has taken reliance on documentary record in Ex.A1 to A5 and the sworn affidavit of the complainant , the opposite party side has taken reliance on documentary record in Ex.B1 to B3 and sworn affidavit of the opposite parties 1 and 4 in reiteration of their defence
6. Hence the point for consideration is whether the complainant has made out any deficiency on the part of the opposite parties to hold their liability to the complainants claim
7. The Ex.A1 is the Xerox of certificate which certifies one Sampangi Maddileti son of S.Yellappa as person insured for Rs.50,000/- covering the risk of accidental death / permanent total disability to him for the period commencing from 15-9-2004 to 14-9-2009 under Group Personal Accident Policy No100300/ 42/04 / BZ0001Z and signed by authorized signatory of opposite party No.2 . As the written version of the opposite party No.1 and the Ex.A2 of opposite party NO.2 addressed to opposite party NO.3 and the Ex.A4 letter dated 26-3-08 of opposite party No.2 to opposite party NO.3 admits the coverage of its members with insurance in undertaking with opposite party No.3 and forwarded the claim of complainant to opposite party No.3 , the Ex.A1 remains established that it was policy issued covering the life risk / permanent total disability of the member of opposite party No.1 for an assured amount of Rs.50,000/- for a period of five years.
8. While the opposite party NO.2 redirected the notice in Ex.A3 to opposite party No.3 the other Ops did not choose to reply to the said Ex.A3 with any denial . This circumstance also goes in favour of the bonafidees of Ex.A1 .
9. The Ex.A5 letter dated 27-3-2008 of opposite party No.3 , as to the claim of the complainant , besides alleging non submission of claim without attested photocopy of FIR in English version , attested copy of FIR of police / charge sheet in English version and the attested copy of post mortem report in English version, attested copy of ration card , voters identity card on the name of the deceased and local panchayat / municipality certificate as to the incident and status of the nominee , alleges the intimation of occurrence within 30 days and submission of claim papers within 90 days is mandatory under conditions of policy and the belated claims are not covered under policy as per conditions enumerated on the over leaf of the certificate provided to the member being excluded from claim and said condition is in pursuance of the memorandum of understanding entered in between opposite parties 2 and 3 and in the circumstances the non submission of said required documents enclosed in the said claim has been treated as no claim and the jurisdiction for settlement of all disputes as per Clause H of memorandum of understanding is with Courts in Kolkata .
10. As stated above there is any over leaf to the Ex.A1 envisaging any such condition as alleged by the opposite party nor the opposite party side placed any duplicate of the said certificate envisaging alleged conditions. Hence in the absence of any such material in substantiation of the alleged condition stipulating the time permissible for intimation and submission of the claim in the Ex.A1 policy there appears any merit and force in the said contentions of belatedness in the claim of the complainant .
11. Even though the condition No.15 in Annexure of Ex.B1 at Page No. 9 envisages the claim intimation should be given within 30 days by the claimant / GMSC Limited (opposite party NO.2) to NIC Limited ( opposite party NO.3) in regard to the claim services and claim formulating with necessary supporting documents should be submitted within 90 days from the happening of the accident and any claim submitted after 90 days shall not be entertained , the said condition does not appear to be of any merit and binding force firstly because the said Ex.B1 being an memorandum of understanding entered in between the opposite parties 2 and 3 binding them alone and not the deceased policy holder under Ex.A1 being not a party to said Ex.B1 and on that reason the conditions of Ex.B1 are having any binding effect on the said policy holder and on his nominee who is claiming , secondly because to have any binding effect of said enumerated condition of Ex.B1 on this claim as to the time stipulated for intimation of accident and submission of claim , the claim is not made by the opposite party NO.2 for its insured member but by the nominee of the insured mentioned in Ex.A1 . Further if there is any intention in said Ex.B1 to apply said time stipulation in its strict spirit and sense to the opposite party No.2 and its insured members alike without any discrimination in between them as to the applicability of said stipulation of time in regards to the claim services , the opposite party No.3 ought to have got it mentioned in the Ex.A1 to that effect . In the absence of said circumstances with any such recitals on Ex.A1 , it remains very hard to take any presumptive applicability of the above provision of Sl.No.15 of Ex.B1 stipulations of time for intimation an submission of claims and non entertainability of claim made in violation of the said time stipulation.
12. Neither the Ex.A1 nor the memorandum of understanding in Ex.B1 envisages what type of documents ought to be submitted for consideration of claim . When any such stipulation is there as to the documents to be submitted for consideration of claim , the prudence expects those documents which may envisages the accidental death of the insured member if the claim is for accidental death or the other record envisaging his permanent total disability in case the claim is arising on that count.
13. While the Ex.B2 attested copy of letter dated 6-8-2007 addressed by opposite party NO.2 to opposite party No.3 takes mention of the documents accompanied the claim of the complainant through it as original insurance certificate, original death certificate of the insured , photocopy of death certificate issued from Sahana Hospital, photo copy of first information report , the Ex.B3 attested copy of letter dated 7-9-2007 addressed by opposite party No.2 to opposite party No.3 states of submission of original claim form , photo copy of FIR and photo copy of death certificate requesting for disposal of the claim at the earliest .
14. From these two documents i e., Ex.B2 and B3 it appears that relevant documents envisaging the accidental demise of the deceased insured appears to have been submitted to the opposite party No.3 for consideration and disposal of the claim . Hence there appears any justification to the opposite party No.3 in treating the claim as no claim on the pretext of non production of such documents which does not require for consideration of the claim.
15. The opposite party NO.4 contents that the case against him is bad for want of permission of this forum contemplated U/ S 11 (2 ) (b) of C.P.Act . But there appears any merit and said contention in view of several alternatives provided in this said Section and when the opposite party No.4 is a Branch Office of opposite party No.3 .
16. In the said circumstances discussed supra , as the liability of the opposite parties 1 and 2 being only to forward the claims submitted by its insured members to the opposite party No.3 and except that there being any liability on them to settle the claim arising out of the contingency mentioned in certificate of insurance policy issued and the opposite parties 1 and 2 appear to have discharged the said obligation toward the complainant in forwarding the claim to the opposite party No.3 , there appears any deficiency on their part towards the complainant and there by any liability of theirs to the complainants claim the case against opposite parties 1 and 2 is dismissed. Similarly any deficiency being alleged against opposite party No.4 the case against opposite party No.4 is also dismissed.
17. In sum up of the above discussion as there appears clear deficiency on the part of the opposite party No.3 alone on account of his conduct in repudiating the claim as no claim without any justifiability and the said deficient conduct of the opposite party No.3 as has ensured mental agony to the complainant besides driving him to the forum for redressal , the complaint is allowed directing the opposite party No.3 to pay to the complainant the assured amount of Rs.50,000/- under Ex.A1 policy and Rs.5,000/- as compensation for mental agony and Rs.2,000/- as cost of this case within a month of receipt of this order. In default the opposite party No.3 shall pay the supra stated award amount 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 30th day of October, 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 Group Personal Accident Policy No.
100300/ 4Z/ 04/BZ0001Z.
Ex.A2. Letter dated 05-21-2007 addressed to OP.NO.3 by OP.NO.2.
Ex.A3. Office copy of legal notice dated 14-03-2008 along with three postal acknowledgements.
Ex.A4. Reply dated 26-03-2008 of OP.No.2 to the complainants Counsel .
Ex.A5. Letter dated 27-03-2008 of OP.No.3 as to no claim.
List of exhibits marked for the opposite parties:
Ex.B1. Attested Xerox copy of Memorandum of understanding dated 02-04-2004.
Ex.B2. Attested copy of letter dated 06-08-2007 addressed by OP. No.2 to OP.No.3
Ex.B3. Attested copy of letter dated 07-09-2007 addressed by OP.No.2 to OP.No.3
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 :
