BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, ADDITIONAL BENCH, MANGALORE   

Dated this the 7^TH January 2017

   PRESENT

     SRI VISHWESHWARA BHAT D   : HON’BLE PRESIDENT

     SRI T.C. RAJASHEKAR                 : HON’BLE MEMBER

     SMT. SHARADAMMA H.G             : HON’BLE MEMBER

ORDER IN

C.C.No.161/2014

(Admitted on 14.05.2014)

Smt. Sundari,

W/o Late Anni Poojary,

Bailu house, Aithhuru Village,

Puttur Taluk, D.K.                                                      ….. COMPLAINANT

(Advocate for the Complainant: Sri HKB)

VERSUS

1. Manager,

    Dakshina Kananda District Milk Fedration, Kulashekara,

    Mangalore.

2. Secretary,

    Mardhala Milk Fedaration,

    Puttur, D.K,

3. Manager,

    Pension and Group Schemes Unit

    Life Insurance Corporation of India,

    Udupi Division, Popular Building, 3^rd Floor, P.B. No.117,

    K.S.Rao Road, Mangalore  575001.

                                                                        ….....OPPOSITE PARTIES

(Advocate for the Opposite Parties No.1 & No.2: Sri. LCH)

(Advocate for the Opposite Party No.3: Sri. AKU)

ORDER DELIVERED BY HON’BLE MEMBER

SRI T.C. RAJASHEKAR:

1. 1. The above complaint filed under Section 12 of the Consumer Protection Act 1986 by the same complainant against same opposite parties alleging deficiency in service against claiming to pay Rs.14,000/ with interest at 12% per annum from the date of application till the date of payment with cost.

2.  In support of the above complainant Smt. Sundari filed affidavit evidence as CW1 and answered the interrogatories served on her and produced documents marked Ex.C1 to C9 detailed in the annexure here below.  On behalf of the opposite party Mrs. M. Jacintha Pais (RW1) Manager (L & HPF), also filed affidavit evidence and answered the interrogatories served on her and Dr. Nithyananda Bhaktha (RW2) Manager (Procurement) also filed affidavit evidence and answered the interrogatories served on him and produced documents marked Ex.R1 to R17 detailed in the annexure here below..

The brief facts of the case are as under:

     Perused the complaint and the version documents. The dispute is with regard to repudiation of the claim submitted under group insurance policy. The complainant alleges that, her husband Annu Poojari s/o Shivappa Poojari(Amoni poojari S/O Shivappa Poojari as per policy record) is the member under Opposite party no 2 which was affiliated under the Opposite party no 1. The members are eligible for group insurance under the Aam Admi Bima Yojana as such the complainant’s husband also covered under the said insurance. The Annu poojari expired on 08.02.2013. The complainant being the legal heir lodged the claim with the Opposite party no 3 through opposite party no 1 & 2. The claim was rejected with the reason that at the time of death as per record the Annu Poojari age was 59 years, stating that the insurance is not applicable. Complainant claims her husband age was 57 years at the time of death and the repudiation is illegal and hence deficiency in the part of the Opposite parties. The opposite party no 1 contends that, as per membership record the age of the deceased during the policy period 2012.2013 was 59 years completed and as per details furnished by the opposite party no 2 the insurance policy was taken for the year 2012.2013 excluding the deceased Annu poojari from the list of eligible member. At the time of death of deceased Annu poojari he was not covered under the policy. And as such there is no deficiency in service from their part. The Opposite party no 2 adopted the version of the opposite party no 1. The opposite party no 3 contended that they are the only insurance provider and as per details furnished by the opposite party no 1 issued the policy covering the names of eligible persons. The name of Annu poojari was not covered in the policy of 2012.2013, hence no coverage no claim and no deficiency in service. It is also contended by the  Opposite party that the policy was given free and the deceased Annu poojari not paid any consideration hence not a consumer. These are being the nature of dispute we formed the following

POINTS FOR ADJUDICATION:

     We have traversed through the documents and the evidence produced. The admitted facts are, the complainant’s husband  deceased Annu poojari was the member of the Opposite party no 2 and the Opposite party no 2 has taken the group insurance policy called Aam Admi Bima Yojana sponsored by the ministry of finance, Govt of India,  for its members. It is admitted that the Annu poojari died on 08.02.2013 while he is a member and deceased Annu poojari was also covered under group insurance but not admitted that he was covered at the time of death. It is denied by the complainant  that the age of the deceased Annu poojari was 59 years at the time of death and the Opposite party denies the age as 57 years at the time of death of Annu poojari as contended by the complainant,. At this situation we considered the following point for adjudication in resolving this dispute.

1. Whether the complainant proves there is insurance coverage for the deceased Annu poojari at the time of his death and he is the consumer under Consumer Protection Act 1986?
2. Whether the complainant is entitled for the relief prayed for?
3. What order?

We have examined the evidence produced and considered the documents produced. Hard the parties and answered the above points as under:

1. In the negative.
2. In the negative.
3. As per delivered order.

REASON

POINT NO 1 & 2: The pivot point of dispute is whether there is insurance coverage for the deceased Annu poojari at the time of death. It is the burden of the complainant to prove there is insurance policy coverage to deceased Annu poojari and he is the consumer of the opposite party no 3. However the deceased Annu poojari is not consumer to the opposite party no 1 or opposite party no 2. but only a member of the federation. Any dispute with regard to the deficiency on the part of the opposite party no 1 and 2 is not maintainable in this Forum hence the point no 1 taken for adjudication.

2.      The complainant swore that her husband was the member of the opposite party no 2 and there by covered by the Aam Admi Bima Yojana insurance through opposite party no 2 and opposite party no 1 who have obtained insurance policy covering their members among those her husband also covered. The complainant states her husband died on 08.02.2013 during the coverage of the policy. The complainant in proving her case produced the document Ex C1 to show the death of deceased Annu poojari. However the complainant not produced any documents or evidence to establish the coverage of risk through group insurance for her husband. However the EX R11 list of members covered under the group insurance for the year 2012.13 produced by the Opposite parties do not show the deceased Annu poojari is covered under the insurance. Where as in previous years of 2010.11, 2011.12, the name of deceased Annu poojari is covered under the Group insurance obtained by the opposite party no 1. The Opposite party contention is the age of the Annu Poojari as per membership record was 35 years as declared by the deceased Annu poojari on 29.08.1988 and based on this record Annu poojari age would be above 59 years as on policy renewal date 17.11.2012 and hence he is not eligible as per policy condition. The policy is for those age groups between 18 years complete and 59 years of age. Hence his name was not included in the policy obtained in the year 2012.13. It is established beyond doubt that there is no coverage of the policy at the time of death of the complainant s husband.

3.      We deem fit to discuss in few lines with regard to age dispute raised by the complainant. The complainant contends that the deceased Annu poojari age was 57 years when he died. So he is covered under the insurance. There are three documents with regard to the age of the deceased Annu poojari. First one is the membership record maintained by the Opposite party no 2 as per which the age of the deceased Annu poojari was 35 years when he joined the federation on 29.08.1988. The second one is the ration card produced by the complainant wherein the age mentioned as 52 years in the year 2008. The third one is the post mortem report the age said to be 56 years at the time of death. There is inconsistency with regard to his age. There are no any other documents to establish his age with proof. The Opposite party depended on the age declared by the deceased Annu poojari when he has joined the federation on 29.08.1988 an undisputed point of time. However specifically and categorically we state the dispute with regard to age of the deceased Annu poojari is not a consumer dispute. It is only between the member and the federation i.e.  the  deceased Annu poojari and opposite party no 1 and 2. If at all any miscalculation of the age of the deceased Annu poojari in obtaining the policy the consumer Forum is not appropriate to agitate before. The complainant has to choose appropriate forum for his relief. Once the deceased Annu poojari is not covered under the group insurance scheme he is not a consumer of the Opposite parties and specifically the opposite party no 3. Hence we are of the opinion that the complainant not proved the coverage of the insurance policy at the time of death of her husband and the point no 1 answered negative and so also the point no 2 in the negative.

POINT NO 3: in the light of above discussion and the adjudication of points we pass the following

ORDER

                             The complaint is dismissed.      

Copy of this order as per statutory requirements, be forwarded to the parties free of cost and file shall be consigned to record room.

(Page No.1 to 8 directly typed by member revised and pronounced in the open court on this the 7^th January 2017)

             MEMBER                                          PRESIDENT

(SRI T.C. RAJASHEKAR)                (SRI VISHWESHWARA BHAT D)

D.K. District Consumer Forum                 D.K. District Consumer Forum

 Additional Bench, Mangalore                   Additional Bench, Mangalore

              MEMBER

(SMT. SHARADAMMA H.G)                                           

D.K. District Consumer Forum

 Additional Bench, Mangalore 

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1  Smt. Sundari

Documents marked on behalf of the Complainant:

Ex.C1: Death Certificate

Ex.C2: Letter dated 07.03.2013 from O.P No.2  to O.P. No.1

Ex.C3: Notarized copy of the Ration of the family of the complainant

Ex.C4: Certified copy of the F.I.R

Ex.C5: Certified copy of the Charge Sheet

Ex.C6: Certified copy of the Post Mortem Report

Ex.C7

& Ex.C8: Legal notice along with acknowledgement

Ex.C9: Reply by OP No.1

Witnesses examined on behalf of the Opposite Parties:

RW1   Mrs. M. Jacintha Pais, Manager (L & HPF)

RW2  Dr. Nithyananda Bhaktha  Manager (Procurement)

Documents produced on behalf of the Opposite Parties:

Ex.R1: 30.10.2012: Circular by the Opposite party No.1

Ex.R2: 29.08.1988: Copy of the Application form by Sri Annu Poojary

Ex.R3: 13.11.2010: Letter from the opposite party No.2

Ex.R4: 13.11.2010: List of members

Ex.R5:                  : AAM Admi Bima Yojana

Ex.R6: 13.11.2010: Copy of the letter

Ex.R7: 2011.10     : Membership list

Ex.R8: 17.11.2011: Membership list

Ex.R9: 17.11.2011: Copy of the letter

Ex.R10: 2011.12       : Membership list

Ex.R11: 17.11.2012  : Copy of the letter

Ex.R12: 2012.13       : Membership list

Ex.R13: 09.04.2013  : Copy of the letter

Ex.R14:25.10.2013   : Application under RIT

Ex.R15:                   : Copy of the pay order

Ex.R16: 13.11.2013  : Copy of the letter

Ex.R17: 24.08.2013  : Copy of letter

Dated:  07.01.2017                                          MEMBER