BEFORE THE DAKSHINA KANNADA DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,  MANGALORE                       

Dated this the 6^thJune 2017

PRESENT

  SRI VISHWESHWARA BHAT D     : HON’BLE PRESIDENT

SMT.LAVANYA M. RAI                   : HON’BLE MEMBER

ORDERS IN

C.C.No.41/2015

(Admitted on 19.1.2015)           

Smt. Irine Lobo,

W/o. Thomus Lobo,

Aged 48 years,

R/at Mariya Church Compound,

Kunjathur Post, Talapady,

Kasaragod District 23.

                                                                           ……… Complainant

(Advocate for Complainant by Sri UA)                                                                                                   

VERSUS

1. M/s TATA AIA (Formerly TATA AIG),

Insurance Company Ltd,

Represented by its Managing Director,

Corporate Office, Delphi B Wing, 2^nd floor,

Orchard Avenu, Hiranandani Business,

Part, Powal, Mumbai 400076.

2. M/s TATA AIA (Formerly TATA AIG),

Insurance company Ltd,

Represented by its Branch Manager,

Solitary Apartments, 1^st floor,

Opp. Rupa Hotel, Balamatta, Mangalore 2.

                                                                           …. Opposite Parties

(Advocate for Opposite Party No.1 and 2.Sri.AKS)

ORDER DELIVERED BY HON’BLE MEMBER

SMT. LAVANYA M. RAI

1.  This complaint is filed under section 12of the Consumer Protection Act alleging deficiency in service against the opposite party claiming certain reliefs.

The brief facts of the case are as under:

          The complainantsubmits that, her aunt Miss. Juliet D souza had obtained a TATA AIG LIFE insurance policy bearing No.U070565096 from the Opposite Party No.1 through the Opposite Party No.2, had paid Annual premium amount of Rs.65,147/.  The policy commenced on 23.12.2008,  at the time of obtaining the said policy, the policy holder named the complainant as the nominee to receive the policy benefits in case of the death of the policy holder during the subsistence/validity of the policy. The policy holder died on 16.4.2011 as unmarried and issueless.  Thereafter the death of the original policy holder, the complainant had duly submitted the claim form to the Opposite Party No.2 seeking the release of the policy amount.  The Opposite Party No.2 has received the claim form and sent the same to the Opposite Party No.1 with all the annexures including the original policy and claim form.  Instead of processing the claim made by the complainant/Nominee under the aforesaid policy.  The Opposite Parties have illegally asked for the relationship of the nominee of the policy holder.  The Opposite Party No.2 also had made the complainant to believer that, the claim amount will be paid to the complainant within one month but the same has not been released till this day.

          The Opposite Party has ultimately sent a letter dated 27.12.2011 and called upon the complainant to prove the relationship of the nominee policy holder.  It is made clear and it is well within the knowledge that, the nominee named in the policy need not be any blood relation of the policy holder.  Once the nomination is accepted by the Opposite Parties in the application form seeking the policy.  After making repeated requests and reminder to the Opposite Party, the Opposite Party had again sent a letter dated 27.2.2012 stating that, the insurance amount under the said policy will be deposited into the court.  The Opposite Parties have not deposited the policy amount nor paid the same to the complainant.  Therefore Opposite Parties committing deficiency in service. Hence the above complaint filed by the complainant before this forum under section 12 of the C.P.Act 1986(here in after referred to as the Act) seeking direction to pay the insurance amount along with bonus in respect of TATA AIG LIFE insurance for Rs.10,00,000/ and also pay interest on the aforesaid claim amount at the rate of 18% p.a from the 16.4.2011 till this date amounting to Rs.6,60,000/ and also pay future interest on the above amount till the date of actual payment and cost of the complaint.

II. Version Notice served to the opposite parties by RPAD, Opposite Parties filed version stating that after understanding all the terms and conditions of the policy namely Invest Assure Health, Ms.Irine Lobo. Upon receipt of the duly filled form along with the initial premium Rs.65,147/ the Opposite Parties issued the policy with commencement dated 28.12.2008 to the deceased policy holder.  Thereafter policy documents along with the schedule were sent to the deceased policy holder which was duly delivered to the address of the deceased policy holder. On 19.7.2011 the Opposite Parties received death claim intimation from the complainant that the deceased policy holder suddenly died on 16.4.2011, the nominee in the said policy was mentioned as Smt. Irine Lobo.  On receipt of the claim form, the Opposite Parties proceeds to process the claim.  During the investigation the Opposite Parties noticed that the name of the nominee mentioned in the policy was Smt. Irine Lobo.  However, the relationship status of the said Smt. Irine Lobo mentioned in the application form was contradictory as in the application form the relationship of the nominee with the DLA is mentioned as sister in the claim submitted by the complainant, the Opposite Parties in order to issue claim in favour of the Opposite Party had requested the complainant vide letter dated 12.6.2013 to submit succession certificate with the Opposite Parties, the complainant has not produced the succession certificate till date for the reason best known her.  The Opposite Party is willing to settle the said claim amount and the said fact is also evident from the letter dated 12.6.2013. The Opposite Parties are not in receipt of the succession certificate of the complainant which is required as per the terms and conditions of the policy and as per the IRDA regulations (protection of Policy holders’ Interests Regulations, 2002), in order to consider and examine the claim of the complainant.  As per insurance act, once the insurance company received the intimation of the claim along with all the relevant documents as per the requirement.  Thereafter, the insurance company carries out an internal investigation and depending upon the outcome of the investigation the claim is either processed or is repudiated.  In the instant case, since there is discrepancy in the relationship status of the nominee with the DLA and also the complainant has not provided the succession certificate, it cannot be held that the Opposite Parties is deficient in providing service.  It is further submitted that even if the documents have been received by the Opposite Parties, the processing of claim will be decided only after a thorough investigation. The relationship status of the said Smt. Irine Lobo mentioned in the application form was contradictory as in the application form the relationship of the nominee with the DLA is mentioned as sister and in the claim submitted by the complainant, her relationship with the DLA is mentioned ,hence prays for dismissal.       

III.     In support of the above complaint, the complainantSmt. Irene Lobo,filed affidavit evidence as CW1 andproduced documents got marked at Ex.C1 to C6.Except version Opposite Party not lead evidence.

IV.     In view of the above said facts, the points for arise for our consideration in the case are:

1. Whether the Complainant proved that the Opposite Party committed deficiency in service?
2. If so, whether the Complainant is entitled for any of the reliefs claimed?
3. What order?

  We have considered the arguments submitted by the complainant and Opposite Party and also considered the materials that, placed before the Fora and answered the points are as follows:

                             Point No. (i) :Negative

                             Point No. (ii) : Negative

                             Point No.(iii): As per the final order.

REASONS

V.   POINTS No. (i) and (ii):

          In order to substantiate the case of the complainant produced documents Ex.C1 to Ex.6. After the death of the policy holder, the complainant submitted the claim form before the Opposite Party No.2 as per Ex.C3, but Opposite Party refused to pay the claim and asked the relation of the nominee with the policy holder.  As per Ex.C5 stated that the documents submitted by the complainant not proved the relationship as Sister with Juliet D Souza (insured) since deceased as mentoned in the application form. Therefore the Opposite Party asked to provide succession certificate in favour of the complainant. However,   the General Amendment form produced by the Opposite Party at the time of filing version,  it contains that Step 3A Out of my good will I want to nominate my sister as a nominee for this policy because I dont have any insurable interest relative in my family. It is true that the nominee named in the policy need not be any blood relation of the policy holder, but case in our hand it is specifically mentioned as sister, hence the complainant must prove the relationship of policy holder.  Further we also noted that the Opposite Party not repudiated the claim, but seeking the succession certificate to prove the relationship of the complainant with the policy holder.  The duty of the complainant is that to establish the case to prove the relationship with the policy holder or otherwise would have examine witness in  favour of the complainant. In the absence of the same we are unable to come to conclusion that the complainant is the nominee.  Except stating aunt, in the complaint there is no proper document to show the relationship with the policy holder and also without providing the documents and insisting to release the amount is bad in nature. Now points for consideration is that the case in our hand is premature, and without providing succession certificate to the Opposite Party is impossible to release the claim amount to the complainant therefore Opposite Party not committed the deficiency in service.  As such point no. 1 and 2 negative.

          In the result, accordingly we pass the following Order.

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 8directly dictated by Memberto the Stenographer typed by him, revised and pronounced in the open court on this the 6^th June 2017)

          MEMBER                                           PRESIDENT

(LAVANYA M RAI)                         (VISHWESHWARA BHAT D)

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

              Mangalore                                             Mangalore

ANNEXURE

Witnesses examined on behalf of the Complainant:

CW1  Smt. Irene Lobo

Documents marked on behalf of the Complainant:

Ex.C1:The copy of the application.

Ex.C2: 16.4.2011: Original death certificate of Julian . Juliet D Souza.

Ex.C3: 23.1.2012: copy of the letter addressed by the complainant to the Opposite Party.

Ex.C4: Copy of the sworn affidavit submitted by the complainant.

Ex.C5: 27.12.2011: The original letter addressed by the Opposite Party.

Ex.C6: 27.2.2012: The letter addressed by the Opposite Party.

Witnesses examined on behalf of the Opposite Parties:

Nil

Documents marked on behalf of the Opposite Parties:

Nil

Dated: 6.6.2017                        MEMBER