This complaint is coming before us for hearing, in the presence of       Sri. Beesha Ramesh & Sri. T. Thirumal Rao, Advocates for Complainant, and of Sri. G. Harender Reddy, Advocate for Opposite parties No.1; and of Sri. G. Sita Rama Rao, Advocate for Opposite party No.3, and of Sri. Kandibanda Srinivasu, Advocate for Opposite party No.4; Opposite party No.2 served called absent; Upon perusing the material papers on record; upon hearing and having stood over for consideration this Forum passed the following:-

O R D E R

(Per Sri R. Kiran Kumar, FAC President)

          This complaint is filed u/s.12-A of Consumer Protection Act, 1986. 

2.       The averments made in the complaint are that the complaiant is resident of Kodavatimmetta (Reddygudem) village of Thallada Mandal, Khammam District and mother of the complainant by name Seelam Lingamma, W/o. late Bhadraiah had taken two insurance polices from opposite party No.2 vide policy certificate Nos.360085 and 360086 with Group Personal Accident Master Policy No.12/29/14/00138/05 and Policy No.12/29/14/00138/05 both valid from 27-02-2007 to 26-02-2008 for Rs.1,00,000/- towards death claim.  After receiving the premium amount of Rs.3,300/- each, totally Rs.6,600/-, the opposite party No.1 issued policy certificates in favour of the mother of the complainant wherein the complainant is the nominee to the said policies. The complainant submitted that the mother of the complainant died on 07-06-2007 due to sudden cardiac arrest (Heart attack) leaving behind the complainant as her nominee and legal heir to the said policies. Immediately after the death of her mother, the complainant intimated the death intimation along with all original documents to the opposite party No.1 along with claim form for death benefit of her mother.  The complainant further submitted that after a prolonged period the opposite parties intimated to the complainant to submit all certified copies once again for process of the claim and accordingly as per the directions of the opposite parties, the complainant again submitted all certified copies for settlement of claim and the opposite parties assured that the claim of the complainant is under process and they will pay the claim amount within few days.  The complainant also submitted that she made many oral requests to the opposite party No.1 to pay the claim amount but the opposite party No.1 has been postponing the same by saying that the claim is under process.  In spite of lapse of more than two years the opposite party No.1 have not responded and not settled the claim and dragging the matter for years together with one pretext or the other, which clearly shows the deficiency of service on the part of the opposite parties.  As such there is no other alternative except approaching this Forum for redressal the complainant filed this complaint.

3.       To prove her case, the complainant filed the following documents and the same have been marked as Exs.A1 to A5.

Ex.A1:-Photocopy of Membership Certificates issued by opposite party No.1 (Nos. 2).

Ex.A2:-Photocopy of Certificate of Insurance for Group Personal Accident Master Policy (Nos.2) issued by opposite party No.3.

Ex.A3:-Photocopy of Death Certificate, dt.17-06-2007 issued by Dr. S. Venkateswar Rao, MBBS, Tallada, Khammam District.

Ex.A4:-Photocopy of Death Certificate issued by Tahsildar, Thallada, Khammam District., dt. 14-06-2007.

Ex.A5:-Photocopy of Identity Card of the complainant issued by Election Commission of India.

4.       On receipt of notice, the opposite party No.1 appeared through their counsel and filed counter.  In the counter opposite party No.1 denied all the averments mentioned in the complainant except those that are specifically admitted by them.   The opposite party No.1 further submitted that the opposite party No.1 is a private limited company launched with an object to risk awareness among the public and the public were encouraged to become members of the Road Safety Club, consequent upon which they will get insurance cover depending upon the type of Membership.  And also they admitted that the mother of the complainant Sheelam Lingamma was the member of the Road Safety Club with certificate TR Nos. 3183527 and 3183593 for the purpose of insurance cover for a period of 36 months.  The opposite party No.1 further submitted that they are coordinating with the insurance company for providing polices to the members, they are not liable and the insurance policy provided by Bajaj Life Insurance Company Ltd., for the period in which the deceased died is subject to the terms and conditions of the policy to satisfy the claim and they are nothing to do with the claim of the complainant.  The opposite party No.1 further submitted that there is no deficiency of service on their part, when the claim is made, they forward the same to Bajaj Allianz Life Insurance Company ltd, on 28-11-2007, 16-06-2008 and on 14-07-2008 along with documents which were furnished by the complainant to settle the claim.  The opposite party No.1 further submitted that Bajaj Allianz Life Insurance Company Ltd., issued group personal accident master policy specifically mentioning the name of each member, though the first opposite party is reflected as insured, the ultimate beneficiary is the member of whose benefit the policy has been issued, there is no deficiency on their part and the complaint is not maintainable and prayed to dismiss the complaint. 

The opposite party No.1 further submitted that without utilizing the arbitration clause, provided and the terms and conditions of the Road Safety Club Programme, the complainant straight away approached the District Forum, which is not maintainable.  The opposite party No.1 further submitted that it is clearly manifested from the terms and conditions that any dispute in relation to this will be subject to jurisdiction of Chennai courts only, as such Forum is not having competent jurisdiction to entertain the complaint, the complainant is not a consumer as defined under chapter 1 section 2 (d) of the Consumer Protection Act 1986, the complainant had no local standee to file the complaint as such prayed to dismiss the complaint.

5.       On behalf of the opposite party No.1 the following documents were filed and marked as exhibits B1 to B4.

Ex.B1:-Letter dt.20-11-2007 addressed by opposite party No.1 to opposite party No.4.

Ex.B2:-Letter, dt.26-06-2007 addressed by complainant to opposite party No.4.

Ex.B3:-Letter dt. 14-07-2008 addressed by opposite party No.1 to opposite party No.4.

Ex.B4:-Certificate of Insurance coverage period from 13-05-2007 to 12-05-2008.

6.       The complainant filed a petition to add the Reliance General Insurance Company Ltd., Narimon Point, Mumbai rep. by its Branch Manager as in the array of opposite party No.2, and the same is allowed, and opposite party No.2 is added as per orders in. IA.No.150/2011, dt.06-01-2012.

          The opposite party No.3 appeared through their council and filed counter.  In their counter, the opposite party No.3 submitted that the insurance is a contract of indemnity and to be viewed as a normal contract as per the Indian Contract Act, any violation of the insurance contract by the parties to the contract of insurance, the contract becomes void and in such an event the insurance company would not be liable to answer the claim of the other party.  The opposite party No.3 further submitted that the opposite party No.3 has not rendered any deficiency of service by declaiming the claim of the complainant and the complainant is not entitled for any of the claim as prayed for.  And also submitted that the complainant did not mention that for what reason the opposite party repudiated the claim of the complainant, by suppressing such fact the complainant filed this case with a malafide intention to have wrongful gain, as such there is no deficiency of service on their part and prayed to dismiss the complaint.  The opposite party No.3 further submitted that the opposite party No.3 do not admit that the complainant made any oral request to the opposite party No.1 to pay the claim amount of her mother, but the opposite party No.1 has been postponing the same by saying that the claim is under process, but not paid sofar, even after lapse of more than 2 years, the opposite party No.1 has not responded.  Upon the counter filed by the opposite party No.1, on the petition filed by the complainant, this opposite party No.3 added as party to the proceedings in IA.No.150 of 2011, dt. 06-01-2012.  The opposite party No.3 further submitted that the Forum is lacking in jurisdiction to entertain the complainant, as several questions of law and facts are involved, it is civil court, which can only adjudicate the same, the claim of the complainant is not accordance with the terms and conditions of the policy issued by the opposite parties, the complainant is not entitled for the claim and prayed to dismiss the complaint.   

7.       The complainant filed a petition to add the Bajaj Allianz Life Insurance Company Ltd., office GE Plaza, Yerawada, Pune as opposite party No.4, and the opposite party No.4 is added as per orders in IA.No.26/2015, dt.09-06-2015. 

          After receipt of the notice from this Forum, the opposite party No.4 appeared through their council and filed written version.  In their written version the opposite party No.4 denied all the allegations made by the complainant against them.  The opposite party No.4 further submitted that the death claim against the polices bearing Nos. 360085 and 360086 for a sum assured amount of Rs.50,000/- each was processed by them in the year 2008, the opposite party No.4 was intimated about the death of the life assured on 29-01-2008 and upon receipt of the death claim intimation they processed the same in accordance with the terms and conditions of the policy and dispatched the cheque bearing No.012822, dt. 27-12-2008 drawn on Axis Bank for Rs.1,00,000/- against the policies, but the complainant has not encashed the cheque till date, for the reasons best known to her and unnecessarily filed the complainant in the year 2009 and arrayed the opposite party No.4 on 09-06-2015 alleging deficiency of service against them without any valid reasons.  The opposite party No.4 further submitted that the complainant’s allegation against them for deficiency of service is illegal and unethical as the opposite party No.4 has discharged their part of the liability by processing the death claim and the complainant has to blame herself for not encashing the said cheque in time and after 6 years cannot allege deficiency of service, the claim of the complainant for Rs.1,00,000/- against each policy as sum assured amount is false and incorrect and the sum assured amount against each of policy is only Rs.50,000/-, there is no deficiency on the part of opposite party No.4 as such prayed to dismiss the complaint.       

8.       Upon perusing the material papers on record, now the points that arose for consideration are,  

1. Whether the complainant is entitled for the claim?
2. To what relief?

Point No.1:-

          In this case the mother of the complainant by name sheelam Lingamma had taken an insurance policy from the opposite party No.1 through the opposite party No.2 pertains to the opposite party No.4 vide policy certificate Nos.360085 and 360086 with Group Personal Accident Master Policy No.12/29/14/00138/05 valid from 27-02-2007 to 26-02-2008 for Rs.1,00,000/- towards death claim and the complainant is the nominee to the said policy.  According to the complainant the mother of the complainant died on 07-06-2007 due to sudden cardiac arrest (Heart Attack), immediately after the death of her mother, the complainant intimated the same to the opposite party No.1 and submitted claim form along with all original documents for the death benefit.

          That as per the complaint and perusing all the documents on record, we observed that the complainant submitted claim form along with all the necessary documents through opposite party No.1 and requested for payment of claim amount.  After filing of the complaint before the Forum the opposite parties No. 1 filed counter submitting that the opposite party No.4 i.e. Bajaj Allianz Life Insurance Company Ltd, assured the life of the deceased and issued Group Personal Accident Master policy.  Basing on the counter filed by the opposite party No.1 complainant impleaded Bajaj Allianz Life Insurance Company Ltd., as opposite party No.4. 

          From the record we observed that the complainant submitted claim form through opposite party No.1 and taken all the steps to settle the claim amount.  The opposite party No.1 also discharged their part of obligation i.e. submitting claim form along with necessary documents of the complainant to settle the claim of the complainant.  On receipt of claim, the opposite party No.4, processed the same in accordance with the terms and conditions of the policy and dispatched the cheque bearing No.012822, dt. 27-12-2008 drawn on Axis Bank for Rs.1,00,000/- against both policies, but the complainant has not encashed the said cheque and filed the present complaint.  From the above we observed that for the best reasons known to them the complainant failed to encash the cheque and the amount is lying with the opposite party No.4.  In the above circumstances we directing the opposite party No.4 to pay the policy amount of Rs.50,000/- each for the two policies to the complainant with interest @9% per annum.

9.                 In the result, the complaint is allowed, directing the opposite party No.4 to pay an amount of Rs.1,00,000/- (Rs. 50,000/- each policy) covered under the group policy bearing No.12/29/14/00138/05, to the complainant with interest @9% per annum from 27-12-2008 (the date on which the opposite party No.4 issued the cheque bearing No.012822, drawn on Axis Bank on 27-12-2008  in favour of the complainant) till the date of deposit.   The complaint against opposite parties No.1 to 3 is dismissed.

          Typed to dictation, corrected and pronounced by us, in the open forum on this the 30^th day of May, 2016.   

        FAC PRESIDENT                       MEMBER

   DISTRICT CONSUEMR FORUM, KHAMMAM

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                     For Opposite party:-   

       -None-                                                                           -None-

DOCUMENTS MARKED:-

For Complainant:-                                                     For Opposite party:-   

FAC President               Member

District Consumer Forum, Khammam.