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 complainant is the resident of Bathulapalli village of Kalluru Mandal of Khammam District, the father of the complainant by name A. Ramakota Reddy had taken an insurance policy from opposite party No. 1 through the opposite party No.2 vide policy certificate No.357684 with Group Personal Accident Master Policy No.12/29/14/00138/05 valid from 01-11-2006 to 31-10-2007 for Rs.1,00,000/- towards death claim. After receiving the premium amount of Rs.5,000/-, and the opposite party No.1 issued policy certificate in favour of the father of the complainant wherein the complainant is the nominee to the said policy. The complainant submitted that the father of the complainant died on 19-12-2006 due to sudden cardiac arrest (Heart pain) leaving behind the complainant as his nominee and legal heir to the said policy. Immediately after the death of his father, 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 his father. 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 he made many oral requests to the opposite party No.1 to pay the claim amount of his father, 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 his case, the complainant filed the following documents and the same have been marked as Exs.A1 to A5.
Ex.A1:- Photocopy of Membership Certificate issued by opposite party No.1.
Ex.A2:- Photocopy of Certificate of Insurance for Group Personal Accident Master Policy issued by opposite party No.3.
Ex.A3:- Photocopy of Certificate of Insurance for Group Term Life Voluntary Plan issued by opposite party No.4.
Ex.A4:- Photocopy of Death Certificate, dt.28-12-2006 issued by Village Secretary, Gram Panchayath, Bathulapalli, Kalluru Mandal, Khammam District.
Ex.A5: - Photocopy of Household Card of the complainant issued by Dy. M.R.O. Kalluru, Khammam District.
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 father of the complainant was the member of the Road Safety Club with certificate TR No. 2757191 for the purpose of insurance cover and has been given a membership card for period commencing from 16-11-2006 to 15-11-2007 for Rs.50,000/- under Group Term Life Voluntary Plan with nominee being A. Srinivas Reddy. 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 Allianz General 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 the concerned insurance company and they received a letter from the area office and which was forwarded to Bajaj Life Insurance Company ltd, on 19-02-2007, 26-03-2007 and on 10-07-2008 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 of the 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 any 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 no documents filed.
The complainant filed a petition to add the Reliance General Insurance Company Ltd., 3rd Floor, Market Chambers, Narimon Point, Mumbai rep. by its Branch Manager as in the array of opposite party No.3, and the same is allowed, and opposite party No.3 is added as per orders in. IA.No.107/2013, dt.04-12-2013.
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 denied that the complainant is resident of Bathulapally village of Kalluru Mandal, Khammam and the father of the complainant had taken insurance policy from the branch of opposite party through the opposite party No.2 vide policy certificate No.357684 with Group Personal Accident Master Policy No.12/29/14/00138/05 valid from 01-11-2006 to 31-10-2007 for Rs.1,00,000/-, the father of the complainant died on 19-12-2006 due to sudden cardiac arrest leaving behind the complainant as his nominee and legal heir in the said policy and the complainant is put strict proof of the same. The opposite party No.3 further denied that immediately after death of his father, the complainant intimated the death intimation along with all other documents and claim form for the death benefits to the opposite party No.1, after prolonged period the opposite party no.1 intimated to the complainant to submit all certified copies once again on that the complainant once again submitted all certified copies and requested for settlement of the claim, upon which, the opposite party No.1 assured that the claim of the complainant is under process and they will settle the claim within days, the complainant is put to strict proof of the same.
The opposite party No.3 further submitted that the complainant initially filed the case against the opposite party No.3 and impleaded Bajaj Life Insurance Company as opposite party No.4, in this case the only liability on the part of opposite party No.4, hence the claim against the opposite party No.3 is liable to be dismissed. The opposite party no.3 further submitted that this Forum is lacking in jurisdiction to entertain the complaint, as several complicated questions long facts are involved, the claim of the complaint is not accordance with the terms and conditions of the policy issued by opposite party No.3, therefore, the complainant cannot allege that there is deficiency of service, the present complaint does not attract the provisions of the Consumer Protection Act., and prayed to dismiss the complaint.
The complainant filed a petition to add the Bajaj Allianz Life Insurance Company Ltd., Head Office GE Plaza, Yerawada, Pune as opposite party No.4, and the opposite party No.4 is added as per orders in IA.No.52/2015, dt.30-09-2015.
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 complaint is misconceived, misconstrued contrary to the contract between the parties and therefore untenable in law and deserves to be dismissed, the opposite party has not been intimated about the death of the policy holder, neither any death claim documents have been submitted by the complainant and the first opposite party till date for processing the same. The opposite party No.4 further submitted that since they are not in receipt of the death claim documents the question of deficiency of service as averred in this complaint does not arise. The opposite party No.4 further submitted that neither the complainant in his complaint nor the opposite party No.1 have mentioned the details of submission of claim documents to the opposite party No.4 and they failed mention details of dispatch (postal or courier details) of death claim documents, which clearly proves that they have indeed not sent the death claim documents to the opposite party No.4. The opposite party No.4 further submitted that, the complaint averments clearly reveals as to lethargic attitude of the complainant wherein he kept silent from December 2006 to 2009 about the death claim settlement details and approached the Forum belatedly by making the opposite party No.4 as party to the proceedings who are not necessary party to the complaint at this stage. The opposite party No.4 further submitted that as per the complaint the life assured died on 19-12-2006 and the death of said deceased was due to sudden cardiac arrest, the deceased A. Ram Kota Reddy had availed the said policy on 16-11-2006 and died on 19-12-2006 i.e. within one month from the date of availing the policy, hence for the above said reasons it become very much necessary to investigate the exact cause of death towards processing of the death claim amount, which is not impossible and the opposite party submit that they had been deprived their rights to investigate the cause of death of the life assured towards the processing of the death claim, the claim has belatedly and without any justifiable reason has approached the Forum by suppressing the material facts, as such prayed to dismiss the complaint. The opposite party No.4 further submitted that as per certificate of insurance copy, life assured had availed the policy in the year 2006 and the coverage period started from 16-11-2006 to 15-11-2007 for a sum assured amount of Rs.50,000/- only, it is pertinent to note here that the complaint filed CC.No.84/2010, 32/2009 and 94/2011 before the Forum against Road Safety Club Pvt. Ltd, shows that the policy holder / life assured have all died due to sudden heart attack and all the life assured have died within one month from the date of commencement of policy and further all the complainants have filed complaints after two years from the date of death of the policy holder, from the above said facts it is crystal clear that there is some criminal activity involved against the death of the life assured who has availed the said policies wherein all the life assured are died only because of sudden cardiac arrest which has to be looked into and recommended for investigation by the jurisdiction of police station to bring out the truth from the respective complainants, the complaint filed by the complainant is frivolous, vexatious and is not maintainable as such prayed to dismiss the compliant. No documents filed on behalf of opposite party No.4
6. Upon perusing the material papers on record, now the points that arose for consideration are,
- Whether the complainant is entitled for the claim?
- To what relief?
Point No.1:-
In this case the father of the complainant by name A. Rama Kota Reddy 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 No.357684 with Group Personal Accident Master Policy No.12/29/14/00138/05 valid from 01-11-2006 to 31-10-2007 for Rs.1,00,000/- towards death claim and the complainant is the nominee to the said policy. According to the complainant the father of the complainant died on 19-12-2006 due to sudden cardiac arrest (Heart Attack), immediately after the death of his father, the complainant intimated the same to the opposite party No.1 and submitted claim form along with all original documents for the death benefits. As the opposite parties failed to settle the claim the complainant approached the Forum.
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 for getting the claim amount. As per the counter submitted by the opposite party No.1, they have sent relevant documents required by the opposite party No.4 and also addressed letters on 19-02-2007, 26-03-2007 and 10-07-2008 to the Bajaj Life Insurance Co. Ltd., but the opposite party No.1 failed to produce any documentary evidence to support their contention. The opposite party No.4, denied the submission of claim made by the complainant through the opposite party No.1. According to the opposite party No.4 the life assured had availed the policy in the year 2006 and the coverage period started from 16-11-2006 to 15-10-2007 for a sum assured amount of Rs.50,000/- only. From the above, we observed that the complainant submitted claim form along with all necessary documents to the opposite parties, but they failed to settle the claim. In the above circumstances we are directing the opposite parties No.1 & 4 to pay the policy amount of Rs.50,000/-, as such this point is answered accordingly, in favour of the complainant.
7. In the result, the complaint is allowed in part, directing the opposite parties No.1 & 4 to pay an amount of Rs.50,000/- covered under the group policy bearing No.12/29/14/00138/05, to the complainant with interest @9% per annum from 11-08-2009 (i.e. from the date of complaint) till the date of actual payment. The complaint against the opposite parties No.2 and 3 is dismissed.
Typed to dictation, corrected and pronounced by us, in the open forum on this the 31st 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:-
Ex.A1:- | Photocopy of Membership Certificate issued by opposite party No.1. | | |
Ex.A2:- | Photocopy of Certificate of Insurance for Group Personal Accident Master Policy issued by opposite party No.3. | | |
Ex.A3:- | Photocopy of Certificate of Insurance for Group Term Life Voluntary Plan issued by opposite party No.4. | | |
Ex.A4:- | Photocopy of Death Certificate, dt.28-12-2006 issued by Village Secretary, Gram Panchayath, Bathulapalli, Kalluru Mandal, Khammam District. | | |
EX.A5:- | Photocopy of Household Card of the complainant issued by Dy. M.R.O. Kalluru, Khammam District. | | |
FAC President Member
District Consumer Forum, Khammam.
