BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, Lady Member
Friday the 8th day of December, 2006
C.C. No.97/2006
M. Raziya Bee,
W/o. Late M.Rasool,
Aged about 22 years, Muslim,
R/o. Nandhavaram (V),
Banaganapalle (M),
Kurnool District. …Complainant
-Vs-
1.The Branch Manager,
Andhra Bank,
Banaganapalli,
Kurnool District.
2.The Divisional Manager,
Life Insurance Corporation of India
Divisional Office,
2nd Floor, Jeevan Prakash,
Secretariat Road, Saifabad,
Hyderabad. …Opposite parties
This complaint coming on this day for orders in the presence of Sri. A. Prabhakara Reddy, Advocate, Kurnool for complainant, Sri. M. Sanjeeva Reddy, Advocate, Kurnool for opposite Party No.1 and Sri. I. Anantha Rama Sastry, Advocate, Kurnool for opposite party No.2 and stood over for consideration till this day, the Forum made the following:-
ORDER
As per Sri. K.V.H. Prasad, Hon’ble President
1. This case of the complainant is filed U/S 12 of Consumer Protection Act, seeking a direction on the opposite parties to pay her Rs.1,00,000 assured sum under A.B.J. account 1292 of Andhra Bank Banaganapalle, Rs.10,000/- as compensation for mental agony and Rs.26,000/- as interest at 12% per annum from the date of demise of said account holder to the date of filing of this case alleging deficiency of service on the part of the opposite parties in settling the claim of said account holder in favour of the complainant as nominee of the said account holder, consequent to demise of said account holder on account of Heart-attack on 27-4-2004.
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 their liability to the complainant’s claim and seeking dismissal of the complaint with costs.
3. The opposite party No.1-Andhra Bank Banaganapalle, in its written version even though admits the deceased B.Imambi as A.B.J. account holder of account number 1292 with it maintaining minimum balance of Rs.1400/- as required and entitleness of said member under said account for an assured sum of Rs.1,00,000/- in case of natural death or Rs.2,00,000/- in case of accidental death of said member account holder as per the M.O.U arrived in between the opposite parties 1 & 2 as to said A.B.J. accounts holder, denies of any deficiency on its part in non settlement of the claim by the opposite party No.2 (Life Insurance Corporation) as it has discharged its liability in transmitting the required documents of claim to the opposite party No.2.
4.The written version of opposite party No.2 even though admit the submission of claim by the complainant on the basis of A.B.J. account number 1292 of Imambi consequent to the later demise, it denies any of its deficiency in non settlement of the claim as certain documents required in its letter dt:26-02-2004, 01-01-2005 and 25-01-2005 for settlement of claim were not furnished by the opposite party No.1 and complainant .
5. In substantiation of the contentions while the complainant’s side has relied upon documentary record in Ex.A1 and A2 and the sworn affidavit of the complainant in reiteration of its case besides to the replies to interrogatories caused on opposite parties side, the opposite party has said taken reliance on to the documentary record in Ex.B1 to B4 and the sworn affidavit filed by the opposite parties 1&2 besides to the replies to the interrogatories of complainant’s side.
6. Hence point for consideration is whether the complainant has made out the deficiencies of the opposite parties and thereby their liability to the complainant’s claim.
7. The Ex.A1 is the passbook of account number A.B.J.1292 of Andhra Bank Banaganapalle, (Opposite party No.1) issued on 19.04.2004 to Imambi wife of Ismail resident of Nandavaram (v) of Banagapalle (M) with an opening balance of Rs.1400/- credited to said account on 19-042004. As the said account was admitted by opposite party No.1 and the claim was received by opposite party No.2 on the basis of said account there appears any material to doubt the bonafidies of said account with the opposite party No.1 on the name of the said Imambi .
8. The Ex.A2 is the Xerox of letter dated:18-05-2004, the original of which was said to have been caused on to opposite party No.1 requesting for the needful to see the payment of assured insurance amount to her consequent to demise of said account holder on 27-04-2004 due to heart attack and as she is only surviving daughter of said account holder. In view of the admissions of the opposite party No.2 in its pleading as to the receipt of claim of said complainant the Ex.A2 requires no further proof as to the complainant’s setting up of her claim on the basis of said A.B.J. A/C No.1292 of said Imambi consequent to her demise on 27-04-2004 due to heart attack.
9. The Ex.B1 is attested Xerox of M.O.U. as to A.B. Jeevan group L.I.C. Insurance policy arrived at on 1st December 2005 in renewal to its earlier M.O.U.s dated:27-01-2005 and 29th November 2003, in between the L.I.C. of India and M/s Andhra Bank.
i). As per the rules of scheme in section 1 under definition 1(iii) the said scheme shall mean group insurance scheme for the account holders of A.B. Savings Bank account known as A.B. Jeevan Abhaya (A.B.J) S.B.A.B.J and A.B. Jeevan Abhaya special accounts.
ii). under R.1(IV) the member shall mean a personal account holder of A.B. Jeevan Abhaya (A.B.J), S.B.A.B.J, and A.B. Jeevan Abhaya special accounts who has been admitted to the membership of the scheme and on whose life an assurance has been or is to be effected in accordance with these rules..
iii). From R.1(vii) its effective date shall mean 01-12-2003 i.e., the date from which scheme commenced and 01-12-2004 i.e., the date from which the said scheme is renewed and 01-12-2005 i.e., current renewal date.
iv). As per R.1(viii) of definitions the entry date shall be from the date on which is account holder opens an account of A.B.J, S.B.A.B.J-special accounts by deposit of appropriate premium or submits a good health declaration form which ever is later.
v). As per R.1(X1.V) of said definition it covers up to the age of 55 years of said member and the benefit to the nominee of the member as per R.1(X11).
vi). under R.3 (a)(b) the bank shall be at an obligation of furnishing to L.I.C. data of eligible members on monthly basis and any other information called from time to time for ensuring the fulfillment of the terms of the scheme and it is also obligatory on the bank to provide to corporation a summary of consolidate data in respect of all individuals admitted newly in to the scheme and in respect of existing member in the, prescribed proforma covering various age groups from 18 to 55 years with relevant particulars as to their number, coverage amount and premium and their total.
vii). under R.4(b) R/w R.6 of the rules of the scheme, to become member of said scheme, submission of a signed declaration of good health of member not only of the present but also of the past from any critical illness is to be made at the time of entry into the scheme and in case of its non submission no coverage will be granted to the member and consequently in the event of death of member in such case the corporation is not liable to pay.
viii). R.12 of the rules of the scheme enunciated in Ex.B1 provides an assurance to a sum of Rs.1,00,000/- on the life of each member and the said assurance shall be held on Bank upon trust for the benefit of the persons entitled to in accordance with these rules and subject to the exclusions mentioned in rule 14 and 15 of the scheme.
ix). R.13 of the rules of the said scheme provides assurance for the double of the normal assured amount, if the death of the member is due to accident, subject to the terms and conditions of R.16 and exclusions there under.
x). R.22 of the said scheme contemplates issual of a single master policy in favour of the bank and R.21 excludes jurisdiction to try the disputes to any others except to the courts at Hyderabad and R.23 provides the nomination facility to the member and its maintenance in the register maintained by the bank. It provides to the member to appoint his legal representative to be the nominee in case the member doesn’t have wife, children or dependents.
xi). R.26 of the said schemes contemplates the obtaining of health declaration from each individual opting for the membership and the Bank as Master policy holder its sending in original to the L.I.C. along with other claim requirements for processing a claim in respect of any member and it ceases the liability of corporation in respect of claim of a member if any statement in the health declaration form is found incorrect.
Xii). R.28 of said scheme provides the procedure for claim and under it, it warrants the intimation of death within 90 days to the Bank and submission of claim to P.&G.S. Unit within 180 days through respective bank along with attested copy of the account opening form, original health declaration form with a nomination particulars incorporated, in addition to them can call for age proof, death certificate in case natural death, First Information Report, Inquest report, Final investigation report and Postmortem examination report, in case of accidental death. It provides the submission of claim proceeds to the bank by the corporation on valid discharge provided by the bank as facilitator. It reserves the right of rejection of the claims to the corporation in case of incomplete submission of documents or misrepresentation of facts brought out on investigation. It reserves to the corporation a right to call for any additional information regarding claim.
10. From the above rules what remains clear is that the bank (O.P.No.1) as master policy holder for the benefit of members of A.B.J account holders should facilitate all the requirements of corporation which may be called for the settlement of claim. Hence the bank (O.P.No.1) cannot shurk of its said responsibility on the pretext that it is a mere agent, as the privy of said policy if any is to the bank with the corporation and not to its beneficiary or account member with the corporation. Therefore, the opposite party No.1 who is at an obligation of fecilitating the furnishing of necessary data for settlement of claim taking the indulgence of the beneficiary of said scheme who sets up the claim through it. As stated above the supra stated rules providing an unequivocal rights in corporation (O.P.2) for rejection of claim in case of omission to furnish the required material or called for material, as master policy holder for the benefit of member and its beneficiaries, the bank (O.P.No.1) should be deligent and vigilant in fecilitating the proper processing of the claim for its due settlement by corporation. As any correspondence of the corporation shall be with the bank only the said obligation of fecilitating the proper processing of the claim for the benefit of members beneficiaries getting the required from beneficiary, shall be more on bank than on the beneficiary of member as the later he will be in know of the matters is the from the bank-master policy holder alone is later intimations the same and nor being having any direct correspondence with the corporation and so the bank as master policy holder shall absolve of its obligation of fecilitating the proper processing of the claim for settlement, in case of defaultive and non-co-operative conduct of the beneficiary of the said account member in furnishing the necessary material in that regard.
11. Hence, to find out where the actual problem lied and with which of the opposite parties in settlement of claim an advertense to the appreciation of the following material in the scope of the supra stated rules applicable to the scheme under Ex.B1 (M.O.U) is remaining essential.
12. The Ex.B2 is an attested copy of letter dt:22-06-2004 the original of which was said to have been addressed by the opposite party No.2 to the opposite party No.1 requiring the submission of discharged voucher duly stamped, signed and witnessed, copy of death certificate, account opening form attested by Branch Manager and original health declaration form for settlement of the claim. Even though no cogent material is placed by the opposite party No.1 as to the compliance of the requirements sought in Ex.B2 as the attested Xerox reminder letters dt:01-01-2005, and 21-05-2005 in Ex.B3 and B4 is not repeating the submission of documents sought in Ex.B2 it remains clear that the documents sought in Ex.B2 must have been furnished to the opposite party No.2 .
13. The Ex.B3 is attested Xerox of letter dated:01-01-2005, the original of which was said to have been addressed by the opposite party No.2 to opposite party No.1 requiring the furnishment of details of the leave availed by the deceased account holder during one year prior to death certified by the employer and the copy of school/college certificate or Municipal birth certificate or Passports, Voters Identity card or ration card towards proof of age duly attested by the manager Andhra Bank. Even though no cogent material is placed by opposite party No.1 side as to compliance of the requirements sought in Ex.B3 but as attested Xerox letter dated:21.05.2005 is Ex.B4, the original of which was said to have been issued in sequence of correspondence to the Ex.B3, as is not repeating the furnishment of the documents sought in Ex.B3 but on the other hand making a new requirement to furnish copies of previous hospitalization reports duly attested by the manager Andhra Bank which was not sought for in earlier references there remains any circumstances to believe the non compliance by the opposite party No.1 of the requirements sought in Ex.B3.
14. No cogent material is placed by the opposite party No.1 as to its compliance of the requirement of sought in Ex.B4. But on the other hand while the opposite party No.1 is completely silent on this aspect, the contention of the compliant is that the opposite party No.1 has not brought in to its notice the requirement sought in Ex.B4 and so thereby its non furnishment.
15. As stated earlier as the rule 28 provides to the corporation to call for any additional information and also reserves the right of rejection of claim in the corporation in case of incomplete submission of documents, or non furnishing of additional informations the non furnishing of the additional information sought in Ex.B4 by the opposite party No.1 justifies the opposite party No.2 in not settling the claim and in the light of the circumstances alleged by the complainant in supra para as to the conduct of the opposite party No.1 in not intimating him for furnishing the material sought in Ex.B4 for processing the claim by the opposite party No.2, the lapse in furnishing the required material sought in Ex.B4 appears to more on the defaultive conduct of the opposite party No.1 in not fecilitating the requirement for settlement of claim, than on the complainant who was kept in darkness of the needed requirements sought in Ex.B4 for settlement of claim.
16. Either the complainant or the opposite party No.2 allege anywhere in the record that the claim was repudiated and on the on the other hand from the opposite party No.2 it appears that the said claim is still pending for settlement for want of the documents sought in Ex.B4 and not for any other thing. Even though the opposite party No.1 alleges the repudiation of the claim, in the absence of any cogent material to that effect and in the circumstances stated above from the line of opposite party No.2 and the complainant the said repudiation of claim alleged by the opposite party No.1 hardly remains with any truth. Hence, in these circumstances, a direction for furnishing the material required in Ex.B4 appears to serve the need required for settlement of claim of complainant.
17. Consequently the complaint is disposed accordingly directing the opposite party No.1 to obtain from the complainant the document required Ex.B4 or a relevant information in said regard and transmit the same in the manner required by the opposite party No.2 with in a reasonable time of fortnight from the date of the receipt of this order and at the same time the complaint is also directed to co-operate with opposite party No.1 in furnishing the above required material for its transmission to the opposite party No.2, hoping that no further new requirements from the opposite party No.2 in this regard and the requirement sought in Ex.B4 as a final and last one for settlement of claim. On said submission of said relevant material the opposite party No.2 shall settle the claim of the complainant with in a month from there on .
18. In default of the opposite party No.1 in fecilitating the relevant material sought in Ex.B4, inspite of co-operation of complainant in that regard it stands as a clear deficiency on the part of the opposite party No.1 in discharging its obligation of fecilitating the required material for the processing of the claim for the benefit of the beneficiary under said A.B.J. account and thereby depriving the benefit of said scheme to the complainant, and as such the opposite No.1 shall be liable to make good of the assured sum of Rs.1,00,000/- under said scheme to the complainant- beneficiary of said A.B.J. account holder, with interest at 9% from the date of said defaultive conduct till realization and also to pay Rs.1,000/- as costs. In the circumstances each party to the case shall bear their costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced in the Open bench on this the 8th day of December, 2006.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the Complainants: Nil For the Opposite Parties: Nil
List of Exhibits marked for the complainant:-
Ex.A1 Original pass book A/C No.ABJ 1292 in the name of H.Imam Bee.
Ex.A2 Office copy of Death Intimation,Dt:18-05-2004.
List of Exhibits marked for the opposite parties:-
Ex.B1 Attested copy of M.O.U. between opposite party No.1 & No.2.
Ex.B2 Attested copy of letter Dt:22-06-2004. Issued by opposite party No.2 .
to No.1.
Ex.B3 Attested copy of letter Dt:01-01-2005 of opposite party No.2 to No.1.
Ex.B4 Attested copy letter, Dt:25-01-2005 by opposite party No.2 to No.1.
MEMBER PRESIDENT
Copy to:
1. Sri. A. Prabhakhara Reddy, Advocate, Kurnool.
2. Sri. M. Sanjeeva Reddy, Advocate, Kurnool.
3. Sri. I. Anantha Rama Sastry, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
