BEFORE THE DISTRICT COMSUMER FORUM: KURNOOL
Present:Sri.K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, M.A., LL.B., Member
Tuesday the 10th day of July, 2007
CC No.152/2006
J.Naga Lakshmamma, W/o Late Naga Raju,
H.No.11-33, Owk Village and Mandal,
Kurnool District. ……COMPLAINANT
Verses
- The Managing Director, Road Safety Club Private Limited,
2A, 2nd Floor, Prakasam Road, T.Nagar, Chennai.
- The branch Manager, Road Safety Club Private Limited,
C/o Sri Ram Chit Fund Private Limited, Sreenivasa Nagar,
Nandyal, Kurnool District.
- M/S National Insurance Company Limited,
G.T.Branch, Chennai-600 108. ……OPPOSITE PARTIES
This complaint coming on this day for hearing in the presence of Sri.K.Bhasker Reddy and Sri.A.Prabhakar Reddy, Advocate, Kurnool for complainant, Sri.P.Siva Sudarshan, Advocate, Kurnool for opposite party No.1, Sri.D.M.Ramachandra Reddy, Advocate, Kurnool for opposite party No.2 and Sri.P.Sunkanna, Advocate, Kurnool for opposite party No.3 upon the perusing the material papers on record, the Forum made the following.
ORDER
(As per Smt.C.Preethi, Member)
CC No.152/2006
1. This consumer complaint of the Complainant is filed U/s 12 of C.P. Act., 1986, seeking a direction on the Opposite Parties to pay to the Complainant the assured amount of Rs. 3,00,000/- with 24% interest and bonus, Rs. 50,000/- as compensation, costs of the complaint and any other relief or reliefs which the Complainant is entitled in the circumstances of the case.
2. The brief facts of the Complainant’s case is that the Complainant husband J. Naga Raju was a member of Opposite Party No.1 club and a membership certificate bearing No. 386768 was issued for 96 month covering personal accident benefit for Rs. 3,00,000/- to its members. On 18-08-2005 the Complainant died in a road accident near Owk village and a case was registered under C.R.No. 57/2005. The claim form was sent to Opposite Party No.1 on 06-09-2005 along with FIR, Inquest Report, PM Certificate, Death Certificates. The Opposite Party No.1 received a letter on 17-10-2006 from Opposite Party No.3 informing that the claim is not payable. The above rejection of claim by the Opposite Party No.3 is amounting to deficiency of service and the Complainant resorted to the Forum for redressal.
3. In support of her case the Complainant relied on the following documents viz; (1) Member Ship Certificate issued by Opposite Party No.1 along with covering letter (2) Letter dated 12-01-2004 of Shriram direct to Home Pvt., Ltd., Chennai containing the receipt for Rs. 100/- (3) Xerox copy of Certificate of Insurance of Tata AIG General Insurance Company Ltd., Chennai, in reference to Master Policy No. GPA. 0000486 dated 12-01-2004 (4) Xerox copy of claim form and (5) No Claim letter dated 09-06-2006 of Opposite Party No.3, besides to the sworn affidavit of the Complainant in reiteration of her complaint avernments and the above documents are marked as Ex.A1 to A5 for it appreciation in this case .
4. In pursuance to the notice of this forum as to this case of the Complainant the Opposite Parties appeared through their standing counsel and filed their separate written versions.
5. The written version of Opposite Party No.1 admits the Complainant’s husband as its member with certificate No. 386768 and further submits it is only an agent of Opposite Party No.3 for making arrangements for entering into insurance agreement and cannot be made liable for the liabilities of the principal and immediately after receiving claim form from the Complainant it forwarded the same to Opposite Party No.3. Hence there is no deficiency of service on part of Opposite Party NO.1 and seeks for the dismissal of complaint with cost.
6. The written version of Opposite Party No.2 submits that it has nothing to do with Opposite Party No.1 or Opposite Party No.3 and there is no branche of Opposite Parties No.1 and 2 at Nandyal. Late. Naga Raju is not know to Opposite Party No.2 and the accident to Naga Raju on 18-08-2005 is also not know to Opposite Party No.2 and there is no cause of action against Opposite Party No.2 and the Complainant unnecessarily added Opposite Party No.2 by giving misdescription and lastly seeks for the dismissal of the case.
7. The written version of Opposite Party No.3 submits that it is not aware of accidental death of Naga Raju on 18-08-2005 and further submits the Complainant did not inform the said fact to Opposite Party No.3 and there is delay in giving intimation and submitting the documents. Therefore, the claim is not maintainable. It also submits that there is variation in furnishing the age of the deceased in the certificates of Insurance and Post Mortem certificates. It is for Opposite Party No.1 to intimate with regard to accident and submit claim form within stipulated time and not the members of the club as per this agreement. It also submits that the deceased died in a road accident while he was on a motor cycle and a jeep bearing No AHA 2062 dashed against the deceased and case is registered against the driver of the jeep which caused the accident. Hence the complainant has to approach Motor Accidents claims Tribunal and Forum has no jurisdiction. It lastly submits to direct the complainant to submit succession certificates to enable her to claim compensation of her husband and seeks for the dismissal of complaint with cost.
8. The Opposite parties in support of their case relied on the following document Viz (1) Certified copy of FIR in Cr.No.57/05 of Police Station, Owk (2) Certified copy of Inquest Report held over J. Naga Raju (3) Certified copy of Post Mortem certificate, besides to the sworn affidavit of Opposite Party 1 to 3 in reiteration of their written version avernments and the above documents are marked as Ex.B1 to Ex.B3 for its appreciation in this case. The Opposite Parties caused interrogatories to the Complainant and suitablely replied to the interrogatories of Complainant.
9. Hence, the point for consideration is to what relief the Complainant is entitled alleging deficiency of service on part of Opposite Parties?
10. There is no dispute as to the deceased Naga Raju covered under the Group Personal Accident Insurance Policy issued by Opposite Party No.3 vide Ex.A3 and nominated the Complainant as his nominee. There is no dispute as to the death of deceased Naga Raju on 18-08-2005 in a road accident. The only dispute is regarding the delay in intimating the death of the deceased to Opposite Party No.3. The counsel for Complainant submitted that all relevant documents are submitted to Opposite Party No.3 and the Complainant being a women un aware of the fact of informing the Opposite Party No.3 within a stipulated time of the fact of informing the Opposite Party No.3 within stipulated time could not intimate before, but on the other hand the counsel for Opposite Party No.3 submitted that belatedness of the Complainant in informing the Opposite Party No.3 about the death of deceased within stipulated from the date of accident is clear violation of policy condition.
11. The Ex.B1 certified copy of FIR in Cr.No. 57/05 of Police Station, Owk, it says that the death of deceased was due to road accident, the Ex.B2 is the certified copy of inquest report held over the deceased the Ex.B.3 in the certified copy of Post Mortem Certificate, all the above documents in unit one says that the death of Naga Raju is due to accident only. From the above it is clear that the deceased died on a road accident. The only attack of Opposite Party No.3 is that the Complainant intimated the death of deceased belatedly i.e., after stipulated time and her claim is not entertainable. The Ex.A5 is letter of Opposite Party No.3 to the Complainant it envisages that the claim of the Complainant is treated as “No claim” as there is violation of policy conditions. The said conditions no where envisages forfeiture of the insured amount of the deceased on failure of nominee not informing the death of deceased to the insurance company within stipulated time.
12. In support of their case the Complainant’s side relied on the following decision of Uttarpradesh State Commission between LIC of India Vs Rajendra Singh Gaur reported in (IV) 2004 CPJ Pg 531, where in it was held that repudiation of claim by LIC on the ground that intimation of death was delayed, the complainant contented that he was 80 years and not able to intimation earlier and he completed all formalities, hence, held repudiation of claim unjustified and illegal.
13. In the above said case the policy holder died on 29-11-1994 and intimation of death was given by the nominee to the insurance company in June 2003. The complainant was allowed on the ground that the policy stood intact for 10 years and the complainant was nominee under the policy and the complainant alone is entitle to the policy amount.
14. Following the above mentioned decision in the present case the death of policy holder occurred on 18-08-2005 and the same was intimated to opposite party No.2 on 16-02-2006 but the complainant submitted all documents and being a woman unaware of the fact of informing the opposite party No.3 within the stipulated time, as such the complainant is showing a reasonable cause of the delay in intimating the death of Naga Raju beyond stipulated time and as such there appears no fraudulent suspicion on the face in violation of policy conditions. Hence, the complainant’s approach to this Forum seeking redressal is justified. The opposite party No.3 by its doscile conduct should not have repudiated the claim of the complainant and should have condoned the delay after the stipulated time limit.
15. The other decision relied by the complainant is that of Chhattisgarh State Commission reported in (III) 2006 CPJ pg 180 between Bajaj Allianz General Insurance Company Ltd Vs Manoj Agarwal, where in, it was held that intimation of death was delayed but intimation to the police was given in time, if the intimation to insurance company was delayed, but duly informed the police, hence the delay of intimation to the insurance company would not be fatal. In the present case intimation to Police was given on the same day of accident and FIR was issued on 19-08-2005, but there is delay in intimating insurance company. Hence basing on the above decision the delay in intimating Opposite Party No.3 would not be fatal.
16. To conclude, from the above discussion and following the afore mentioned decisions the complainant except delay in intimating the opposite party No.3 and in all other aspects certainly remaining entitled to the accidental benefit under the Group Personal Accident Insurance Policy issued by opposite party No.3 covering the risk of her husband Naga Raju and opposite party No.3 is liable to pay the same as there is deficiency of service on part of opposite party No.3 in not paying the said amount. As there is no cause of action against to opposite party No.1 and No.2 case against opposite party No.1 and No.2 is dismissed. The Deceased at the time of the accident was on two wheeler, hence as per the policy the nominee is entitled to the assured amount of Rs.2,00,000/- only.
17. In the result, the complaint is allowed directing the Opposite Party No.3 to pay the insured amount of Rs.2,00,000/- under the certificate of insurance No. ACL/PC 000000541A of Naga Raju to the complainant with 9% interest per annum from the date of complaint i.e., 10-11-2006 till realization along with Rs. 5,000/- as costs within a month of receipt of this order.
Dictated to the Computer Operator, transcribed by her, corrected and pronounced in the Open bench this the 10th day of July, 2007.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1 Member Ship Certificate issued by Opposite Party No.1 along with covering letter
Ex.A2 Letter dated 12-01-2004 of Shriram direct to Home Pvt., Ltd., Chennai containing the receipt for Rs. 100/-
Ex.A3 Xerox copy of Certificate of Insurance of Tata AIG General Insurance Company Ltd., Chennai, in reference to Master Policy No. GPA. 0000486 dated 12-01-2004
Ex.A4 Xerox copy of claim form
Ex.A5 No Claim letter dated 09-06-2006 of Opposite Party No.3
List of exhibits marked for the opposite parties:-
Ex.B1 Certified copy of FIR in Cr.No.57/05 of Police Station, Owk
Ex.B2 Certified copy of Inquest Report held over J. Naga Raju
Ex.B3 Certified copy of Post Mortem certificate
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1) Sri. K. Bhasker Reddy and A. Prabhakar Reddy, Advocates, Kurnool.
2) Sri P. Siva Sudarshan, Advocate, Kurnool.
3) Sri. D.M. Ramachandra Reddy, Advocate, Kurnool.
4) Sri. P. Sunkanna, Advocate, Kurnool for Opposite Party No.3
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
