3

respondents the complainant filed the present complaint alleging the deficiency of

service on the part of the respondents for not settling her claim for a long period.

4. The R2 & R3 filed their counter adopted by R1 with memo. The

respondents stated that the complaint is bad for non-joinder of necessary party i.e.

Bajaj Allianz Insurance Co. Ltd., and in the absence of such the complainant is not

entitled for any relief as prayed in the complaint. The R4 i.e. Reliance General

Insurance Co. Ltd., issued policy to the complainant covering the risk of personal

accident and that the Bajaj Allianz Insurance Co. Ltd., issued policy to the

complainant covering the risk of life of the deceased. Therefore, the complainant

has to sort out her claim with Bajaj Allianz Insurance Co. Ltd., who covers the risk

of life of the deceased P. Obulamma. The respondents stated that they are no way

concerned with the allegations made by the complainant and stated that the

complainant has not submitted the relevant documents before Bajaj Allianz

Insurance Co. Ltd. and the complainant cannot allege deficiency of service on the

part of the respondents. In the terms and conditions of the Road Safety Club

Services i.e. R3 it was mentioned that the members have specific knowledge that

the insurer will not be liable in any manner whatsoever, by virtue of any insurance

coverage period and the insurance company will be solely liable in case of any

claim. The complainant cannot find fault with the insured. The respondents

further stated that the complainant has to prove that she is the legal heir of her

mother by documentary evidence. The death of the insured due to heart attack

was also denied by the respondents and stated that it has to be proved by

documentary evidence. Further the respondents stated that their role is only to

bring awareness among the public with regard to the AMS life card and enable

them to get insurance coverage from insurance company. Once the insurance

company issued insurance policy the role of these respondents thereby ends and

the services of the respondents are only to the extent of arranging insurance policy

4

under the policies to its members. If there is any dispute with regard to settlement

of the claim the same has to be sorted out with the insurance company. There is

no deficiency of services on the part of these respondents. The R1 to R3 are not

insurance companies and they are only a Pvt. Ltd., companies launched with an

object to create risk awareness among the public and that the public are

encouraged to become members of Road Safety Club and the members will get

insurance coverage depending upon the type of membership. The insurance

company issued “certificate of Insurance” specifically mentioned the name of the

each member, through these respondents as reflected as insured, the beneficiary is

the member for whose benefit the policy was insured. Further the respondents

stated that the member specifically acknowledged with the insurer will not be

liable in any manner whatsoever, by virtue of any insurance coverage provided the

insurance will be solely liable in case of any claim. The respondents further

stated that in accordance with the provisions of Arbitration and Conciliation Act

1996 it is a settled law that if at all, the complainant is having any dispute or

claim, she is entitled to seek relief of the dispute in the Arbitration in terms of

arbitration clause in the Road Safety Club programme terms and conditions.

5. The R4 filed a counter denying all the allegations made by the

complainant except those which are specifically admitted herein. The present

complaint is misconceived as the claim is made against the wrong party i.e. R4

company and the claim form which was filed along with the complaint disclose that

it relates to M/s Tata AIG General Insurance Co. Ltd., in the counter filed by the

R1 to R3 respodnents it is stated that the risk of life of the deceased was covered

by M/s Bajaj Allianz Insurance Co. Ltd. And this respondent is no way concerned

to the present complaint. The claim form was made by the insured i.e. R3

company under the four policies issued by this respondent company. Except

receiving notices in the above case from the Hon’ble Forum this respondent

5

company is not aware of anything r e garding the subject matter of present

complaint as seen from the policies issued by this respondent company. The scope

of coverage is as a) accidental death by accident Rs. 1,00,000/-. B) permanent

total disablement / dismemberment up to Rs. 1,00,000/-, c) permanent partial

disablement up to Rs. 1,00,000/- and d) in-patient hospitalization expenses

following an accident Rs. 10,000/-. Therefore, it is clear that natural death of the

deceased P. Obulamma is not covered under four policies issued by R4 company.

The fact is also confirmed by R3 company in their counter. Therefore, the present

case is liable to be dismissed against R4 company. As per terms and conditions of

the policy only accidental death caused due to sudden and violent extent means is

covered and natural death does not cover the policy. The respondent further

stated that the R4 is shown as its Mumbai Office admittedly R1 to R3 companies

are not the business concern of this respondent company as such the present

complaint cannot be entertained against R4. The R4 has no obligation or liability

whatsoever, for any other services or facilities offered by the group to which the

member belongs other than the insurance cover accepted, being offered by Road

Safety Club Pvt. Ltd., under which the members have joined. The insurer will be

responsible only for the insurance coverage provided in the policy which comes

into effect only upon receipt of the premium by the insurer as per the signed

receipt issued by the insurer to the group and based on the enrolment details

submitted to the insurer by the Road Safety Club Pvt. Ltd., and subject to all the

other terms, conditions and exclusions of the policy issued.

6. On behalf of the complainant Ex. A1 to A13 w ere marked and no

document was marked on the side of the respondents.

7. On the basis of the above pleadings the following points are settled for

determination.

i. Whether the complainant is entitled to receive the policy amount of

Rs. 2,00,000/- towards risk coverage from the respondents?

6

ii. Whether the complainant is entitled to receive Rs. 1,00,000/- towards

mental agony from the respondents?

iii. Whether ther e i s any deficiency of service on the part of the

respondents?

iv. To what relief?

8. Point Nos. 1 to 3. Heard both sides and perused the records available

with the forum and the forum made the following order. The complainant is the

daughter of P. Obulamma, who is the insured. The R1 to R3 are the companies of

Shriram Group of companies and R1 is situated at Kadapa doing business, who

gave propaganda about the AMS life card – 3 designed by R2 through R3. The

AMS life card holders having age in between 18 to 54 years will get benefit of

Rs. 50,000/- in case of natural death and Rs. 1,00,000/- in case of accidental

death. The period of life card is 36 months. The R3 i.e. Road Safety Club Pvt. Ltd.,

issued member ship certificate through R1, and the deceased was attracted by the

benefit of the above said policies, that she purchased four AMS life card-3 under

certificate Nos. 1520216, 1520217, 1520232, 1520233. In case of natural death

the R2 assured to pay Rs. 50,000/- on each through R1. The R1 also given

certificate of insurance issued by R4 i.e. Reliance General Insurance Co. Ltd.,

bearing Nos. AF3/PH000000005, AF3/PH000000006, AF3/PH000000007 and

AF3/PH000000008. The complainant is the nominee of the above said policies.

On 14-7-2006 the insured P. Obulamma died due to heart attach and the same

was confirmed by the doctor at Pragathi Orthopedic & General Hospital, Kadapa.

At the time of death of the insured all the four certificates of insurance are in force.

The complainant being the nominee approached R1 and requested them to settle

her claim and R1 instructed her to submit relevant documents.

9. Accordingly the complainant submitted claim form along with four

original certificates of insurance issued by R4 through R1 and four membership

certificates issued by R3 through R1 along with death certificate and family

7

members certificates. The R1 gave an endorsement on 26-6-1007 that he received

claim form. Ex. A1 is the Xerox copy of claim form submitted by the complainant.

Ex. A2 is the Xerox copy of certificate issued by doctor confirming the death of the

insured. Ex. A3 is the Xerox copy of death certificate issued by Panchayat

Secretary, Utukur Grampanchayat. Ex. A4 is the Xerox copy of family members

certificate issued by Tasildar, C.K. Dinne Mandal, Kadapa District, dt. 20-4-2007.

Ex. A5, A8, A9 and A10 are Xerox copies of member ship certificates issued by R3

i.e. Road Safety Club Pvt. Ltd., Ex. A6, A11, A12 and A13 are Xerox copy of

certificates of insurance issued by R4 i.e. Reliance General Insurance Co. Ltd., Ex.

A7 is brochure issued by R1 & R2.

10. The complainant approached the R1 many times for settlement of her

claim but they have not settled the claim till today and postponing the matter on

some pretext or other. The complainant was vexed with the attitude of the

respondents and filed the present complaint. The R2 and R3 filed their counter

adopted by R1 and stated that they are no way concerned to the present complaint

as Bajaj Allianz Insurance Co. Ltd., is liable to pay compensation to the

complainant as natural death of the members is covered by above said insurance

company and they are no way concerned to the present complaint. They were not

the insurance companies. It is their duty to create awareness among the members

to became members of R3 company and they have a tie-up with different insurance

companies and after that their job will end. When the insurance company issued

certificates to its members, the responsibility of settling the claim of the members

is on insurance company only but not on these three respondents. The R4 filed its

counter denying the allegations made by the complainant and stated that

according to the counter of R1 to R3 respondents it was pointed out that the Bajaj

Allianz Insurance Co. Ltd., to settle the claim of the complainant. If at all and

there is no burden on the shoulders of the R4 company only. In the present

8

complaint the complainant submitted the claim form belongs to TATA AIG

Insurance Co. and mentioned R4 company certificate numbers.

11. Further the counsel of R4 argued that it is clear that the certificates

issued to the insurer clearly mentioned that only accidental death by accident is

covered and not natural death. All the counsels for the respondents argued that

there is no responsible on any of the respondents companies and the complainant

is liable to approach Bajaj Allianz Insurance Co. Ltd., only. Surprisingly there was

no certificate issued to the insured with regard to the Bajaj Allianz Insurance Co.

Ltd., but now all the respondents have stated that the natural death if at all is

Bajaj Allianz Insurance Co. Ltd any claim with regard to natural death, the

complainant has to approach the Bajaj Allianz Insurance Co. Ltd., only and there

is no burden on their shoulders. By seeing Ex. A7 i.e. the brochure issued by R1

and R2 it is clearly mentioned that AMS life card – 3 holders are liable to receive

Rs. 50,000/- in case of natural death and in case of accidental death they are

liable to receive Rs. 1,00,000/-. The brochure i.e. Ex. A7 issued by R1 and R2 was

very attractive with all different packages like AMS classic card, AMS silver card,

AMS first lady card, AMS protection card and AMS health card etc., when the

companies are issuing such type of brochures attracting the general public they

have to stick on the terms and conditions mentioned in the brochures. Likewise

the complainant’s mother was attracted by the propaganda of R1 and R2 company

and she purchased four certificates through R1 in the brochure also they have

mentioned that it is a special offer to purchase four cards and get Rs. 2,00,000/-

life insurance and Rs. 4,00,000/- towards accidental benefit and Rs. 40,000/-

towards medical expenses at the time of accident. Now all the respondents want to

through the burden on Bajaj Allianz Insurance Co. Ltd., No where it is mentioned

in the certificates issued by R3 or polices issued by R4. Surprisingly now the Bajaj

Allianz Insurance Co. Ltd., has come in to the picture. If at all the natural death

9

was covered by Bajaj Allianz Insurance Co. Ltd., why they have not issued the

same certificate to the insured. The R4 issued certificates to the complainant and

mentioned that the same was issued under AMS life card – 3 and the complainant

is not nominee of the said certificates. Now the R1 to R3 took objection that the

complainant has to prove that she is legal heir by documentary evidence. For

which the complainant submitted the legal heir certificates issued by Tahsildar,

C.K. Dinne Mandal i.e. Ex. A4 and the death of the insured was also proved by

documentary evidence i.e. Ex. A2 certificate issued by Doctor i.e. Pragati

Orthopedic & General Hospital, Kadapa what else the respondents required?. The

companies are showing more enthusiasm in issuing different types of brochures to

attract the general public and making them to become members under different

categories. When the time comes for settlement of their claim they want to blame

through of each other and their job is end when the public will become members

and after that the insurance company has to take care of the things etc., The

decision filed by R4 are not applicable to the present case. It is clear that the

insured i.e. the mother of the complainant purchased four AMS Life card-3 by

paying Rs. 2,400/- and she is entitled to Rs. 2,00,000/- towards natural death on

each certificate Rs. 50,000/- she is entitled to receive. The respondent cannot

escape from their liability stating that only accidental death is covered not the

natural death. In their brochure it is clear that AMS life card – 3 members are

entitled to receive Rs. 50,000/- on each certificate as the deceased purchased four

polices from the respondents and who died due to heart attack. The complainant

is the legal heir of the deceased. The complainant is entitled to receive

Rs. 2,00,000/- from the respondents. We are of the opinion that the respondents

are showing gross negligence and deficiency of service in settling the claim of the

complainant throwing the burden on each of them.

12. Point No. 4. In the result, the complaint is allowed. Directing the

respondents 1 to 4 jointly and severally to pay Rs. 2,00,000/- (Rupees two laksh

10

only) without interest and also to pay Rs. 2,000/- (Rupees two thousand only)

towards mental agony and Rs. 500/- (Rupees five hundred only) towards costs,

within 60 days from the date of receipt of this order.

Dictated to the Stenographer, transcribed by him, corrected and pronounced

by us in the open forum, this the 12

MEMBER MEMBER PRESIDENT

APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant : NIL For Respondents : NIL

Exhibits marked for complainant:-

Ex. A1 X/c of claim form submitted by the complainant.

Ex. A2 X/c of certificate issued by doctor confirming the death of the insured.

Ex. A3 X/c of death certificate issued by Panchayat Secretary,

Utukur Grampanchayat.

Ex. A4 X/c family members certificate issued by Tasildar, C.K. Dinne Mandal,

Kadapa District, dt. 20-4-2007.

Ex. A5 X/c of member ship certificates issued by R3 i.e. Road Safety Club

Pvt. Ltd,

Ex. A6 X/c certificate of insurance issued by R4 i.e. Reliance General

Insurance Co. Ltd.,

Ex. A7 Brochure issued by R1 & R2.

Ex. A8 X/c of member ship certificates issued by R3 i.e. Road Safety Club

Pvt. Ltd

Ex. A9 X/c of member ship certificates issued by R3 i.e. Road Safety Club

Pvt. Ltd

Ex. A10 X/c member ship certificates issued by R3 i.e. Road Safety Club

Pvt. Ltd.,

Ex. A11 X/c of certificate of insurance issued by R4 i.e. Reliance General

Insurance Co. Ltd.,

Ex. A12 X/c of certificate of insurance issued by R4 i.e. Reliance General

Insurance Co. Ltd.,

Ex. A13 X/c of certificate of insurance issued by R4 i.e. Reliance General

Insurance Co. Ltd.,

Exhibits marked for Respodnent. --NIL--

MEMBER MEMBER PRESIDENT

Copy to :-

1) Sri M. Venkataswamy Reddy, Advocate.

2) Sri M. Sudhakar Babjee, Advocate.

3) Sri G.S. Murthy, Advocate.

4) Sri D. Lakshminarayana, Advocate.

1) Copy was made ready on :

2) Copy was dispatched on :

3) Copy of delivered to parties

B.V.P - - - -