AT HYDERABAD.

F.A. 822/2007 against C.C.  7/2007, Dist. Forum, Karimnagar.         

Between:

Manupati Kanakaraju

S/o. Pochaiah, Age: 45 years

R/o. 3-1-710, Vavilalapally locality

Karimnagar.                                                ***               Appellant/

                                                                                      Complainant.  

And

1)  The Manager

Andhra Bank Main Branch ,

Girls Junior College Road

Karimnagar.

2)  The Divisional Manager

L. I. C. of India, Divisional Office

II Floor, Jeevan Prakash

Secretariat Road, Saifabad

Hyderabad.                                                           ***               Respondents/Ops.

Counsel for the Appellant:                          M/s. J. Prabhakar.

Counsel for the Resps:                               Mr. K.  Kishore Kumar Reddy  (R1)

R2 – Served.

CORAM:

                             HON’BLE SRI JUSTICE D. APPA RAO, PRESIDENT 

&

                                            SMT. M. SHREESHA, MEMBER

FRIDAY, THIS THE NINETH DAY OF  JULY TWO THOUSAND TEN

Oral Order: (Per Hon’ble  Justice D. Appa Rao, President)

***

1)                Appellant is un-successful complainant. 

2)                The case of the complainant in brief is that he along with his son   Shekhar Babu opened an S.B. account in R1 Andhra Bank under AB-Jeevan Abhaya Scheme wherein the nominee would be entitled to Rs. 2 lakhs in the event of accidental death of the accountholder.    In fact his son was also an accountholder vide account no.  ABJ-1355.  He died in a motor vehicle accident on 8.2.2006 which was registered as a case in Crime No. 21/2006 by the police.    In view of death of his son, he could not inform within six months.    When he approached the bank, it refused to entertain the claim.  On that he got issued a legal notice for which no reply was given and therefore prayed that Rs. 2 lakhs be awarded together with compensation and costs. 

3)                R1 bank resisted the case.    While admitting that the complainant and his son had bank accounts  and covered by the policy,  however alleged that  it was only a facilitator/mediator between the accountholder and the insurance company.   Any claim for compensation should be settled by the insurance company.  It has no role to play.  Since there was neither negligence nor deficiency in service on its part it prayed for dismissal of the complaint with costs. 

4)                R2 insurance company by way of counter affidavit equally resisted the case.    While admitting that it has issued Jeevan Abhaya Group Insurance Scheme for the accountholder of Andhra Bank’s Jeevan Abhaya Savings Bank accountholders, it alleged that intimation of death along with requirements should  be submitted to it through its bank within 180 days from the date of death of the accountholder.   On admission of claim, the claim proceeds would be sent to Andhra Bank on submission of valid discharge by the authorized signatories of Andhra Bank.    Since it did not receive any   intimation of death and other  requirements, it could not process it.   In fact it was ready to consider and process the claim as per the terms and conditions of the Jeevan Abhaya Group Insurance Scheme.    Therefore it prayed for dismissal of the complaint with costs. 

5)                The complainant in proof of his case filed his   affidavit evidence and got Exs. A1 to A14 marked, while the insurance company filed Ex. B1 to B6.

6)                The Dist. Forum after considering the evidence placed on record opined that the claim of the complainant was made  beyond the  period of three months  and that the death was informed  after  7 months, contrary to the stipulation in the policy, and held that “though there is deficiency  of service on the part of Op No. 2, we are of the view that  the complainant is not entitled to  the relief as  he has not informed the Op1 bank about the death and sending the policy  within 90 days  of the accident,”  and consequently dismissed the complaint.

7)                Aggrieved by the said decision, the  complainant preferred the appeal contending hat the Dist.  Forum did not appreciate facts or law in correct perspective.       It ought to have seen that R2 insurance company had agreed to process the claim, there is no reason why the claim was refused.    At any rate the policy conditions were not supplied to the account holder at the time of opening the account,  and LRs were not in a position to know the rules.   R1 bank ought to have forwarded   Ex. A3 legal notice to the insurance company instead of refusing that they have no concern.    Therefore, he prayed that the complaint be allowed.

8)                The point that arises for consideration is whether the order of the Dist. Forum is vitiated by mis-appreciation of fact or law?

9)                It is an undisputed fact that   the complainant Manupati Kanakaraju and his son M. Shekar Babu are having   AB Jeevan Abhaya Savings account evidenced under Ex. A14 pass book.    In the very pass book there is a mention that the said account provides life insurance coverage and extends death benefit.    There is a  stipulation that they have to maintain a minimum balance of Rs. 1,000/-.  The pass book shows that they had Rs. 2,000/- in their account.  Clause-4 deals with sum assured.   In case of normal death an amount of Rs. 1 lakh would be paid while in case of accidental death an amount of Rs. 2 lakhs would be paid.  Clause-8 further stipulates that:  “Settlement of claims is done by insurance company at their sole discretion and Andhra Bank will only act as a facilitator.    The insurance company can reject the claims in case of incomplete submission of documents or mis-representation  of facts.   

10)              They themselves posed a question a question:   “Can I include my family members in the scheme, and answered as “Yes”.  By opening a joint account and on payment of premium applicable for each joint account holder.”   The family members shall furnish death certificate, FIR/Final police report, post mortem report in case of accidental death.     The death due to suicide and self-infected injuries are excluded under the scheme.   

11)              Evidently there is no clause stipulating that the claim should be made within a particular period.    In other words, no period was prescribed to submit the claim. 

12)               It is not in dispute  that  one of the joint account holders   M. Shekhar Babu died in a motor vehicle accident evidenced under FIR Ex. A8 (registered as crime no.  21/2006), inquest report Ex. A9,  post-mortem report  Ex. A10,  Motor Vehicle Inspector’s report Ex. A11,  Accident Information Report Ex. A12 and  Charge Sheet Ex. A13.   The complainant by way of  legal notice Ex. A3 dt.  9.10.2006 informed to insurance company to pay Rs. 2 lakhs mentioning the above details.    In the first instance he informed R1 Andhra Bank under Ex. A6 dt. 20.9.2006 and later to the insurance company under Ex. A3.  The Andhra Bank in turn gave reply in Ex. A7 Dt.  28.9.2006 stating that since the death was not intimated within 3 months from the date of death, as per the terms and conditions no liability could be fastened against it.    However,  it has forwarded the claim to the insurance company by making endorsement therein.    The bank has forwarded the very same documents that were attached to the claim marked as Exs. B1 to B8.  It did not choose to give reply.  It did not controvert the fact that the bank had not  forwarded the claim to it.   When Photostat copies of these proceedings   which the complainant was required to submit, as per the terms and conditions of the pass book  were submitted there is no reason why the insurance company did not settle the claim.    The plea that the claim has to be made within 90 days or 180 days is not particularly mentioned in the pass book.    Obviously the complainant having lost his son must have been in shock and depression and therefore for the accident that took place on 8.2.2006 he formed the bank on   20.9.2006 under Ex. A6 by way of legal notice.    He made a mention that the pass book

preserved by the deceased was not traced out, and therefore delay was occurred.    Equally the complainant has given legal notice to the insurance company under Ex. A3 dt.  9.10.2006 enclosing FIR, charge sheet, inquest, PM report, death certificate etc.  besides copy of pass book.    Obviously having satisfied with the claim, the insurance company was ready to settle the claim.  But it did not do so.  It ought to have taken cognizance of these documents which were not in dispute and could have settled the claim even at least  after filing of the complaint.  

13)              To sum up,  in the light of the fact that the complainant as well as his son are account holders and the death was due to an accident and the claim was made enclosing all the required documents  the insurance company ought to have settled the claim.    Even they did not object for settling the claim.    We do not intend to direct the insurance company to consider the claim once again.    Since the claim is in order, as could be seen not only from the counter but also from the documents, we direct the insurance company to pay the amount covered under the policy.

14)               In the result the appeal is allowed, consequently the complaint is allowed.  R2 insurance company is directed to pay Rs. 2 lakhs with interest @ 6% p.a., from the date of complaint viz., 17.1.2007 till the date of realization together with costs of Rs. 5,000/-.    The complaint against R1 bank is dismissed.  No costs.  Time for compliance four weeks.

1)       _______________________________

PRESIDENT                 

2)                                             _______________________________

 MEMBER

                                                                             Dt.  09. 07. 2010.  

*pnr

“UP LOAD – O.K.”