Complaint filed on: 28-10-2011
Disposed on: 11-06-2012
BEFORE THE BANGALORE IV ADDITIONAL DISTRICT
CONSUMER DISPUTES REDRESSAL FORUM,
BANGALORE URBAN DISTRICT, NO.8, SAHAKARA BHAVAN, CUNNINGHAM ROAD, BANGALORE – 560 052
C.C.No.1969/2011
DATED THIS THE 11th JUNE 2012
PRESENT
SRI.J.N.HAVANUR, PRESIDENT
SRI.GANGANARASAIAH, MEMBER
SMT.ANITA SHIVAKUMAR.K., MEMBER
Complainant: -
Shanthamma
W/o. C.M.Paramesh,
Aged about 40 years,
Occupation: house wife
R/at No.58, 4th Cross,
SVG Nagar, Mudalpalya,
Bangalore
V/s
Opposite party: -
Bharathi AXA General Insurance Co. Ltd, 1st Floor, FERS ICON,
Sy.No.2, Doddanakkundi Village,
K.R.Puram Hobli, Bangalore-37
ORDER
SMT.ANITA SHIVAKUMAR.K., MEMBER
This is a complaint filed by complainant against Opposite party, praying to pass an order, directing Opposite party to award Rs.2,00,000=00 towards damages alongwith interest and cost of litigation.
2. The brief facts of the complaint filed by the complainant against Op are that the complainant is mother of Mr. late Madusudan.C.P who was working as employee in Parle Products Ltd. During his employment period he had opted for Apex Personal accident policy with Op which starts from 28/10/2010 to 27/10/2011 for sum insured Rs.2,00,000/-. The complainant is mother as well as beneficiary as mentioned in the policy copy. On 28/10/2010 at about 9.30 p.m. when complainant’s son Madhusudhan was preceding to his house after finishing his work, he met with an accident while crossing road at NH-4 near Makali village, Dasanapura Hobli, Bangalore. One red colour Scorpio car came negligently and dashed to Mr.Madhusudhan and he died at spot. One Mr.Narasing who saw the incident lodged a complaint before Madanayakanahalli police. The jurisdictional police came to the spot and registered a criminal complaint against driver of Scorpio car under section 304 A of IPC R/W 187 of IMV Act in the crime no: 180/2010. Since, he opted a personal accident insurance policy with Op, the complainant made representation to the Op in claim no. CO121099. But Op has repudiated the claim of the complainant on the ground that the claim was reported on 22/6/2011 after the delay of 237 days. As per the policy condition which was supposed to intimate through written notice unless reasonable cause, be given before cremation. The complainant is mother of the deceased and the policy was issued by the company where he was working. The complainant immediately made representation to the Op for claiming the amount soon after the issuance of policy came to her notice. OP had not furnished any terms and conditions at the time of issuance of policy for which she is not bound. Therefore rejection of claim only on untenable grounds is illegal. The deceased was earning Rs.5,000/- which was used for family maintenance. Hence, she seeks direction to the Op to honour the claim and direct them to pay Rs.2,00,000/- with interest @ 24% p.a along with Rs.2,00,000/- compensation and cost.
3. Notice sent to Op through RPAD, was served on him. He was absent on the date of appearance before the forum. Hence, He was placed exparte.
4. In the course of enquiry into the complaint, the complainant has filed his affidavit evidence reproducing what he has stated in his complaint. The complainant produced covering letter written by Op addressed to the insured dated 4/11/2010 along with policy copy and receipt for payment of premium, copy of police complaint, copy of FIR, copy of post mortem report, copy of death certificate, copy of repudiation letter dated 9/7/2011. Heard the counsel for complainant and perused the records.
5. After going through the documents produced by the complainant, there is no doubt about the premium paid towards obtaining insurance policy and Op has issued SMART personal Accident policy for insured sum of Rs.2,00,000/-. The policy was in force from 00.01 hours on 28/10/2010 to midnight on 27/10/2011. The said accident took place on 28/10/2010 at 9.30 p.m at NH 4 while insured/ deceased was crossing the road. As per the repudiation letter of Op dated 9/7/2011 there is no dispute about effectiveness of policy. Op has repudiated only on the ground that there is 237 days delay in claiming the insurance amount by the complainant. In the said letter Op mentioned that as per the policy Sec.12 (a) the claimant must claim it in writing before the cremation or within one calendar month from the date of death. May be the conditions of policy revealed, there is delay in claiming the amount of insurance. But the complainant was not known about the policy taken by the deceased and also the said copy of policy does not contain the policy conditions. In case the complainant deliberately or knowingly made delay in claiming the amount, the repudiation by Op is justifiable. But here the Insurance was taken through his employer which was issued on 4/11/2010. It has come to the knowledge of complainant in later stage, and immediately she made claim before Op. Even Op has not furnished policy conditions with the copy of policy.
6. In such a condition, the repudiation in disbursing the insurance amount doesn’t have value since Op has not made efforts to know the policy condition. Insurance company like Op must produce policy condition, exclusions of policy to the insured to understand the consequences of delay in claiming it. Op mentioned the exclusion clause only after claim made before him and gave reasons on which they are repudiating it in letter dated 9/7/2011. If his repudiation is really on the genuine ground, he should have appeared before the forum to defend himself and made it clear that his stand is in accordance with the condition of policy. But Op did not do so. He has neither appeared before the forum nor rebutted the allegation of the complainant. It indicates Op caused deficiency in service in not paying the insurance amount to the complainant who is beneficiary under the said policy and also mother of the insured person.
7. The condition of delay in claiming doesn’t apply in certain cases like this because death has caused due to accident which has been proved by the complainant by producing police complaint filed before the jurisdictional police, FIR report, post mortem report issued by the concerned authorities. Apart from that complainant was not knowing about the insurance policy taken by the deceased for a long period and conditions of policy was not furnished by the Op along with policy copy. The lack of information about condition is not fault of the complainant. If the condition of policy has been enclosed and complainant had made delay in making claim, it would have been stated, it is her fault. Here OP is at fault in not producing the conditions of policy at the time of inception of policy. So, he cannot stand on the ground of conditions of policy. Hence, delay in submitting the claim by complainant is not the proper ground to reject her claim. A person died means died only; there will be no doubt about his survival. It is not like a theft of vehicle or damages to vehicle and such claims before the insurance company may be rejected on the ground of delay, but not the claim of complainant. Therefore, the complainant is entitled for the claim amount. Op caused deficiency and he is liable to compensate for it. Accordingly we pass the following order.
ORDER
Complainant is allowed.
Op is directed to pay Rs.2,00,000/- to the complainant with interest @ 9% p.a from the date of claim i.e. from 22/6/2011, within 30 days from the date of receipt of this order.
Failing which Op shall pay interest @ 12% p.a from the date of claim till it is realized.
Op shall pay Rs.2,000/- to the complainant towards cost.
Supply free copy of this order to both parties.
Dictated to the Stenographer, got it transcribed and corrected, pronounced in the Open forum on this the 11th day of June 2012.
MEMBER MEMBER PRESIDENT
