Complaint filed on: 08.12.2015
Complaint Disposed on:30.11.2016
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, AT CHICKMAGALUR.
COMPLAINT NO.147/2015
DATED THIS THE 30th DAY OF NOVEMBER 2016
:PRESENT:
HON’BLE SRI RAVISHANKAR, B.A.L, LL.B., - PRESIDENT
HON’BLE SMT B.U.GEETHA, M. COM., LL.B., -MEMBER
HON’BLE SMT H. MANJULA, B.A.L., LL.B., - MEMBER
COMPLAINANT:
B.R.Roopa
W/o Late Govindappa,
Aged about 30 years,
B.Kodihalli, Birur Hobli,
Kadur Taluk,
Chikmagalur District.
(By Sri/Smt. J.S.Chandrappa, Advocate)
V/s
OPPONENT:
Branch Manager,
National Insurance Co., Ltd.,
2nd Floor, Yashoram Chambers,
Rathnagiri Road,
Chikmagalur.
(OP By Sri/Smt. T.R.Harish, Advocate)
By Hon’ble President Sri. Ravishankar,
:O R D E R:
The complainant filed this complaint U/s 12 of the Consumer Protection Act 1986 against OP alleging deficiency in service in not settling the personal accident benefit to the complainant towards the death of her husband. Hence, prays for direction against the OP to settle the claim to the tune of Rs.1,00,000/- along with compensation for deficiency in service.
2. The brief facts of the complaint is that:
The husband of the complainant during his life time had obtained group insurance policy bearing policy No.251100/42/11/8200000005 for the sum assured amount of Rs.1,00,000/- towards personal accident. Such being the case, on 09/12/2013 at about 5.30 p.m. the husband of the complainant while travelling in the bike met with an accident, due to which he suffered grievous injuries and later on 10/12/2013 he succumbed to injuries. Subsequently the complainant on 02/04/2014 claimed for compensation under personal accident coverage which was obtained by the husband of the complainant by furnishing all required documents along with claim form. The said claim form and entire documents were received by the OP on 03/04/2014. But so far, the OP/Company had not settled the claim towards personal accident benefits under group insurance. After the receipt of the entire documents, the OP demanded for production of original policy, for which, the complainant had sent a Xerox copy of the said policy on 06/05/2014, because she had not in possession of the original policy as because she does not know that where the original policy was kept by her husband during his lifetime. Hence, she sent Xerox copy of the policy to the OP/Company for the settlement of the claim. Even after that the complainant also sent the entire documents by translating into English language as because the OP/Company has demanded for translated copy of the entire documents. Accordingly, the complainant sent the documents to OP/Company on 23/01/2015. The said documents were also received from OP/Company on 27/01/2015. Even in spite of receipt of translated documents, the OP had not settled the claim. Hence, the OP rendered a deficiency in service in not settling the claim made by complainant towards personal accident benefit under group insurance policy.
Subsequently the complainant issued a legal notice dated:20/04/2015 and called upon the OP to settle the claim. Even in spite of receipt of legal notice, the OP had not settled the claim, instead of that had replied untenable. Hence, the complainant filed this complaint and prays for settlement of the claim along with payment of compensation for deficiency in service as prayed above.
3. After service of notice the OP appeared through his counsel and filed version and contended that it is true that a group personal accident policy bearing No.251100/42/82000000005 for the period from 01/06/2013 to 31/05/2014 covering the risk was issued to Mr.Govindappa K.R. by this OP through IIFL. The serving branch of the said policy is National Insurance Company Limited, II Floor, Royal Insurance Building, 14th Jamshedji Tata Church Gate, Mumbai 400 020. This OP denies that the deceased Govindappa K.R. had holding valid and effective D.L. as on the date of accident. The liability of this OP is governing by terms, conditions and limitations of the policy. They have covered the risk of personal accident benefit to the maximum liability of Rs.1,00,000/- under the policy. They have not received any documents on 02/04/2014 and also not received any request from the complainant for settlement of the claim.
The OP further contended that the complainant had not furnished any English translated version of the documents on 23/01/2015 to OP. They have sent reply dated:04/05/2015 to the legal notice issued by the complainant. In-fact, the complainant also was requested to submit the original policy issued by this OP, but the complainant had not produced any policy for the settlement of the claim. Hence, there is no deficiency in service on the part of this OP. Hence, prays for dismissal of the complaint.
4. The complainant filed affidavit and marked the documents as Ex.P1 to P15. The OP filed also filed, affidavit but no documents marked.
5. Heard the arguments:
6. In the proceedings, the following points do arise for our consideration and decision:
- Whether there is deficiency in service on the part of OP.
2. Whether complainant entitled for any relief & what Order?
7. Our findings on the above points are as follows:-
- Point No.1: Affirmative.
- Point No.2: As per Order below.
: R E A S O N S :
POINT NOs. 1 & 2:
8. It is an admitted fact that the OP/Company had issued group insurance policy to the husband of the complainant Mr.Govindappa K.R. for the period from 01/06/2013 to 31.05.2014. It is also not in dispute that the husband of the complainant met with an accident on 09/12/2013 and succumbed to injuries at Hospital. After the death of the husband of the complainant, she claimed for compensation under personal accident coverage under group insurance policy issued by OP/Company. But so far, the OP/Company had not settled the claim. Hence, alleges a deficiency in service on the part of OP/Company.
9. On the other hand, this OP had contended that they have issued a policy in the name of Govindappa K.R. vide policy bearing No.251100/42/11/00000005. But the issuing branch of this company is National Insurance Company Limited, II Floor, Royal Insurance Building, 14th Jamshedji Tata Church Gate, Mumbai 400 020 and also denied that the said Govindappa had valid Driving License at the time of accident.
10. The complainant had produced all documents pertaining to the accident such as FIR, Charge sheet, P.M. report, Spot Mahazar, IMV report, marked as Ex.P1 to P7. Further, the complainant produced copy of the D.L. marked as Ex.P8. On going through the Ex.P8 there is a clear D.L. stands in the name of said Govindappa as on the date of accident. Hence, we found there is no ground for rejection of the claim made by complainant.
11. The complainant in her affidavit has sworn that she constrained to send the entire documents by translating the said documents from Kannada Language to English Language and sent to OP/Company. Even in spite of sending translated documents, the OP had not settled the claim. Hence, alleges deficiency in service.
12. The complainant also produced a copy of the policy issued by OP marked as Ex.P15, which clearly shows that the policy is issued by the OP/Company is group insurance personal accident policy for the period from 01/06/2013 to 31/05/2014. Knowing fully that as on the date of accident, the policy is in force, the OP failed to settle the claim. Even after issuance of the legal notice also, the OP not made any attempt to settle the claim of the complainant. The complainant constrained to file this complaint in order to receive compensation for Rs.1,00,000/- under the group personal accident insurance policy issued by OP. Hence, it is a clear case of negligence and a deficiency in service on the part of OP in not settling the claim. Hence, we have no hesitation to award a compensation of Rs.20,000/- for deficiency in service in not settling the genuine claim of the complainant. The complainant being a beneficiary and only a legal heir of the deceased Govindappa is entitled to get compensation of Rs.1,00,000/- under the group personal accident insurance policy issued by OP/Company.
13. We are of the opinion that the OP had taken a contention that the policy issued by other branch which was situated at Mumbai. The said defense is not relevant. The OP/Company would have settled the claim as and when the legal notice was issued to them. But they have failed to settle the claim. Hence, the complaint is to be allowed and OP is also liable to pay litigation expenses of Rs.2,000/- to the complainant. As such for the above said reasons, we answer the above points accordingly and proceed to pass the following:-
: O R D E R :
- The complaint filed by the complainant is allowed in part.
- The OP is directed to pay Rs.1,00,000/- to the complainant under the group personal accident insurance policy.
- The OP is further directed to pay Rs.20,000/- towards compensation and Rs.2,000/- towards litigation cost to the complainant.
- The OP is further directed to comply the above order within 30 days from the date of receipt/knowledge of the order, failing which the payable amount shall carry interest @ 9% P.A. from the date of complaint to till realization.
- Send free copies of this order to both the parties.
(Dictated to the Stenographer transcribed typed by him, transcript corrected by me and then pronounced in Open Court on this the 30th day of November 2016).
(RAVISHANKAR)
President
(B.U.GEETHA) (H. MANJULA)
Member Member
ANNEXURES
Documents produced on behalf of the complainant:
Ex. P1 - FIR dated:10.12.2013 is
Ex.P2 - Charge Sheet dated:12.02.2013
Ex.P3 - PM Report
Ex.P4 - Photo copy of the spot Mahazar
Ex.P5 - Photo copy of the seizer Mahazar
Ex.P6 - Photo copy of the IMV report dt:27.12.13.
Ex.P7 - Photo copy of the Election ID
Ex.P8 - Photo copy of the DL (subject to objection)
Ex.P9 - Death Certificate 17.02.2014
Ex.P10 - Application to the OP
Ex.P11 - Postal receipt
Ex.P12 - Genealogy tree issued by VA
Ex.P13 - Reply notice dated:04.05.15 issued by OP
Ex.P14 - Letter issued by postal Dept.
Ex.P15 - Insurance policy issued by OP
Documents produced on behalf of the OPs:
NIL
Dated:30.11.2016 President
District Consumer Forum,
Chikmagalur.
Tss
