F.A.No.1323/2005 against  C.D.No.59/2004 , Dist.Forum,Adilabad.   

Between

The National Insurance Company Ltd.,

Division No.1, Post Box No.236,

Jhaveri Mansion, Bank Street, Koti,

Hyderabad rep. by its Divisional Manager.                                    …Appellant/

                                                                                                                Opp.party no.2

                      And

1.E.Madhavi, W/o.Late Srinivas Rao,

    Age:29 years, Occupation:Household,

     R/o.H.No.18-410, LIC Colony, Mancherial,                                 …Respondent/

                                                                                                                 Complainant

2. The Manager, Andhra Bank,

     Mancherial Branch.                                                                      …Respondent/

                                                                                                                Opp.party no.1

..

 Counsel for the appellant                 :         Mr.T..Ramulu

Counsel for the respondent             :         M/s. M.Gangarao –R1

                                                                          M/s. Alluri Krishnam Raju    

CORAM :THE HON’BLE JUSTICE SRI   D.APPA  RAO , PRESIDENT,

                            SMT. M.SHREESHA,HON’BLE MEMBER      

          AND

                        SRI G.BHOOPATHI REDDY , HON’BLE   MEMBER.

                WEDNESDAY, THE  TENTH   DAY  OF  SEPTEMBER,

                                       TWO THOUSAND   EIGHT.

 Oral Order   :   (Per Sri G.Bhoopathi Reddy, Hon’ble Member)

                                                                ******

           This is an  appeal filed by the appellant/opp.party no.2 under Section 15 of the Consumer Protection Act,1986 to set aside the order passed by the District Forum, Adilabad  in C.D.No.59/2004  dt.15.2.2005.   

      The respondent no.1 herein is the complainant before District Forum.    She filed  complaint to direct the opp.parties to  award an amount of Rs.1 lakh  towards the insurance coverage over the Abhaya Gold Savings a/c. No.100181 of Andhra Bank Mancherial, to award Rs.25,000/-  towards compensation for the inconvenience  and mental agony caused  by the negligent , unfair trade practice and  defective  service caused by the opp.parties .  

      The case of the complainant is as follows:

  The husband of the complainant during his life time obtained a savings account under Abhaya  Gold  Scheme vide A/c.no.100181 of Andhra Bank, Mancherial Branch  and unfortunately he died in the month of February 2003 in a road accident under the limits of Bibinagar Police Station.  After death of her husband the complainant has submitted all the necessary documents to opp.party no.1 on 20.3.2003  and 6.8.2003  for  settlement of insurance claim covered under the Abhaya Gold Savings Account.       As the  opp.parties have not settled the claim,  the complainant  got issued a legal notice to the Chairman    and M.D. of Andhra Bank, Hyderabad  on 17.2.2003  requesting him to do justice  .    The opp.party no.2 addressed   a letter dated 11.10.2003  informing that the opp.party no.1 might have deposited the insurance premium to their account in their branch , but the  same was not credited to their account as per stipulations mentioned in agreement entered  with opp.party no.1 and unfortunately the premium    received in their account at Hyderabad after the death of  her  husband  .on   27.3.2003.   . The opp.party no.1 bank has not credited the insurance premium to the insurance  company upto 27.3.2003 which resulted for non settlement of insurance claim under the Abhaya Gold  Scheme.  Due to negligence of opp.party no.1 the opp.party  no.2  rejected the claim of the complainant.   Alleging   deficiency in service  on the part of the   opp.parties the complainant approached the District Forum   to direct the opp.parties  to  award an amount of Rs.1 lakh  towards the insurance coverage over the Abhaya Gold Savings a/c. No.100181 of Andhra Bank Mancherial, to award Rs.25,000/-  towards compensation for the inconvenience  and mental agony caused .

     The opp.party no.1 filed counter denying    the allegations made in the complaint and   contending that they have remitted the premium to the account of opp.party no.2 within time as agreed per agreement entered into and only    to avoid payment of compensation , the opp.party no.2  took the shelter of non  receipt of premium in time.  The opp.parties 1 and 2 entered into an agreement with regard to Abhaya Gold Savings Bank  Account-holders Group Personal Accident Policy and as per the  terms and conditions no.3(a)  of  the agreement, the payment of premium shall be made by crediting  the premium to the non operating  account of the insurer maintained  with the branches of the banker and such crediting of the premium shall  be deemed to be the payment of the premium by the banker to the insurer in advance within the meaning of Section 64 VB of the Insurance Act.  The risk coverage  shall commence from the date of crediting the  premia in the account of the insurer with the branch of the banker not with  standing any delay in the transfer  of the premia to the main account of the   insurer  at Sultan Bazar Branch, Hyderabad  and in the instant case  the opp.party no.1 bank has remitted the premia deducted towards the account of the deceased to the non operative account of the insurer and the same was transmitted to the main account to the insurer  subsequently the opp.party no.2 company received the said  premia .  As  per clause 3(b) of the said agreement, the insurance risk coverage of the account holders shall be  for a period of one year  and as per clause 6 of the above said agreement the opp.party no.1 made a deposit of Rs.1 lakh through DD No.672329 dt. 31.10.2002 with opp.party no.2  with intent to cover any delay  in payment of premium by the branches in the non operative current accounts of the insurer maintained in the branches of the banker  .  The insurer shall not reject any claim on the ground of delay/default in payment of premium or remittance of premium by  any of the banks branches.   .   There is no delay or  deficiency in service on the part of the opp.party no.1.   The    death of the account holder occurred during the existence of insurance coverage and hence the opp.party no.2 is liable to pay the claim of the complainant.   The opp.party prayed to dismiss the complaint.

          The opp.party no.2    filed counter contending that after receipt of the intimation from opp.party no.1 the claim of the complainant was processed in the routine course and after duly processing and examining the feasibility of the claim , the opp.party no.2 was unable to settle the claim and informed the  bank authorities about their inability to entertain the claim  vide their  letter dt.31.10.2003.   There is  a link insurance scheme which is to be operated by a mutual agreement (MOU)   entered  between opp.parties 1 and 2   as per which a Group Personal Accident policy under  Table 1A benefits to M/s.Andhra Bank covering  their  Abhaya  Gold Savings Bank Account holders for a period of one year form  1.11.2002  to 31.10.2003  and entered into agreement of MOU.  . In this case the date of death is 2.2.2003  whereas the  premium was received by opp.party no.2 on 20.3.2003   obviously  after the death of the deceased.    Unless the premium is received by opp.party no.2 from opp.party no.1 in respect of the particular account holder , there is no coverage  of risk    or any liability.    Receipt of premium is presupposed as per Section 64 VB  of Insurance Act.    As per clause 12 of the MOU the Courts  at Hyderabad exclusively have the  jurisdiction to try any dispute raised by the insured persons , the banker/insurer in respect of any claims arising out of the agreement/risk coverage.   In terms of the said clause any dispute has to be    entertained  or tried only in the courts at Hyderabad only.   The opp.party  no.2 prayed for dismissal of the complaint. 

        The complainant filed evidence affidavit and documents Exs.A1 to AA4. The opp.party no.2 filed evidence affidavit.  .   Exs.B1 to B6 documents are filed on behalf of the opp.parties.    The Dist.Forum based on the evidence adduced and pleadings allowed the complaint directing the opp.parties to pay Rs.1 lakh  with interest @ 9% p.a. from the date of complaint i.e. 25.9.2004  till realization and pay court fee of Rs.200/- and costs of Rs.300/-  to the complainant within a period of one month from the date  receipt of the order.

      Aggrieved by the said order   the appellant/opp.party no.2 preferred this appeal  contending that the District Forum has not properly appreciated the evidence on record and directed   to pay Rs,. 1 lakh  with 9% interest from the date of  complaint i.e. 25.9.2004 till the date realization.  . The Dist.Forum should have considered that the date of the death is 2.2.2003  whereas the premium was  received by the    insurance company   on 20.3.2003 obviously after the death of the diseased   and as per clause 3(A) of the agreement the insurance  premium credited to the insurer’s account shall be transferred by the bankers branch to the main account of the insurer  bearing no.10115  with Sultan Bazar Branch , Hyderabad.   The receipt of premium is pre-supposed as per Section 64 VB of the Insurance Act..  As per clause 12 of MOU the Courts at Hyderabad exclusively had jurisdiction to try any dispute raised by the insured persons.  The appellant prayed to allow the appeal and  set  aside the order of the District Forum.

     The points that arise for determination in this appeal are:

1.  Whether the District Forum is having  jurisdiction to entertain the complaint?         

 2. Whether there was deficiency in service on the part of the appellant ?

3. Whether the order passed by the District Forum is sustainable?

 Point no.1:  The appellant contended that as per clause 12 of MOU ,any dispute  raised by the insured persons  shall be tried in the courts at  Hyderabad only. The respondent no.1 resisted the plea that  as per Section 11 of C.P.Act 1986   if the  head office  or branch office  is situated  within the limits  where cause of action arose the Consumer Forum  has   jurisdiction to entertain the complaint.      . The complainant has got right  to file complaint either at Hyderabad where  opp.party no.2  is situated  or  at Adilabad where Andhra bank branch  is situated . The District Forum , Adilabad is having territorial jurisdiction. The complaint filed before the District Forum, Adilabad   is maintainable.     As per the clause 12 of the MOU   the courts at Hyderabad exclusively have the  jurisdiction to try any dispute raised  by the insured persons,   the banker/insurer in respect of any claims  arising out of the agreement/risk coverage   and no other court shall have jurisdiction to entertain  any such dispute.   The said clause  12 of MOU is not binding on the complainant . The Section 3 of C.P. act overt rights the other Acts.  The complaint filed before  the District Forum,Adilabad  is maintainable and  is    having  territorial jurisdiction  . Finding of the District Forum is confirmed .This point is proved in favour of the respondents.

     Pont no.2 :   The appellant submits that the    premium amount was  received by  the insurance company after the death of the insured , hence the policy is not valid and  as per the policy terms and conditions  insurance company is not  liable . The respondents  contended  that the premium amount is already sent   to the insurance company    before the death of the insured and there was  no delay  with  regard to the payment  of premium amount and finding of the District Forum may be confirmed.     There is no dispute that the  husband of the complainant who is the accountholder under Abhaya Gold Scheme  died in a road accident.  After the death of the insured the complainant has  submitted  the claim form to the  opp.party no.1 bank  and the bank has  forwarded the same to the opp.party no.2  insurance company.  .  The opp. parties 1 and 2  entered into agreement with regard to  Abhaya Gold Savings Bank Account holders Group Personal Accident policy  and as per the terms and conditions no.3(a) of the  agreement, the payment of premium shall be made by crediting the premium to the non operating account of the insurer maintained with  the branches of the banker .  Ex.A2 is the  letter  from the office of the banking Ombudsman addressed by PVD Rajeswar Rao, Asst. Secretary to opp.party no.1 dt.17.3.2004 in respect of complaint  no. 286 of 2003-2004  wherein in para 2 it is stated that as per the above   letter the  opp.party no.1 has deposited Rs.1 lakh  vide DD.no.672329 dt. 31.10.2002  with opp.party no.2 to cover delayed payment of premium/remittance by the bank.   The District Forum has elaborately discussed  all the documentary  evidence  and held that the premium amount is received before the death of the insured  and the insurance policy is valid on the date of the death of the deceased  and the as per the policy terms and conditions  the  complainant is entitled to the insurance claim amount.     The respondent no.2/opp.party no.1  contended   that there was  no delay on their part with regard to the payment  of premium amount , that  the bank is only   facilitator  between the complainant and opp.party no.2,  that they have  forwarded the papers submitted by the complainant to the insurance company   and  they are not liable to pay  insurance policy amount and     the insurance company is alone liable to pay  the claim amount.  The submission made by the  respondent no.2 is not sustainable.   The  opp.party no.1  has not filed any appeal .   Appeal is  filed  only by the opp.party no.2.   Hence finding cannot be given with  regard to the respondent no.2/opp.party no.1 that it is  not liable to pay the said amount.  The respondent no.2 further submits that  they have  established before the  Dist.Forum that the bank has deposited the premium  before the death of the insured and the finding of the District Forum that the    opp.party no.1  is also liable  to pay the  compensation  is not sustainable. . The submission made by the respondent no.2 is not sustainable.  The District Forum    has elaborately discussed all the documentary  evidence and given finding that as per the terms and conditions of  Abhaya  Gold Savings  Scheme  the  opp.parties  are  liable to pay the insured  amount   as the  death of the insured is an accidental  death while the    insurance policy was in force.      There are no reasonable grounds to interfere with the order passed by the  District  Forum.  Order passed by the District Forum is a well considered order .    We do not see any reason to interfere with the order passed by the District Forum.               

     In the result appeal is  dismissed .  In the circumstances without  costs.   The appellant  is directed to comply the order of the  District Forum  within four weeks from the  date of  this order

                                                PRESIDENT        LADY MEMBER    MALE MEMBER

                                                                               Dt