Andhra Pradesh

Visakhapatnam-II

CC/51/2007

Maipili Chinathalli - Complainant(s)

Versus

Golden Multi Services Club Limited - Opp.Party(s)

A. Appa Rao

19 Sep 2014

ORDER

                                              Date of Registration of the Complaint:31-01-2007 

                                                                                                Date of Order:19-09-2014

BEFORE THE DISTRICT CONSUMERS FORUM-II AT

                             VISAKHAPATNAM

 

P  r  e  s  e  n  t:      

1. Smt K. Saroja, M.A. B.L.,

     President (FAC)  

                                2. Sri C.V. Rao,  M.A., B.L.,

                                    Male Member

 

                        Friday, the 19^th day of September, 2014.

                             CONSUMER CASE No.51/2007

Between:-

Smt.Maipali Chinathalli, W/o Babu Rao (late),

Hindu, aged 34 years, R/o Mutrasi Street,

Gavarapalem, Anakapalli, Visakhapatnam District,

Presently come down to Visakhapatnam.

                                                                                        ….. Complainant

And:-

1.Golden Multi Services Club Limited,

   Rep. by its Branch Manager, Dwarakanagar,

   Visakhapatnam-16.

2.Bajaj Allianz General Insurance Co. Ltd.,

   Rep. by its Manager, GE Plaza Airport Road,   

   Yerwada, Pune-411006.

                                                                                         …  Opposite Parties

                     

This case coming on 27.08.2014 for final hearing before us in the presence of Sri        A. Appa Rao, Advocate for the Complainant and Sri P. Partha Sardhy, Advocate for the 1^st Opposite Party and Sri Syed Moinuddin, Advocate for the 2^nd Opposite Party  and having stood over till this date for consideration, this Forum made the following:

 

                                                ORDER

        (As per Smt. K. Saroja Honourable President (FAC)on behalfofthe Bench)

 

1.       The case of the Complainant in brief is that the Complainant’s husband had obtained Personal Accident Insurance Policy for an amount of Rs, 5,00,000/- from the Opposite Parties vide Policy No.OG-07-2401-9961-00000952/15660.  The said policy was in force from 15.04.2006 to 14.4.2007.   The insured was accidentally bitten by a dog on 20.06.2006 and he was treated for the dog bite at Area Hospital, Anakapalli,  but he died on 06.07.2006.   The Complainant had intimated to the 2^nd Opposite Party about the death of the insured on 19.10.2006 and requesting them to send Claim Form and settled the Insurance Policy.   The relevant documents were sent to the 2^nd Opposite Party along with letter but the 2^nd Opposite Party failed to send any Claim Form or reply letter dated 19.10.2006 till today then the Complainant approached this Forum.   Hence, this Complaint.

 

2.       a) For an amount of Rs.5,00,000/- (Rupees five lakhs only) together with interest at the rate of 24% per annum on it from the date of claiming the amount till its payment;      

          b) Compensation of Rs.1,00,000/- towards damages and mental agony, pain and suffering;

          c) For the costs of the Complaint; and        

          d) for such other relief or reliefs as the Forum deems fit and proper in the circumstances of this case.

           

3.       The Opposite Parties strongly resisted the claim of the Complainant by contending, as can be seen from their individual counters.    The 1^st Opposite Party denied the allegation of the Complainant stating that in pursuance of a Memorandum of Understanding between the insured and the 2^nd Opposite Party which is the insurance company, the 1^st Opposite Party facilitated the insurance coverage between the insured and the 2^nd Opposite Party.   The insurance premium was paid through the 1^st Opposite Party and deposited the same to the 2^nd Opposite Party and the 2^nd Opposite Party in turn issues the certificate of insurance in favour of the insurer.  So, the contract of insurance was between the 2^nd Opposite Party and the deceased.  So, they have no liability to pay any insurance amount and the said reliefs asked by the Complainant.

 

4.       The 2^nd Opposite Party stated in their counter alleged the date of death on 06.07.2006 due to dog bite on 20.06.2006.  Whereas, the Complainant did not intimate or furnish the OP Chit and the Medical Certificate alleged should have been issued by the Medical Officer, KGH and suppressing facts and filed this complaint before this Forum, the Complainant failed to submit all the documents along with Claim Form. So, the 2^nd Opposite Party had no opportunity to process the claim so they have liability to pay any reliefs asked by the Complainant.

 

 

5.       At the time of enquiry, both the Opposite Parties filed their affidavits as well as written arguments to support their contentions.     Exs.A1 to A6 are marked for the Complainant.   Exs.B1 to B5 are marked for the 1^st Opposite Party.   No documents are marked for the 2^nd Opposite Party.  Treated as heard in view of written arguments filed by both Parties.

 

6.       Ex.A1 is the photo copy of Policy Bond issued by the Opposite Parties on 15.04.2006.   Ex.A2 is the photo copy of OP Chit issued by the A.P. Vaidya Vidhana Parishad, Anakapalli on 20.06.2006.    Ex.A3 is the letter issued by the Complainant to the Opposite Parties on 18.10.2006.  Ex.A4 is the Death Certificate issued by the Department of Medical & Health Services on 16.10.2006.     Ex, A5 is the Courier Receipt on 19.10.2006.  Ex.A6 is the Courier Receipt on 19.10.2006.

 

7.       Ex.B1 is the Authorization Letter issued by Golden Multi Services Club Limited i.e., 1^st OP on 14.04.2007.          Ex.B2 is the attested copy of Memorandum of Understanding for Group Personal Accident Insurance between the 1^st Opposite Party and the 2^nd Opposite Party on 4.2.2004.   Ex.B3 is the Application Form.  Ex.B4 is the attested copy of letter addressed by the 2^nd Opposite Party to the 1^st Opposite Party.  Ex.B4 is the attested copy of letter addressed by the 2^nd Opposite Party to the 1^st Opposite Party.   Ex.B5 is the letter addressed by the 2^nd Opposite Party to the Complainant on 12.02.2014. 

 

8.       The point that would arise for determination in the case is:-

Whether there is any deficiency in service on the part of the Opposite Parties.  The Complainant is entitled to any reliefs asked for?

 

9.         After careful perusal of the case record, this Forum finds that the Complainant gave death intimation on 08.10.2006 by means of Ex.A3 by the Complainant to the 2^nd Opposite Party, but there was no response.  After filing of this complaint only, the 2^nd Opposite Party repudiated the claim on 12.2.2007 by means of Ex.B5, but the 2^nd Opposite Party deficiency of service is evident as it blows hot and cold in its counter.   In para No.5 of the said counter, the 2^nd Opposite Party stated that it did not receive any letter, informing the death of the insured from the Complainant.   But Ex.B5 says that it (repudiation letter) i.e., (Ex.B5) was issued in response to the claim of the Complainant.   In para No.6 of the same counter, the 2^nd Opposite Party contents that it did not keep quiet and readily respond asking the Complainant to submit various relevant documents.   But no such letter issued to that effect by the 2^nd Opposite Party, was presented before this Forum.   It can also be seen though the 2^nd Opposite Party alleged that the deceased/insured was a HIV positive Patient by the said facts were covered by their investigator, but   very peculiarly such Investigation Report was not filed by the 2^nd Opposite Party.   All these make nonsense of the 2^nd Opposite Party counter.   It is also settled law that apparent causes of death such as snake bite and dog bite etc., do not require FIR and Police Investigation.   In the circumstances, the 2^nd Opposite Party insurer is bound to pay a claim amount promptly in and around 18.10.2006, on which date Death Intimation-cum-Claim was forwarded by the Complainant.   As the Complainant was suffering for the last 8 years, she is entitled to get the policy amount of Rs.5,00,000/- with suitable interest from 18.10.2006 to till date.   As the deficiency of service-cum-unfair trade practice should have caused financial hardship, physical strain and mental agony, the Complainant is entitled to compensation and costs too.    However, the case against the 1^st Opposite Party is dismissed basing on the documents filed by the 1^st Opposite Party which shows that the 1^st Opposite Party is facilitator only.   So, the case against the 1^st Opposite Party is dismissed.

 

10.     In the result, this Complaint is allowed directing the 2^nd Opposite Party: a) to pay insurance amount of Rs.5,00,000/- (Rupees Five lakhs only) with interest @ 9% p.a. from 18.10.2006 to till the date of actual realization, and to pay b) a compensation of Rs.50,000/- (Rupees fifty thousand only) and c) Costs of Rs.2,000/- (Rupees two thousand only) to the Complainant.   Time for compliance, one month from the date of this order.

 

          However, the case against the 1^st Opposite Party is dismissed.

 

 

 

 

          Dictated to the Steno, transcribed by him, corrected and pronounced by us in the Open Forum, this 19^th day of September, 2014.

 

Sd/-                                                                                     Sd/-

Male Member                                                                           President

                                     

 

APPENDIX OF EVIDENCE

For the Complainant:-

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.A01	15.04.2006	Policy copy issued by the Opposite Parties to the Complainant.	Photo copy
Ex.A02	20.06.2006	OP Chit issued by the A.P. Vaidya Vidhana Parishad, Anakapalli	Photo copy
Ex.A03	18.10.2006	Letter issued by the Complainant to Ops	Office copy
Ex.A04	16.10.2006	Death Certificate	Original
Ex.A05	19.10.2006	Courier Receipt	Original
Ex.A06	19.10.2010	Courier Receipt	Original

For the 1^st Opposite Party:-

                                               

NO.	DATE	DESCRIPTIONOFTHEDOCUMENTS	REMARKS
Ex.B01	14.04.2007	Authorization letter issued by the 1st OP	Office copy
Ex.B02	04.02.2004	Memorandum of Understanding for Group Personal Accident Insurance between the 1st OP and the 2nd OP	Attested copy
Ex.B03		Application Form	Original
Ex.B04	02.07.2004	Letter addressed by the 2nd OP to the 1st OP	Attested copy
Ex.B05	12.02.2007	Letter addressed by the 2nd OP to Complainant.	Attested copy

For the 2^nd Opposite Party:-

 

                                                -Nil-

Sd/-                                                                                         Sd/-

Male Member                                                                              President