Per Sri A. Hazarath Rao,  President:-

            The complainants filed this complaint u/s 12 of the Consumer Protection Act seeking payment of Rs.15,00,000/- being the insured amount + RS.3, 20,000/- being interest @ 24% p.a. and for costs.

2.  In brief the averments of the complaint are hereunder:

            One Sriveri Venkateswarlu during his life time obtained an accident protection plan from the opposite parties for Rs.15,00,000/- vide policy bearing No.93835621/00001.  The said venkatewarlu paid premium of Rs.2695/- on 24-12-10 by way of cheque.  The opposite parties issued policy and was valid from 27-12-10 to 26-12-11.  The complainant is daughter of the said Venkateswarlu.  The said Venkateswarlu (insured) died on 28-02-11 in train accident. The Station House Officer of Government Railway Police station, Narasaraopet registered a case as Cr.No.9/11 and gave final report stating that the said Venkateswarlu died in train accident.  The complainant is the only legal heir of the deceased Venkateswarlu (insured).  The complainant submitted all necessary papers to the opposite parties on 27-07-11.  The opposite parties required the complainant to produce succession certificate.  Immediately the complainant obtained family member certificate from  the Tahsildar, Sattenapalli Mandal , and furnished the same to the opposite party.  On  27-09-11 the opposite parties required the complainant to produce Income Tax returns and income certificate of the insured (deceased).  Insured did private business and used to get income of Rs.2, 00,000/- per year.  The opposite parties are quite aware that in a claim for compensation arising out of an accident, there is no need to produce succession certificate.   The opposite parties intentionally delayed settlement of the claim and it amounted to deficiency of service.  The opposite parties though received the notice kept quite without settling the claim.  The complaint therefore be allowed.

3.    The 2^nd opposite party remained exparte.                 

4.    The contention of the 1^st opposite parties in brief is here under: 

            The complainant is not a consumer and there is no consumer dispute as envisaged under Consumer Protection Act.     The complainant failed to produce succession certificate from competent Court to prove that she is a legal representative of the insured (deceased), Income Tax returns of the deceased (insured) to prove his income and his capacity to pay the premium are necessary. As the complainant did not submit particulars showing income of the insured (deceased) in spite of remainders claim was not processed.  The 1^st opposite party recently came to know that the deceased (insured) involved in a racket and gathered  information of died persons and insured policies in various companies in the name of such persons by giving false information regarding age, occupation, income tax and health conditions in collusion with legal representatives of  those deceased.  The 1^st opposite party after verification further came to know that the subject claim is fake and she was a member of the said racket and claiming compensation with false evidence.  The 1^st opposite party suspected the complainant for non production of succession certificate and income tax returns of the insured (deceased). The said Venkateswarlu was aged 73 years as on the date of proposal to the company and was bed ridden for the last three years prior to the proposal.  The complainant submitted school certificate of alleged deceased Venkateswarlu.  Enquiries of the 1^st opposite party revealed that insured (deceased) Venkateswarlu did not study in any school.  The age of the insured (deceased) at the time of generating the policy and the one mentioned in inquest are contradicting.  The complainant claimed the claim basing on an unidentified corpse of 30 years aged person.  Even as per the inquest and police record it was not proved that the said unidentified person died in train accident was the insured (deceased) Venkateswarlu.  The complainant mentioned her age as 28 years and she is leading marital life with one Venkataramaiah as house wife in Sattenpalli.  The complainant is a 3^rd party and not daughter of the said Venkateswarlu.  The said Venkateswarlu had two sons and a daughter Mahankali Venkayamma residing at Vinukonda and is getting widow pension every month from the Government.  The said Venkateswarlu (insured) had multiple life insurance policies from various life insurance companies to a tune of Rs.66,98,711/- and they were not disclosed at the time of proposal.  The complainant failed to produce any record showing actual date of birth of the said insured and his business and income and capacity to pay the premium in all policies of different companies.  Some insurance companies lodged a complaint before the concerned police against culprits, involved in the rocket including nominees and investigation is pending.  The complainant approached Ombudsman of insurance company in claims arose out of the policies of the said Venkateswarlu and they were rejected by Ombudsman. The opposite parties did not commit any deficiency of service.  The complainant did not approach the Forum with clean hands.  The complaint therefore be dismissed with exemplary costs.

5.  Exs.A-1 and A-11 on behalf of complainant and Exs. B-1 to B-55 on behalf of the 1^st opposite party were marked.

6.  Now the points that arose for consideration in this case are these:

1.  Whether the complainant is a consumer?

2.  Whether there is a triable consumer dispute?

3.  Whether the opposite parties committed deficiency of service?

4.   Whether the complainant is entitled for compensation and if so, to

            what amount?

5.   To what relief?

7.   POINTS No.1&2:-   The opposite parties issuing E.A-1 policy in favour of the insured (deceased) Siriveri Venkateswarlu is not in dispute.  Like wise the payment of Rs.2, 695/- as premium for the policy covered by Ex.A-1 by the insured is also not in dispute.  Since the opposite parties issued Ex.A-1 policy after receipt of premium we are of the considered opinion that there is nexus of consumer and service provider.  The complainant contended that the opposite parties repudiated her claim on flimsy grounds.  The averments of the complaint alone have to be taken into considered to ascertain whether there is a triable consumer dispute or not.  Under these circumstances we are of the opinion that the complainant is a consumer being  a beneficiary under Ex B22 proposal and there is a triable consumer dispute and answer these points in favour of the complainant.

8.    POINTS No.3&4:- Ex.A-3 (copy of FIR) and Ex.A-4 ( copy of inquest report) revealed that an unidentified male corpse aged thirty years was found on 28-02-11 in between Vinukonda – Cheekateegalapalem.  Ex.A-5 (postmortem certificate) revealed that postmortem was conducted on 28-02-11 at the behest of the S.H.O., Narasaraopet railway police station.

9.         In pursuance of summons issued to him one M.Jeevaratnam, Retd., R.P.S.I., Narasaraopet, produced documents before this Forum on 20-12-12.  The S.H.O, Government Railway police station, Narasaraopet on 02-03-11 (Ex.B-9) requested the medical officer, Government  Hospital, Vinukonda to issue postmortem certificate with the name of Siriveri Venkateswarlu, S/o.Kotaiah, aged about 50 years.  Basing on that the learned counsel for the contending opposite party contended that fraud and collusion took place among the complainant and some other officials.   Original of Ex.A-5 postmortem certificate was prepared on 11-07-11 though postmortem was conducted on 28-02-11 as revealed from it.  This raised a genuine suspicious in the minds of the insurers to settle the claim as rightly contended.

10.       Ex.B-22 was copy of proposal form pertaining to Ex.A-1 policy.  In Ex.B-22 one Mahankali Sujatha was shown as beneficiary and the relation between her and the insured was mentioned as daughter.  Gross income of the insured did not find place in Ex.B-22 proposal form though mentioned as mandatory.  In spite of absence of those particulars  the opposite parties issued Ex.A-1 without mentioning name of the beneficiary.  The said attitude of the opposite parties in issuing policy without mentioning name of the beneficiary is quite improper.

11.       The opposite parties under Ex.A-7 dated 27-07-11 required the complainant to produce succession certificate to process the claim for want of name of beneficiary/nominee in Ex.A-1 policy.      The opposite parties   on 27-09-11 repudiated the complainant’s claim for want of income proof.  It is not the case of the complainant that she furnished income particulars of the insured (deceased).

12.       Ex.A-1 policy issued by the opposite parties is under accident protection plan.  In Ex.B-22 proposal form signed by the insured (deceased) the following was mentioned:

“The maximum compensation in respect of an insured person under the policy shall not exceed 5 times with the annual income (as declared in the proposal form) income proof for availing the compensation at the time of claim as mandatory.  Income proof shall mean the previous years returns filed with the Income Tax Department.

It is not the case of the complainant that the insured (deceased) was an income tax assessee.  For the absence of income particulars of the insured (deceased) the opposite parties expressed their inability to process the payment against the captioned claim in Ex.A-8.

13.       Now this Forum has to see whether the repudiation of claim by the opposite parties is justified or not.  Ex.B-21 is copy of award dated 19-12-11passed by Insurance Ombudsmen on the complaint No.I.O.(Hyd)L-21-018-503-2011-12 given by the complainant herein.  In the said award the insurer is IDBI Federal Insurance Company Ltd.  In Ex.B-21 it was mentioned that the insured/deceased took insurance policies amounting to Rs.56,98,711/-.  It is the case of the contending opposite party that the insured suppressed his other insurance policies.  Nothing was mentioned against the column of Ex.B-22 dealing with any personal accident insurance with HDFC ERGO or any other insurance company.  Obtaining personal accident insurance policies from other insurance companies is within the special knowledge of any insured.  The said contention of the contending opposite party is amply corroborated by Ex.B-21.  The other exhibits filed by the contending 1^st opposite party are not relevant to consider.

14.       In Jagdish Prasad Dagar vs. Senior Divisional Manager, Life Insurance Corporation 1992 (2) CPJ 493 (NC) dated 05-03-92 in appeal No.153/91 held that:

            “Once it is found that the insurer had duly considered all the relevant facts and circumstances and taken a decision in good faith as to whether the claim put forward by the insured or a nominee under the policy should be allowed to any extent, it cannot be said that there has been any ‘deficiency in service’ on the part of the insurer in relation to the performance of its duties under the contract of insurance.

            In such a case, in the event of the insured or his nominee or legal heir as the case may be, feeling dissatisfied with the decision communicated by the insurer, he will have to seek redressal either by resort to arbitration under the relevant clause in the policy or by institution of a suit before the ordinary Civil Court.    The jurisdiction of the Forum constituted under the Consumer Protection Act can be invoked only in case there has been a ‘deficiency in service’ on the part of the insurer.   Whether the decision to repudiate the liability has been communicated by the insurer without stating reasons or where the decision is taken arbitrarily or without due application of mind or otherwise than in good faith, the insured can in all such cases legitimately maintain an action before the Redressal Forum under the Act on the ground of deficiency”.

15.       In Janta Machine Tools vs. Oriental Insurance Company Limited 1991 (1) CPJ 234, dated 21-08-90 in Original Petition No.12/90 (Full bench) held:

            This is a claim primarily against the first respondent – Oriental Insurance Company., on the allegation that there has been a deficiency in the service which the company was bound to render to the complainant under two policies of general insurance that the complainant had take out with the company.   From the facts disclosed by the record and particularly the averments contained in the counter affidavit filed by the first respondent it is seen that the Insurance Company had fully investigated into the claim put forward by the complainant, got surveys conducted and had finally come to the conclusion that the claim put forward by the complainant was false and accordingly informed the complainant that his claim was rejected.   Thus this not a case where the Insurance Company did not take prompt and necessary stops for deciding the claim under the policies of insurance.   It may be that the complainant is not satisfied with the said rejection of his claim by the Insurance Company.  Having   regard to the facts and circumstances of this case and the nature of the controversy between the parties we consider that this is a matter that should be adjudicated before a civil court where the complainant as well as the respondent will have ample opportunities to examine witnesses at length, take out Commission for local inspections etc. and have an elaborate trial of the case.   Without prejudice to the right of the complainant to take resort to the remedy by way of civil before the proper Court.   We dismiss this petition.

16.       Taking a clue from the above decisions the rejection/repudiation of claim by the opposite parties did not amount to deficiency of service for want of income particulars of the insured (deceased).

17.       Ex.A-1 coupled with Ex.B-22 revealed that the opposite parties issued Ex.A-1 policy without mentioning the name of the beneficiary (though mentioned in Ex.B-22) and in the absence of gross annual income itself amounted to deficiency of service in our opinion.  We therefore opine that the opposite parties issued Ex.A-1 improperly.  Under these circumstances awarding compensation of Rs.2, 00,000/- (Rupees two lakhs only) will meet ends of justice.  We therefore answered these points accordingly.

18.       POINT NO.5:-  In view of the above findings, in the result the complaint is allowed partly as indicated below:

1. The opposite parties are directed to pay compensation of Rs.2,00,000/- (Rupees two lakhs) to the complainant together with interest @ 9% p.a. from the date of order  till realization.
2.  The opposite parties are directed to pay costs of Rs.2,000/-.towards costs of the complaint.

 3) The said amounts are ordered to be paid within the six weeks from the date

      of receipt of the order.

            Dictated to Junior Steno, transcribed by him corrected by me and pronounced in the open Forum dated this the 2^nd day of July, 2013.

Sd/-XXX                                                                                            Sd/-XXX

MEMBER                                                                                                       PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite parties:   

                                                                                                                                    Sd/-XXX

     PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.