Due to road an accident that occurred at about 10 am on 06-09-2012, a 29 years old pedestrian by name Shankrappa Kabbinad died at the accident spot.   During his lifetime, he has purchased three certificates issued by M/s Swastik General & Health Care Services (P) Ltd., Bengaluru as per Ex.A.1, Ex.A.2 and Ex.A.3, under which certificates insurance covered provided by ICICI Lombard GIC Ltd., provides insurance coverage for a sum of Rs.1.00 Lakh as death benefit to any accident during the period of insurance to the certificate holder.  Membership in Ex.A.1 is Group No. MB/o/SRK84.  Membership in Ex.A.2 pertains to Group No. MB/O/SRK83.  Membership in Ex.A.3 pertains to Group No.MB/0/SRK82.  The complainant name is the name in respect of the benefits available under the certificates.   Therefore, the complainant made a claim to the OP No.1 requesting for payment of sum assured soon after the accident, for which OP No.1 sent a reply as per Ex.A.7 dated: 31-10-2012 requesting to sent all the original documents within 7 days.  The complainant sent the document sought by the company on 04-03-2013.  As the amount has not been paid, the complainant approached this Forum on 01-07-2014 seeking for payment of Rs.3.00 Lakhs towards certificates and compensation for the deficiency in service.

            2.  The complaint was filed on 01-07-2014 against three parties.  OP No.2 served on 12-07-2014 and notice to OP No.3 returned unserved as no such addressee.  Sri. S.N.Muttagi advocate filed vakalat for OP No.2 (Insurance Company) on 22-08-2014.  Section 13(2) of the Consumer Protection Act – 1986 provides maximum of 45 days for filing written version in a proceedings before the Consumer Forum.  Section 13(3-A) of Consumer Protection Act – 1986 lays-down for a expeditious disposal of the claims within 3 months from the date of service of the notice on the opposite parties.  In the instant case, the OP No.2 was served with the notice of this Forum on 12-07-2014.  Written version ought to have been filed on or before 11-07-2014.   Written version has been filed on 10-4-2015 when the case posted for final order on 10-4-2015 beyond the time limit prescribed by the statute governing the conduct of the proceedings before a district forum.  The case against OP No.3 has been dismissed as per order of this Forum dated:
31-01-2015.

            3.  On going through the materials on record available in the file, this Forum is of the opinion that the insurance company (OP No.2), which has not disputed the policy No. 4005/67137470/00/003, which was in force from 24-11-2011 to 23-11-2012 and the certificate holder died on 16-09-2012 succumbing to the injuries sustained by him in a road accident.  These policies were furnished by the complainant in this proceedings along with the complaint on 01-07-2014.  Copies of documents were also sent to the OP No.2 alongwith copy of the complaint and notice, which has been served on 12-07-2014.  OP No.2 has not disputed the claim.  The liability is therefore established.

            4.  The complaint has sent the representation with documents for payment of the sum assured to the OP No.I company but OP No.1 has not given an intimation about the claim to the Insurance Company.  Hence there is a deficiency in service on the part of the OP No.1 Company.  Considering the claim amount and gennineous of the claim.  A sum of Rs.10,000/- is awarded as compensation for deficiency in service payable by OP No.1 to the complainant.  The litigation expenses is also required to be paid by the OP No.1, which is at fault resulting in unnecessary litigation, which we award at Rs.3000/-.

            5.  Policy document, Ex.B.1 clearly disclose that any liability from OP No.1 is covered in respect of 2000 members and the total capital sum assured was Rs.200,000,000/- and the details of persons to be insured are given in the annexure attached under the policy number mentioned in the complaint.  The annexure contains 498 names.  The name of the deceased certificate holder is available at Sl.No.4, 170 and 403 in respect of certificate No.SRK 83,84 and 82. Therefore, the insurance company should have paid the amount soon after the receipt of the notice of the complainant from this Forum if not earlier.  Bur the company wants the complaint to be dismissed without looking into the policy document.  As such the OP No.2 is to be saddled with liability to pay the insured sum and so also the compensation for the harassment and deficiency in service as defined u/sec. 2(1)(g) of the Consumer Protection Act – 1986. 

            6.  For the reasons stated above, this claim is disposed-off in the following terms;

1. OP No.2, Insurance Company is directed to make payment of Rs.3,00,000=00 (Rupees three lakhs only) to the complainant within three months and report compliance.

2. OP No.2, Insurance Company is further directed to pay sum of Rs.10,000/- (Rupees ten thousand only) to the complainant as compensation for deficiency in service within 3 months.

3. OP No.1, Company is directed to pay sum of Rs.6,000=00 (Rupees six thousand only) to the complainant within three months and report compliance.

4. In the event of failure to make payment within time granted, interest at 10% p.a. from the date of expiry of time given till actual payment shall become payable by the opposite parties in respect of amount payable by them to the complainant.

// ANNEXURE //

List of Documents Exhibited for the Complainant.

Witnesses examined for the Complainant / Respondent.