FA   86/2008  against C. C. No. 152/2007   on the file of the

District Forum II, Hyderabad.

Between :

Andhra Bank, Credit Card Division, Head Office,

Kothi, Hyderabad represented by its Officer,

Sri V. Kesavas Rao, S/o Late Venkata Subba Rao

Aged about 50 years, R/o Hyderabad.

  .. appellant/opposite party no.1

And

1.                  Mrs. Dinas Vervatwala, W/o Jamshed Vervatwala,

139/A, MLA Colony, Road no.12, Banjara Hills,

Hyderabad – 34                  … Respondent/complainant

2.                  Manager, United India Insurance Company

Having its Divisional Office, at Saptagiri Towers,

Begumpet, Hyderabad          .. Respondent/ OP.2

Counsel for the Appellant            :           M/s. Rupendra Mahendra

Counsel for the Respondents    :           Mr. B. Srihari  for R-1

                                                                        M/s. R. Briz Mohan Singh for

                                                                        R2.

Coram           ;           Sri Syed Abdullah              …        Hon’ble Member

And

Sri R. Lakshminarasimha Rao…      Hon’ble Member

Friday, the Thirtieth Day of July, Two Thousand Ten

Oral Order     :           ( As per Sri Syed Abdullah,  Hon’ble Member )

*******

The unsuccessful first opposite party   in CC 152/2007 before the District Forum II, Hyderabad  has filed this appeal questioning the legality and propriety of the order in directing payment of Rs. One lakh towards insurance amount  and  compensation with joint and several liability  along  with 2^nd opposite party insurance company. The impugned order is assailed as erroneous  contrary to the facts,  evidence on record  and  law and sought it to be set aside.

The facts of the case disclose that  the complainant is a Physical Fitness Trainer having a number of clients in her occupation.  While so, there was a  fire accident  at her home and sustained burn injuries, for which, she took treatment  and incurred an amount of Rs.5,25,000/-. That she had taken Credit Card issued by OP 1 bank  with a tie up  with Insurance policy issued by the  OP. 2 to cover personal accidents. The complainant applied for payment of insurance claim  but the claim was repudiated. 

The opposite parties 1 and 2 in their version have resisted the claim. Their defence is that  since the complainant  had suffered only 20 to 25% disability and as per the terms and conditions unless there is permanent loss or damage by the accident there is no necessity to pay insurance claim to the card holder and thereby the claim was repudiate.

During the enquiry, the complaint along with evidence affidavit filed Ex. A-1 to A-4 while so, the opposite parties have filed  Ex. B-1 to B-18 along with evidence affidavit.

The District Forum adjudicated on the aspect of deficiency in service for entitlement of relief to the complainant.   Basing on the evidence on record, the District Forum came to the conclusion that the complainant had proved deficiency in service and unfair trade practice  adopted by the opposite parties 1 and 2  and thereby directed payment of Rs.one lakh with compensation of Rs. 10,000/- with joint and several liability and also costs of Rs.1000/-. 

The appellant/1^st opposite party filed this  appeal  taking the stand that as per the terms and conditions of the policy having  tie up with  OP. 2 it is for the insurance company which is liable to settle the claim which fact the District Forum failed to consider it.  It is also the stand that the appellant/1^st opposite party is only a facilitator for extending additional facility  of accident insurance benefit  to the credit card holders  which is provide at free of cost.  It is also contended that  the appellant had forwarded the claim papers to the second opposite party/insurance company as such  it cannot be attributed with any deficiency in service  on its part.

The 2^nd  opposite party also filed FASR 4999/2007  along with delay petition in FAIA 2419 seeking condonation of delay of two days in filing the appeal.  After condonation of delay,   the appeal was disposed of by dismissing the appeal  and consequently  the order of the District Forum was confirmed fastening liability of Rs. One lakh.

Point for consideration is,  whether the appellant/1^st opposite party is liable to pay insurance amount along with OP. 2 insurance company to the respondent/complainant in view of terms and conditions of Personal Accident Insurance Policy  issued by the second opposite party ?

The learned counsel for the appellant reiterating in the appeal grounds has emphasized  that as per Ex. B-1 voucher Clause 3(O) it is clearly stated that bank shall not be responsible or liable  in any manner whatsoever for any matter  arising out of or in connection with such insurance coverage  whether for  or in respect of any deficiency or defect in such insurance cover.  It is also emphasized that  recovery or payment of compensation processing of settlement of claims or any other matter in relation to the insurance cover shall be addressed to and resolved directly by  the cardholder with the insurance Company.  However, insurance cover  will be available to the Cardholder  only as per the terms of the relevant insurance policy in force and only  as long as the card  Account is maintained in good standing.  So also,  in case,  the card being suspended or  cancelled that whatsoever  reason  or expired, the benefit of such insurance cover would automatically cease to be available from the date of  such suspension or cancellation.

The appeal filed by the second opposite party Insurance company was disposed of by the State Commission in FA 1494/2007 on 7^th   December , 2007 confirming the order of the District Forum so it is not necessary to go into the merits of the case  against the second opposite party or as to the quantum of  compensation.   In the present appeal , it is only to be considered whether  the appellant Bank/1^st opposite party  is to be fastened with liability  along with OP 2 Insurance company.  Ex. B-1 is the Andhra Bank brochure   which contains details of the obligation between the parties.  A reading of conditions in Sec. 3(O) it  is very clear as to the liability of the Bank . The condition no. 3.2. has made it clear that   bank  shall not be responsible or liable  in any manner whatsoever for any matter  arising out of or in connection with such insurance coverage  whether for  or in respect of any deficiency or defect in such insurance cover.  As contended by the learned counsel for the appellant, the appellant is only a facilitator  so as to cover  personal Accident of the Cardholder and as per the tie up with second opposite party/ Insurance company the insurance claim was floated to extend benefit to the Card holders. In fact, the insurance premium was not paid by the Card holder and the bank undertakes to pay  insurance premium regularly and as per the conditions.  As along as the  Card Account is continued,  the Card holder is entitled for the insurance benefit  and in the event of any personal accident that takes place the Insurance Company is liable to pay the benefit.  Ex. B-16 is the Insurance policy issued by the second opposite party which contains terms and conditions.   Though the policy is subject to some exclusion, it is not necessary to go through it since the defence raised by the second opposite party  ws already negatived by the order passed by the State Commission in FA 1494/2007 and  the order has become final in the absence of any appeal against the order.  Whatsoever it may be  it is very much clear that the 1^st  opposite party is  only a facilitator  and it has no liability  to pay the insurance claim. The District Forum though had considered Ex. B-1 brochure issued by the 1^st opposite party to the Cardholder  it has not considered the terms and conditions in right perspective.   It is the duty of the Card holder  to insist the bank to issue the terms and conditions of the Credit card and also insurance benefit  that is tied up with it.   Ex. B-14 contains several guidelines and it is the duty of the Card holder to insist the bank to furnish details of it, in case, the same was not furnished at the time of issuance of Credit Card.   It cannot be said that the contention of the complainant  is not tenable  that he was not aware of  terms and conditions covered by Ex. B-14.  The complainant is not an innocent or gullible  person to say that  she was lured to obtain Credit Card  without appraising the terms and conditions of it.  As observed by the District Forum, it is not correct to state that  the first opposite party enticed the customer to get the  Credit Card especially when the complainant had applied for the claim from Insurance Company. In fact, the evidence on record shows that  when the complainant had applied for claim, the same was  forwarded to the Insurance Company. But the Insurance company had repudiated he claim on the ground that the disability of 20 to 25% caused by burn injuries which was certified by the Doctor so as to cover the policy conditions.  It is seen that the complainant has not filed  medical bills to say that she had incurred an expenditure of Rs.5,25,000/- for taking treatment to the burn injuries.   Based  on the evidence on record, no deficiency or unfair trade pratice as alleged has been established against the first opposite party bank to fasten the insurance liability.

 For the reasons cited above, the order passed against the 1^st opposite party is not sustainable, as such, it is liable to be set aside.

In the result, the appeal is allowed setting aside the order dated 09.07.2007 in CC 152/2007 on the file of the District Forum II, Hyderabad, passed against the appellant/1^st Opposite Party Bank fastening liability to pay Rs.one lakh and compensation of Rs.10,000/-  with joint and several liability along with 2^nd Opposite Party. Each party to bear its  own costs in the appeal.  Consequently, the complaint against the  Opposite party No. 1  is dismissed.

Sd/-MEMBER

                                                                                                                                                                        Sd/- MEMBER

                                                                                                                                                                        DATED :   30.07.2010