Date of filing:4.2.2014
Date of Disposal:4.7.2014
BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II::
VIJAYAWADA, KRISHNA DISTRICT.
Present: SRI A. M. L. NARASIMHA RAO, B.SC., B. L., PRESIDENT
SMT N. TRIPURA SUNDARI, B. COM., B. L., MEMBER
FRIDAY, THE 4th DAY OF JULY, 2014.
C.C.No.52 OF 2014
Between :
1. Mallela Seetha, W/o Late Veera Babu, Hindu, 41 years, Housewife, R/o N.T.R. Colony, Vissannapet, Krishna District.
2. Mallela Durga Ramu, S/o Late Veera Babu, Hindu, 26 years, Coolie, R/o N.T.R.Colony, Vissannapet, Krishna District.
3. Mallela Naga Durga Rani, D/o Late Veera Babu, Hindu, 22 years, Housewife, R/o N.T.R. Colony, Vissannapet, Krishna District.
4. Malleala Chitti Babu, S/o Late Veera Babu, Hindu, 18 years, Coolie, R/o N.T.R. Colony, Vissannapet, Krishna District.
….. Complainants.
And
M/s ICICI Lombard General Insurance Company Limited, Rep., by its Divisional Manager, Divisional Office, Upstairs of Anjaneya Jewellery, M.G.Road, Vijayawada.
…..Opposite Party.
This complaint is coming before us for final hearing on 23.6.2014 in the presence of Sri N.Srinivasa Rao, Advocate for complainant and Sri D.Ravi Kiran, Advocate for opposite party and upon perusing the material available on record, this Forum delivers the following:
O R D E R
(Delivered by Hon’ble Member Smt N. Tripura Sundari)
This complaint is filed under Section 12 of the Consumer Protection Act, 1986.
The averments of the complaint are in brief:
1. The first complainant’s husband during his life time obtained personal accident policy for a sum of Rs.1,00,000/- from the opposite party covering the period from 22.1.2008 to 22.1.2009. While so on 12.5.2008 when the policy holder proceeding from the house towards Vissannapeta on his bike he met with an accident and died instantaneously. The complainant informed the said fact to the opposite party and submitted necessary documents for settlement of personal accident claim. But the opposite party did not settle the claim till today. Therefore the complainants are got issued legal notice demanding the opposite party to settle the claim. The opposite party received the said notice but neither settle the claim nor gave any reply which amounts to deficiency in service. Hence the complainants are constrained to file this complaint against the opposite party praying the Forum to direct the opposite party to pay a sum of Rs.1,00,000/- being the claim under the policy to the complainants along with subsequent interest at 24% per annum from the date of demand i.e., 18.2.2013 till realization of the claim, to pay Rs.50,000/- towards compensation for mental agony to pay costs of Rs.3,000/-.
2. The version of the opposite party is in brief:
The opposite party denied all the allegations of the complaint and submitted that the opposite party had received the claim intimation along with some documents on 8.10.2008 under the policy from the complainants informing about the death of 1st complainant’s husband in motor vehicle accident occurred on 12.5.2008. Thereupon after scrutiny of the documents and survey in the matter the opposite party came to conclusion that the acts of the complainants itself are violation of terms and conditions of insurance policy in regarding to intimation of the claim within stipulated period and therefore claim was repudiated and the same was communicated to the complainants long back. As per the terms and conditions the claim should be intimated within 90 days of happening of the insured event failing which the company shall not be liable for the payment of any claim. The complainants are under the obligation to intimate and lodge a claim with the opposite party with necessary documents within a stipulated period of 90 days of happening of insured event, but the complainants failed to do so and violated the terms and conditions of the policy. But the complainants having received the repudiation letter from the opposite party have wantonly not filed the same before the Forum and filed this complaint with all false allegations. There is no deficiency in service on the part of the opposite party and prays to dismiss the complaint with costs.
3. On behalf of the complainant the 1st complainant gave her affidavit and got marked Ex.A.1 to Ex.A.9 and on behalf of the opposite party Sri P.Vankata Siva Kumar Legal Manager of the opposite party gave his affidavit and got marked Ex.B.1 to Ex.B.4.
4. Heard and perused.
5. Now the points that arise for consideration in this complaint are:
1. Whether there is any deficiency in service on the part of the opposite party in
repudiating the claim of the complainants?
2. If so is the complainant entitled for any relief?
3. To what relief the complainant is entitled?
POINTS 1 AND 2:-
6. On perusing the material on hand the 1st complainant’s husband during his life time obtained personal accident policy Ex.A.1 from the opposite party for a sum of Rs.1,00,000/- covering the period from 22.1.2008 to 22.1.2009. on 12.5.2008 when the policy holder proceeding from his house towards Vissannapeta on his motor cycle he met with an accident and died on the spot. Ex.A.2 is First information report dated 12.5.2008, Ex.A.3 is post mortem report conducted by A.P. Vaidya Vidhana parishad on 13.5.2008. Ex.A.4 inquest report of the death of the insured and Ex.A.5 charge sheet filed under Section 304 A IPC in Crime No.60/A Ex.A.7 death certificate evidences the death of the insured. The 1st complainant says that she informed the said fact to the opposite party and submitted necessary documents for settlement of personal accident claim. But the opposite party did not settle the claim till today. Therefore the complainant got issued a legal notice dated 18.2.2013 under Ex.A.8 to the opposite party and the opposite party received the same under Ex.A.9. It is an admitted fact by the opposite party under Ex.B.2 certificate of group policy that the complainant’s husband insured his life with the opposite party for an amount of Rs.1,00,000/- for the period from 22.1.2008 to 21.1.2009. It is also an admitted fact by the opposite parties that the insured died in road accident. On receiving the claim from the complainant the opposite party informed the complaint under Ex.B.3 dated 13.10.2008 to forward to the opposite party the following documents in original within 15 days on receipt of the letter (1) two recent photographs of nominees attested (2) identity proof of nominee attested and opposite party requested to send the above mentioned documents to process the claim of the complainant on receipt of the above documents. The opposite party informed the complainant under Ex.B.1 dated 22.6.2009 that on processing the documents submitted by the complainant in support of the personal accident claim of her husband that the opposite party arrived at a conclusion captioned claim is not admissible under the policy as the claim was intimated after 90 days from the date of incident. Whereas as per the conditions of the policy the claim should have been intimated within 90 days of an insured event failing which the company shall not liable for the payment of any claim. Ex.B.4 is correspondence between the opposite party officials.
7. On examining the documents Ex.A.1 and Ex.B.2 the insurance policy we, the Forum noted that the claim should be intimated within 90 days of happening of an insured event failing which the company shall not be liable for payment of any claim. In this case the husband of the complainant died on 12.5.2008 and she intimated the same along with necessary documents to the opposite parties on 8.10.2008 on lapse of 90 days. Hence as per the terms and conditions of the policy the opposite party is not liable to pay any insurance claim to the complainant as the stipulated time of 90 days has lapsed for intimation of the claim. Hence the complainant is not entitled to receive any claim amount from the opposite party. Accordingly these points are answered.
POINT No.3:-
8. In the result, the complaint is dismissed without costs.
Dictated to the Stenographer K.Sivaram Prasad, transcribed by him, corrected by me and pronounced by us in the open Forum, this the 4th day of July, 2014.
PRESIDENT MEMBER
APPENDIX OF EVIDENCE
WITNESSES EXAMINED
For the complainant: For the opposite parties:-
P.W.1 M.Seetha, D.W.1 P.Venkata Siva Kumar,
1st Complainant Legal Manager,
(by affidavit) of the opposite party
(by affidavit)
DOCUMENTS MARKED
On behalf of the Complainant:_
Ex.A.1 . . Photocopy of Group Personal Accident (GPA) Policy.
Ex.A.2 12.05.2008 Photocopy of First Information Report.
Ex.A.3 13.05.2008 Photocopy of post mortem report.
Ex.A.4 13.05.2008 Photocopy of Inquest report.
Ex.A.5 . . Photocopy of charge sheet.
Ex.A.6 29.09.2008 Photocopy of Family Members Certificate.
Ex.A.7 29.05.2008 Photocopy of Death Certificate.
Ex.A.8 18.02.2013 Office copy of legal notice.
Ex.A.9 . . Postal acknowledgement.
For the opposite parties:-
Ex.B.1 22.06.2009 Photocopy of letter from the opposite party to the 1st
complainant.
Ex.B.2 . . Photocopy of Group Personal Accident (GPA) Policy.
Ex.B.3 13.10.2008 Photocopy of letter from Customer Service Manager of the
opposite party to the 1st complainant.
Ex.B.4 . . Copy of E-mail correspondence between the official of the
opposite party.
PRESIDENT
