PER SHRI. S. G. CHABUKSWAR – HON’BLE  MEMBER

1)        This is a complaint for the reliefs for issuing directions to the Opposite Party for payment of Group Personal Accident Claim standing in the name of deceased Dilip Prabhu Rs.4 Lacs with interest @ 21% p.a. from 29/09/2009 and Rs.50,000/- compensation towards the mental torture, Rs.10,000/- cost of complaint to the Complainant.

2)        The case of the Complainant in short is as under –

           The Complainant is the mother of late Dilip Prabhu who died at Kalyan on 18/09/1996.  Mr. Dilip Prabhu was working in UDHE at Vikhroli.  The said Dilip Prabhu during his life time insured in Group Personal Accident insurance under Standard Chartered Bank cover bearing Classic Credit Card No.5404 6070 1007 6803 in June, 1995 which was valid upto June, 1997. Mr. Dilip Prabhu had got married with Priya at Bombay on 30/10/1993.  After marriage they started to reside at Kalyan.  After some days of the marriage the differences arosed between deceased Dilip and Smt. Priya and therefore, they had decided to take divorce by mutual consent.  They had filed divorce petition No.1150 of 1996 at Family Court Bandra on 23/06/1996.  It was agreed between them that Mrs. Priya will accept sum of Rs.20,000/- as monetary claim being alimony and she had agreed to forgo all the properties movable and immovable belongs to deceased Dilip including insurance claim in question.  The marriage of deceased Dilip and Mrs. Priya was to be dissolved on 26/12/1996 being the expiry of six months period upon the date of filing of consent divorce petition. Dilip Prabhu died before passing of the decree of divorce by the Family Court.  Deceased Dilip had already nominated the Complainant as his nominee to receive the claim upon his death.

3)        The further case of the Complainant is that her son Dilip died under tragic circumstances at Kalyan on 18/09/1996 and the said matter was pending before the Police Authorities at Kalyan as well as CID for investigation.  Smt. Priya had filed Testamentary Petition No.892/1997 in the Hon’ble High Court of Judicature at Bombay for succession certificate and she claimed the entire property of deceased Dilip except the insurance cover claim in question.

4)        The further case of the Complainant is that on 30/12/1996 Opposite Party No.2 wrote a letter to her and called certain documents for processing the claim under Group Personal Accident Claim.  The Complainant submitted the documents called for with Opposite Party No.2 by the letter dtd.20/12/1996.  The Complainant being the nominee and legal heirs of deceased Dilip Prabhu Opposite Party No.2 did not call further requisitions and agreed to settle the claim.  On 02/09/1997, the Complainant submitted proposal to Opposite Party No.1 for settlement of claim of the Group Personal Accident. Opposite Party No.1 had asked the Complainant for submitting Coroner’s report, however, the said report was not available with the hospital therefore, Complainant requested to Opposite Party No.1 that she will submit the same as soon as she will receive it.  Thereafter on 16/11/1998 Opposite Party No.1 called upon the Complainant for submitting information about the outcome of testamentary petition pending in the Hon’ble High Court.  The Complainant intimated to Opposite Party No.1 by the various letters that the said matter is pending in the Court and she will intimate the same as soon as the petition is disposed of.  Opposite Party No.1 informed to the Complainant that she should submit final investigation report so that they would proceed further by the letter dtd.17/02/2004.  The Complainant informed to Opposite Party No.1 that she did not receive final investigation report and she will submit it as soon as she receives from the police authority.

5)        The further case of the Complainant is that she was regularly attending the matter at the Hon’ble High Court which was filed by the wife of deceased Dilip Prabhu.  However, the said matter was not appearing on the board therefore, Complainant could not give any satisfactory information to Opposite Party No.1.  The Complainant was also pursuing with the police authority for obtaining the final report.  However, the police did not take any efforts and wanted to close the matter by giving false evidence.  Opposite Party No.1 informed to the Complainant that if they do not receive the final investigation report from the Complainant then they will close the claim treating it as no claim by the letter dtd.18/09/2006. The Complainant replied the said letter through her advocate on 29/09/2006 and informed to Opposite Party No.1 that she has submitted all the documents except the final investigation report and requested not to close her claim. 

6)        The further case of the Complainant is that the Director General of Police, Maharashtra State submitted the final report by the letter dtd.30/04/2007.  The said authority has concluded that there is no substance in the complaint lodged by the Complainant and the matter may be treated as closed.  The Complainant submitted the said report with the Opposite Party No.1 by the letter dtd.30/07/2007. The Complainant through her advocate again informed to Opposite Party No.1 and requested for settlement of her claim by the letters dtd.17/09/2007,13/11/2007 and 08/02/2008.  The further case of the Complainant is that since the wife of deceased Dilip did not attend the Testamentary Petition No.892/1997 pending before the Hon’ble High Court therefore, the Hon’ble High Court dismissed the said petition on 25/08/2009.  The Complainant submitted the certified copy of the said order with Opposite Party No.1 and requested for settlement of claim by the letter dtd.29/09/2009. She had also visited the office of Opposite Party No.1. The Complainant has complied all her obligations even then Opposite Party No.1 deliberately with ill-intention not settled her claim.  Hence, this complaint for the reliefs mentioned in above para no.1. 

7)        Opposite Party No.1 resisted the claim by filing written statement. The contention of Opposite Party No.1 is that, Standard Chartered Bank is one of the party to the Insurance Contract with deceased Dilip therefore, the said bank is necessary party to the complaint. Smt. Priya, wife of deceased Dilip has filed Testamentary Petition No.892/1997 before the Hon’ble High Court of Bombay claiming all the properties of her husband deceased Dilip.  It means Smt. Priya has not forgone her right and claims in the property of her husband deceased Dilip.  Smt. Priya wife of deceased Dilip is necessary party to the complaint.  After filing of written statement by Opposite Party No.1, the Complainant has made party to the Standard Chartered Bank and Smt. Priya Dilip Prabhu as Opposite Party Nos.2 & 3.     

8)        The further contention of Opposite Party No.1 is that, Complainant has not produced any document on record to show that she is the nominee of the insurance claim in question.  The Consumer Forum cannot adjudicate the matter in exercise of its summary jurisdiction. The Complainant with malafied intention and to get wrongful gain from Opposite Party No.1 shown in para no.24 b of the complaint Rs.4 Lacs sum insured whereas the Classic Credit Card Holder’s sum insured is only Rs.2 Lacs for road accident and in the event of accident by air it is Rs.4 Lacs.     

9)        The further contention of the Opposite Party No.1 is that, the Complainant did not submit relevant documents including death certificate of deceased insured Dilip Prabhu and there is dispute between Smt. Priya wife of deceased Dilip who filed testamentary proceeding before the Hon’ble High Court of Bombay.  The claim of Complainant cannot be settled unless the dispute of Complainant and Smt. Priya wife of deceased is not decided by the competent Court.  The death of Dilip Prabhu also took place in a doubtful manner. The Complainant has furnished certain documents which are incomplete and therefore, she was asked to furnish the final investigation report of the police and also the status of the pending testamentary suit filed by the wife of deceased Dilip.  The Complainant had assured for furnishing the said documents by the letter dtd.15/03/2004 but the same were not furnished by her to Opposite Party No.1 and therefore, Opposite Party No.1 constrained to issue letter to the Complainant dtd.18/09/2006 informing her to submit the documents within 15 days otherwise her claim will be treated as ‘no claim’. In the absence of final investigation report of the police and final postmortem report it cannot be established that the death of deceased caused by an accident.  Opposite Party No.1 was unable to decide as to who is the legal representative of the deceased Dilip and to whom the insurance claim is to be given in the absence of succession certificate as the wife of deceased had claimed in the testamentary suit all the properties of her husband deceased Dilip.  There is no deficiency in service on the part of Opposite Party No.1. Opposite Party No.1 has denied all the rival contention of Complainant and prayed for dismissal of compliant with cost.

10)      Opposite Party No.2 has not filed its written version.  Opposite Party No.3 duly served with notice of the complaint but remained absent hence, complaint proceed ex-parte against her.   

11)      The Complainant has filed affidavit of evidence of her son Chetan Prabhu.  Opposite Party No.1 has filed affidavit of evidence of Prabhakar A. Shetty, Deputy Manager. The Complainant and Opposite Party Nos.1 & 2 have submitted their respective written notes arguments. We perused the documents produced by the parties.  We heard Shri. Gangarkar, Ld.Advocate for the Complainant, Shri. S.S. Singh, Ld.Advocate for Opposite Party No.1, Smt. Manisha Kadam, Ld.Advocate for Opposite Party No.2.

12)      The evidence of both parties clearly shows that, Mr. Dilip Prabhu a son of Complainant had obtained Credit Card from Opposite Party No.2 Standard Chartered Bank (hereinafter referred as Opposite Party No.2 Bank).  Opposite Party No.2 bank had entered in to a insurance contract with Opposite Party No.1 National Insurance Company (hereinafter referred as Opposite Party No.1 Insurance Company) and obtained Group Personal Accident Policy who in turn had entered into contract with Opposite Party No.2 Bank by granting them Group Personal Accident Cover.  Dilip Prabhu was in service in UDHE.  Mr. Dilip was covered under the Group Personal Accident Policy obtained by Opposite Party No.2 Bank from Opposite Party No.1 Insurance Company. Opposite Party No.1 Insurance Company produced copy of policy in question alongwith written statement.  The said policy shows that Opposite Party No.2 bank paid total premium Rs.1,50,49,914/- to Opposite Party No.1 Insurance Company for the period 01/08/1996 to 31/07/1997 for the insured persons named in the list attached.  The said policy is bearing no.260300/43/96/82/00200.  It is not the case of Opposite Party No.1 Insurance Company that name of Dilip Prabhu is not in the said list.

13)      The evidence further shows that Mr. Dilip Prabhu was married with one Priya.  After the marriage there was dispute and difference between Dilip and Priya therefore, they had filed mutual Divorce Petition No.1150/1996 in the Family Court Bandra on 23/06/1996. Dilip Prabhu died under tragic circumstances at Railway Station Platform Kalyan on 18/09/1996. The first information report of said incident was lodged at Railway Police Station Kalyan.  The crime was registered by the police on the basis of said report.  Mr. Dilip died before expiry of six months period upon the date of filing of the divorce petition.  Mr. Dilip died before passing the divorce decree.  Smt. Priya wife of deceased Dilip had filed Testamentary Petition No.892/1997 before the Hon’ble High Court of judicature at Bombay for succession certificate and she had claimed the entire property of deceased Dilip except the above insurance cover claim.

14)      The documents produced by the Complainant shows that, on 20/12/1996 Complainant issued letter to Opposite Party No.2 Bank and requested for sending claim form and for guidelines. The Complainant had sent to Opposite Party No.2 Bank xerox copies of First Information Report, Panchanama, Post Mortem Report and Death Certificate by the said letter Exh.B.  On 30/12/1996 Opposite Party No.2 Bank sent to the Complainant a letter Exh.A and given her advice about submission of claim form and documents to Opposite Party No.1 Insurance Company. On 02/09/1997 Complainant had sent to Opposite Party No.1 Insurance Company copies of First Information Report, Spot Panchanama, Death Certificate of Dilip, Inquest Panchanama, Post Mortem Report and English translation of Marathi documents and claim form by the letters Exh.C & D1 to D8.  On 16/11/1998 & 17/02/2004 Opposite Party No.1 Insurance Company sent letters Exh.E & F to the Complainant and asked her for submitting decision of Hon’ble High Court in testamentary suit and final investigation report of police.  The Complainant had informed to Opposite Party No.1 Insurance Company that she will submit those documents as soon as she will get it by the letters dtd.28/07/1999 and 15/03/2004. On 18/09/2006 Opposite Party No.1 Insurance Company directed the Complainant for submitting above documents within 15 days otherwise the claim will be closed by treating as no claim.  On 30/04/2007 the Director General of Police issued to the Complainant a final investigation report of CID.  On 30/07/2007 the Complainant has submitted said final investigation report to Opposite Party No.1 Insurance Company. The Hon’ble High Court of Judicate of Bombay has dismissed in default the testamentary suit No.13/1998 and Testamentary Petition No.892/1997 on 25/08/20009. The copy of said order is on record. The Complainant had sent to Opposite Party No.1 Insurance Company copy of said order by the letter on 29/09/2009.  The Complainant requested for early settlement of the claim by the said letter and also by the letters dtd.13/11/2007 and 08/02/2008.

15)      Opposite Party No.1 Insurance Company has not settled the claim of Complainant for want of decision of the Hon’ble High Court of Judicature at Bombay in Testamentary Petition No.892/1997 and for want of final investigation report of the police.  The contentions of Opposite Party No.1 Insurance Company is that they are unable to decide as to who is the legal representative of deceased Dilip and to whom the insurance claim is to be given in the absence of succession certificate.  There was no succession certificate on record or no document stating therein that Priya has forgone the insurance claim in favour of Complainant.  The post mortem report was incomplete. Death Certificate and complete post mortem report are mandatory to determine the cause of death.  It shows that Opposite Party No.1 Insurance Company could not settled the claim of Complainant till filing of copy of order passed by the Hon’ble High Court of Judicature at Bombay in Testamentary Petition No.892/1997 i.e. 29/09/2009.  Opposite Party No.1 has not settled the claim of Complainant after submission of final investigation report of police and copy of order passed by the Hon’ble High Court in Testamentary Petition No.892/1997 and it is the deficiency in service on the part of Opposite Party No.1 Insurance Company.

16)      Opposite Party No.1 Insurance Company has opposed the Complainant on the ground that the Complainant has not brought on record any evidence to the fact that she is the nominee/assignee under the said policy.  From the evidence it is clear that deceased Dilip left behind his parents i.e. mother Complainant and father Raghuvir Prabhu, two brothers namely Chetan and Sandeep, two sisters namely Priyanka and Archana.  Shri. Chetan, Priyanka, Archana and Raghuveer Prabhu appeared in the complaint through Shri. G.S. Kamble, Ld.Advocate and submitted their consent terms on 31/10/2012.  The consent terms of Shri. Sandeep Prabhu also filed on record on 31/10/2012. The above two consent terms clearly goes to shows that Raghuveer father, Sandeep and Chetan brothers, Priyanka and Archana sisters of deceased Dilip Prabhu have no objection for payment of claim amount to the Complainant.  All they have not claimed insurance claim in question. Smt. Priya wife of deceased Dilip Prabhu did not appear and file her written statement. She has not claimed the insurance claim by appearing in the present complaint. The Testamentary Petition No.892/1997 and Testamentary Suit No.13/1998 filed by Smt. Priya has been dismissed by the Hon’ble High Court of Judicate at Bombay on 29/08/2009.  It appears the above order is in existence as Smt. Priya has not filed any appeal against the said order. Smt. Priya has not claimed Share in insurance claim. So also Testamentary Petition came to be dismissed therefore, it is clear that Smt. Priya has given up her share of insurance claim.  In view of the above fact and consent terms filed by father, brothers and sisters of deceased Dilip we hold that sole Complainant is entitled to file complaint for insurance claim in question and there is no substance in the objection raised by Opposite Party No.1 Insurance Company.

17)      Shri. S.S. Singh, Ld.Advdocate for Opposite Party No.1 has argued that, Dilip Prabhu, Credit Card holder not died in the accident.  The murder of Dilip took place on 18/09/1996.  It has not been mentioned in the policy in question that murder covered under the Group Personal Accident Insurance Cover. The question arises whether murder comes within the meaning of accident or not.  As per dictionary meaning accident means an unfortunate incident. The murder of Dilip is an unfortunate incident.  The accident is something that happens by chance.  It is not the case of the Opposite Party No.1 Insurance Company that deceased Dilip was having knowledge of his murder dated 18/09/1996 and he obtained insurance policy in question with intention to take benefit of it. The murder of Dilip is an unfortunate incident and therefore, it is an accident.   As  per the terms and conditions of Insurance policy produced by Opposite Party No.1 Insurance Company, if any of the insured persons sustains any bodily injury resulting solely and directly from accident caused by external, violent and visible means. Violtens means using great force.  The murder of Dilip Prabhu took place by the violtant act using great force and by stabbing therefore, it is an accident within the meaning of policy in question. The Hon’ble National Commission in Revision Petition No.3559/2012, Life Insurance Corporation of India V/s. Shankaravva, decided on 22/01/2014 (reported in I (2014) CPJ 291 N.C.) observed that nominee is entitled to return the premium as per clause 4(B) of the insurance policy.  In the said case daughter of Complainant had nominated the name of the Complainant as beneficiary under the insurance policy. On 08/06/2006 daughter of Complainant was murdered. The Hon’ble National Commission passed order and directed the Life Insurance Corporation for payment of premium amount to the Complainant as per clause 4(B) of the policy.  Considering the fact of complaint and evidence we hold that murder of insured Dilip comes within the definition of accident.  The advocate for Opposite Party No.1 has not submitted any citation on the said point in support of his arguments therefore, said argument cannot be accepted.

18)      Opposite Party No.1 has opposed the complaint on the ground that the Complainant with malafied intention claimed Rs.4,00,000/- in para no.24(b) instead of Rs.2,00,000/-.  Dilip Prabhu son of Complainant died on the road.  As per the terms of the policy sum insured is payable Rs.2,00,000-/ on road accident, Rs.4,00,000/- Air accident in the event of death of classic credit card holder.  Deceased Dilip Prabhu was classic credit card holder. 

            The Complainant has pleaded in para no.1 of the complaint that Dilip Prabhu during his life time insured in group personal accident insurance policy Standard Chartered Bank cover bearing Classic Credit Card No.5004 6070 10076803, in June, 1995 which was valid upto 1997.  On 20/12/1996 the Complainant sent a letter Exh.B to Opposite Party No.2 Bank wherein she has mentioned in the subject of letter “Standard Chartered” Classic Credit Card No.5404 6070 1007 6803 Holder Shri. Dilip R. Prabhu.  From the above pleading and letter it clear that, deceased Dilip was insured as a classic credit card holder.  Opposite Party No.1 Insurance Company filed written statement and pleaded the above fact therein.  The Complainant in the written notes of argument taken the different stand and submitted that Dilip was executive card holder and therefore, Complainant is entitled to the sum insured Rs.4,00,000/-    in the case of road accident and Rs.8,00,000/- in the case of Air accident. Opposite Party No.1 Insurance Company has submitted alongwith written statement a copy     of terms and conditions of the policy in question.   The insured sum of different card holders given in the said policy is as under -      

   Product                           SUM  INSURED                 SUM  INSURED      BENEFIT

  (Visa/Mastercard)          ROAD      AIR                           SPOUSE             ________            

    GOLD                              5 Lacs    10 Lacs                       2.5 Lacs                   Table I

                  (Death Only)

    EXECUIVE                      4 Lacs      8 Lacs                       2.5 Lacs               ___do___

    CLASSIC                         2 Lacs      4 Lacs                        2.5 Lacs              ___ do___

            The Complainant neither deposed on oath nor produced any document to show that deceased Dilip was holder of executive credit card and he was not classic credit card holder. The pleading and letter Exh.B dtd.20/12/1996 clearly goes to show that deceased Dilip was classic credit card holder.  Hence, argument of Complainant on the said point cannot be accepted. As the deceased Dilip was classic credit card holder and died on the road therefore, Complainant is entitled to the insured sum only Rs.2,00,000/- and not for Rs.4,00,000/-as claimed by her. Opposite Party No.1 Insurance Company has not settled the claim from 20/09/2009 till May, 2010.  Therefore, Complainant is entitled to Rs.4,000/- towards compensation for mental agony caused to her and Rs.3,000/- cost of the complaint. No relief is claimed by Complainant against Opposite Party No.2 Bank hence, compliant deserves to be dismissed against Opposite Party No.2 Bank. The said Bank has to bear its own cost.  

             In the result complaint deserves to be partially allowed only against Opposite Party No.1 Insurance Company.  Hence, we proceeds to pass following order –

O R D E R

 i.         Complaint No.181/2010 is partly allowed against Opposite Party No.1 Insurance Company.

             ii.         Opposite Party No.1 Insurance Company  is  directed to pay insurance amount to  the  Complainant  Rs.2,00,000/-  (Rs. Two

                         Lacs Only) with interest  @ 6%  p.a. from  the  date  of  filing complaint  i.e. 03/06/2010 till realization of the amount.  

                    iii.        Opposite Party No.1 Insurance Company is directed to pay Rs.4,000/-(Rs. Four Thousand Only) to the Complainant towards 

                                compensation for mental harassment caused to her.

             iv.       Opposite Party No.1 Insurance Company is directed to pay to the Complainant Rs.3,000/-(Rs. Three Thousand Only) towards

                        cost of the complaint.

v.        Opposite Party No.1 Insurance Company is directed to pay amount mentioned above para No. ii, iii, iv to the Complainant within 

           one month from the date of this order.

vi.       The complaint against Opposite Party No.2 Bank is dismissed.

                    vii.       Opposite Party No.2 Bank shall bear its own cost.       

            viii.      Certified copies of this order be furnished to the parties.