BEFORE THE DISTRICT FORUM:KURNOOL

Present: Sri K.V.H.Prasad, B.A., LL.B., President

And

Smt C.Preethi, M.A., LL.B., Member

Friday the 15^th day of June, 2007

C.C.No.15/2007

Mrs. Momin Noorjahan Bee, W/o Late M. Khaja Mohinuddin,

D.No. A-117, Shair Ahmed Street, Velgode Vand M, Kurnool District, A.P.                                          

... COMPLAINANT

Verses

1)     National Insurance Company Limited,

   Rep. by its Divisional Manager,   Kurnool.

2)     Golden Multi Services Club Limited,

   S.B. Monsoon, 16, R.N. Mukharjee Road,Kolkata - 700 001.

3)     G.T. Finance Service,

   Far East Plazee, Himayat Nager, Hyderabad - 29.                                

   ... OPPOSITE PARTIES

        This complaint coming on this day for hearing in the  presence of               Sri. M. Abdul Rab and Syed Shafaqath Hussain, Advocates, Kurnool for Complainant, Sri L. Hari Hara Natha Reddy,  Advocate, Kurnool for Opposite Party No.1 and  Sri. M Azmathulla, Advocate, Kurnool for Opposite Party No.2 and 3 upon the perusing the material papers on record, the Forum made the following:

O R D E R

(As per Smt. C. Preethi,  Member)

1. This Consumer Case of the Complainant is filed under section 12 of Consumer Protection Act, 1986 seeking a direction on Opposite Parties to pay insurance amount of Rs. 2,00,000/- with 24% per annum, Rs. 50,000/- as compensation and costs of the complaint.
2. The brief facts of the Complainants case is that the Complainant’s son          M. Farrok insured his life under the Group Personal Accident Policy bearing No. 100300/42/04/8200012 and nominated the complainant as his nominee.           On 01-12-2004 the insured M. Farook died in an accident and a claim form was submitted by the Complainant to Opposite Party No2 and Opposite Party No.2 requested the Complainant to submit final report of Police, Voters identity card of deceased and the insured and the same was complied by the Complainant.  But to the surprise of the Complainant the Opposite Party No.1 vide letter dated  17-02-2006 stated that claim intimation should be given within 30 days and the Complainant intimated the accident after 5 months 25 days and as such her claim is treated as “No claim”.  But the Complainant submits that she intimated the accident to Opposite Party No.2 on 27-12-2004 and claim form was submitted to Opposite Party No.2, hence there is no violation of terms and conditions of policy.  Thereafter on 02-06-2007 the Complainant got issued legal notice to which there was no reply.  The act of Opposite Party no.1 in treating the claim of the Complainant as No claim is amounting to deficiency of service to the Complainant.  Hence the Complainant resorted to the Forum for relief.
3. The Complainant in support of her case relied on the following documents viz; (1) Office copy of Policy bearing No. 100300/42104/13200012 (2) Xerox copy of claim form (3) Letter dated 15-03-2005 of Opposite Party to Complainant (4) Letter dated 23-05-2005 of Opposite Party No.2 to Opposite Party No.1 (5) Letter dated 14-11-2005 of Complainant to Opposite Party No.1 (6) Letter dated 17-02-2006 of Opposite Party No.1 to Complainant (7) Office copy of legal notice dated 02-06-2006 along with postal receipts and acknowledgements and (8) Reply letter dated 30-06-2006 of Opposite Party No.3 to Complainant, besides to the sworn affidavit of Complainant in reiteration of her complaint aveinnments and the above documents are marked as Ex.A1 to A8 for its appreciation in this case.  The Complainant caused interrogatories to Opposite Parties and replied to interrogatories of Opposite Parties.
4. In pursuance of the notice of this Forum as to this case of the Complainant Opposite Parties appeared through their standing counsels and filed separate written versions.
5. The written version of Opposite Party No.1 submits that upon happening of any event which may give rise to claim under the policy issued by Opposite Party No.1 written notice with all particulars must be given to the company immediately and in case of death written notice must be given to the company within calendar month by the claimant / G.M.S.E. Ltd., and the claim form with supporting documents should be submitted with in 90 days from the date of accident.  But the Complainant intimated the accident and submitted claim form after 5 months 25 days, hence it is clear violation of terms and conditions of the policy and Opposite Party No.1 did not entertain the claim and treated the claim as “No claim”.  Hence  there is no deficiency of service on part of Opposite Parties and the District Forum has no jurisdiction to entertain the case as policy issued by Opposite Party No.1 company are subject to Kolkota jurisdiction and seeks for the dismissal of Complaint with costs.
6. The written version of Opposite Parties 2 and 3 submits that as per memorandum of understandings between Opposite Party No.1 and 2 for covering the members of Opposite Party No.2 and 3 under Group Personal accident Insurance Policy, the Opposite Party No.2 collected premium and forwarded the same to Opposite Party No.1 and Opposite Party No.1 issued certificates to the effect and it is Opposite Party No.1 who has to settle the claim.  It further admits that the deceased M. Farook was member of Opposite Party No.2 club and obtained Group Personal Accident Insurance Policy bearing No. 100300/42104/13200012 and a certificates covering risk was issued by Opposite Party No.1 and nominated the Complainant as his nominee.             On 15-03-2005 the Opposite Party No.2 addressed a letter to the Complainant asking her to send final report of police and Voters Identity Card and after submitted the above documents the Opposite Party No.2 forwarded the same to Opposite Party No.1 along with letter dated 23-05-2005 and Opposite Party No.1 vide letter dated 17-02-2006 intimated the Complainant that her claim has been treated as “No claim”.  It lastly submits that Opposite Party No.1 is exclusive and sole authority to settle the claim of the policy and there is no deficiency of service on part of Opposite Party No.2 and 3 and seeks for the dismissal of complaint with costs.
7. The Opposite Parties in support of their case relied on the following documents viz; (1) Office copy of memorandum of understandings between Opposite Party No.1 and 2, besides to the sworn affidavit of Opposite Party No.1 to 3 in reiteration of their written version avernments and the above document is marked as Ex.B1 for its appreciation in this case.  The Opposite Parties caused interrogatories to the Complainant and replied to the interrogatories caused by Complainant.
8. There is no dispute as to the deceased M. Farook covered under the Group Personnel Insurance Policy issued by Opposite Party No.1 and the Complainant is the nominee under the policy.  There is no dispute as to the death of the deceased on 01-12-2004 in a road accident and death information was given to Opposite Party No.2 on 27-12-2004 and claim form was submitted to Opposite Party No.2 on 17-02-2005 and Opposite Party No.2 forwarded the same to Opposite Party No.1 on 26-05-2005 after completing formalities.  The only dispute is regarding the delay in intimating the death of the deceased to Opposite Party No.1.  The counsel for Complainant submitted that death information and claim form with all documents were submitted to Opposite Party No.2 on 27-12-2004 and 17-02-2005 respectively and the Complainant being a women unaware of the fact of informing the Opposite Party No.1 with in stipulated time but informed Opposite Party No.2 within stipulated time, but on the other hand the counsel for Opposite Party No.1 submitted that belatedness of the Complainant in informing the Opposite Party No.1 about the death of the policy holder and submitted claim form after 90 days from the date of accident is clear violation of condition laid down in Ex.B1 agreement between Opposite Party No.1 and 2.
9. The Ex.A4 is the letter dated 23-05-2005 of Opposite Party No.2 addressed to Opposite Party No.1, it envisages the enclosing of all relevant and necessary documents regarding the claim of the Complainant and submitted to Opposite Party No.1, it is clear from the above documents submitted to Opposite Party No.1 that the death of M. Farook is accidental one.  The only attack of Opposite Party No.1 against the Complainant is that the Complainant is not entitled to any amount under the policy as she intimated the death of her son and submitted claim form after the stipulated time which is clear violation of policy terms and conditions.  In Ex.B1 on page 12 (Annexure ‘A’) at claim settlement column, it says that sincere endeovour to settle claims lodged either by the insured or the GMSC Ltd., preferably with in 30 days after receipt of all requisite papers and / or information but in this case the Opposite Party No.1 closed the claim of the Complainant on 17-02-2006 i.e., after a lapse of 9 months from the dated of receipt of claim form i.e., 26-05-2005.  Hence, what appears is that no importance was given to the MOU (Ex.B1) entered between Opposite Party No.1 and 2.  In the Ex.B1 on page 10 column 15, it says intimation and claim form should be given within 20 days and 90 days from the date of accident and the claim submitted after 30 days will not be entertained.  Where no importance was given to Ex.B1 by Opposite Party No.1 itself in setting the claims, then no credence can be given to column 15 also. Hence the plea of Opposite Party No.1 is rejected. The said procedure no where envisages forfeiture of insured amount of the deceased on failure of the dependent/ nominee not informing the death of the insured to the Insurance Company (Opposite Party No.1) within stipulated time.
10. In support of their case the complainant’s side relied on the following decision of Uttar Pradesh State Commission between LIC of India Vs Rajendra Singh Gaur reported in (IV) 2004 CPJ Pg 531, where in it was held that repudiation of claim by LIC on the ground that intimation of death was delayed, the complainant contented that he was 80 years and not able to intimate earlier and he completed all formalities, hence, held repudiation of claim unjustified and illegal.
11. In the above said case the policy holder died on 29-11-1994 and intimation of death was given by the nominee to the insurance company in June 2003. The complainant was allowed on the ground that the policy stood intact for 10 years and the complainant was nominee under the policy and the complainant alone is entitle to the policy amount.
12. Following the above mentioned decision in the present case the death of policy holder occurred on 01-12-2004 and the same was intimated to Opposite Party No.2 on 27-12-2004 and claim form was submitted to Opposite Party No.2 on 17-02-2005 and it was forwarded to Opposite Party No.1 on 23-05-2005 by Opposite Party No.2, but the complainant submitted all documents and being a woman unaware of the fact of informing the opposite party No.1 within the stipulated time, but intimated Opposite Party No.2 on 27-12-2004 and submitted claim form on 17-02-2005 as such the complainant is showing a reasonable cause of the delay in intimating the death of M. Farook beyond reasonable time of 90 days as per Ex B.1 and as such there appears no fraudulent suspicion on the face in violation of agreement in Ex B.1. Hence, the complainant’s approach to this Forum seeking redressal is justified. The opposite party No.1 by its doscile conduct should not have rejected the claim of the complainant and should have condoned the delay after the reasonable time limited of 90 days.
13. The other decision relied by the complainant is that of Chhattisgarh State Commission reported in (III) 2006 CPJ pg 180 between Bajaj Allianz General Insurance Company Ltd Vs Manoj Agarwal, where in, it was held that intimation of death was delayed but intimation to the police was given in time, if the intimation to insurance company was delayed, but duly informed the police, hence the delay of intimation to the insurance company would not be fatal.
14. To conclude, from the above discussion and following the afore mentioned decisions the complainant except delay in intimating the opposite party No.1 and in all other accepts certainly remaining entitled to the accidental benefit under the Group Personal Accident Insurance Policy issued by opposite party No.1 covering the risk of her son M. Farook and opposite party No.1 is liable to pay the same as there is deficiency of service on part of opposite party No.1 in not paying the said amount. As there is no cause of action against to opposite party No.2 and 3 case against opposite party No.2 and 3 is dismissed.
15.  
16. In the result, the complaint is allowed directing the opposite party No.1 to pay insured amount under the policy of the deceased M. Farook to the complainant with 9% interest per annum from the date of complaint i.e.,          19-01-2007 till realization along with Rs.5,000/- as costs within a month of receipt of this order.

Dictated to the Computer Operator transcribed by him, corrected and pronounced in the Open bench on this the 15^th day of June, 2007.

        MEMBER                                                            PRESIDENT

APPENDIX OF EVIDENCE

Witnesses Examined

For the Complainant: Nil                                        For the Opposite Party: Nil

List of Exhibits marked for the complainant:-

Ex.A1 Office copy of Policy bearing No. 100300/42104/13200012

Ex.A2 Xerox copy of claim form

Ex.A3 Letter dated 15-03-2005 of Opposite Party to Complainant

Ex.A4 Letter dated 23-05-2005 of Opposite Party No.2 to Opposite Party No.1

Ex.A5 Letter dated 14-11-2005 of Complainant to Opposite Party No.1

Ex.A6 Letter dated 17-02-2006 of Opposite Party No.1 to Complainant

Ex.A7 Office copy of legal notice dated 02-06-2006 along with postal receipts and acknowledgements

Ex.A8 Reply letter dated 30-06-2006 of Opposite Party No.3 to Complainant

List of Exhibits marked for the opposite parties:-

Ex.B1 Office copy of memorandum of understandings between Opposite Party No.1 and 2

        MEMBER                                                            PRESIDENT

Copy to:

1.  Sri. M. Abdul Rab and Syed Shafaqath Hussain, Advocates, Kurnool.

2.  Sri. L. Hari Hara Natha Reddy Advocate, Kurnool.

2.  Sri. M Azmathulla, Advocate, Kurnool.

Copy was made ready on:

Copy was dispatched on:

Copy was delivered to parties: