By Jayasree Kallat, Member:

 

            The case is filed on 17-1-05  bySmt. Lalitha Sadasivan alleging deficiency in service on the part of opposite party. The complainant’s husband was having Group Janata Personal Accident Policy 47/710600/00846 with M/s. Dollar India Card Ltd. The card No.was 13626 which was valid for the period 7-5-99 to 6-5-2009. The Dollar India Cards Ltd subsequently amalgamated with the opposite party. Complainant’s husband met with an accident on 22-6-04 at about 5 A.M. at Selam and died on 8-7-04 at Medical College Hospital, Kozhikode. The complainant being the nominee of the insurance policy sent all the relevant documents along with details on 3-8-04 requesting the opposite party to pay the insured sum of Rs.2,00,000/-. The complainant received a reply from the opposite party informing that the policy was cancelled with effect from 1-5-03. The complainant was not informed about the cancellation or did not receive any money from the opposite party. The opposite party had repudiated the complainant’s claim for the insured sum of Rs.2,00,000/-. Complainant is alleging deficiency in service on the part of opposite party for repudiating the claim. Hence this complaint.

 

            Opposite party filed a version denying the allegations in the complaint except those that are specifically admitted. Opposite party admits that they have issued a Mater Janata Personal Accident Policy to all cardholders of M/s. Dollar India Ltd. The policy period was for 10 years. Opposite party had covered 112569 lives under the said group JPA policy. But the Regional Office of the opposite party vide their Circular No. CHNRO/RID/DUK/2001 dated 19-11-02 asked the opposite party to cancel all long term JPA policies. Opposite party had cancelled the policy of husband of the complainant accordingly with effect from 1-5-03. Opposite party has refunded pro-rata premium of the unexpired portion of the risk. Opposite party has submitted refund calculation list of the husband of the complainant.

 

 

           

            Sum Insured.                                        : Rs. 2,00,000/-

            Policy period.                                       : 07.05.1999 to 06.05.2009

            Premium collected for ten years.            : Rs.112/-

            Pro-rata premium for 1455 days           : Rs.44.61

            Refund premium                                   : Rs.67.39 R/o Rs.67/-

            Refund order No.                                 : 088268 dt. 01-05-2003

            Clearance date                                     : 09.05.2003.

 

            The cancellation was made by the opposite party basing on the policy condition. There was no deficiency in service or unfair trade practice on the part of the opposite party. As the insurance company acted as per the terms and conditions of the policy, by observing necessary formalities, there is no deficiency on the part of opposite party. Opposite party prays to dismiss the petition with cost to the opposite party.

 

            The points for consideration is (1) Whether there was any negligence on the part of opposite party? (2) Whether the complainant is entitled to get any relief? (3) If so what is the quantum?

 

            PW1 was examined and Ext.A1 to A6 were marked on complainant’s side. RW1 was examined and Ext.B1 to B5 were marked on opposite party’s side.

 

Point No.1:

 

            The complainant’s case is that complainant’s husband had joined Group Janata Personal Accident Policy with M/s. Dollars India Cards Ltd. M/s. Dollar India Cards Ltd. subsequently amalgamated with New India Insurance Company. Complainant’s husband met with an accident on 22-6-04 and died on 8-7-04. Being the nominee of the insurance policy the complainant had sent all the relevant documents to the opposite party on 3-8-04 to get insured sum of Rs.2,00,000/-. Complainant received a letter from the opposite party repudiating the claim and informing that the above mentioned policy was cancelled with effect from 1-5-03. Opposite party had taken the contention that they had already informed the complainant regarding the cancellation vide Ext.B3 letter. According to the opposite party they have cancelled the policy as per clause-5 of the policy conditions. Opposite party states that they had covered 1,12,569 lives under JPA policy. The Regional Office of the opposite party vide their Circular No. CHNRD/RID/DUK/2001 dated 19-11-02 had asked the opposite party to cancel all long term JPA policies issued. Opposite party had cancelled the policy of complainant’s husband also with effect from 1-5-03. Opposite party has also refunded pro-rata premium of the unexpired portion of the risk. The premium collected by the opposite party for 10 years was Rs.112/- only. The pro-rata premium for 1455 days was Rs.44.61. Opposite party has already refunded a balance amount of Rs.67/- vide refund order NO.088268 dated 1-5-03. Opposite party has produced Ext.B3 which is a letter sent by the opposite party to Sadasivan, Kolangarath the husband of the complainant which shows that the policy was cancelled and premium refunded to the insured person as per the cancellation certificate. Ext.B5 is a declaration of the Federal Bank and including a list of persons who were paid as per the refund order for New India Assurance Company Ltd. Ext.B4 list includes the name of Sadasivan Kolangarath which shows that opposite party has paid Rs.67/- on 9-5-03. Basing on these documents opposite party has argued that they have cancelled the policy as per Clause-5 of the policy conditions which gives the right for the opposite party to cancel the policy at any time. There is no negligence on the part of opposite parties. Opposite party has cancelled the policy as per the terms and conditions which is binding on the complainant’s husband also. Basing on these facts the opposite party has argued that as there is no deficiency, the complainant is not entitled for the sum insured Rs.2,00,000/-. The next point to be looked into is whether the opposite party has observed all the necessary steps mentioned in Clause-5 of the policy condition. Clause-5 clearly states that “ The company may at time by notice in writing cancel this policy, Caluse-5 is very clear that notice shall be given to the insured. We accept the stand of the opposite party that as they have cancelled the policy according to Cl.5 they are not entitled to pay the sum insured of Rs.2,00,000/- to the complainant.

 

            But the question still remains whether the insured persons were properly intimated of the cancellation. Opposite party has produced which is a true copy of letter sent to the complainant’s husband Sadasivan. But there is no evidence to show that complainant or her husband had received the intimation. Opposite party has not produced nay acknowledgement card or any other proof to show that the insured had received the intimation letter. The documents produced Ext.B2 to B5 are from Federal Bank. Ext.B3 will not show that the complainant or her husband have received such a letter. Also opposite party has produced Ext.B4 and B5 to show that they have refunded the amount of Rs.67/- by the Federal Bank, but there is no evidence that the complainants have received this amount. After hearing both sides the Forum has been convinced that opposite party has cancelled the policy as per the policy condition and according to the direction of the regional office of the opposite party vide their Circular No. CHNRO/RID/DOK/2001. The policy was cancelled with effect from 1-5-03. As the opposite party has cancelled the policy they have refunded the pro-rata premium. But the Forum is not convinced about the opposite party giving proper intimation regarding the policy cancellation to the husband of the complainant. Opposite party has not produced any concrete proof showing that the complainant or her husband has received the intimation. Hence we are of the opinion that there was slight negligence on the part of opposite party by not giving proper intimation to the complainant.

 

Point No.2:

 

            The complainant has filed the petition claiming Rs.2,00,000/- as the sum insured by the complainant’s husband in the membership of the Dollars India Ltd.- Group Janata Accident Policy. Opposite party has produced documents and argued that the policy was cancelled as early as with effect from 1-5-03. The complainant’s husband died on 8-7-04 ie. long after the cancellation of the policy. So the opposite party is not in a position to pay the sum insured amount of Rs.2,00,000/- to the complainant. But even though the opposite party has taken the view that they have intimated all the insured people regarding the cancellation, opposite party has failed to produce concrete documents before the Forum showing that the complainant or her husband has received the intimation on time. In such a circumstance we are of the opinion that the complainant is entitled to get compensation from opposite party for the slight negligence which occurred on the opposite party.

 

 

 

 

Point No.3:

 

            As the Forum has been convinced of the policy cancellation we are of the opinion that opposite party is not liable to pay Rs.2,00,000/- to the complainant. But as the opposite party has failed to produce concrete proof regarding the intimation of the cancellation to the complainant, we are of the opinion that the complainant is entitled for a compensation of Rs.5000/- for the mental strain, the complainant had to suffer.

 

            In the result the petition is partly allowed. Directing the opposite party to pay compensation of Rs.5000/- and a cost of Rs.500/- to the complainant within one month from the date of receipt of copy of the order.

 

Pronounced in the open court this the 27^th day of May 2010.

Date of filing : 17-01-2005

           

            SD/- PRESIDENT                   SD/- MEMBER           SD/- MEMBER

 

APPENDIX

Documents exhibited for the complainant:

A1. Photocopy of Dollar Save Card with No.173626.

A2. Photocopy of Policy certificate.

A3. Photocopy of Claim Form with postal receipt and acknowledgement

A4. Reply letter from the opposite party dt. 6-8-04.

A5. Copy of Lawyer notice dt. 8-12-04

A6. Reply notice dt. 14-12-04.

 

Documents exhibited for the opposite party.

B1. Janata Personal Accident Insurance Policy

B2. Photocopy of letter dt. 29-6-05.

B3. Photocopy of letter dt. 1-5-03.

B4. Extract of clearance statement.

B5. Certificate issued from Federal Bank.

Witness examined for the complainant:

PW1. Lalitha.K. (Complainant)

Witness examined for the opposite party.

RW1. Jagadhy Satheesh, 5/385, Karthika, P.O. Civil Station.

 

                                                                        Sd/- President

            // True copy //

(Forwarded/By order)

 

 

SENIOR SUPERINTENDENT.