This case is coming for final hearing on 22-07-2014 in the presence of Sri V.V.Bhaskar Kumar, Advocate for Complainant and Sri E.Govinda Reddy, Advocate for Opposite party and having stood over till this date, the Forum delivered the following.
The complainant filed the present complaint against the Opposite party under Sec.12 of Consumer Protection Act on 29.11.2013 and requested the Forum to direct the Opposite party to pay the Insurance Claim amount of Rs.1,00,000/- along with benefits vide Policy No.432200/47/2007/1006 along with interest @ 24% p.a. from date of death of his father i.e. 19.08.2010. The complainant also requested the Forum to direct the Opposite party to pay Rs.50,000/- compensation for causing mental agony and costs Rs.10,000/- towards legal expenses..
The brief facts are as follows: The complainant’s father has taken accident policy from the Opposite party vide Policy No.432200/47/2007/1006 from the Opposite party. The policy is valid from 4.5.2006 to 3.5.2011 and the policy amount is R.1,00,000/-. In that policy the complainant is the nominee. On 15.08.2010 the complainant’s father was hit by buffalo and was admitted in Shirdisai Hospital, Anakapalle for treatment and he was discharged from the Hospital. On 19.08.2010 the complainant’s father died at his house. After his death, on 20.09.2010 complainant informed about the death of his father to the Opposite party and requested for settlement of the claim amount. Even after receiving request letters 20.10.2010, 03.01.2011, 08.02.2011 also the Opposite parties did not responded and thereafter on 6.7.2012 Opposite party sent a letter to the complainant stating that the policy amount cannot be issued and the policy claim was repudiated. On 01.10.2013 the complainant got issued a Legal Notice to the Opposite party and after receiving the same on 12.10.2013 the Opposite party gave reply with false averments. Thereafter on 21.10.2013 the complainant gave rejoinder reply for the Reply Notice dt. 12.10.2013 given by the Opposite party. After receiving the Rejoinder Reply Notice dt. 21.10.2013, the Opposite party sent another rejoinder reply for the same on 30.10.2013 with false allegations confirming the repudiation letter given by them on 6.7.2012. As the Opposite party did not settle the claim inspite of several repeated requests the complainant filed the present complaint seeking reliefs.
On behalf of the opposite party Sri E.Govinda Reddy filed Vakalatnama and Sri P.Siva Prasad in capacity of Regional Manager, Oriental Insurance Company Limited, Visakhapatnam filed counter and stated as follows. The complainant has to show strict proof that he has informed about the death of his father on 20.09.2010, 03.01.2011, 08.02.2011 i.e. the correspondence letters done to the Opposite party. As the complainant is stating that his father was hit by buffalo and taken treatment at Shirdi Sai Hospital, Anakapalle for treatment and he was discharged. It is the duty of him to produce the proper documents to prove the same. Though the complainant is stating that his father obtained the policy No.
On perusing the pleadings of the both sides, the Forum has framed the following points for consideration:
Whether there is deficiency of service on the part of Opposite party and
to what relief.
The complainant filed his Chief Examination Affidavit reiterating the entire averments of the complaint and on his behalf Ex.A1 to A11 were marked. On behalf of the Opposite party the Regional Manager Sri P.Siva Prasad filed Evidence Affidavit and on behalf of the Opposite Party Exs.B1 to B4 were marked. The complainant and Opposite party submitted Written Arguments and thereafter both parties submitted their oral arguments. At the time of arguments, the Opposite party filed Memo dt. 22.07.2014 along with the letter dt. 23.06.2012 addressed to the Opposite party by complainant in which there was acknowledgement given by the Opposite party which is marked as Ex.B4.
At the time of Arguments, the counsel for complainant did not object for the same and stated that the complainant might have submitted the said letter for claim of the insurance policy which was not known to complainant and there is no objection from the complainant’s side for marking the Document and the same is marked as Ex.B4. The Opposite party vehemently argued and raised objection with regarding to the documents i.e. (1) Ex.A3 dt. 19.09.2010 (2) Ex.A4 dt. 20.10.2010 (3) Ex.A5 dt. 3.1.2011. (4) Ex.A6 dt.8.2.2011 for settlement of the Insurance Claim basing upon the Insurance Policy No.
Point Nos.1 & 2 : The present complaint was filed by the complainant claiming Insurance policy obtained by the complainant’s vide Policy No. 432200/47/2007/1006 in which the complainant is a nominee. Though the Opposite party raised objection that he has to prove that he is a nominee as seen from Ex.A1 Policy copy. On the face of the document, it reveals that the complainant i.e. M.Ramu is the son of Sri M.Venkanna. So that the said doubt was cleared as raised by the Opposite party in the Counter, Evidence Affidavit & Written Arguments.
Now with regard to the issue of the deficiency of service on part of the Opposite parties, as seen from Exs.A1 to A11 and Exs.B1 to B4, the description of the documents are as follows. Ex.A1 is the Policy copy vide Policy No. 432200/47/2007/1006 which is on the name of the complainant’s father and in which the complainant is the nominee. As seen except the policy has not furnished the terms and conditions shown by the Opposite Parties. Ex.A2 is the Death Certificate issued by the Registrar Births & Deaths and Panchayat Secretary, Tummapala on 6.11.2013. In the said document it reveals that the date of Registration for the death certificate is mentioned as 25.06.2011 and the date of death of the complainant’s father is mentioned as 19.08.2010. Ex.A3 is the letter dt. 19.09.2010 submitted to the Opposite parties for clearing the accident policy amount of Rs.1,00,000/-, in which there is no acknowledgement from the Opposite party. Exs.A3, A4, A5 & A6 are the letter submitted to the Opposite parties for clearing Rs.1,00,000/- accident policy which was submitted by the complainant, in which there is no acknowledgement obtained from the Opposite Party. Ex.A7 is the letter dt. 6.7.2012 stating that the Opposite party is not able to admit the claim as it was not intimated to the Opposite party within one month basing upon the conditions mentioned in Ex.B3 i.e. Condition Nos. 1 & 2. Ex.A8 is the Lawyer Notice dt.1.10.2013 served to the Claims Service Centre for settling the accident policy claim. Ex.A9 is the Reply Notice for Ex.A8 confirming the Ex.A7 Repudiation letter stating that in Para 3 the representations i.e. Ex.A3 to A6 are not sent to the Opposite party for settlement of claim and same was informed to the Opposite party only vide Ex.B4 letter, dt. 23.06.2012 by the complainant and viewing the condition No.1 mentioned in the Ex.B3 that the claim shall be intimated within one calendar month from the date of event, the claim was repudiated and the Ex.A7 Repudiation letter is confirmed. Ex.A10 is the Reply given by the complainant dt. 21.10.2013 to the Ex.A9 for settlement of claim at the earliest stating that there is not clause that in (Page No.2) there is no clause that the event should be intimated within one calendar month from the date of incident and thereby complainant is entitled for the claim. Ex.A11 is the Reply for Ex.A10 given by the Opposite party confirming the Repudiation letter dt. 6.7.2012 and also stated (in Para 7) that as the documents related to the accident i.e. FIR or Postmortem Report enclosed or any charge sheet are not furnished, the claim cannot be considered and basing upon that and as it was not intimated within time as per Condition No.1, Ex.B3 the claim is repudiated legally.
Ex.B1 & Ex.A9 are the same documents. Ex.B1 is the 1st copy of the Reply Notice for Ex.A9, which was sent to the complainant’s counsel. Ex.B2 is the 1st copy of the Reply notice dt. 30.10.2013 which was served to the complainant after receiving Ex.A10, Ex.B2 & Ex.A11 are same documents. Ex.B2 is the 1st copy of the Notice served to the complainant and the served copy i.e. Ex.A11 is the 2nd copy for Ex.B2. Ex.B3 is the copy of the Policy No. 432200/47/2007/1006 along with terms and conditions of the Insurance policy in which exclusions (6) and 8 conditions are mentioned. The Condition No.1 reveals that “Upon the happening of any event which may give rise to a claim under this Policy insured shall forthwith give notice thereof to the Company. Unless reasonable cause is shown the insured should within one calendar month after the event which may give rise to claim under the policy, give written notice to the Company with full particulars of the claim”. Ex.B4 is the letter submitted to the Opposite party for clearing the insurance policy signed by the complainant and on the face of the letter, the acknowledgement given by the Opposite party is there for receiving the original copy of the letter dt. 23.06.2012.
Observing the entire facts of both sides the main issue is regarding repudiation of the claim is whether it was done in accordance with the terms and conditions of the policy or not.
The Opposite party at the time of the Arguments, vehemently argued that Ex.A3 to A6 are created and fabricated just for want of wrongful gains from the Opposite party. The complainant filed Ex.B4 dt.23.06.2012 along with death certificate i.e. after 23 months from the date of death of his father. Even the counsel for the complainant has not denied about Ex.B4 and stated that the said letter might have been served by the complainant. On perusing Ex.A3 to A6 there is no acknowledgement to prove that they were served to the Opposite parties.
In Page No.2 of the Ex.A10 the complainant alleged the Opposite Party that the repudiation was done vide Ex.A7 dt. 6.7.2007 that there is no particular clause that it has to be intimated within one calendar month. For the said objection in Ex.A10 Opposite party sent reply vide Ex.A11 confirming the Ex.A7 repudiation letter.
On perusal of the Condition No.1 mentioned in the Ex.B3 it disclosed that the event has to be intimated to the Opposite party i.e. the death of the complainant’s father within one month.
On perusal of the Ex.A2, Death Certificate it itself shows that they submitted request letter for death certificate on 25.06.2011 i.e. after 11 months from the death of the complainant’s father and it was issued to complainant on 6.11.2013. Ex.B4 dt.23.06.2012 discloses that after the date of death of his father on 19.08.2010 from 20.08.2010 to 23.06.2012 i.e. for 673 days he kept quiet and submitted the letter for claiming insurance amount on 23.06.2012.
Viewing condition No.1 mentioned in Ex.B3, Ex.A2 & Ex.B4 along with Ex.A10 (Pg.2) it reveals that the claim was not made within time as per the stipulated time mentioned in Condition No.1 of the Ex.B3. Hence on this ground only we are of conclusive opinion that there is no deficiency of service on part of Opposite parties for repudiating the claim and we are firmly concluded that the repudiation is legal.
Observing the contentions of Opposite related to Exs.A3 to A6, the Opposite party is strongly objecting the Ex.A3 to A6. As per Case Law, III (2013) CPJ 114 (NC) between Prakash Vs Shrikanth in R.P.112/2013 decided on 30.05.2013 while deciding the issue of jurisdiction, it was held that, “the execution of a Agreement is alleged by Complainant has been denied by the Opposite Party. The question arised regarding validity of Agreement, which shall be examined only in proper Civil Court by lengthy evidence. Hence the forum is not having jurisdiction. In this case on hand, “the Opposite Party is objecting and denying the documents Ex.A3 to A6 that they are not valid under the law”. So for that issue, actually the complainant has to approach proper Civil Court, not in this Forum.
As seen from the condition No.8 mentioned in the Ex.B3, as the claim was repudiated by Opposite party vide Ex.A7 because the complainant has not approached the Opposite party within time as per Condition No.1, he may at his liberty can approach the Arbitrator as per Condition No.8 for his reliefs, if so, he is advised.
Viewing Condition No.1 and Ex.B4 this Forum cannot entertain the complaint as the complainant has violated the terms and conditions mentioned in Ex.B3.
Hence, in the light of the facts along with Condition No.1 of Ex.B3, B4 (Pg.2) of Ex.A10 & Ex.A7 repudiation letter, we firmly conclude that there is no deficiency of service on the part of Opposite parties and the complaint is dismissed without costs.
In the result the complaint is dismissed without costs.
Dictated to the Shorthand Writer, transcribed by him, corrected and pronounced by us in the open Forum on this the 31st day of July, 2014.
Sd/- Sd/-
President (FAC) Member
District Consumer Forum-I
Visakhapatnam
CC 269/2013
APPENDIX OF EVIDENCE
Exhibits Marked for the Complainant:
Sd/- Sd/-
President (FAC) Member
District Consumer Forum-I
Visakhapatnam
