ADV. RAVI SUSHA, MEMBER.

            The complainant’s husband Mr.Vinod had taken a family insurance policy which was introduced by the 2^nd opp.party under the instruction of 1^st opp.party.   The complainant’s family was a regular subscriber of Mathrubhomi Daily for the last three years.   The policy was issued byt 3^rd opp.party.   The deceased Vinod taken the first policy on 31..1..2005.  For renewing the policy Mr. Vinod paid Rs.80/-  to the 1^st opp.party on 28..9..2006.  On 20..10..2006 the said Vinod died in an accident..  After that as per the instructions from the 1^st opp.party the complainant submitted claim before the 2^nd and 3^rd opp.parties.  But the 3^rd opp.party had repudiated the claim of the complainant.  Hence for getting the claim and compensation.  Complainant filed this complaint before the Forum.

          1^st and 2^nd opp.parties filed joint version stating that the complainant’s husband paid the premium to the 1^st opp.party only on  19..10..2006 and the said amount was remitted at the office of the 2^nd opp.party on the very same day and the receipt was issued to the deceased Vinod.   After the death of Vinod the 1^st opp.party instructed the complainant to submit the claim  form to 3^rd opp.party and help them to fill the claim form properly.   All the formalities were duly complied by the 1^st and 2^nd opp.parties and there is no deficiency in service and  unfair trade practice on their part and prays for the dismissal of the complaint.

          3^rd opp.party filed separate version stating that  the complainant is not a consumer of this opp.party with whom no insurance coverage was existed in the name of the deceased Sri. Vinod at the time of the death of Sri. Vinod.  In the absence of an insurance contract with the opp.party covering the risk of the deceased Vinod under the Tailor made group personal accident subscribers policy of Mathrubhoomi Daily the complainant has no manner of cause of action to raise a consumer dispute against the opp.party. As per the clause 4 of the Memorandum of understanding the coverage of a subscriber who got enrolled into the scheme shall commence from the midnight of the subsequent day of receipt of premium amount of the said member at Mathrubhoomi Kozhikode.  It is also mentioned to clause 6 of the memorandum of understanding that on receipt of the application with premium of the subscriber, Mathrubhoomi Kozhikode office will issue a receipt cum certificate to the applicant incorporating name of  the  insured age, amount of premium received, scheme opted, some insured, validity period of the policy and assignees name etc.  It is also mentioned in clause 13 of the prescribed application form of the subscribers family insurance scheme that, the insurance coverage will commence only within 48 hrs from the date of joining in the scheme.   The deceased Vinod joined in the scheme vide his application dated 19..10..2005 who had opted to cover for accidental death only for sum insured of Rs.1 lakh.   A certificate No.HO11817 was issued by Mathrubhoomi wherein the period of insurance is clearly mentioned as “from the midnight of 20..10..2006 to midnight of 20..10..2007 and died at 12 noon on 20..10..2006. The death of the Vinod was well before the commencement of the risk as per the specific period of insurance mentioned in the concluded terms of the contract.  This opp.party is purely justified in disallowing the claim of the complainant due to legal and valid reasons and the complainant has no manner of cause of action against this opp.party for the decision taken by the opp.party in disallowing the claim.   In view of the facts and circumstances submitted above the complaint is liable to be dismissed in limine with heavy compensatory cost to this opp.party.

Points that would arise for consideration are:

1.     Whether there is deficiency in service on the part of the opp.partes

2.     Reliefs and costs.

For the complainant PW.1 was examined and marked Exts. P1 to P5

For the opp.parties DW.1 and 2 were examined and marked Ext. D1 to D3

POINTS:

          In this case the complainant’s main case is that her husband paid Rs.80/- to the 1^st opp.party on 28..9..2006 for renewing the policy and hence as legal heir she is entitled to get the insured amount.  But according to the opp.parties the deceased Vinod joined in the scheme only on 19..10..2006 vide his application and as per the policy condition the policy started only from the midnight of 20..10..2006 to midnight of 20..10..2007” and since Mr. Vinod met with an accident on 20..10..2006 and died at 12 noon on 20..10..2006 ie before the inception of the policy the claim submitted by the complainant is repudiated   Opp.party 3 in their version stated that as per clause 4 of the Memorandum of understanding, the coverage of a subscriber who got enrolled into the scheme shall commence from the midnight of the subsequent day of receipt of premium amount of the said member at Mathrubhoomi ‘Kozhikode’,    In clause 6, on receipt of the application with  premium of the subscriber “Mathrumbhoomi Kozhikode office’ will issue a receipt cum certificate to the applicant in corporating name of insured, validity period of the policy etc. Opp.parties depending Ext.P1 for proving their contention.  In Ext.P1 the date of payment is 19..10..2006.  While taking the evidence DW.1 deposed that 19..10..2006  glijsh 8;30 enA ilb\bj; Le\SelX receipt  Qr\rkA rHdjujh\h; Ext.P1 Lmkf\f pjicA glijsh fsr\r rHdj Ext. P1 YedlgA alf{.oaj sdlh\hA QlEJcjH rjr\rlSnl  Calicut QlEJcjH rjr\rlSnl issue svu\fsfr\rk eyulrlijh\h    But during examination of DW.2 the Assistant Manager of Opp.party 3 clearly stated that Ext.P1 [Ext. D2]  alf{.oaj SdlqjS]lm\ QlEJcjH rjr\r\   issue svu\fflnk\In Ext. D1, agreement between opp.parties 2 and 3 also as per condition No.6, on receipt of the application with premium, Mathrubhoomi, “Kozhikode” will issue a Receipt-cum-certificate to the applicant.  Then how opp.party 1 could issue Ext.P1 to the deceased Vinod on 20..10..2006 morning.  If opp.party 1 received the premium amount  on 19..10..2006 morning opp.party 1 ought to have issued receipt to Mr. Vinod at the time of receiving the premium amount  without doing that from the above circumstances we cannot believe the version of opp.parties 1 and 2 ie. the deceased had paid the premium amount only on 19..10..2006.   During cross examining PW.1 categorically stated that the premium amount was given on 28..9..2006.

          On considering the entire evidence [oral and documentary] and circumstances we are of the view that the deceased husband of the complainant paid the premium on 28..9..2006 to  opp.party 1 as an agent of opp.party 2 in good faith and his nominee is not supposed to suffer in the matter of getting maturity value of the insurance amount due to the failure of agent  to make payment of money to opp.party 2.   As per the principle of vicarious liability,  the principal will also be responsible for all acts and omissions of the agents to a third party.  Hence  opp.parties 1 and 2 are  liable to pay the insured amount to the complainant as a legal heir of the insured.   As per Ext.P1 the sum assured is Rs. 3 lakh

          In the result complaint is allowed in part.  Opp.parties 1 and 2 are  directed to pay Rs.3 lakh[ 2 lakh for education] to the complainant.  Opp.parties 1 and 2 are also directed to pay Rs.5000/- as compensation and Rs.1000/- as cost to the complainant.   The order is to be complied with within one month from the date of receipt of this order.

Dated this the 12^th day of April 2012.

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I N D E X

List of witnesses for the complainant

PW.1. – Radhamony

List of documents for the complainant

P1. – Receipt dated 19..10..2006

P2. – Application form

P3. – Death certificate

P4. – Postmortem certificate

P5. – Copy of FIR

List of witnesses for the opp.parties

DW.1. – Rahim.M.

DW.2. – K. Radhakrishnan

List of documents for the opp.parties

D1. – Agreement

D2. – Receipt-cum-certificate

D3. – Repudiation letter