PER HON'BLE MR. K.M. LAWANDE MEMBER 1(i) This consumer complaint is filed by complainant No. 1 Shrimati Raziya Sultana and other four complainants against the Opponent No. 1 Reliance General Insurance Company and Opponent No. 2 Road Safety Club Private Limited under section 17 of the Consumer Protection Act ,1986. It is contended that they are from Bhandara and their family is engaged in business .It is contended that complainant No. 1 is the mother of the deceased Haji Mohammad Abdul Rahman and complainant No. 2 is the wife and complainant No. 3 ,4 are the sons and complainant No. 5 is the daughter of the deceased.It is contended that deceased Haji Abdul Rehman had obtained 8 insurance policies of opponent No.1, the Insurance Company through opponent No. 2. (ii). The deceased met with a road accident on 30/04/2006.He was treated initially at one HOPE Hospital at Nagpur and their after shifted to Dr. Tambes Critical Centre. However, he could not survive and died on 18/05/2005.The complainants communicated the death incident to both the opponents. The complainants there after submitted insurance claims through opponent No. 2 to the opponent No. 1 Insurance Company. The details of policy No.s ,premiums paid, Sum insured and application No. submitted to opponent No. 1 is given in the complaint. (iii). The complainants were pursuing the opponent No. 1 for settlement of their insurance claims. It is further contended that in the course of follow up by the complainants , on visit to office of OP No. 2 at Nagpur in September 2008 , they were informed that OP No.1 vide their letter dt. 7/02/ 2007 demanded various documents including Post Mortem report of the deceased .The said letter is adressed to OP No. 2 at their office at Chennai. The Chennai office of OP NO.2 further forwarded the same information to their office at Nagpur and after a long period complainants were informed of the same. The said later is not addressed to the compliments. (iv). The OP No. 1 is avoiding to consider the death claim of deceased Abdul vide said letter dated 07 /02/ 2007 by making false and mischievous demand of the documents which are already supplied to them.The complainants have already submitted the certificate issued by Dr. Tambe which categorically mentioned that injuries sustained by the deceased which were fatal and he died of the same. The OP NO.1 is having custody of all the required documents. The OP NO.1 is reluctant and deliberately avoiding to settle the Complaints claim.The complainants issued legal notice to both the opponents .However, OP NO.1 Insurance Company did not reply to their notice and only (v). OP NO.2 replied first time that the complaints claim is repudiated. The complainant have cause of action at Nagpur as the deceased was issued disputed insurance policies at Nagpur and relevant formalities in that regards were complied at Nagpur. (vi). The complainants filed the consumer complaint before the this Commission seeking directions to the opponents to settle the complainance Insurance claim of Rs 24 lakhs and pay interest at 14% on this amount from May 2006, from the date of death of the deceased. Complaints also claimed Rs 55 lakhs towards mental and physical agony and Rs 50000 towards cost of litigation. 2. The OP No.1 Insurance Company submitted their written version and denied the rival allegations.It is contended that this Commission has no territorial jurisdiction to decide the case as it is contended that the deceased was the member of the OP NO.2 club situated at Chennai and he paid the amount of membership at Chennai and certificates contended to be issued at Chennai. It is contended that the complaint is time barred as it is filed beyond 3 years after the death of deceased. The opponent Insurance Company has not issued any insurance policy to the deceased for which the complaints are claiming. The complainants have not preferred any claim to them along with claim form, insurance policy, FIR, spot panchnama, Post Mortem report and other documents to substantiate their claim. The OP NO.1 also denied the relationship of the deceased with the complainants. It is denied that the details of all the insurance policies are within the record of OP No.1 without their being any policy shown. It is contended that the complainants be directed to produce the original policies to establish the fact to enable the OP No.1 to verify their record. The payment of premium of any amount is also denied. It is denied that the deceased met with a road accident on 30/04/2006 and died during the treatment on 18/05/2006. It is contended that the complainants have filed the false and vexatious complaint for the wrong full gain. 3. The opponent No. 2 /OP NO.2 has filed their written statement and denied the rival allegations made in the complaint. It is contended that there is no specific relief sought from them and they are the formal party and entitled to be deleted from the complaint. The OP NO.2 is a private limited company and launch with an object to create awareness amonst the public. The public were encouraged to become members of the club ,consequent upon which the members will get complimentary insurance cover depending upon the type of membership. It is further contended that OP NO.2 educate people and give them membership of the club so as to enable them to get insurance cover from insurance company and once insurance policy is issued, the role of OP No.2 ends. The service of the OP NO.2 is only confined to the extent of arranging the Insurance policy. In case in hand, OP NO.1 Insurance Company provided the policy.It is admitted that complainants raised the death claim on the basis of insurance policies obtained by deceased through them and provided all relevant documents except Post Mortem certificate. After receiving claim papers from complainants, OP NO.2 sent those documents to Insurance Company on 07/ 07/ 2006.The OP NO.1 vide their letter dated 27/07/2006 sent a request to complainant for providing the documents as claim form, postmortem report ,ID proof, age proof , true copies of the hospital record ,death summary from the hospital, nomination or legal heir certificate, membership certificate and insurance certificate.The copy of the said letter is marked to this OP NO.2. The OP NO.2 sent a letter dated 09/08/2006to area office of OP NO.1 at Nagpur for getting the documents from the party. Attested FIR was sent to the insurance company. There was lot of correspondence for the PM report and at last OP NO.2 received a repudiation from OP No.1 that complainants claim is repudiated for want of P.M. report and required documents. It is admitted that complainants visited OP NO.2 in September 2008. 4. Ld.Advocate Shri.Bhishiksr appeared for the complainant, Ld Advocate Smt.Dehadrai appeared for the OP NO.1 Insurance Company .The ld Advocates Shri. Dabrase appeared for the OP NO.2 Road Club. 5. After respective submissions of the parties, following points arose for our determination. We have noted them and answered them for the reasons to follow. Points Answers - Whether the complainant established that he is the
consumer of the opponents as regard to insurance ?In Negative (ii) Whether complainant established deficiency in service on the part of opponents? In negative (iii) Whether State Consumer Dispute Commission ,this Commisdion is having Territorial jurisdiction to decide this consumer complaint ? In affirmative (iv) What order? As per final order REASONING 6. The ld. advocate Shri Bhishikar argued for the complainant in the line of complaint. He relied on letter by OP No.2 to OP No.1 dated 11/12/2006 showing that OP NO.2 submitted attested ID proof of the deceased and beneficiary ,death summary to process the claim. He further argued that the death summary issued by Dr Tambe Hospital which is at page 11 of Complaint compilation showing that deceased admitted to that hospital on 02/05/2006 and was earlier admitted and left from HOPE hospital and died at Tambes Hospital Critical Care Unit. He has also kept reliance on the medical information certificate signed by Dr Awani Ghonge of Tambe’s hospital wherein cause of accident is answered as car accident .He also referred cause of death certificate issued by Critical Care Unit hospital which mentioned cause of death due to cardiac arrest out of head injury.He further argued that the insurance policies are with the insurance company (OP NO.1) and OP NO.2, Roadways Club. There was no post-mortem report as there was no suspicion as to death of the diseased, therefore it could not be submitted to the OP No.1.The OP NO.1 wrongly insisted for submission of PM report. The complainant has also moved application for directions to OP NO.2 for furnishings the insurance policies ,however they have not responded. The repudiation is not communicated to complainants. The learned advocate for the Complainant relied on judgement of Hon’ble High Court, Patna in the case of Branch Manager, New India Assurance Co. Ltd. Vs. Nakulsah & Ors. Reported in 2003(2) T.A.C.101(Pat.) wherein Hon’ble High Court directed the Insurance Company to produce the copies of Insurance policy on record. Therefore, the learned advocate further argued that in the given case also, the Insurance company is liable to produce the copies of Insurance on record. He concluded that the opponents have rendered deficiency in service towards complainants by not settling the legitimate claims of the complainants and therefore complaint deserves to be allowed. 7. The ld. advocate Shrimati Dehadrai argued for the OP No.1 that OP NO.1 has not issued any insurance policy to the deceased. The complainants or the OP NO.2 is liable to produce the copies of insurance policies issued to the diseased. The OP NO.1 has already asked for certain documents including post mortem report and insurance certificate ,membership certificate etc vide letter dt. 27/06/2006 and 07/02/2007. However, those are not supplied. The OP No.1repudiated the insurance claim as no insurance policies are issued by the OP NO.1.The complainants were required to file separate complaints for individual certificate or policy . The commission is not having territorial jurisdiction to decide the complaint as alleged policy is issued through OP NO.2at Chennai and also office of OP NO.1 is at Chennai. She further argued that the complaint is time barred. 8. The OP No.2 remained absent for oral arguments, however their written notes are on record. We have gone through it. It is contended that it is the matter on record that complainant has taken membership of OP NO.2 club and taken the policy of OP No.1.The complainant has no cause of action against OP NO.2.Complainants have not come with clean hands and supressed material facts on record. The OP No.2 has no role after policy is issued. There is no case of deficiency in service against the OP NO.2. 9. Discussion The complaints have their case of not settling the insurance claims filed by them to OP No.1 Insurance Company through OP No.2. It is contended by complainants that deceased Abdul has obtained 8 insurance policies through OP No. 2. It reveals that OP No.2 has not denied this contention . The OP No.2 have submitted that they have forwarded claim with certain documents to OP No.1 including claim for death summary report etc. OP No.1 has not denied it .It reveals that OP No.1 is contending that they have not issued any insurance policy/policies to the deceased .It reveals that complainant have not brought on record the copy/copies of insurance policy/policies before us. It appears that the complainants in their pleadings have mentioned certain 8 membership No.s of deceased with OP No.2 , premium paid ,sum insured and application No.s made to OP No.1. However, there is no mention of insurance policy No.s, name of the policy, period of the policy/policies dates of premium paid, sum insured along with the copy or copies of policy/policies .Complainants not have produced any copies of receipts of premium paid by the deceased to OP No.1. OP No.2 has contended that the deceased was their member and was issued insurance policies by OP No.1. It reveals that complainant contended for directions to opponents to place copy of insurance on record. OP No.1 has denied that they have issued insurance policy/policies to the deceased. It reveals that though it was directed to OP No.2 to produce the copy of insurance policy/policies, those are not produced by OP No.2 to support complainants case. Though it is accepted that deceased was member of OP NO.2, However, it cannot be inferred that OP No.2 is having the copy of insurance policies with them. The OP No.2 has contended that OP No.2 is playing role for facilitating or obtaining insurance policy only by their member and thereafter their role ends .Complainants have not brought before us any agreement or document that OP No.2 legally required to secure, maintain or preserve copies of insurance of their members. Therefore, the liability to fasten to produce copy of insurance cannot be fastened on OP No.2 and for non fulfilment of it, it cannot be held that OP No.1 is liable to settle the insurance claims in absence of copies of insurance submitted by complainants. Also, when it is denied by OP No.1 that they have not issued insurance policies ,in this situation, it cannot therefore asked to produce those by OP NO.1.Thus,it reveals that complainant have failed to establish that the deceased had obtained any insurance policy/policies from OP No.1 Insurance Company. Therefore, we answer point No.1 in negative. 10. Though the complainant is relying upon the judgement of Hon’ble High Court, Patna in the case of Branch Manager, New India Assurance Co. Ltd. Vs. Nakulsah & Ors. Reported in 2003(2) T.A.C.101(Pat.) wherein Hon’ble High Court directed the Insurance Company to produce the copies of Insurance policy on record, however, in that case, the complainant had disclosed the policy numbers. In the case in hand, it is not the case that Complainants have disclosed the policy numbers. Therefore, this judgement is not applicable to the case in hand. Also, in the case in hand there is no slightest cogent and tangible evidence on record to infer that op.1 has issued insurance policies through the op.2 except bare admission by OP NO.2 and without any evidence adduced by op.2.There is no record by OP No.2 that on any particular date proposal forms were filled in, proposals forwarded to OP No.1 and OP No.1 issued policy /policies to the members of OP No.2. It appears that complainant is claiming that policies are obtained by the deceased and complainants are claiming 24 lakhs towards settlement of claims. No doubt ,amount of 24 lacs is a very huge amount .It is difficult to accept that deceased purchased eight policies in the absence of policies on record and, therefore, it will not be appropriate to fasten the liability of settlement for payment of this amount on OP No.1. Definitely it is required for the complainant to give evidence of issuance of insurance policy. Had it been before us, it was there after possible for this Commission to impose the liability of settlement of Insurance claim on the OP No.1 insurance company. 11. It reveals that complainants contended that deceased obtained policies through OP No.2 and OP No.2 have also admitted the same .It appears that OP No.2 denied their role after issuance of policy by the insurance company to the insured person. The complainants have also not brought the membership certificate on record to establish any contractual liability on the OP No.2. Therefore,we agree with the contention of OP No.2 that OP No.2 cannot be held liable for settlement of Insurance claim. Therefore we answer point No. 2 in negative In case in hand, the complainants not established that the deceased obtained insurance policies therefore question does not arise for settlement of Insurance claim by OP No.1 &2. It is contended by the OP No.1 that this Commission is not having territorial jurisdiction as OP No.2 who facilitated for policy is at Chennai and also the office of insurance company is at Chennai however it reveals that the deceased had obtained membership of OP No.2 through their office situated at Nagpur and alleged Issuance of insurance policy is also at Nagpur therefore we answer point No. 3 in affirmative 12. In view of the aforesaid discussion and circumferences and facts on record, the complaint deserves to be dismissed. Hence we pass the following order. ORDER - The Complaint is dismissed.
- No order as to costs.
- Copies be furnished to both the partiers free of cost.
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