Andhra Pradesh

Chittoor-II at triputi

CC/9/2016

Kogila Koteswaramma, W/o Late K.Gunnaiah - Complainant(s)

Versus

Reliance General Insurance Company Limited (Anil Dhirubai Ambani Group), Rep. by its Claims Manager - Opp.Party(s)

M.Subrahmanyam, N.Rajagopal

24 Aug 2017

ORDER

 

 

                                                                                                Filing Date:-28-01-2016                                                                                                               Order Date: -24-08-2017

 

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II, CHITTOOR AT TIRUPATI.

Present: - Sri. Ramakrishnaiah, President

                                                       Smt.T.Anitha, Member

 

THURSDAY, THE TWENTY FOURTH DAY OF AUGUST, TWO THOUSAND AND  SEVENTEEN

C.C.No.09/2016

Between

Smt. Kogila Koteswaramma,

W/o. Late K. Gunnaiah,

Hindu, aged about 40 years, House Wife,

Residing at D.No. 4-46, Kuravakaneri Village,

Lingamanaidupalle Panchayat, Poyya Post,

Thottambedu Mandal,

Chittoor District.                                                                    …. Complainant

 

And

1.Reliance General Insurance Company Limited,

   (Anil Dhirubai Ambani Group)

    4^th Floor, Sagar Plaza, 4/1/327 to 337,

    Abids Road, Hyderabad – 500001.

    Rep. by its Claims Manager.

 

2. The District Co-Operative Central Bank Limited,

    Kongareddipalle,

    Chittoor Post,

    Chittoor District.

    Rep. by its Chief Executive Officer.

 

3. The Thangellapalem Primary Agricultural

   Co-Operative Society Limited,

   Srikalahasti Post, Thottambedu Mandal, Chittoor District.

   Rep. by its Chief Executive Office                                    …. Opposite parties

 

         This complaint coming on before us for final hearing on 09.08.2017 and upon perusing the complaint, written arguments of the complainant and other relevant material papers on record and on hearing of Sri. M.Subramanyam, counsel for the complainant and Sri. S.M.Jhan counsel for the opposite party no.1, Sri. A.Sudarsana Babu, counsel for the opposite party no.3 and opposite party no.2 is remained exparte having stood over till this day for consideration, the Forum made the following.

ORDER

DELIVERED BY SMT. T. ANITHA, MEMBER

ON BEHALF OF THE BENCH

        This complaint is filed by the complainant under Section - 12 of the Consumer Protection Act 1986, complaining the deficiency in service on part of the opposite parties and prayed this forum to direct the opposite parties to pay the insurance claim of Rs.1,00,000/- to the complainant together with interest @ 18% p.a. from the date of claim till the date of realization, to pay compensation of Rs.25,000/- towards mental agony caused to the complainant and deficiency in service and to pay Rs.3,500/- towards costs of this complaint.

        2. The brief facts of the case are:  The complainant submits that her husband was a farmer and a member in the opposite party no.3 organization vide general No.4905 and he availed a loan for the development of his agricultural lands and the opposite party no.1 is an insurance company doing business through its branch at Tirupati and the opposite party no.2 is a Co-Operative Bank registered under the A.P. Co-Operative Societies Act VII of 1964 and doing business for consideration of interest through its branch at Srikalahasthi.

        The complainant further submits that opposite party No.3 is a Co-Operative Society and affiliated to the opposite party no.2 under single window credit delivery system and financing its members for the development of agriculture for consideration of interest. The complainant further submits that the opposite party no.2 has insured life of the deceased husband of the complainant for Rs.1,00,000/- with the opposite party no.1 vide Reliance Janatha Personal Accident Insurance (RJPAI) Policy No. 1811-38-30-11-100004 dt:27.04.2008 under the Co-Operative Kisan Credit Card (C.K.C.C) scheme in the year 2008-2009 with effect from 12.04.2008 till midnight of 11.04.2009. Thus the original policy bond is with the opposite party no.2. The complainant further submits that her husband died in an accident on 01.10.2008 when the policy was in force and the claim was submitted to the opposite party no.3 on 29.10.2008 in the prescribed format for onward transmission to the opposite party no.1 through the opposite party no.2 through proper channel and opposite party no.2 in turn has forwarded the claim of the complainant on 07.01.2009 to the opposite party no.1 and the name of the  complainant  was mentioned as  nominee in the said policy.

         3. The opposite party no.2 Vide RC No. A3/GJPAI/414/RMC/2010-11                   dt: 06.08.2010 reminded the opposite party no.1 to settle 39 pending death claims, among those claims the complainant’s husband name was stood as Serial No.18 in the enclosed list, but after receipt of the said reminder also the opposite party no.1 failed to settle the claim. Hence, the complainant got issued a legal notice on 15.12.2015 to all the opposite parties demanding for the settlement of the death claim. But after receipt of the said notices they have not sent any reply to the complainant. Hence the opposite parties have neither settled the claim nor repudiated the claim of the complainant till today, which is nothing but deficiency in service on part of the opposite parties. Hence, she filed the present complaint.  

        4.  The opposite party no. 1 and 3 came in to appearance and filed their separate written versions and opposite party no.2 after receipt of the notices failed to appear before this Forum. Hence the opposite party No.2 called absent and set exparte.

       The opposite party no.1 filed the written version by admitting the policy of the husband of the complainant and rest of the allegations were denied and further submits that the complainant has not followed the procedure laid down in the group policy and not submitted required documents within the time limit provided to the opposite party no. 2 and 3 in accordance with the terms and conditions of the policy. The opposite party no.1 further contended that, there was enormous delay in submitted the documents to this opposite party and also the complainant was not mentioned the real facts of the accident for which he died on 01.10.2008 was not clearly shown in her complaint and also she has not submitted the supportive documents to prove the same to process  her claim and also her claim is excessive. The opposite party no.1 denies the membership of the deceased with opposite party no.3 and also the opposite party no. 2 and 3 have not submitted required documents to process the claim of the complainant. Hence in the above circumstances the complaint is filed by the complainant is untenable and also there is no deficiency in service on part of them and the complaint is liable to be dismissed.

         The opposite party no.3 filed the written version by admitting that, the husband of the complainant was a member in the opposite party no.3 organization vide general No.4905 and the opposite party no.2 has insured the life of the deceased for Rs.1,00,000/- with the opposite party no.1 on 12.04.2008 for the year 2008-2009 with effect from 12.04.2008 till the midnight of 11.04.2009 and the policy holder died in an accident on 01.10.2008. The opposite party no.3 submitted that  the husband of  the complainant was a member the society of them and also he himself with his own will and wish joined with the scheme of the opposite party no.1 through  opposite party no.2 and further submitted that their role is limited to an extent of confirming that the insured is the member of this opposite party society and to that extent the application was authorized and also submits that they have duly attested the claim form and forwarded the same to the opposite party no.2 through complainant and subsequent to the receipt of the legal notice they have properly advised the complainant to approach the opposite parties 1 and 2 as it is their end to settle and the role of this opposite party was completed when the claim application was duly attested and forwarded through the complainant. The opposite party further submits that their role is very limited and it is duly discharged by duly attesting the claim form on forwarding the same to the opposite party no.2 through the complainant.  The opposite party no.3 further submits that  the document no.12 dt: 06.08.2010 caused by the opposite party no.2 to the opposite party no.1 clearly shows that the settlement of the death claim is in between the opposite parties 1 and 2 only and this opposite party no.3 is nothing to do with that. Hence as their role is limited to attest the claim form and they have duly discharged their part. Hence, there is no deficiency in service on part of them towards the complainant and the complaint is liable to be dismissed against the opposite party no.3.

        5.  The complainant filed her evidence on affidavit and Ex:A1 to A15 were marked on behalf of her and on behalf of the opposite party no.1 one Ravi Kumar Badugu, Assistant Manager Legal  filed his evidence on affidavit and on behalf of opposite party no.3 one P.Chiranjeevi Reddy, S/o. Munireddy, Chief Executive Officer filed his evidence on affidavit and no documents were marked on behalf of the opposite parties. Both the complainant and opposite parties 1 and 3 filed their written arguments and oral arguments were heard.       

       6.  Now the points for consideration are:

              (i)  Whether there is any deficiency of service on part of the opposite parties

                     towards the complainant?            

              (ii)  Whether the complainant is entitled for the reliefs as prayed for? If so?            

              (iii)  To what Relief?

        7.Point No:-(i):-   There is no dispute regarding the policy taken by the complainant’s husband at his life time from the opposite party no.1, as the husband of the complainant who is a farmer and member in the opposite party No.3 organization and availed loan for the development of his agriculture and entered into Group Insurance Policy with Reliance Janatha Personal Accident Insurance (RJPAI) and the said policy is covered from 12.04.2008 to 11.04.2009, and the policy amount is Rs.1,00,000/-. The main contention of the complainant is, her husband died in an accident on 01.10.2008 and  the complainant is stood as a nominee and  submitted her claim form to the opposite party no.3 and same was transmitted to the opposite party no.2 in turn they have forwarded the claim to the opposite party no.1 on 07.01.2009. The complainant further submits that the opposite party no.2 sent a reminder letter dt:06.08.2010 to the opposite party no.1 to settle 39 pending death claims and also the husband of the complainant is stood as Serial No.18 in the enclosed list  submitted to the opposite party no.1. After receipt of the said reminder letters and the claim form the opposite party no.1 did not choose to settle the claim so far. Hence finally she got issued a legal notice on 15.12.2015 to all the opposite parties demanding for the settlement of the claim. But after receipt of the notices by the opposite party 1 to 3 they have not taken any steps to settle the claim. Hence she filed the present complaint.

        The counsel for the opposite party no.1 admitted the policy of the complainant’s husband but they have contended that the complainant has not followed the procedure laid down under the Group Policy and not submitted required documents within the time limit provided to the opposite parties 2 and 3 as per the terms and conditions of the policy and there was enormous delay in submitting documents to them. The Opposite party no.1 further contended that the complainant has not clearly stated the reasons of the death of her husband and also she has not filed any supportive documents to prove the same and she has not submitted the claim form before them as per prescribed format provided by opposite parties 2 and 3. The opposite party no.1further contended that the complainant never approached this opposite party directly and she approached the opposite party      no.2 and 3 as manner of process in processing her claim and there is no direct access with them with the complainant and the complainant has no right to make allegations of deficiency in service on part of them. Hence, prayed this forum that there is no deficiency in service on part of them and the complaint is liable to be dismissed against them.

        The counsel for the opposite party no.3 argued that their role is very limited and they have duly discharged their role by duly attesting the claim form and forwarded the same to the opposite party no.2 through the complainant and also after receipt of the legal notice they have properly advised the complainant to approach the opposite party no. 1 and 2 for settlement of the claim and also further the very Ex:A12 dt: 06.08.2010 caused by the opposite party no.2 to the opposite party no.1 clearly shows that the settlement of the death claim is in between the opposite party no. 1 and 2 only and this opposite party no.3 is nothing to do except the limited purpose by identifying the beneficiary and forwarding the claim form by duly attesting the same and their role has been successfully completed by them.

       By perusing the documents and evidence on affidavits filed by both the parties  clearly shows that the complainant husband is having the insurance policy by the date of his death and the same was in force and also as per Ex:A3 FIR and Ex:A5 Postmortem Report clearly manifests that the deceased was died due to injuries sustained by him through accident.  The counsel for the opposite party no.1 stated that the complainant was not submitted her claim with in stipulated time as per the terms and conditions of the policy. But the Ex:A7 dated 07.01.2009 claim form submitted by the complainant to opposite party no.1 clearly shows that she submitted her claim with in time  and also the opposite party no.1 has not filed any policy copy before this forum to prove their bonafides and also except the bald allegations they have not filed any document to prove the same. As per Ex:A12 reminder letter caused by the opposite party no.2 to opposite party no.1 to settle the 39 pending claims  shows that the opposite party no.1 even after receipt of the reminder letter dt:06.08.2010 kept silent and did not choose to take any steps to settle the pending claims. Hence in the present case the opposite party no.1. Even after receipt of the required documents they failed to settle the claim of the complainant which is nothing but unfair trade practice and deficiency in service on part of opposite party no.1. Hence this point is answered against the opposite party no.1. 

       As duly the opposite party no.3 the co-operative agricultural society discharged their role by attesting the claim form and same was forwarded to opposite party no.2 through complainant.  And also Ex: A12 clearly shows that the opposite party no.2 forwarded claim of the complainant to opposite party no.1 and also the opposite party no.2 issued reminders to opposite party no.1 to settle the pending claims. Hence both the opposite parties 2 and 3 duly discharged their duties in processing the claim of the complainant to the opposite party no.1. Hence on those circumstances we cannot hold any deficiency in service on part of opposite party no.2 and opposite party no.3. 

        8. Point(ii):-    As already point no.1 is discussed against the opposite party no.1. The policy taken by the husband of the complainant for Rs.1,00,000/-(Rupees one lakh only) and also as per Ex: A7 clearly shows that the complainant submitted her claim to opposite party no.1 on 07.01.2009 but the opposite parties has not chosen to settle the claim till today. Hence, the complainant is entitled for the policy amount of Rs.1,00,000/- (Rupees one lakh only) along with interest @ 9% p.a. from the date of the claim i.e.07.01.2009 till realization and also the complainant is entitled of Rs.10,000/- (Rupees ten thousands only) towards compensation for mental agony and deficiency in service and Rs.2,000/- (Rupees two thousands only) towards costs of the litigation .

     9.Point(iii):- In view of our discussions in point no.1 and 2 we are of the opinion that the complainant has established that there is deficiency in service on part of the opposite party no.1.    

         In the result, the complaint is allowed in part directing the opposite party no.1 to pay the assured amount  of Rs.1,00,000/- (rupees one lakh only) along with interest @ 9% per annum from the date 07.01.2009 on which the opposite party no.2 forwarded the claim to opposite party no.1 till date the date of realization. The opposite party no.1 is further directed to pay a sum of Rs.10,000/- (rupees ten thousands only) towards compensation for mental agony and deficiency in service and  further directed to pay a sum of Rs.2,000/- (rupees two thousand only) towards costs of the litigation expenses. The opposite party no.1 is further directed to comply with the order within six (6) weeks from the date of receipt of copy of this order failing which, the compensation amount of Rs.10,000/- (rupees ten thousand only) shall also carry interest @ 9% per annum from the date of this order till realization.

        The claim against opposite party no. 2 and 3 are here by dismissed.

        Dictated to the stenographer, transcribed and typed by her, corrected and pronounced by me in the Open Forum this the 24^th day of August, 2017.

          Sd/-                                                                                                  Sd/-

  Lady Member                                                                                                President

APPENDIX OF EVIDENCE

                               Witnesses Examined on behalf of Complainant.

 

PW-1: Kogila Koteswaramma (Chief Affidavit filed).

 

Witnesses Examined on behalf of Opposite PartIES.

 

RW-1: Ravikumar Badugu (Chief Affidavit filed).

RW-2: P. Chiranjeevi Reddy (Chief Affidavit filed).

 

EXHIBITS MARKED ON BEHALF OF THE COMPLAINANT

 

Exhibits (Ex.A)	Description of Documents
	Original Pass Book of the deceased issued by the Opposite Party No.3 filed by the Complainant.
	Original House Hold Card No.WAP101500900109 filed by the Complainant. Dt: 04.06.2006.
	Photo copy of F.I.R. of Thottambedu P.S. filed by the Complainant. Dt: 01.10.2008.
	Photo copy of Inquest Report filed by the Complainant. Dt: 01.10.2008.
	Photo copy of the Post Mortem Report issued by Government Area Hospital, Srikalahasthi, filed by the Complainant. Dt: 02.10.2008.
	Photo copy of the Death Certificate filed by the complainant. Dt: 14.10.2008.
	Photo copy of Claim Form submitted by the Complainant.
	Photo copy of the Final Investigation Report of the Police filed by the Complainant.
	Photo copy of the Family Member Certificate in the way of Affidavit issued by the Tahsildar, Thottambedu Mandal filed by the complainant. Dt: 10.11.2008.
	Photo copy of the paper clippings (2 in number) filed by the Complainant.  Dt: 02.10.2008.
	Original Election Card of the Complainant filed by the Complainant. Card No.AP/20/135/387382. Dt: 15.12.1995.
	Photo copy of the letter Dt: 06.08.2010 addressed by Opposite Party No.2 to Opposite Party No.1 filed by the Complainant.
	Office copy of the Legal Notice Dt: 15.12.2015 filed by the Complainant.
	Original postal acknowledgments (3) filed by the Complainant.
	Photo copy of letter Dt: 28.01.2010 addressed to opposite party No.2 by the opposite party No.1 filed by the complainant.

 

EXHIBITS MARKED ON BEHALF OF THE OPPOSITE PARTIES

 

     -NIL-

                                                                                                                             Sd/-

  President

                                                  // TRUE COPY //

                                                  // BY ORDER //

 

 

                                              Head Clerk/Sheristadar,

                                    Dist. Consumer Forum-II, Tirupati.

 

 

 Copies to: 1. The Complainant.

                 2. The Opposite Parties 1 to 3.