This complaint is coming before us for hearing, in the presence of       Sri. Beesha Ramesh, Advocate for Complainant, and of Sri. G. Harender Reddy, Advocate for Opposite parties No.1; and of Sri. G. Sita Rama Rao, Advocate for Opposite party No.2, and of Sri. Kandibanda Srinivasu, Advocate for Opposite party No.3; Upon perusing the material papers on record; upon hearing and having stood over for consideration this Forum passed the following:-

O R D E R

(Per Smt.V.Vijaya Rekha, Member)

This complaint is filed under section 12(1) of the Consumer Protection Act, 1986. 

2.       The brief facts as mentioned in the complaint are that the grandfather of complainant had obtained four life insurance policies through Sriram Direct to Home Pvt. Ltd., vide certificate Nos. 358801, dt.10-12-2006,  359046, dt. 25-12-2006, 359269 and 359270 on 31-12-2006 for the period of 1 year.  The complainant is the nominee to the said policies.  During the policies were in force, the grandfather of complainant / policy holder was died due to heart attack on 15-02-2007, being the nominee, intimated the same to the opposite parties and sent necessary documents in order to claim death benefits under policies, issued.  Thereafter, the opposite parties asked to furnish some other documents, accordingly, the complainant submitted required documents to the Branch Office of opposite party No.1 at Vijayawada, even after making many rounds, they failed to settle the claim till the date of filing of complaint, therefore, by alleging  the deficiency of service on the part of opposite parties filed the present complaint, praying to direct the opposite parties to pay assured amounts under four policies @ Rs.1,00,000/- each together with interest @12% per annum from the date of death of policy holder till realization and Rs.50,000/- towards damages and costs.    

3.       In support of his case, the complainant filed Affidavit and Exhibits A1 to A4.

4.       On being noticed, the opposite parties No. 1 to 3 appeared and filed counters by denying the averments as mentioned in the complaint.

In the counter, the opposite party No.1 admitted the issuance of membership certificates in favour of grandfather of complainant under road safety club programme and also submitted that the opposite party No.3 had issued four life insurance policies under Group Term Life Voluntary Plan vide policy No.RCN0000131 for the period of one year from 27-01-2007 to 26-01-2008 vide TR Nos. 3183249, 3183584, 3190299 and 3190300.  After receipt of relevant documents from the complainant, forwarded the same to the opposite party No.3 from time to time without any delay and also stated that the opposite party No.3 addressed a letter dt.10-05-2007, wanting to send some other documents are required, immediately, the same was informed to the complainant, after receipt of those documents from the complainant, forwarded the same to the opposite party No.3 through a letter dt.12-05-2007.  Thereafter, the complainant also made a written representation dt. 26-06-2008 to the Pune Branch of opposite party No.3 with a request to give directions to its central office for settlement of claim.  It is also averred that the opposite party No.1 is only the issuer of policies, not an insurer, therefore, there is no liability in payment of insurance amounts on it’s part, the insurer, who issued the policies will be liable to pay insurance amounts. And contended that the complainant straight away filed the present complaint without utilizing the arbitration clause, provided in the terms and conditions of Road Safety Club Programme and as such the complaint is not maintainable and prayed to dismiss the same by imposing exemplary costs.   

5.       In it’s counter, the opposite party No.2 submitted that the present complaint is not maintainable either in law or on facts and the contract of insurance is a contract of indemnity.  According to the Indian Contract Act, if there is any violation, the contract becomes void.  In the present case, there is no deficiency of service on the part of it, therefore, the complaint is not admissible.  The opposite party No.2 further stated that as per the averments of complaint and the letter dt.29-05-2007 addressed by the opposite party No.1 the opposite party No.2 is no way concerned, the opposite party No.3 is only answerable to the case in hand and as such there is no liability on the part of it.  The present complaint is having several complicated issues and as such the Consumer Forum has no jurisdiction to entertain this matter and prayed to dismiss the complaint with costs. 

6.       In it’s written version, the opposite party No.3 admitted the issuance of four life insurance policies @Rs.50,000/- each to the grandfather of complainant and further submitted that neither the death was intimated nor submitted the claim papers / documents either by the complainant or by the opposite party No.1 contended that it was added as a party to the proceedings at belated stage, due to which, deprived its right of investigation to reveal the cause of death of the life assured.  The life assured / policy holder was died within one month from the date of availing of policies, so it requires detailed investigation for revealing of cause of death but it was impossible at belated stage.  The opposite party No.3 also stated that the present complaint is not maintainable as it is frivolous and vexatious, therefore, prayed to dismiss the same with exemplary costs.

7.       During the proceedings, the opposite party no.1 filed exhibits B1 to B6 through a petition vide IA.No.149/2013.  In support of their averments, the complainant and the opposite parties No.1 and 2 filed written arguments by reiterating the same averments. 

8.       In view of above submissions, now the point that arose for consideration is,

Whether the complainant is entitled to the relief as prayed for?

Point:-        

In this case, the deceased / policy holder had availed two different types of insurance policies from the Reliance General Insurance Co. Ltd. and Bajaj Allianz Life Insurance Co. Ltd.  The Reliance General Insurance Co. Ltd. i.e. opposite party No.2 had issued Group personal accident policies for the coverage of accidental death / injuries, under which, the opposite party No.2 is only liable for the risk caused due to accident but the opposite party No.3 had issued policies under Group Term Life Coverage.  In the present case, the policy holder was died due to sudden heart attack, so the complainant cannot claim the opposite party No.2 for death benefits under accident insurance coverage.  Now the question is whether the complainant entitled to the assured amounts under Group Term Life Insurance policies, issued by the opposite party No.3 or not?   It is an admitted fact that the opposite party No.3 had issued four life insurance policies @ Rs.50,000/- each under Group Term Life Voluntary Plan in favour of deceased / grandfather of complainant through Road Safety Club Programme. The only dispute is regarding the timely intimation of death / submission of claim form to the opposite party No.3.  It is the case of the complainant, after sudden death of his grandfather; the death was intimated to the opposite parties by sending necessary documents for settlement of claim.  Thereafter, he also sent some other documents to the to it’s branch office of opposite party No.1 at Vijayawada.  Though, they failed to settle the claim even after making many representations. The opposite party No.1 also averred that after receipt of relevant documents from the complainant, without delay, forwarded the same to the opposite party No.3 for settlement of claim.  In support of their averments the complainant and opposite party No.1 placed the correspondence made by them to the opposite party No.3.  The material filed by the complainant was marked under exhibits A1 to A4 and the documents filed on behalf of opposite party No.1 were marked under exhibits B1 to B6. Exhibit A4 is the letter dt. 29-05-2007 addressed by the opposite party No.1 to the complainant, wherein, the opposite party No.1 clearly mentioned that the insurance company i.e. opposite party No.3 had asked to send attested identity proofs of the deceased and the beneficiary along with original Bajaj Allianz Life Policies (Nos.4) for processing of claim.   And as per exhibit B1 it is clear that the opposite party No.1 sent original policies (Nos.4) to the opposite party No.3 vide letter dt.06-07-2007.  Again, the opposite party No.1 had furnished Identity proofs of the deceased and beneficiary to the opposite party No.3 through a letter dt. 19-10-2007, evidenced under exhibit B2, it seems that the complainant had claimed the opposite party No.3 through the opposite party No.1 prior to asking of some more documents by the opposite party No.3 i.e. within 3 ½ months from the date of death of the policy holder, evidenced under exhibit A4 and it clearly shows that the claim was preferred without any abnormal delay as averred by the opposite party No.3.  Therefore, the contentions raised by the opposite party No.3 regarding the delay in intimation of death, non submission of claim form, non furnishing of dispatch details of claim form have no weight.  And as such, we are of the opinion that the attitude of opposite parties in non-settlement of claim for years together is not just and fair, definitely, it amounts to unfair trade practice and also against the principle of utmost good faith, so, such type of attitude cannot be tenable.  Therefore, the point is safely concluded in favour of complainant.    

In the result, the complaint is allowed in part, directing the opposite party No.3 to pay Rs.50,000/- each vide insurance certificate TR.Nos. 3183249, 3183584, 3190299 and 3190300 (in total Rs.2,00,000/-) under Group Term Life Voluntary Plan to the complainant together with interest @9% per annum from the date of filing of complaint i.e. dt. 25-02-2009 till its realization.  Further directed to pay Rs.1,000/- towards costs.  The complaint against opposite parties No.1 and 2 is dismissed.

Typed to dictation, corrected and pronounced by us, in the open Forum on this the 30^th day of May, 2016.

              Member                  FAC President              

District Consumer Forum, Khammam

APPENDIX OF EVIDENCE

WITNESSES EXAMINED:-

For Complainant:-                                                     For Opposite party:-   

       -None-                                                                           -None-

DOCUMENTS MARKED:-

For Complainant:-                                                     For Opposite party:-    

              Member                  FAC President             

District Consumer Forum, Khammam