KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD, THIRUVANANTHAPURAM FIRST APPEAL 885/2006 JUDGMENT DATED: 22.12.09 Appeal filed against the order passed by CDRF, Kollam in OP.No.364/2004 PRESENT JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT SRI.M.K.ABDULLA SONA : MEMBER 1. Geethakumari Amma., : APPELLANTS W/o late Dileep Kumar, Parampil, Perinadu, Now residing at Thadathil house, Alummood.P.O., Mukhathala, Kollam. 2. Ananthakrishnan, aged 13 years(Minor), rep.by Geethakumaari Amma, Who is the first appellant and natural Guardian and the mother. 3. Chandu D Kumar, aged 7 years(Minor), rep. by Geethakumari Amma Who is the first appellant and natural Guardian and the mother. (By Adv.V.Sasidharan & V.K.Sreela) vs. 1. Senior Branch Manager, : RESPONDENTS United India Insurance Co.Ltd., Branch Office, II Code 07184, 10/3 Geetha Mansion, Ground Floor, Bangalore – 560 009. 2. The Regional Manager, United India Insurance Co.Ltd., Bangalore. (By Adv.R.Jagadish Kumar, Counsel for R1 and R2) 3. The Manager, Vysya Bank, Chinnakkada, Kollam, KSFE Building, P.B.No.5101, Kollam. (By Adv.R.S.Kalkura, counsel for R3) JUDGMENT JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT The appellant is the complainant in OP.364/04 in the file of CDRF, Kollam. The complaint filed by the legal heirs of the deceased/insured stands dismissed. 2. The complainants are the widow/nominee and minor children of the deceased policy holder who died in a motor accident on 21.1.04. The policy coverage for accidental death is a sum of Rs.3,00,000/- for premium savings bank account holders of Vysya bank. The opposite party repudiated the claim on the ground that the death the claim intimation has been given beyond the period of 90 days within which the intimation ought to have been given although the claim was submitted within 180 days as specified. According to the 1st complainant she was under mental shock and was under treatment and that she came to know about the policy only on 2.5.04. The claim notice has been given on 3.5.04. The opposite party refused to issue the claim form. The complainant has sought for the claim amount and compensation of Rs.20000/- and cost of Rs.5000/-. 3. The 1st and 2nd opposite party/insurance company has filed version. It is stressed that the claim intimation ought to have been given within 90 days of the occurrence. According to the opposite parties they are liable to settle the claim only if the conditions governing the claim procedure is complied with. It is admitted that the husband of the 1st complainant was a savings bank account holder with the 3rd opposite party bank and covered under the group janatha personal accident policy. It is pointed out that the death was on 21.10.04 but the claim intimation was given on 3.5.04. Hence according to them they are not liable to settle the claim. 4. The 3rd opposite party/Bank has also filed version supporting the case of opposite parties 1 and 2. 5. The evidence adduced consisted of testimony of PW1; Exts.P1 to P5 and D1 to D7. 6. The Forum has upheld the contention of the opposite parties. The Forum has relied on clause 9 in Ext.D1 master policy agreement between the 1st and 3rd opposite party wherein it is specified that claim intimation is to be given within 90 days. 7. We find that the fact of the policy coverage and the incident of accidental death and the amount of the sum assured are not disputed. Ext.D1 is copy of the memorandum of understanding between the insurance company and the bank with respect to the master policy as per which the insurance company has undertaken to provide accident insurance coverage for the premium savings account holders of the bank. Clause 9 in ext.D1 provides procedure for claims. The above clause provides that intimation of the accident shall be given by the claimant to the insurance company with in 90 days from the date of the accident. The clause also provides that the documents specified also should be submitted along with the duly filled in claim form issued by the insurance company on intimation of the incident. In the instant case the claim form was not issued and the insurance company repudiated the claim as the claim intimation was not given within 90 days. It is seen that the claim intimation telegram is dated 3.5.04. The delay is only of 13 days. The counsel for the appellant has relied on the decision of the Maharashtra State CDRC in National Insurance Co. Ltd. vs. Asha Jamdar Prasad I (2009) CPJ 147 wherein in a similar matter the Commission has held that it was not proper on the part of the insurance company of throw away genuine claim of widow simply relying on the policy conditions. It was also observed that the widow undergoing mourning period cannot be expected to rush to the office of the insurance company to lodge the claim when she was completely in dark about the group janatha personal accident insurance policy. We find that in the instant case copy of the master policy was not produced. The reliance placed is on clause 9 of the memorandum of understanding, the marginal heading of which is procedure for claims. We find that the particular clause is with respect to the procedure only. There is no inordinate delay in intimating the death. So also the reason for the delay of 13 days has been explained by PW1/1st claimant. In the circumstance we find that the attitude of the 1st opposite party cannot be approved. The complainants are entitled for the amount due under the policy. Hence the order of the Forum is set aside. The appeal is allowed. The opposite parties 1 and 2 are directed to pay the sum of Rs.3,00,000/- to the appellants/claimants with interest at 7.5% from the date of the order of the Forum ie 21.7.06. The appellants are also entitled for a cost of Rs.5,000/-. The amounts are to be paid within 3 months from the date of receipt of this order failing which the complainant would be entitled for interest at 12% per annum from today. JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT SRI.M.K.ABDULLA SONA : MEMBER ps
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