DATE OF FILING : 03.02.2010
BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI Dated this the 29th day of April, 2010
Present: SRI.LAIJU RAMAKRISHNAN PRESIDENT SMT.SHEELA JACOB MEMBER SMT.BINDU SOMAN MEMBER C.C No.31/2010 Between Complainant : T.N.Sunil S/o Late S.Narayanan Nair, Edathil(Thykkoodathil) House, Kanjiramattom, Thodupuzha East – 685 585, Idukki District. (By Adv: K.M.Sanu) And Opposite Parties : 1. The Accounts Officer, BSNL, TRA Unit, Jyothi Super Bazar, Thodupuzha – 685 584, Idukki District. (By Adv: Sibi Thomas) 2. The Manager, Cholamandalam M.S. General Insurance Company Limited, Ist Floor, Plot No.6, Pusa Road, Near Mehopillar No.81, New Delhi – 100 005. (By Adv: K.Pradeepkumar) O R D E R SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
The complainant's father was a subscriber of BSNL under the Thodupuzha Telephone Exchange as Telephone No.222934. The Ist opposite party introduced an insurance policy which is a subscriber's policy, with the partnership of the 2nd opposite party. The complainant's father was also a member of the policy because he availed the BSNL land phone connection. Unfortunately the father of the complainant died on 25.09.2009 in an accident and the complainant's mother applied for the insurance claim to the Ist opposite party. The Ist opposite party denied the same stating the reason that she did not submit the application within the time limit. So the petition is filed for getting the insurance amount of the deceased S.Narayanan Nair.
2. As per the written version of the Ist opposite party, it is admitted that late Sri.S.Narayanan Nair was a subscriber of the Ist opposite party. The 2nd opposite party is the responsible insurance company to entertain the claim of the insurance of the BSNL subscribers. It is submitted by the petitioner that application was submitted on 13.10.2009, but such an application was neither received nor processed through this office. The petitioner has not contacted the office either in person or through telephone. The Ist opposite party paid insurance premium on behalf of BSNL subscribers to the 2nd opposite party. The 2nd opposite party is bound to honour the claim of BSNL subscribers. So there is no deficiency in service on the part of the Ist opposite party. 3. The 2nd opposite party filed a written version admitting that Group Personal Accident Policy had been issued to the Bharath Sanchar Nigam Limited under the policy bearing No.APG-00004621-000-00 for the period from 14.01.2009 to 13.01.2010 covering 3,24,96,363 persons for the sum insured of Rs.50,000/- for accidental death and permanent total disability. The liability is subject to various terms, conditions and exclusions of the policy and its due and strict compliance of the person covered under it. Any violation of the insurance contract by the parties to the contract of insurance, the contract becomes void and in such an event the insurance company is not liable to answer the claim of the other party. The insurance policy between the insurer and the insured represents a contract between the parties. In this case the claim was intimated to the 2nd opposite party from the complainant for the demise of the holder of the BSNL connection on 29.12.2009 for the alleged death dated 25.09.2009, after a lapse of 2 months. As per the memorandum of understanding with BSNL, the claim intimation is to be submitted within 60 days from the date of death. A letter was sent to the complainant on 5.01.2010 expressing the opposite party's inability to consider the claim of the complainant as per the terms and conditions and the exclusion of the policy. So the petition is not maintainable.
4. The point for consideration is whether there was any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to?
5. No oral evidence adduced by both parties. Exts.P1 to P4 marked on the side of the complainant and Exts.R1 and R2 marked on the side of the opposite parties.
6. The POINT :- The petition is filed for getting the insurance amount of the complainant's father who expired in an accident. The complainant's father who was a subscriber of the Ist opposite party BSNL. The Ist opposite party entered into an insurance agreement with the 2nd opposite party which is a group personal accident policy covering 32496363 persons for a sum assured as Rs.50,000/- for accidental death and permanent total disability. The policy period was from 14.01.2009 to 13.01.2010 as policy No. APG-00004621-000-00. The father of the complainant Mr.S.Narayanan Nair who expired on 25.09.2009. Ext.P3 is the post-mortem certificate. He was a subscriber of BSNL, Ext.P2 is the bill showing the same. After the death of Mr.S.Narayanan Nair, his wife Mrs.Kanakamma filed a petition before the Ist opposite party for getting the policy amount on 13.10.2009, copy of the said petition is marked as Ext.P1. But the 2nd opposite party denied the claim by a letter dated 5.01.2010 stating the reason that the time limit fixed for the submission of the claim by the BSNL customers shall be 60 days of the date of occurrence of the accident, which is marked as Ext.P4. According to the Ist opposite party, the 2nd opposite party is bound to honour the claim of the BSNL subscribers. No application submitted by the wife of late Mr.S.Narayanan Nair received to the opposite party, dated 13.10.2009. The Ist opposite party's office never processed such application to the 2nd opposite party. The petitioner has not contacted either in person or through phone to the Ist opposite party. As per the 2nd opposite party, they have admitted the policy. But the complainant availed the policy as per the memorandum of understanding with the BSNL. The claim intimation is to be submitted within 60 days of the date of the alleged accident and a letter was sent to the complainant on 5.01.2010 expressing the inability of the 2nd opposite party to consider the claim. Ext.R1 is the policy copy and conditions of the Group Personal Accident Policy.
According to the complainant, the complainant duly submitted an application for getting the insurance policy amount to the Ist opposite party on 13.10.2009 and it was filed by the wife of the late Mr.S.Narayanan Nair, copy of which is Ext.P1. But the opposite parties denied the same stating that information relating the death of the insured person and application for getting the claim were received only on 29.12.2009 which is after 2 months of the death of the insured. As per Ext.R1 condition, the claim should be given within 60 days of the death of the insured. But there is no evidence produced by the opposite party to show that the complainant claimed for the insurance amount only on 29.12.2009. The opposite party never submitted that whether the information received is over telephone or through letter, no copy of such application filed by the complainant is produced before the Forum. But the complainant produced Ext.P1 letter dated 13.10.2009. The only evidence produced by the opposite party to substantiate their claim is Exts.R1 and R2. Ext.R2 which is a letter, from the 2nd opposite party to the Ist opposite party stating the time limit of submission of claim is within 60 days. No policy conditions were supplied to the complainant at the time of insuring, because the insurance policy was obtained by the Ist opposite party from the 2nd opposite party. The complainant is an ordinary lay man who may not be known about the conditions of the policy and the Memorandum of understanding between the opposite parties. There is no contention raised by the opposite party stating that the policy conditions were supplied to the insured at the time of availing the policy. So without knowing the policy conditions and without getting the copy of the same, the ordinary lay man will not be able to know about the same. Anyway the complainant produced a document Ext.P1, which shows that the wife of the insured duly applied for the claim amount within the limited period of 60 days. So it is a gross deficiency from the opposite party to deny the claim of the complainant after receiving the premium. Hence the opposite parties are liable to pay the insurance amount to the nominee of the insured late Mr.S.Narayanan Nair. The 2nd opposite party is the insurer as per the Ist opposite party and it is also admitted by the 2nd opposite party.
Hence the petition allowed. The 2nd opposite party is directed to pay Rs.50,000/- which is the insurance amount, to the nominee of late Mr.S.Narayanan Nair or to the authorised person of the nominee with 12% interest from the date of this petition and Rs.2,000/- as cost of this petition within one month of receipt of a copy of this order, failing which the outstanding amount shall carry further interest at 12% per annum from the date of default. Pronounced in the Open Forum on this the 29th day of April, 2010
Sd/- SRI.LAIJU RAMAKRISHNAN(PRESIDENT)
Sd/- I agree SMT.SHEELA JACOB(MEMBER) Sd/- I agree SMT.BINDU SOMAN(MEMBER)
APPENDIX Depositions : On the side of Complainant : Nil On the side of Opposite Parties : Nil Exhibits: On the side of Complainant: Ext.P1 - Letter dated 13.10.2009 issued by the wife of Late S.Narayanan Nair to the Ist opposite party Ext.P2 - Policy copy-cum-bill issued by the Ist opposite party Ext.P3 - Photocopy of Post-mortem Certificate Ext.P4 - Repudiation letter dated 5.01.2010 issued by the 2nd opposite party On the side of Opposite Parties : Ext.R1 - Group Personal Accident Policy Schedule with conditions Ext.R2 - Photocopy of letter dated 6.03.2009 issued by the 2nd opposite party to the Ist opposite party
| | [HONORABLE Sheela Jacob] Member[HONORABLE Laiju Ramakrishnan] PRESIDENT[HONORABLE Bindu Soman] Member | | 
