BEFORE THE DISTRICT CONSUMER FORUM : MEDAK AT SANGAREDDY

PRESENT: Sri Patil Vithal Rao, B.Sc., LL.B.,President

Smt. Meena Ramanathan, B.Com., Lady Member

                    Sri G.Sreenivas Rao, M.Sc., B.Ed.,LL.B.,PGADR (NALSAR),Member

Tuesday, the 22^nd day of October, 2013

CC. No.36 of  2012

Between:

Smt. M. Rukmini W/o Jemla,

Aged: 50 years, Occ: Household,

R/o Koyyagunda Tanda, Kowlampet village,

Sangareddy Mandal, Medak District.                                                 ……Complainant

                   And

1. The Area Development Officer, L.L.L.C. Ltd.,

C/o Shankar @ Ranjiya,

R/o Koyyagunda Tanda, Kowlampet Village,

Sangareddy Mandal, District Medak.

2. The Manager, L.L.L.C. Ltd.,

Head Office Rainbow House,

Savedi Road, Ahmed Nagar, M.S. 414 003.

3. The Oriental Insurance Company Ltd.,

Through its Divisional Manager,

Division Office, Amber Plaza, Station Road,

Ahmed Nagar, 414 001, M.S.                                         ……Opposite parties

This case came up for final hearing before us on 17.10.2013 in the presence of Sri M. Dhanraj, Advocate for complainant, opposite party no. 1 set exparte, opposite party no. 2 in party and Sri P. Bal Reddy, Advocate for opposite party No. 3 and heard the arguments of both sides, on perusing the record and having stood over for consideration till this day, this Forum delivered the following:

O R D E R

(Per Se Smt. Meena Ramanathan, Lady Member)

                   The complainant, who is the mother-in-law of one deceased M. Anasuja, approached this Forum by way of the present complaint under Section 12 of the Consumer Protection Act, 1986 claiming Rs. 2,50,000/- the policy amount with interest @ 18% p.a. from the date of death of the deceased and Rs. 50,000/- towards compensation and Rs. 50,000/- towards damages. Her contention, in brief, is that her daughter-in-law M. Anasuja, is the policy holder and was assigned the policy no. 163305/47/2011/1123 by the opposite party no. 3. The policy was covering the period from 30.08.2010 to 29.08.2014 with opposite party no. 3. The opposite party no. 1 is the Area Development Officer of opposite party no. 2. This policy L.L.L.C. Ltd., is issued by opposite party no. 3 [Through opposite party nos. 1 and 2]. The complainant was the nominee of the said policy.

                   On 17.05.2011 the complainant’s daughter-in-law died owing to a fire accident. A case was registered with Sangareddy PS and an inquest was duly conducted. The autopsy report of the medical officer has also been filed. As per the instructions of the opposite party no. 1 (through opposite party no. 2), the complainant submitted the claim form along with original policy and other necessary documents. Despite having taken the necessary steps she has not received the policy amount, hence she has filed this present complaint.

2.                The opposite party no. 1 set exparte.

3.          The opposite party no. 2 only posted a memo which is treated as counter. This letter is dated 01.09.2012 and in that they clearly state that L.L.L.C. Ltd., (Life Line Life Care Limited) had an official tie-up with Oriental Insurance Company Limited, Ahmednagar (Maharshtra). Their representatives used to sell those Life Line Cards and an accident policy was obtained from Oriental Insurance Company and as such the insurance company is legally bound to settle a claim as per terms and conditions of the policy.

                   They further state that in this case, for late M. Anasuja W/o Gopal, LLLC Ltd had obtained a JPA policy LLLC no. 163305/47/2011/1123 for Rs. 1,00,000/- for the period from 30.08.2010 to 29.08.2014. The claim was received on 26.07.2011 and it was forwarded to the oriental Insurance company, Ahmednagar, Maharastra for consideration and settlement. There has been no delay on their side and hence feel the complaint against them is unjustified.

4.              The opposite party no. 3 filed their counter denying all the allegations made in the complaint. They state that the deceased voluntarily caused burn injuries to herself and as such they are not liable to pay any compensation. Yet at another level they submit that opposite party no. 1 and 2 did not intimate the death of the policy holder and have colluded to create this complaint. Hence they seek the complaint to be dismissed.

5.               Complainant filed her evidence affidavit and marked Exs. A1 to A9 to substantiate her claim.

                 Opposite party no. 2 did not adduce any evidence.

Opposite party no. 3 filed evidence affidavit of their Executive Legal as RW.1.

                   Heard both the sides, there was no representation for opposite party no. 1.

6.           Now the point for consideration is that whether there is any deficiency of service on the part of the opposite parties and whether the complainant is entitled to the reliefs claimed?

Point:

7.           It is not in dispute that the deceased, M. Anasuja took a “Janata Personal Accident Insurance” policy, vide policy no.  163305/47/2011/1123. The problem is regarding the payment of the claim amount to the nominee. There are three opposite parties. The policy was taken from the opposite party no. 2. The opposite party no. 1 is the area development officer of the opposite party no. 2. The opposite party no. 2 state that they have an official tie-up with the opposite party no. 3 and have sold these L.L.L.C. cards as the agents and are not the main insurance company.

8.             In their complaint, the complainant states that the policy covers the period from 30.08.2010 to 29.08.2014 and that the policy holder (her daughter-in-law), M. Anasuja died on 17.05.2011. The policy was very much in force at that time.

 9.             Ex.A1 is the Janata Personal Accident Insurance claim form. The form is printed with ‘The Oriental Insurance Company Limited’ and address given is  Ahmednagar, Maharastra, i.e. opposite party no. 3. Other details recorded in the form are:

 a) Cause of death – owing to accidental burns and

 b) Nominee – M. Rukmini Jemla and address given is – Koyyagundu Tanda, Kowlampet.

          This form is also signed by Dr. Praveen – Civil Assistant Surgeon, District Hospital, Sangareddy.

          Ex.A2 is the FIR report. Also attached in an attested letter by the father of the deceased, stating that his daughter M. Anasuja died owing to an accident and was happy in her marriage.

          Ex.A3 is the inquest report. Ex.A4 is the post mortem report. The report says she died owing to burn injuries. Ex. A5 is the LLLC Ltd card issued by Oriental Insurance Company and the amount of premium paid Rs. 1500/- and total cost Rs. 2,50,000/-. Ex. A6 is the legal notice issued to the opposite parties dated 28.03.2012. Ex. A7 is the postal receipt. Ex. A8 is the acknowledgement receipt and Ex. A9 is the reply to the complainant’s counter by the opposite party no. 2. In this reply notice – dated 06.04.2012, the opposite party no. 2 state that the claim was initially received by them and then forwarded to the opposite party no. 3 for consideration and settlement. As it is their policy and thus their liability. The accept that the claim was received on 26.07.2011 and that the opposite party no. 3 has not finalized the claim as yet. It is the responsibility of opposite party no. 3.

10.                The opposite party no. 2 filed a letter which is treated as their counter and in that they clearly state and accept having received the documents relating to the claim. They further submit that their company LLLC Ltd had an official tie-up with oriental insurance company and their representatives used to sell those life care cards. Against this facility each person was given a proposal form and this accident policy was obtained from oriental insurance company (the opposite party no. 3). And in this particular case the deceased M. Anasuja had obtained a Janata Personal Accident policy LLLC No. 163305/47/2011/1123; CSI Rs. 1,00,000/- for the period from 30.08.2010 to 29.08.2014. The claim was duly forwarded by them to opposite party no. 3 for consideration and settlement. In this letter the policy amount is given as Rs. 1,00,000/-.

11.                The opposite party no. 3, besides filing a formal counter denying all responsibility, did not file any documents. From the documents submitted by the complainant [i.e. Ex.A1] shows it is issued by the oriental insurance company (opposite party no. 3). It is the claim form. In Ex. A9, letter submitted by the opposite party no. 2 in reply to legal notice, they accept having received the claim and having checked the documents and forwarded the same to the opposite party no. 3. Therefore it is very obvious that the opposite party no. 2 and 3 are responsible and cannot blame each other to evade their responsibility. Opposite party no. 1 is the area development officer of the opposite party no. 2 and therefore is also held responsible.

12.         In view of the aforesaid discussion we hold that the complainant being the nominee of the policy holder, is entitled to the policy amount of Rs. 1,00,000/- with interest @ 9% p.a. from the date of maturity of the policy (i.e., death of the insured) till realization. The complainant is entitled for a compensation of Rs. 10,000/- and costs of Rs. 2,000/-.

13.              The point is answered accordingly.

14.            In the result, the complaint is allowed, directing the opposite parties no. 1 to 3 jointly and severally to pay to the complainant the policy amount of Rs. 1,00,000/- with interest @ 9% p.a. from the date of maturity of the policy 9i.e. death of the insured) till realization. The complainant is also entitled for a compensation of Rs. 10,000/- and costs of Rs. 2,000/-. Time for compliance is one month, from the date of receipt of a copy of this order.

                 Dictated to Stenographer, after transcription and correction the order is pronounced by us in the open court today on this the 22^nd day of October, 2013.

              Sd/-                                     Sd/-                             Sd/-

    MALE MEMBER               LADY MEMBER                  PRESIDENT

APPENDIX OF EVIDENCE

                              WITNESSES EXAMINED

For the complainants:                                          For the opposite parties:-

DOCUMENTS MARKED

For the complainant:                                                   For the opposite parties:-

              Sd/-                                     Sd/-                             Sd/-

    MALE MEMBER               LADY MEMBER                  PRESIDENT

Copy to:

1. The complainant
2. The opp. Parties
3. Spare Copy.