This Complaint coming up before us for hearing on 01-04-11 in the presence of Sri S. Kalesha, advocate for complainant and of              Sri S.A. Khadar, advocate for opposite party, upon perusing the material on record and after hearing both sides and having stood over till this day for consideration this Forum made the following:-

O R D E R

Per Sri A. Hazarath Rao, President:-

        The complainant filed this complaint U/s 12 of Consumer Protection Act, 1986 seeking assured amount of Rs.1,00,000/- being personal accident claim of her deceased husband together with interest, Rs.50,000/- towards mental agony and Rs.10,000/- towards costs.

2.      In brief the averments of the complaint are these:  

        One Valiveti Narasimha Rao S/o Raghavaiah is husband of the complainant and was member of Yadlapalli Pradhamika Vyavasaya Sahakara Parapathi Sangam Limited.   The said Samithi obtained personal accident insurance policy for its members for the year 2009-2010 with the opposite party.   The sum assured for each member is for Rs.1,00,000/-.   Complainant’s husband unfortunately met with a road traffic accident on 20-06-09 within the limits of Tsunduru PS and later succumbed to injuries on 04-07-09.   Tsunduru PS registered the said accident as crime No.69/2009.   The same was intimated to the opposite party by the said Samithi.   The complainant submitted claim form with all relevant records to the opposite party.   Inspite of requests and notice the opposite party failed to settle the claim of the complainant and it amounted to deficiency of service.   The complaint therefore be allowed.   

3.    The contention of the opposite party in brief is hereunder:-

        There is no privity of contract between the complainant and the opposite party.   Insurance is a contract of indemnity.   Any violation of insurance contract by the parties to it the contract becomes void.   The opposite party issued a Janatha Personal Accident (Group) policy bearing No.1803393011100001 in favour of the Guntur Co-Operative Central Bank Limited, Guntur covering the period from 24-04-09 to 23-04-10 covering the Kisan Credit Card Holders, RMG Members in the district.   The liability if any of the opposite party is subject to various terms and conditions and prospectus of the insurance policy.   The opposite party received a claim intimation from the complainant’s banker on 26-08-09 along with FIR, claim form, death certificate, Inquest, PM report.   On verification like documents like FIR, Pm and Inquest it was found that at the time of accident the age of the deceased was about 72 years.   The policy covers only persons of the age group of 5 to 70.   The avoidance of the liability would largely depend upon violation of the contract of insurance.   Under those circumstances, the opposite party has rightly repudiated the claim of the complainant.   The complaint therefore be dismissed.

4.   Exs.A-1 to A-7 on behalf of complainant and Exs.B-1 and                    B-2 on behalf of opposite party were marked.

5.    Now the points that arose for consideration are:

1. Whether the opposite party committed deficiency of service?
2. To what relief?

6.     POINT No.1:-   To prove the age of the deceased the opposite party relied on the age of the insured as mentioned in Ex.A-2 FIR, Ex.A-3 Inquest report.   Age of the insured i.e., the husband of the complainant was mentioned as 72 years as on 04-07-09.   The complainant in para III a) mentioned that the Yadlapalli Pradhamika Vyavasaya Sahakara Parapathi Sangam obtained personal accident insurance policy for its members for the year 2009-10.   The complainant was silent regarding the policy period.  But in its version the opposite party mentioned the policy period was from 24-04-09 to 23-04-10.   It can therefore be said that the policy period was during 2009-10.   Exs.A-1 and A-2 revealed that the complainant’s husband valiveti Narasimha Rao died on 04-07-09 and he was aged more than 70 years while obtaining policy by the banker for its customers.  

7.     The complainant’s husband obtained personal accident policy through the said banker.   The said banker was not made as a party to this complaint.   It can therefore be said that there is no privity of contract between the insured and the opposite party.

8.     The terms and conditions of insurance policy govern the parties.   Ex.B-1 is the terms and conditions of Janatha Personal accident Insurance prospectus which is as follows:     

        Introduction and scope of cover:

The policy provides for payment of compensation, as given below, on disablement due to bodily injury caused solely and directly by accidental, external, violent and visible means or on death or on loss of eye(s) or limb(s) if such bodily injury shall within 12 months of date of the injury be the sole and direct cause thereof:

                Any individual between 5 and 70 years of age can be       insured under this policy.   This policy is issued also to groups of        persons, and may be availed of either by employees for their         employees or by any institution/society/club for their members.           The sum insured ranges from Rs.25,000 to Rs.1,00,000/-“.

9.     In view of the age limit mentioned in the prospectus the policy did not cover the persons age more than 70 and below 5 years.   To rebut the age mentioned in Ex.A-2 and A-3 the complainant did not produce any other document.  The contention of the complainant is that it was the opposite party who has to ascertain the age of the insured.  In the absence of any particulars either from the complainant or its banker (the insured) the said contention is devoid of merit as the deceased did not approach the insurer directly.  The presence of the said banker is essential to decide the case on point in controversy.   In view of the coverage of policy for certain age groups the opposite party has rightly repudiated the claim of the complainant.   Therefore, we find no deficiency of service on the part of the opposite party.  Hence, this point is answered in favour of the opposite party.

10.   POINT No.2:-    In view of the above findings, the complainant is not entitled to any compensation under any account.

11.  POINT No.3:-    In view of the findings in the result, the complaint is dismissed without costs.

        Dictated to Junior Steno, transcribed by her, corrected by us and pronounced in the open Forum dated this the 16th day of              April, 2011.

Sd/-XXX                                           Sd/-XXX                             Sd/-XXX

MEMBER                                                         MEMBER                                 PRESIDENT

APPENDIX OF EVIDENCE

DOCUMENTS MARKED

For Complainant:

For opposite party :

                                                                               PRESIDENT