BETWEEN:

1. Koppula Tulasamma, W/o. late K.Venkateswara Reddy,

2. Koppula Venkata Ramana, D/o. late K.Venkateswara Reddy,

3. Koppula Padmavalli, D/o. late K.Venkateswara Reddy,

Complainants 2 & 3 being minors rep. by their

mother and natural guardian i.e., 1^st complainant

All are residents of Pillutla Village,

Machavaram Mandal,

Guntur District.                                                    … Complainants

AND

1. The Branch Manager,

    Chaitanya Godavari Grameena Bank,

    Morjampadu Branch and Mandal,

    Guntur District.

2. ICICI Lombard General Insurance Company Ltd.,

    Rep. by its Branch Manager,

    4^th floor, Anjaneya Towers,

    M.G.Road, Venkateswarapuram, Labbipet,

    Vijayawada, Krishna District.                         … Opposite parties

              This complaint coming up before us for final hearing on                      06-05-11 in the presence of Sri P.V.Ramana, advocate for complainants and of Sri P.Siva Rama Prasad, advocate for OP1, Sri S.A.Khadar, advocate for OP2, upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following: 

O R D E R

Per Sri M.V.L.Radha Krishna Murthy, Member:

                This complaint is filed under section 12 of the Consumer Protection Act, 1986 praying to pass an award for Rs.1,26,000/- (comprising of policy amount Rs.1,00,000/-, interest thereon from 13-11-08 to 13-02-10 at 12% p.a. i.e., Rs.14,000/-, Rs.5000/- towards compensation, Rs.5000/- towards mental agony and Rs.2000/- towards expenses) against the opposite parties and in favour of complainant.

The averments of complaint in brief are as follows:

                One Koppula Venkateswara Reddy is the husband of 1^st complainant and father of complainants 2 and 3.  The said Venkateswara Reddy is an agricultural cooli.  The said Venkateswara Reedy is the customer of 1^st opposite party and having NGSB Account bearing No.50474.  The 1^st opposite party insured the personal accident policy with the 2^nd opposite party on behalf of deceased customer.  The 2^nd opposite party received the premium from 1^st opposite party.  On 13-08-08 while the husband of complainant was doing agricultural work he died due to snake bite.  The Village Revenue Officer gave report to the Machavaram Police Station about the death of husband of 1^st complainant and it was registered as crime No.57/08 under section 174 Cr.P.C. on 14-08-08. The police conducted inquest and the concerned medical officer conducted postmortem and opined that the deceased died due to toxic substances produced and shock due to snake bite.  The Mandal Tahsildar of Machavaram recommended the claim under Apathbandhu Scheme.  The 1^st complainant obtained income certificate, legal heir certificate, residence certificate, death certificate and family member certificate and approached the 1^st opposite party to process the claim about her husband’s death due to snake bite.  The policy is in force by the date of death of husband of complainant.  As per the advice of 1^st opposite party, the complainant submitted claim form on 17-09-08 with all relevant documents to 1^st opposite party and the 1^st opposite party in turn has forwarded the same to the 2^nd opposite party. The 2^nd opposite party received the claim of complainant along with relevant documents and kept quite without settling the claim.   The 2^nd opposite party neither settled the claim nor rejected the same with proper endorsement. The contractual obligation is on the part of 2^nd opposite party.  The 2^nd opposite party duly received the premium and issued policy bearing No.0015/04/CLAIM/34 in the name of deceased Koppula Venkateswara Reddy. The complainants are sole surviving representatives of deceased Venkateswara Reddy.  Both the opposite parties are jointly and severally liable to pay the claim amount to the complainants.  Thus there is deficiency of service on the part of opposite parties.  Hence, the complaint.

The 1^st opposite party (Chaitanya Godavari Grammena Bank) filed its version, which is in brief as follows:

                 A savings bank account bearing No.50474 under Nirbhaya Gold was opened by the deceased on 21-09-01.  Later it was informed that the account holder met with an accident on 13-08-08 and died on the same day due to snake bite and the same was informed to the 2^nd opposite party on 16-08-08 by 1^st opposite party through its letter dt.16-08-08 and requested the 2^nd opposite party to send claim forms.  On receipt of claim forms from 2^nd opposite party, the claim forms of complainant are submitted to 2^nd opposite party on 17-09-08 along with supporting documents for settling the claim of complainants.  The 2^nd opposite party acknowledged the receipt of claim forms and documents on 18-09-08.  Subsequently on several occasions the 1^st opposite party telephonically reminded the 2^nd opposite party to settle the claim of complainant but for the reasons best known to 2^nd opposite party, the claim of complainants was not settled.   Thus there is no deficiency of service on the part of 1^st opposite party.  There is contractual obligation on the part of 2^nd opposite party to consider the claim of complainant.  Hence, the complaint may be dismissed with costs against 1^st opposite party.

The 2^nd opposite party filed its version, which in brief as follows:

                The complaint is not maintainable at law and on facts of the case. The complainant has not given any information under which policy, the complainant was covered.  Without the policy number and policy copy it is not possible to search policy and it is not known to 2^nd opposite party under which policy, the complainant was covered.  In this type of JPA/GPA policies, 2^nd opposite party will give open policy to the institution with unnamed persons basis and 1^st opposite party shall submit under which policy the account holder will cover.  If the policy number was submitted to this opposite party even at this stage, we are ready to process the claim as per terms and conditions of policy.  Either the complainant or 1^st opposite party never mentioned in the complaint and even in the version of 1^st opposite party the policy number.  Unless either of the parties submit policy copy, this opposite party denies the issuance of policy and insurance coverage to deceased and on this ground the complaint against 2^nd opposite party is liable to be dismissed.   It was simply stated that the complainant is running savings account under Nirbhaya Gold Scheme, which is an accidental death coverage Rs.1,00,000/- to the account holder.  The complainant never intimated to this opposite party regarding death of deceased due to snake bite and this opposite party has lost the opportunity to investigate the matter regarding genuinity of his death.  Thus there is no deficiency of service on the part of 2^nd opposite party.  Hence, the complaint may be dismissed without costs.

                The complainants and opposite parties have filed their respective affidavits in support of their contentions reiterating the same.         

                On behalf of complainant Ex.A1 to A13 are marked. On behalf of 1^st opposite party Ex.B1 to B7 are marked.  No documents are marked on behalf of 2^nd opposite party.

Now the points for consideration are

1. Whether there is any deficiency of service on the part of opposite parties in settling the claim of complainants?

1. To what relief the complainants are entitled to?

POINT No.1

                The sum and substance of the case is that one Koppula Venkateswara Reddy opened NGSB Account with 1^st opposite party and said account is covered with personal accident policy of 2^nd opposite party, assured amount being one lakh, the said Venkateswara Reddy died on 13-08-08 due to snake bite and that the 1^st complainant submitted claim form along with necessary documents to 1^st opposite party and 1^st opposite party in turn submitted the same to 2^nd opposite party on 18-09-08 under Ex.B6 and the same was received by the opposite party but the claim was not settled inspite of the telephonic reminders of 1^st opposite party.  It is not in dispute that 1^st complainant made claim and the same was forwarded by 2^nd opposite party to 1^st opposite party.   

                A perusal of Ex.A1 FIR shows that the deceased Venkateswara Reddy died due to snake bite on 13-08-08. The doctor who conducted postmortem opined in the postmortem certificate Ex.A3 that the deceased Venkateswara Reddy died due to toxic substances produced and shock due to snake bite.  Ex.A4 is the relevant publication in the news paper.  Ex.A6 is the proforma document for claims settlement under Apathbandhu Insurance.  Ex.A7 is the letter addressed by the Tahsildar, Machavaram to the Collector and District Magistrate under Apathbandhu scheme regarding the deceased Koppula Venkateswara Reddy, wherein Tahsildar recommended for sanction of Rs.50,000/- under Apathbandhu scheme considering the death of the deceased as snake bite.  Ex.A12 is the copy of claim form for personal accident insurance made by 1^st complainant to 2^nd opposite party.  Ex.A13 is the letter addressed by 1^st opposite party submitting the claim papers and required papers relating to the NGSB account holder Koppula Venkateswara Reddy requesting to settle the claim of the complainant being nominee of the deceased and the same was acknowledged on 18-09-08 by one Malleswari.  The claim made by the complainant was not disputed by the 2^nd opposite party.  The contention of 2^nd opposite party is that either the complainant or 1^st opposite party have not furnished the policy number or copy of policy under which the account of deceased Venkateswara Reddy was covered.  As they have not furnished the policy number or the copy of policy, they could not settle the same.  The 2^nd opposite party in its version stated that “if the policy number was submitted to this opposite party even at this stage we are ready to process the claim as per terms and conditions of policy”.  The complainant has furnished the policy number in her complaint as No.0015/04/CLAIM/34.  Even though the complainant has furnished the policy number in her complaint, the 2^nd opposite party in its version stated that if the policy number was submitted to this opposite party even at this stage they are ready to process the claim as per the terms of policy.  Further the 2^nd opposite party has not made any attempt to ascertain the policy number from 1^st opposite party.  Without making any effort to ascertain the policy number from 1^st opposite party, the 2^nd opposite party simply says that they could not settle the claim of complainant as policy number was not furnished to them either by 1^st opposite party or by complainant.  It is also not the case of 1^st opposite party that they have furnished the policy number while forwarding the claim of complainant to 2^nd opposite party.  There is no explanation from 1^st opposite party as to why they have not furnished the policy number to 2^nd opposite party.  The 1^st opposite party in its version stated that “in this case, the payable premium was sent to 2^nd opposite party by 1^st opposite party on 08-10-07 through its head office and the same was received by 2^nd opposite party which covers the risk of account holder of 1^st opposite party upto 30-09-08 and the policy is in force as on the date of alleged accidental death of the deceased account holder Koppula Venkateswara Reddy and the legal heirs are entitled for the claim amount as per the contract between this opposite party and 2^nd opposite party”.   Thus it shows that there is a policy and during the subsistence of policy, the deceased Venkateswara Reddy died in an accidental death and the complainants are entitled for the claim amount.  As already stated above, the 1^st opposite party has not furnished the number of policy and 2^nd opposite party has not made any effort to ascertain the number of policy even though the claim that was made by the complainant was received on 18-09-08 by the 2^nd opposite party since it is not disputed.  The claim was made on         18-09-08 and the complaint was filed before this Forum on 06-02-10. Thus the claim of complainant is pending with the 2^nd opposite party nearly for a period of 1½ years.  Even though the claim is pending with 2^nd opposite party for such a long period, the 2^nd opposite party has not made any effort to ascertain the policy number from 1^st opposite party or the complainant, which shows the attitude of 2^nd opposite party.  The 2^nd opposite party has not evinced any interest in settling the claim of complainant even though it was pending for more than 1½ year with them.  After filing complaint, the 2^nd opposite party has simply come forward with the version that they could not settle the claim since the policy number was furnished. Thus in view of the facts and circumstances of case, we find deficiency of service on both opposite parties, as 1^st opposite party failed to furnished the policy number and 2^nd opposite party failed to ascertain the policy number from 1^st opposite party or the complainant.  Accordingly this issue is answered against the opposite parties.

POINT No.2

                In view of the facts and circumstances of case we feel it just and necessary to direct the 1^st opposite party to furnish policy number to 2^nd opposite party and on furnishing the same by 1^st opposite party, the 2^nd opposite party shall settle the claim of the complainants in terms of policy and also to direct 1^st opposite party to pay an amount of Rs.1000/- towards compensation and Rs.500/- towards legal expenses to the complainants  and also to direct the 2^nd opposite party to pay Rs.1000/- towards compensation and Rs.500/- towards legal expenses to the complainants would meet the ends of justice.  Accordingly this issue is answered in favour of the complainants. 

                In the result, the complaint is allowed in part in terms as indicated below:

1. The 1^st opposite party is hereby directed to furnish the relevant policy number to 2^nd opposite party within two weeks from the date of receipt of copy of this order and to pay Rs.1000/- to the complainants towards compensation for the mental agony suffered and to pay Rs.500/- towards legal expenses.
2. On furnishing policy number by 1^st opposite party, the 2^nd opposite party shall settle the claim of complainants in terms of policy within a period of four weeks and to pay Rs.1000/- to the complainants towards compensation for the mental agony suffered and also to pay Rs.500/- towards legal expenses.
3. The above orders shall be complied within a period of six weeks from the date of receipt of copy of this order, failing which the amounts awarded above shall carry interest at 9% p.a. till the date of realization.   

Typed to my dictation by the Junior Steno, corrected by us and pronounced in the open Forum, this the 12^th day of May, 2011.

          MEMBER                                                                PRESIDENT

APPENDIX OF EVIDENCE

                                        DOCUMENTS MARKED

For Complainant:

For 1^st opposite party:                                                                       

                                                                                               Sd/-XXXX

                                                                                                PRESIDENT