Orissa

Rayagada

CC/344/2015

Edi Saraswati Naidu - Complainant(s)

Versus

The Branch Manager, Andhra Bank - Opp.Party(s)

Self

07 Feb 2019

ORDER

DISTRICT   CONSUMER  DISPUTES REDRESSAL    FORUM, RAYAGADA,

STATE:  ODISHA.

C.C. Case  No.  344/ 2015.                                Date.      7  .     2  . 2019

P R E S E N T .

Dr. Aswini  Kumar Mohapatra,                          President.

Sri  Gadadhara  Sahu,                                           Member.

Smt. Padmalaya  Mishra,                                     Member.

 

            Edi Saraswati  Naidu, W/O: Late  Edi Harish Chandra Naidu,             Vill:Katupdu,Po:Hatikhamaba, Via: Ramanaguda,  Dist:Rayagada,         (Odisha)                                                                    …. Complainant.

            Versus.

1.The  Branch   Manager, Andhra Bank,  New colony,  At/Po: Rayagada, Dist: Rayagada. 

            2.The Manager,  Andhra Bank, Head office, Saifabad, Hyderabad-       500004.                                                                                ..Opp.Parties

Counsel for the parties:                         

For the complainant: - Sri  L.N.Patnaik, Advocate, Rayagada.

For the O.P No.1:- Sri K. Ravindra Kumar, Advocate, Rayagada.

For the O.P.No.2 :- Set exparte.

JUDGEMENT

The  curx of the case is that  the above named complainant alleging deficiency in service  against  afore mentioned O.Ps    for  non payment of  accidental  insurance  claim of Sri  E. Chelpati Rao (DLA) cover bearing S.B. accountNo. ABG/01/00501205 a sum of Rs.1 (One) lakhs  for which  the complainant  sought for redressal of the grievances raised by the complainant.  The brief facts of the case are  summarized here under.

That the son of the complainant namely Edi Chelapati Rao was the account holder  bearing S.B account No. ABG/01/00501205 and the said account covers accident insurance of Rs.1 Lakhs. The son of the complainant  Edi Chelpati Rao expired on Dt. 4.9.2012  due to vehicle  road accident, for which a case U/S- 279/304(A) IPC  was registered vide Chandili PS case No.  142(3) dtd. 4.9.2014 and the said P.S. case has been  registered as G.R. case No. 390/2012 in the court of the S.D.J.M., Rayagada. Further the complainant is a mother of the D.L.A (Death life assured) and nominee of the above S.B.account and she is entitled the assured amount. The complainant from time to time  had approached the O.P and requested him to pay her the  accident insurance amount of Rs. 1 (One) Lakhs, but the O.P has turned deaf ear to her request and did not care to her approaches. Hence this C.C. case. The complainant prays the forum direct the forum to make payment of the insurance amount of  Rs.1(One) lakhs  and such other relief as the forum deems fit and proper for the best interest of justice.

Upon  Notice, the O.P No.1   put in their appearance and filed written version through their learned counsel  in which  they refuting allegation made against them.  The O.PNo.1  taking one and another pleas in the written version   sought to dismiss the complaint as it is not maintainable  under the C.P. Act, 1986. The facts which are not specifically admitted may be treated  as denial of the O.P. No.1  Hence the O.P No.1  prays the forum to dismiss the case against  them  to meet the ends of justice.

Upon  Notice,the O.P No.2  neither entering in to appear before the forum nor filed their  written version inspite of more than  20 adjournments has been given  to them. Complainant consequently filed his memo and prayer to set exparte of the O.P No.2.  Observing lapses of around 3 years  for which the objectives  of the legislature of the C.P. Act going to be destroyed to the prejudice of the interest of the complainant.  Hence after hearing  the  counsel for the complainant set the case  exparte against the O.P No.2. The action of the O.P No. 2  is against the principles of  natural justice as envisaged  under section  13(2) (b)(ii) of the Act. Hence the O.P  No. 2  was set exparte  as the statutory period  for filing of  written version was over to close the case with in the time frame permitted by the C.P. Act.

Heard arguments from the O.Ps  inter alia from the complainant.    Perused the record, documents, written version  filed by the parties. 

This forum  examined the entire material on record  and given  a thoughtful consideration  to the  arguments  advanced  before us by  the  parties touching the points both on the facts  as well as on  law.

                                                                        FINDINGS.

On the basis of the pleadings of the parties, the sole question of determination is  Whether  the complainant is entitled  to insurance claim made by him ?

Undisputedly  Edi Chelapati Rao (Death life assured) had opened ABG account with  the O.P  No.1 vide account No. ABG/01/00501205 and covers Rs.1 (One) Lakhs accident insurance (copies of the  pass book issued by the O.P. in favour of D.L.A is in the file which is marked as Annexure-I) .  Sri Rao had expired on Dt. 4.9.2012   by  vehicle  road accident( copies of the  Death certificate, F.I.R,  Postmortem  report, Accident report of vehicle  are in the file which are marked as Annexure-2 to  Annexure- 5).

                On  perusal of the written version  filed  by the  O.P. No.1  it is revealed that  the  O.P. No.1  contended that  due to  non submission of the following  documents  within 90 days the  claim  of the complainant is not yet settled  i.e.  (1) Death certificate  (2)  Legal heir certificate  (3) Claim forms.

                The  O.P. No.1  in their written version further  contended that as per the terms and conditions of the payment of insurance claim  of ABG account, the nominee/legal heir of the deceased  person  should submit the Death certificate of account holder  along with all relevant papers   within 90 days  of the death of account holder. The complainant  in the complaint petition does not added the insurance company as necessary party as such the complaint petition is not maintainable as per law. The insurance claim of deceased person, the Nominee/Legal heir of the account holder should submit the death certificate along with all relevent papers  along  with claim form  to the O.P. No.1 within  90 days  of date of death of the account holder, the bank after receipt of the claim form should forward to the insurance company within 90 days of the date of death of the account holder.  The O.Ps ( bank)  is the facilitator /Agent  but not the authority to settle the insurance claim.

This forum  for better appreciation  relied citations  in the above case which are mentioned here.

It is  held and reported in  CPR- 2008(4)  page No. 370   the Hon’ble National Commission where in observed  “Just claim under  a policy of  insurance could not  be permitted  to be  defeated  on hyper  technical grounds.”

                This forum observed the complainant was a  widow,   illiterate and does not  know the rules  and regulations of the  Insurance company, the  O.P. No.1   was harash in denying   the assured amount Rs.1 lakhs after depositing the  premium amount.

It is not disputed  by the  O.P. No.1  that the  ABHAYA  GOLD  personal Accident  insurance cover  bearing  account  No. ABG/01/00501205 issued   in favour of the  (D.L.A) Death  life assured  Sri  Chelapati  Rao.  It is also not disputed that the complainant’s  son Sri  Chelapati  Rao  was given  ABHAYA  GOLD  personal Accident  insurance cover and it was mentioned  in the pass book  first page  which was issued  by  the O.P. No.1  in favour of  Sri  Chelapati  Rao  indicating  the sum assured  as Rs.1 lakhs.  It is not disputed  that Sri  Chelapati  Rao was met vehicle road  accident  on DT.04.09.2012  and intimation of the same  was given to the  O.P. No.1 belatedly. There was a minor  technical error in this policy.  This forum also convinced  that  the complainant being  not an educated person had no knowledge of  the rules and regulations of the  insurance company  that the factum  of the death  has to be intimated  within 90 days  of the unfortunate incident.

                By going  through the   case records, it is clear that the  Insurance company has given an  ABHAYA  GOLD  personal Accident  insurance cover   sum assured  as Rs.1 lakhs to the  insured  through the bank i.e. O.P. No. 1  in their  anxiety  to get  substantial  business through  the  policy  which will permit  them to collect  premium  from all over  India  and  therefore  it does not  lie in their mouth   to deny  the just  claim  arising out of  the said policy on hyper  technical  grounds.

                Further in the present case in hand the O.P. No.1 has not submitted the claim  forms to the insurance company  to settle accident   claim of the complainant which was   found  deficiency  in service on the part of the O.P. No.1.

Again it is held and reported in CPR -  2012(1)  page No. 303  the Hon’ble  National Commission where in observed  “Death claim can not be repudiated  where  complainant has already  submitted  required documents  i.e. death certificate  with claim form to  insurance company”.

Further it is held and reported  in CPR- 2007(2)  page No.200   the hon’ble  Chhatisgarh  State  Commission, Raipur  where in  observed “ Repudiation of claim  under policy  on ground of  delay in filing  complaint petition   was held  unsustainable   where complainant  an illeterate    widow was unaware of existence  of policy  and she made no delay  in preferring  claim as soon as  she came to  know about  existence of policy”.

Further in the afore said  judgement  the   hon’ble  State Commission observed  Group Janata Personal Accidential policy- Complainant’s husband an employee of  SECL- Insurer had covered  risk of employees of SECL  in event of accidental  death under Janata policy and complainant’s husband was also one of them – Death of complainant’s  husband in a road accident-   Complainant on coming  to know about policy preferred a claim -  Repudiation of claim by insurance company on ground that claim was filed after  3(three) years of her  husband’s death while  as per terms of the policy claim ought to have  been filed  within 15 days  after  occurance-  Specific averment of complainant  that she was an illiterate tribal women and never know about existence of policy and had not received any information about it and that she  preferred claim  with SECL -  No reason  to disbelieve  averments of complainant-  Complainant was unaware of existence of policy and  she made no delay in preferring claim as soon as she  came to  know about existence of policy- Again,  no reason  as to why  complainant would not have preferred claim  earlier, had she known  about existence of policy – Since complainant preferred  complaint without under undue delay- Hence  repudiation of claim solely based on  ground of delay in intimation by complainant held not proper.

In the present case in hand the complainant is a mother and  nominee  of the D.L.A. Hence the complainant is entitled to receive the  assured amount.

In view of the above discussion relating to the above case and  In Res-IPSA-Loquiture  as well as  in the light of the settled legal position  discussed  as above referring citations the plea of the  O.Ps to avoid the claim  which is Aliane Juris. Hence  we allow the above complaint petition  in part.

Hence  to  meet the  ends of justice, the following order is passed.                                                                        ORDER.

            In  resultant   the complaint petition stands allowed  in  part  on  contest against  the O.Ps. 

The O.P No.1  is   ordered  to  issue claim form  in favour of the complainant  within 7 days. 

The complainant is directed duly  filled in  the prescribed  claim form and submit the same to the  O.P. No. 1 with  other relevant  documents  with  in  7 days.

The O.P. No.1  is ordered to receive  the claim form inter alia   all the documents pertaining to this case  from the complainant and  the same be   forwarded to the  Insurance company along with this  C.C. order  within  7 days  for settlement  of the claim   at their level .

Though the Insurance Company is not necessary party  in this case however  directed the Insurance company  to settle the  insurance claim of the complainant inter alia  to pay the assured accidental  death claim  amount  a sum of Rs.1,00,000/- to the complainant  within 60 days after receipt of the  necessary documents from the O.P. No.1.  Parties are left to bear their own cost.

The OPs  are    ordered to make compliance the aforesaid Order within  60 days from the  date of  receipt  of this order      failing which  an interest  @ Rs.9%  per annum  would  accrue on the above  amount  from  the date of  default   till  realization.  

Serve the copies of above order to the parties free of cost.

Dictated and corrected by me. 

Pronounced on this        7 ^th.   Day of   February,     2019.

 Member.                                                            Member.                                                             President