BEFORE THE DISTRICT FORUM:KURNOOL

Present: Sri.P.V.Nageswara Rao,M.A.,LL.M., President(FAC)

And

Smt. C.Preethi,  M.A.LL.B., Lady Member

And

Sri. M.Krishna Reddy, M.Sc.,M.Phil., Male Member

Thursday  the 03^rd day of September, 2009

C.C. 19/09

Anthi Moolam, S/o. Kilavatara, F/o. Lt.Senthil Kumar,

H.No.64-128, Fort, S.Nagappa Street, Kurnool ,                             

                        …Complainant

-Vs-

1.   The Branch Manager, National Insurance Company Limited,

Post Box. No. 42, Gandhi Nagar, Kurnool.

1. Senior Divisional Manager,National Insurance Company Limited ,

Division III 8,Indian Exchange Place (Gr.Floor) Kolkata - 700001.   

                …Opposite Parties

                        This complaint is coming on this day for orders in the presence of Sri. A. Prabhakar Reddy, Advocate, for the complainant , and Sri. P.Sunkanna , Advocate for opposite party No.1 and called absent set exparte and upon perusing the material papers on record, the Forum made the following.

ORDER

(As per Smt. C.Preethi , Lady Member)

C.C.No.19/09

1.     This consumer complaint  of the complainant is filed U/S 11 and  12 of C.P.Act, 1986, seeking a direction on opposite parties to pay the  sum assured amount  Rs.1 lakh  with 24% interest p.a , Rs.15,000/- as compensation for mental agony  , cost of the compliant and any other relief or reliefs which the complainant is entitled in the circumstances of the case.

2.     The brief facts of the complainants case is that the complainant’s son Senthil Kumar  joined  a Group Janatha Personal Accident Insurance Policy on 08-01-2004 floated by opposite party No.1  and obtained  a policy bearing No. 100300/47/01/9600022/03/96/30350 , from the  authorized  agent “ Golden Multi Service Club” the deceased Senthil Kumar  while returning  from Kadapa to Hyderabad  in auto trailer  met with an accident  near Gadivemula  cross road on 10-04-2007 . The auto  was hit by an APSRTC  Bus bearing No. AP 11 Z 5468 coming from opposite party direction and the deceased  received severe  injuries  and died on 11-04-2007  in Government General Hospital , Kurnool . The death  intimation was  informed to opposite party No. 2 and the claim with relevant documents who also made with a request to settle the claim  and opposite party No. 1 did not settle the claim and postponed to pay claimed amount. Thereafter, the opposite party No. 2 requested the  complainant  to produce  some other documents  and on 18-07-2008,  the complainant submitted  the said documents  to opposite party No. 2  and inspite of submitting the documents , the opposite parties did not settle the claim as there is deficiency of service on part of opposite parties  1 and 2 . Hence the complainant resorted to the forum for reliefs.

3.     In support of his case the complainant relied on the following documents viz., (1) family member certificate, (2) office copy of letter dated 11-12-2008 of complainant to OP.No.1 along with postal receipt No.4575 and acknowledgement (3) office copy of letter dated 18-07-2008 of complainant to Golden Trust Financial Service along with postal receipt and acknowledgement of OP No.2 (4) letter dated 23-05-2008 of Golden Trust Financial Service to OP.No.2, (5) death certificate, (6) certified copy of FIR in Cr.No.63/2007 dated 11-04-2007 orvakal P.S., (7) certified copy of inquest report, (8) attested Xerox copy of post mortem report, (9) letter dated 01-10-2008 of OP.No.2 delivered to the complainant, (10) Xerox copy of policy No.100300/47/01/9600022/03/96/30350, (11) Xerox copy of driving license, besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above documents are marked as Ex.A1 to A11 for its appreciation in this case and  replies to the interrogatories exchanged.

4.     In pursuance to the notice of this forum as to this case of the complainant, the opposite party No.1  appeared through their standing counsel and contested the case and opposite party No.2 remained absent throughout the case proceedings and were made exparte.

5.     The written version of opposite party No. 1 denies  the complaint  as not maintainable either in law or on facts  and submits that  the head on collusion between the auto and APSRTC bus goes to show that the complainants son died to due to negligence of drivers of both the vehicles and the complainant ought to have approached Motor Accidents Claims Tribunal, Kurnool to have necessary compensation.  The complainant never approached opposite party No.1 for settlement of his claim and the deficiency of service on part of opposite party No.1 is an invented one and also submits that opposite party NO.2 would have easily settled the claim if the complainant if the complainant  had submitted all necessary documents within stipulated time.  As such there is no deficiency of service  on part of opposite party No.1 and 2 as complainant did not submit necessary documents within time and there is no proof that the complainant submitted required documents to opposite party No.2 for settlement of claim and seeks for the dismissal of complainant with  exemplary costs.

6.     In support of their case the opposite parties did not file any documents and relied on the sworn affidavit of the opposite party No.1 and replies to the interrogatories exchanged.

7.     Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service?

8.     There is no dispute  as to the deceased Senthil Kumar covered under the Group Personal Accident Policy issued by opposite party No.2 vide Ex. A10 and nominated the complainant as his nominee.  There is no dispute as to the death of Senthil Kumar on 11-04-2007 in a road accident.  The only dispute is regarding the delay intimating the death of the deceased Senthil Kumar to opposite parties 1 and 2.  The counsel for complainant submitted that all relevant documents along with claim form are submitted to opposite parties, but on the other hand the counsel for opposite parties submitted that the complainant intimated the death of the deceased belatedly, which is clear violation of terms and conditions of the policy.

10.    The complainant in support of his case relied on the following documents to prove that the deceased died in an accident,. Ex.A6 is the certified copy of FIR in Cr.63/2007 dated 11-04-2007 of Orvakal (P.S), the Ex.A7 is the certified copy of inquest report held over body of the deceased, the Ex.A8 is the attested Xerox of post mortem report, all the above three documents in uni-tone says that the deceased Senthil Kumar died in a accident only.  The only attack of opposite parties is that the complainant intimated the death of deceased belatedly ie., after stipulated time and that his claim is no0t entertainable.  The Ex.A9 is the letter dated 01-10-2008 of opposite party No.2 to the complainant where in the opposite party No.2 requested the complainant to submit certain documents and to give reasons for giving intimation of death after stipulated time, the said letter no where envisaged, forfeiture of insured amount of the deceased on the failure of the nominee not informing the death of deceased to the insurance company within stipulated time and the complainant relied on the following decision of Uttar Pradesh State Commission between LIC of India Vs Rajendra Singh Gaur reported in IV 25004 CPJ pg.531, where in it was held that  repudiation of claim on the ground that intimation of death was delayed, the complainant contended that he was 80 years and not able to intimate earlier and he completed all formalities, hence held repudiation of claim unjustified and illegal.  On the ground that the policy stood in tact for 10 years and the complainant was nominee under the policy and the complainant alone is entitled to the policy amount.

11.    In the present case the death of deceased occurred on 11-04-2007, the complainant submitted that the death intimation was given to opposite parties but no specific date is mentioned in the complaint.  On the other side the opposite parties allege that death intimation was given after the stipulated period, and no particular date is mentioned on which date intimation was given and hence both are at fault.  From the above what appears is that, the delay in intimating the death of Senthil Kumar beyond stipulated time does not appears to be a fraudulent or suspicious one on the face of it, in violation of policy conditions.  Hence, the approach of complainant to this forum seeking redressal is justified and the opposite parties could have condoned the delay after the stipulated time limit and entertained the claim.

12.    To conclude from the above discussion and relying on the above decision the complaint except in delay in intimating the opposite parties and in all other aspects certainly remaining entitled to the assured amount under the Group Personal Accident Insurance Policy issued by opposite party No.2 covering the risk of Senthil Kumar and opposite parties 1f and 2 are liable jointly and severally to pay to the same as there is deficiency of service on part of opposite parties in not paying the said amount.

13.    In the result , the complaint is allowed directing the opposite parties 1 and 2 jointly and severally to pay to the complainant  the insured amount of Rs.1,00,000/- without interest  and also to pay Rs.5,000/- as compensation for mental agony and Rs.2,000/- as costs within one month from the date of receipt of this order.

Dictated to the stenographer, transcribed by her ,corrected and pronounced by us in the open bench on this the 03^rd  day of September ,  2009.

        Sd/-                                  Sd/-                          Sd/-

LADY MEMBER                   PRESIDENT(FAC)         MALE MEMBER

APPENDIX OF EVIDENCE

Witnesses Examined

For the complainant :  Nil           For the opposite parties :Nil

List of exhibits marked for the complainant:-

List  of exhibits marked for the opposite parties:   Nil

     Sd/-                             Sd/-                                  Sd/-

LADY MEMBER               PRESIDENT (FAC)               MALE MEMBER           

// Certified free copy communicated under Rule 4 (10) of the

A.P.S.C.D.R.C. Rules, 1987//

Copy to:-

Complainant and Opposite parties      

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