Karnataka

Chitradurga

CC/124/2019

Smt Manjula ,Nalina, W/o Late B.Thirumalesha - Complainant(s)

Versus

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

A.C.Raghu

01 Feb 2020

ORDER

COMPLAINT FILED ON:04/02/2019

DISPOSED      ON:01/02/2020

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, CHITRADURGA.

CC.NO:124/2019

DATED: 01^st  February 2020

PRESENT :-     Smt. C.M.Chanchala.                     …. President

                                B.A.L.,,LL.B.,            

                            

                        SRI. SHIVAKUMAR.K.N    :              MEMBER

                     M.Com., LL.B.,

 

……COMPLAINANT/S	Smt. Manjula @ Nalina w/o Late B. Thirumalesha, Aged about 48 years, T Sachin, S/o Late B. Thirumalesha, Aged about 19 years, T Sudarshan, S/o Late Thirumalesha, Aged about 15 Years, Minor Represented by her mother Smt. Manjula @ Nalina W/o Late B. thirumalesha, Aged about 48 Years, All are residents of R/o Shiva Nilaya, Hospete Road, 2nd Cross, 13th Ward, Hiriyur. (Rep by Sri.A.C. Raghu,   Advocate)
V/S
…..OPPOSITE PARTY	1. The Branch Manager, Corporation Bank, Hiriyur Branch, Church Road, Hiriyur. (Rep by C.J. Lakshminarasimha,   Advocate for OP.1) 2. The Divisional Manager, M/s Universal Sompo General Insurance Company Limited, Personal Accident Claims Departments, KLS Tower, Plot No. EL 94, MIDC Mahape, Navi Mumbai-400 710. (Rep by K. Mohan Bhat,   Advocate for OP.2)

 

Pronounced 1^st February 2020 .

Written by C.M.Chanchala, President.

ORDERS

1.   This is a complaint of alleged deficiency of service filed under section 12 of the Consumer Protection Act,1986 by Smt.Manjula the Complainant against the Opposite party (for short ‘OP’ ) praying to direct the OP to pay assured amount out of the policy and Rs. 50,000/ for compensation and cost of the proceeding - etc.

The complaint:-

2.   The complainant is the wife of Late Thirumalesha. B who died in the road accident on 28-03-2017 and during his life time Late Thirumalesha. B was opened a saving account in the 1^st OP Bank and as per the advise of OP-1 he has obtained a SB Saral Plus Health Insurance policy in Universal sompo General Insurance Co.Ltd., by paying monthly premium of Rs.100/-and the said premium amount was deducted regularly from the account of Late Thirumalesha. B and he made the complainant as a nominee to the said policy. The complainant further stated that her husband died in the road accident on 28-03-2017 and after his death when she went to the Bank to close his account, it  came to her knowledge regarding policy obtained by her husband during his life time. Immediately she submitted the claim form along with the required documents before the OPs and requested to settled the claim, but the OPs have refused to settled the claim on the baseless grounds. Hence she alleged deficiency of service on the part of OPs.

 3.   After hearing on admission the complaint was admitted and  notice was ordered to be issued to the OPs  to file their written versions under section 13(2) of the Consumer Protection Act,1986 (  in short “the Act) . The OPs have appeared through their counsel and filed written version.

Defense:

4.      The OPs contended in their written version that  the complainant has not intimated the death of Late Thirumalesha. B  within time prescribed in the policy which violated the terms and conditions of the policy and hence they have justified the repudiation of claim made by the complainant. 

Evidence :

5.      The complainant got herself examined as AW-1 by filing her affidavit as a part of examination in chief and also got Ex.A-1 to A-12 marked and closed the evidence.

6.    On behalf of OP 1, Sri.G.Vinayakalu, Branch manager got himself examined as RW-1 by filing his  affidavit as a part of examination in chief and On behalf of OP-2 one Ramesh P. Senior executive in OP-2 company got himself examined as RW-2 by filing his  affidavit as a part of examination in chief and no documents have been marked and closed the evidence.

Arguments:

7.      We have heard the complainant as well as counsel of OPs and perused the written arguments filed by both side advocates.  

8.      The points that arise for our determination are ;

1. Whether the complainant proves that deficiency of service on the part of opponents?

2. Whether the complainant proves that he is entitled for the relief sought?

3. What order?

9.      Our finding on the above points are as under;

          Point No.1: In the Affirmative

          Point No2: In the Affirmative

          Point No3: As per final order,

Discussion and Reasoning:

Point No.1 to 3:

 

 10.  There is no dispute between the parties regarding, validity of policy, payment of premium, death of Late Thirumalesha. B  in the accident Dtd: 28-03-2017.

11.    The OPs repudiated the claim of the complainant on the  ground that, the complainant has not intimated the accident and death of Late Thirumalesha. B  immediately as per the terms and condition of the policy.

12.  It is not in dispute that Thirumalesha. B, during his lifetime obtained the policy from the OP 2vide No. 3333.56608474/00/000  through 1^st OP and made premium amount till his death. It is also not in dispute that Thirumalesha.B   died in a road accident.

13.   Admittedly Thirumalesha.B   died in the road accident on 28-03-2017. As per EX- A 12 the claim of the complainant repudiated on the ground of delay in intimating the death of life assured and failure to submit required documents within 60 days from the date of intimation. According to OPs claim has been intimated to them on 11-07-2018 that too after 1 year 105 days. In this circumstance it is just and necessary to mention the CIRCULAR OF IRDA Dtd: 20-09-2011.

14.   Insurance Regulatory and Development Authority issued a circular to all life insurers and non-life insurers Dtd: 20-09-2011 regarding delay in claim intimation/submitting required documents with respect to all insurance contracts. The same is re-produced hereunder:-

First Appeal No. 479/2016, IRDA.Re: IRDA/HLTH/CIR/216/09/2011 Dtd: 20-09-2011 circular to all life insurers and non-life insurers.

Reg: Delay in claim intimation/documents submission on with respect to,

1. All life insurance contracts and
2. All non-life insurance contracts.

The authority has been received several complaints that claim are being rejected on the ground of delayed submission of intimation and documents. The current contractual imposing the condition that the claim shall be intimated to insurer with prescribed documents within a specified number of days is necessary for insurer for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However this condition should not prevent settlement of genuine claims, particularly when there is delay in intimating or submission of documents due to unavoidable circumstances. The insurer decision to reject the claim shall be based on sound logic and valid ground.

15.   The delay in the present case appears to be due to the shock and sorrow, which the complainant was suffering on account of early death of her husband and her children being minor were not in a position to intimate or lodge the claim. Ordinarily a prudent man can imagine the state of affairs that how a young widow specifically when she is having small children will be thinking. It is difficult to come out this shock and trauma within a period specified in the policy or OP insurance company. She remains under devastating grief, may be feeling that she has been robbed of the rest of life.

16.   Under the above circumstances, the repudiation made by the OP-2 is not just and proper reason and it amounts to deficiency of service. As the OP-1 is a bank who collected premium and remitted the same to OP-2, we cannot attributed any deficiency of service on its part. Accordingly, we pass the following order. 

       // ORDER //

                  The complaint is partly allowed.

The opposite Party No.2 is directed to pay assured amount under the policy along with interest @ 10 % per annum from the date of death of Thirumalesha.B  ; within six weeks from the receipt of the copy of this order. OP No.2 also shall pay Rs.20,000/- to the complainant as compensation for deficiency of service, mental agony and also cost of the proceeding within six weeks from the receipt of the copy of this order.  In case of non-compliance of the order the entire amount shall carry interest @ 10% per annum till its realization.

The complaint against OP-1 is hereby dismissed.

The assistant registrar is directed to send free copies of this order to the all the parties free of cost within a week from today.

(Dictated to the Stenographer, typescript edited, corrected and then pronounced in the open court this  1st day of February 2020)

MEMBER

PRESIDENT.

-:ANNEXURES:-

Witnesses examined on behalf of Complainant:

PW-1:-Complainant by filing affidavit evidence.

Documents marked on behalf of Complainant:

01	Ex-A-1:-	Account statement
02	Ex-A-2:-	Policy letter issued by Corporation Bank.
03	Ex-A-3:-	Accident claims Forms.
04	Ex.A-4:-	Application form.
05	Ex.A-5:-	Status of Personal Accident Death Claim
06	Ex.A-6:-	Covering letter issued by Corporation bank
07	Ex.A-7:-	Requesting  appliation
08	Ex.A-8:-	Postal Receipt/ Acknowledgement
09	Ex.A-9:-	Legal Notice
10	Ex.A-10:-	AAdhara Card
11	Ex.A-11:-	Account Opening Form.
12	Ex.A-12:-	Rejection Letter.

 

DW-1: Sri. G. Vinayakalu S/o Hanumanthappa, Branch Manager, by way of affidavit evidence.

DW-2:- Sri. Ramesh P. S/o K. Puttaramu Senior Executive.

 

Documents marked on behalf of OP No.1 and 2

 

                                        NIL

 

 

MEMBER                                                      PRESIDENT