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 27^th day of August,  2009

C.C. 09/09

Smt.C.Rukmini Devi, W/o.late.C.Venkateswara Reddy,

R/o/H.No.80/11/131/68,Housing Board Colony, Abbas Nagar,

Kurnool .

                                                …Complainant

-Vs-

1.   The Branch Manager,Golden Trust Financial Services,

      D. No.40/384, 3rd floor, shop Nos.16 to 18,Ucon Plaza, Park Road, Kurnool-518001.

2.   Senior Divisional Manager, Division III,National Insurance Company Ltd.,

      D. NO. 8, Indian Exchange Place (Gr.Floor),Kolkata, West Bengal State-700001.

3.   Senior Divisional Manager,National Insurance Company Ltd.,

D. No.2/78, Saptagiri Complex, Main Road, Anantapur town,

Anantapur District-51501.         

       …Opposite Parties

                This complaint is coming on this day for orders in the presence of Sri. S.Sivaramakrishna Prasad , Advocate, for the complainant , and Sri. M.Azmathulla ,  Advocate for opposite party No.1 and Sri. L.Hariharanatha Reddy ,  Advocate for opposite parties No.2 & 3 and upon perusing the material papers on record, the Forum made the following.

ORDER

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

C.C.No.09/09

1.     This consumer complaint  of the complainant is filed U/S 12 of C.P.Act, 1986, seeking a direction on opposite party to pay the  assured amount of  Rs.1 lakh  with 18% interest p.a , Rs.25,000/- towards 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 is the wife  of Late C.Venkateswara Reddy  who died in road accident on 10-02-2007 . The said C.Venkateswara Reddy joined  as a member  with opposite party No. 1 and opposite party No. 2 and 3  provided  insurance  coverage  to the members  of opposite party No. 1 by collecting necessary premium from the members  and the policy bearing No. 100300/47/01/9600022/03/96/30385 was allotted  to C.Venkateswara Reddy  . The complainant herein  is the nominee  under the said policy  and after the death of her husband the complainant approached opposite party   No. 1and submitted all documents  and opposite party No.1  forwarded  all documents  to opposite party No.2 for settling the claim  and opposite party No. 2 appointed an investigator . Inspite of several  letters  and reminders  the opposite parties  failed to settle the claim  and hence  the complainant resorted to the forum for reliefs.

3.     In support of her case the complainant relied on the following documents viz., (1) letter dated 07-11-2008 of opposite party No.1 to opposite party No.2   and (2) office copy of letter dated 01-11-2008 of complainant  to opposite party No. 2, besides to the sworn affidavit of the complainant  in reiteration of her complaint averments and the above documents are marked  as Ex.A1  and A2 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 parties appeared through their counsel and  opposite party No. 1 and 3 filed separte written versions and opposite party No. 2 adopted the written version of opposite party No.3.

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 opposite party No. 1 and 2  entered into a Memorandum of Understanding  dated 01-01-2001 and agreed to extent  insurance coverage to the members  of opposite party No.1 and opposite party   No. 2 issued certificates to that effect . As per the  certificate  issued by opposite party No.2  the entire liability  will be on opposite party   No. 2 to settle the claims  and opposite party   No.  1 has no role  in settling the claims . Hence ,there is no deficiency of service  on part of opposite party No. 1 and seeks for the dismissal of complaint.

6.     The written version of opposite party No. 2 and 3 denies the complaint as not maintainable either  in the law or on facts and  submits  that the opposite party   No.  3 did not issue any policy to the deceased and the policy is issued by opposite party No.2  through opposite party No.1  and alleges  that there is no  contract between opposite party No.3 and deceased  C.Venkateswara Reddy and the complainant added this opposite party No.3 unnecessarily  only with an intention to harass  and to take undue advanatage  . It further submits  that upon happening  of any event  which may be give raise to claim under the  policy issued  by opposite party   No.  2 written notice with all information must be given  to the company  immediately i.e within one calendar  month after the  accident and claim form along with necessary  supporting documents  should be submitted within 90 days from the happening of the accident, any claim submitted after 90 days shall not be  entered  by the company. In this case the complainant intimated about the death of the  deceased after the stipulated  time mentioned in the policy and the same is clear violation  of terms and conditions  of the policy  and hence the complainant is  not remaining  entitled to any of the relief and the complaint has to be dismissed.

7.     In support of their case the opposite parties relied on the following documents viz, (1) Xerox copy of Memorandum of Understanding  between opposite parties 1 and 2 dated 01-01-2007 , (2) certificate dated  17-07-2001 issued by opposite party No. 2 , (3) Xerox copy of letter  dated 14-07-2008 of opposite party No.  1 and 2 and , (4)  Xerox copy of policy issued  to deceased along with letter  and conditions of said policy,  besides to the sworn affidavit of opposite party No. 1 and 3 in reiteration of their written version averments and the above documents are marked as Ex.B1 to B4 for its appreciation in this case and replies to the interrogatories exchanged .

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

9.     There is no dispute  as to the deceased C.Venkateswara Reddy  covered under the Group Personal Accident Insurance Policy issued by opposite party No. 2 vide Ex.B4 and nominated the complainant as nominee. There is no dispute as to the death of C.Venkateswara Reddy on 10-02-2007 in a road accident. The only dispute is  regarding  the delay in intimating  the death of the  deceased to the  opposite parties. The counsel  for complainant submitted  that all relevant documents are submitted to opposite parties and the complainant  being a woman  unaware of the fact of  informing the opposite parties within  stipulated time could not intimate before, but on the other hand the counsel for opposite parties 2 and 3 submitted that belatedness of the complainant  in informing the opposite parties about the  death of deceased  within one month from the date of accident  is clear violation of terms and conditions.

10.    The  opposite party  No.1 submitted  that vide Ex.B3 letter  dated 06-07-2007  of opposite party No. 1 addressed to O.P.No.3 all required documents  submitted by complainant are forward to  opposite parties  2 and 3,  after receiving the letter dated 01-11-2008 of complainant vide Ex.A2 the opposite party No. 1 addressed a letter dated 07-11-2008 vide Ex.A1 to opposite parties  2  as to submitting  of claim file on 03-04-2007 and documents  on 16-07-2009  and requests for early  settlement of the claim. The opposite party No. 1 further submitted  that as per Ex.B1 Memorandum of Understanding  dated 01-01-2001 between opposite parties No. 1 and opposite party No. 2 , the opposite party No. 2 agreed to extend Janata Personal Accident Insurance cover to the members of opposite party No. 1 and vide Ex.B2 dated 17-07-2001 ,the opposite party No. 2 admitted the responsibility  and liability  to settle the claim  amount to the insured and the liability  is with them only and none else. Therefore, the  opposite party No. 1 submitted that it is for opposite parties 2 and 3 to settle the claim . But inspite  of submitting all documents the opposite parties  2 and 3  did not settle the claim of the Complainant.

11.    In the written version filed by opposite party No.2 & 3 the only attack was  that the complainant  belatedly intimated the death of deceased i.e, after the stipulated time, hence the claim is not entertainable.

12.    In support of her case the complainant relied on the following decision of Uttarpradesh State Commission  between LIC of India Vs Rajendra Singh Gaur reported in (IV) 2004 CPJ Pg.531, where in the LIC repudiated  the claim of the complainant  on the ground  that intimation of death was  delayed , the complainant  contented that he was 80 years  and not able to  intimate earlier  and he completed all formalities , hence , held repudiation of claim unjustified and illegal.

13.    In the above said case the policy holder died on 29.11.1994 and intimation of death was given by the nominee to the insurance company . The complainant  was allowed on the ground that the policy stood  intact for 10 years  and the complainant  was nominee under the policy and the complainant alone is entitle  to the policy amount.

14.    Following the above mentioned decision in the present case the death of  policy holder occurred on 10-02-2007  and the same was intimated  to opposite party No. 1  . But the complainant  submitted all documents  and being a  woman  unaware of the fact  of informing  the opposite party No. 2 within  the stipulated time could not intimate before stipulated time could not intimate before stipulated time, could not intimate before stipulated time as such the  complainant  is showing a reasonable cause of the delay in intimating the death of Venkateswara Reddy beyond  stipulated  time and as such there appears  no fraudulent suspicion  on the face in violation  of policy  conditions. Hence ,the complainant’s approach to this forum seeking redressal is justified.

15.    To conclude, from the above discussion  and following  the afore  mentioned  decisions the complainant except delay in intimating  the opposite party No. 2 and 3 and in all other  aspects  certainly  remaining  entitled  to the accidental  benefit  under the Group Personal Accident Insurance Policy issued by opposite party No. 2 covering  the risk of her husband Venkateswara Reddy  and opposite party No. 2  and 3 are liable  to pay the same , as there is deficiency of service on part of opposite party No. 2 and 3 in not paying the  said amount. As there is no cause of action against the opposite party No. 1 case against opposite party No. 1 is dismissed.

16.    In the result , the complaint is allowed directing opposite party No. 2 and 3 to pay to the complainant  the insured amount of Rs. 1,00,000/- along with compensation of Rs.5,000/- and costs of Rs.2,000/- within one month from the date of receipt of this order. The complainant  against  opposite party No. 1 is dismissed without costs.

Dictated to the stenographer, transcribed by her ,corrected and pronounced by us in the open bench on this the 27^th day of August, 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: 

Ex.B-4               Xerox copy of policy issued to deceased along with letter and conditions of said policy.

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      

Copy was made ready on                :

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