BEFORE THE DISTRICT CONSUMER’S FORUM: KURNOOL

Present: Sri. T.Sundara Ramaiah, B.Com B.L., President

And

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

And

         Smt. S.Nazeerunnisa, B.A., B.L., Lady Member

Thursday the 12^th day of July, 2012

C.C.No.105/2011

Between:

G.Krupaiah,S/o G.Ramudu,

H.No.5/129 A,ABM Palem, Orvakal (V&M) - 518 010,Kurnool District.                                                        

           …Complainant

                                                    -Vs-      

1. The BranchManager, GTFS Multi Services Limited,

   SB Mansion, 16 R .N.Mukaharjee Road,       Kolkatta - 700 001.

2. The Manager,Reliance General Insurance Company Limited,

Himalaya House (5^th Floor), 38 B, J.L. Nehru Road, Kolkatta - 700 001.

3. GTFS Multi Services Limited, Represented by its Agent Raj Kumra,   Kurnool Branch,

   D.No.40/384, U-CON Plaza, Park Road, Kurnool - 518 002.                              

...Opposite ParTies

This complaint is coming on this day for orders in the presence of Sri N.Isaiah, Advocate for complainant and Sri M.Azmathulla, Advocate for opposite parties 1 and 3 and Sri.P.Ramanjaneyulu, Advocate for opposite party No.2 and upon perusing the material papers on record, the Forum made the following.

     ORDER

(As per Smt. S.Nazeerunnisa, Lady Member)                                                             C.C. No.105/2011

1.     This complaint is filed under section 11 and 12 of C.P. Act, 1986 praying:-

1.   To direct the opposite parties to pay the claim amount of Rs.1,00,000/- with interest at 24% per annum from the date of death of deceased till the date of realization;

And

1.   To pay a sum of Rs.20,000/- for causing mental agony to the complainant;

And

1.   To pay Rs.10,000/- towards costs;

1.   To such other relief or reliefs as the Honourable Forum deem fit and proper in the circumstances of the case.

2.    The case of the complainant in brief is as under:- The complainant is the father of Late Gangadhar Ramesh, who died in road accident on 27-03-2010 at about 9.30 A.M. near Pulla Reedy Engineering College, Orvakal, Kurnool District.  The deceased took the policy from opposite party No.2 through opposite party No.1, for a sum of Rs.1,00,000/-.  The complainant being, the nominee submitted claim to opposite party No.2 along with relevant documents.  Opposite party No.2 did not settle the claim.  The complainant got issued legal notice dated             28-04-2011 to the opposite parties but opposite parties did not respond.  Due to the negligent act of opposite parties, the complainant suffered mental agony.  There is a deficiency of service on the part of opposite parties in not settling the claim of the complainant.  Hence the complaint.

3.     Opposite party No.3 filed written version and same is adopted by opposite party No.1.  It is stated in the written version of opposite party No.3 that the complaint is not maintainable.  It is admitted that the deceased G.Ramesh was a member of opposite party No.1 and opposite party No.2 issued “Group Personal Accident Policy” to the members of opposite party No.1, bearing No.1503302914000007.  it is also admitted that, on 01-06-2010 the complainant submitted the claim form along with relevant documents, and it is forwarded to opposite party No.2.  The opposite party No.2 is responsible in not settling the claim of the complainant.  There is no deficiency of service on the part of opposite parties 1 and 3.  The complaint is liable to be dismissed against opposite parties 1 and 3.

        Opposite party No.2 filed written version stating that the complaint is not maintainable.  It is barred by limitation.  It is admitted that the deceased by name G.Ramesh took the policy from opposite party No.2 through opposite party No.1.  It is covered under the “Group Personal Accident Policy” bearing No.1503302914000007.  The period is from 23-02-2010 to 22-02-2011.  The complainant being, the nominee submitted the claim form to opposite party No.1 on 01-06-2010 and it was received by opposite party No.2 on 05-06-2010.  After the perusal of record, the opposite party No.2 repudiated the claim on 21-07-2010, on the ground that the accident took place on 27-03-2010.  The complainant informed and submitted the claim after 71 days.  It is the violation of terms and conditions of the policy.  As per the policy the claim should be made within 20 days from the date of death.  There is no documentary proof to show that the complainant is the nominee of the said policy.  The opposite party No.2 rightly repudiated the claim of the complainant.  There is no deficiency of service on the part of opposite party No.2.  Hence the complaint is liable to be dismissed. 

4.     On behalf of the complainant Ex.A1 to A10 are marked and sworn affidavit of the complainant is filed. On behalf of the opposite parties 1 to 3 Ex.B1 to B5 are marked and sworn affidavits of opposite parties 2 & 3 are filed.

5.     Both sides filed written arguments.

6.     Now the points that arise for consideration are:

1. Whether the complaint is barred by time?

1. Whether there is deficiency of service on the part of Opposite Parties?

1. Whether the complainant is entitled for the reliefs as prayed for?

1. To what relief?

7.      POINT No.i:-Admittedly the deceased G.Ramesh took the policy from opposite party No.2 through opposite party No.1 under Ex.B4.  Ex.B4 is the photo copy of policy along with terms and conditions of the policy.  The accident took place on 27-03-2010.  The complainant being, the nominee submitted claim to opposite party No.2 and the same was repudiated on 21-07-2010 under Ex.B5.  It is the case of opposite party No.2 that the complaint is barred by period of limitation. Under the Consumer Protection Act, 1986 Section 24 (a), the period of limitation to file a complaint before District Forum is two years from the date, on which the cause of action has arisen.    In the present case the accident took place on 27-03-2010 and the insurance company repudiated the claim on 21-07-2010 and the complaint is filed on 26-09-2011.  The complaint is well in time and it is not barred by period of limitation.   

8.      POINTS ii & iii:- Admittedly the original of Ex.B4 “Group Personal Accident Policy” bearing No.1503302914000007 covering the period  from 23-02-2010 to 22-02-2011 was issued by opposite party No.2.  Ex.A2 is the deceased G.Ramesh I.D. Card Code No.014008025 issued by opposite party No.1.  Ex.A6 is the photo copy of F.I.R. in Crime No.69/2010 and Ex.A7 is the Inquest Report. Ex.A8 is the photo copy of Post Mortem Report.  The main contention of opposite party No.2 is that the life assured died on 27-03-2010, the death intimation was not given to them immediately within 20 days from the date of accident.  The complainant informed and submitted claim to opposite party No.3 on 01-06-2010 and it was received on 05-06-2010. There is a delay of 71 days and it is a violation of terms and conditions of policy.  It is also the case of opposite party No.2 that there is no documentary evidence to show that the complainant is the nominee of the said policy.  The opposite party No.2 repudiated the claim on 21-07-2010 through its letter Ex.B5.  Ex.B4 is the photo copy of policy issued by opposite party No.2, wherein it is clearly mentioned the I.D.No.014008025 of G.Ramesh insured name.  Nominee is G.Krupaiah father of insured.  As seen from Ex.B4 it is very clear that the complainant is the nominee of the deceased life assured. 

        The learned counsel appearing for the complainant contended that the complainant is an illiterate person and he could not know the terms and conditions of the policy, and he was in a distressed condition due to the sudden death of his son in road accident.  In support of his contention he cited a decision of National Consumer Disputes Redressal Commission, New Delhi, Revision Petition No.3572/2011 with I.As No.1 and 2 of 2011, Reliance General Insurance Company Limited –Vs- Sri AVVN Ganesh, Son of Late Venkata Ramana.  In the above cited case the intimation of the death of insured was given as against the stipulated period of thirty days, after 4 months.   The National Commission held that it is settled law that the insurance company has the obligation to prove that the grounds of repudiation had been based on legally sustainable evidence.  In so far as the intimation of the death of insured beyond the period of policy is concerned, the appellant not known about the policy.   In the present case also the complainant has not known the terms and conditions of the policy, because it is Group Insurance Policy and it is not kept with the complainant.  As the policy was in the custody of opposite parties he could not know the terms and conditions of the policy. 

        There is no dispute with respect to alleged accident and the deceased G.Ramesh took the policy form opposite party No.2 through opposite party No.1.  Merely because there is some delay in submitting the claim form, opposite party No.2 cannot escape from its liability.  Opposite party No.2 caused mental agony to the complainant by not settling the claim of the complainant.

        Opposite party No.1 and opposite party No.3 forwarded the claim of the complainant to opposite party No.2 and intimated the same to opposite party No.1 through letter Ex.A9 and Ex.A10.  Opposite party No.2 is sole responsible to pay the amount under the policy.  Hence opposite party No.1 and opposite party No.3 is not liable.  In view of the evidence available on record we are of the opinion that the complainant is entitled for insured amount of Rs.1,00,000/- under the policy.

9.      Point No.iv :-  The complainant claims Rs.1,00,000/- with interest at 24% per annum and Rs.20,000/- for causing mental agony and Rs.10,000/- towards cost. It is just and proper to award insured amount of Rs.1,00,000/-, Rs.5,000/- as a compensation for mental agony and Rs.1,000/- is granted as cost of the case. 

10.    In the result, the complaint is partly allowed directing the                                      opposite party No.2 to pay insured amount of Rs.1,00,000/- with interest at 9% from the date of filling the case till the date of payment, Rs.5,000/- for causing mental agony and Rs.1,000/-  as costs to the complainant.  The complaint against opposite party No.1 and opposite party No.3 is dismissed.     

        Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 12^th day of July, 2012.

Sd/-                                   Sd/-                                   Sd/-        

MALE MEMBER                      PRESIDENT                 LADY MEMBER

                                 APPENDIX OF EVIDENCE

                                    Witnesses Examined

For the complainant : Nill            For the opposite parties : Nill

List of exhibits marked for the complainant:-

Ex.A1                Photo copy of Personal Accident Insurance Claim Form.

Ex.A2                G.Ramesh ID0 Card Code No.014008025 issued by GTFS

                Multi Services Limited, Kolkata.

Ex.A3                Office copy of Legal Notice dated 28-04-2011.

Ex.A4                Postal Receipts (Nos.2).

Ex.A5                Reply Letter dated 16-05-2011.

Ex.A6                Photo copy of F.I.R. in Crime No.69/2010 issued by

                Kurnool Talik P.S. dated 27-03-2010.

Ex.A7                Photo copy of Inquest Report dated 27-03-2010.

Ex.A8                Photo copy of Postmortem Examination Report

                No.356/2010 dated 27-03-2010.

Ex.A9                Letter issued by opposite party No.1 to opposite party No.2

dated 17-06-2010.

Ex.A10       Letter issued by opposite party No.1 to opposite party No.2

                dated 04-06-2010.

List of exhibits marked for the opposite parties:-

Ex.B1                Photo copy of Agreement Letter of Proposal for Mediclaim

and Personal Accident Cover dated 13-01-2009.

Ex.B2                Photo copy of Letter issued by opposite party No.1 to

                opposite party No.2 dated 04-06-2010.

Ex.B3                Photo copy of Repudiation Letter dated 21-07-2010.

Ex.B4                Photo copy of Personal Accident Insurance

Policy bearing No.1503302914000007.

Ex.B5                Photo copy of Repudiation Letter dated 21-07-2010.

Sd/-                                   Sd/-                                   Sd/-        

MALE MEMBER                 PRESIDENT                   LADY 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             :

Copy was dispatched on               :