D.o.F:22/3/09

 D.O.O:30/06/2010

IN THE CONSUMER DISPUTES REDRESSAL FORUM, KASARAGOD

                                                    CC.69/10

                            Dated this, the     30^th   day of June 2010.

PRESENT

SRI.K.T.SIDHIQ                                            : PRESIDENT

SMT.P.RAMADEVI                                    :MEMBER

SMT.P.P.SYAMALADEVI                         : MEMBER

Asha.S.Bhat,

Srikrishna.S, C/o Sathyashankara Bhat,

Jayashree Medicals.Po.Neerchal,Kumbla,              : Complainant

Kasaragod.

(Adv.P.Anantharaman,Kasaragod)

1.Deputy Manager

  National Insurance Co.Ltd,

Thiruvananthapuram Divisional Office,

P.B.No.434,St.Josephs Press Building,

Vazhuthacaud, Thiruvananthapuram.                         : Opposite parties

2. The Manager, National Insurance Co.Ltd,

Highway Plaza Building,M.G.Road,Kasaragod.

(Adv.M.Balagopal,Kasaragod)

                                                                                     ORDER

SRI.K.T.SIDHIQ : PRESIDENT

Bereft of unnecessaries the case of complainant is as follows:

   Complainant is the widow of late Sri. Srikrishna.S who was a teacher  at G.H.S Kumbla.  The deceased Srikrishna was a beneficiary of  the Group Personal Accident Insurance Scheme introduced by opposite party.  As per the accident insurance scheme for the accidental death the insurance  coverage is 7,00,000/- rupees.  Sri. Srikrishna died on 20/3/2008 in an accident(strike of lightening).  Immediately after his death, the complainant sent duly filled claim form dtd.7/4/08 enclosing the relevant documents.  But opposite parties did not honour the claim .  Therefore  on 27/4/09 the complainant sent a letter to opposite party to settle the claim  expeditiously.  To the said letter opposite party sent a reply dtd.24/5/09 stating that for finalizing the claim they are awaiting premium remittance confirmation from the govt./Treasury and  they will settle the claim immediately on receipt of the same.  Inspite of the same the claim was not settled and hence the complainant filed a petition against opposite party before the Legal Service Authority.  Before the Legal Service Authority  also the opposite parties reiterated their promises to settle the claim as early as possible and thereby  the disposal of petition was dragged about 5 months and noting their absence before the authority on 13/3/2010 the mediators directed  the complainant to approach the proper court for necessary relief.  Therefore the complaint is filed alleging deficiency in service on the part of opposite arties.

2.  According to opposite parties the complainant is entitled for compensation as per Group Personal Accident Scheme.  The Ist opposite party has written several letters to complainant as well as Dist.Educational Officer to comply the requirement.  In spite of these letters they have dragged the matter for a considerable period.  When the matter come up before the Legal Service Authority the opposite parties informed the complainant that the claim is pending for want of proceedings(a document certifying the beneficiaries entitled to compensation) as per GO(P) No.221/07/Fin dtd. 29/5/07 of Finance(Establishment-D) Dept of  Govt. of Kerala to be issued by the Head of the District office or higher authority.  This is the requirement mandated by the Kerala Govt. under Group Personal Accident Scheme.  At last the complainant through  Dist. Educational Officer sent the proceedings.  Opposite party submit that they are ready to settle the claim without involving the concerned department if an order is passed accordingly.

3.  Complainant produced Exts.A1 to A4 to substantiate her claim.  On the side of opposite parties Exts.B1 to B3 marked.  Both sides heard.  Documents perused carefully.

4.   Ext.A1 is the copy of death certificate pertaining to Sri.Srikrishna, the husband of the complainant.  Ext.A2 is a copy of letter dtd.24/5/09 issued by opposite party to complainant.  In the said letter it is stated that for finalizing the claim they are awaiting premium remittance conformation as required U/S 64VB of the Insurance Act from Govt./Treasury and as soon as the receipt of the same they will proceed with the claim.  Ext.A3 is a copy of the complaint lodged by the complainant before the Legal Service Authority.  Ext.A4 is a copy of the letter dtd.26/3/09 issued by District Educational Officer Kasaragod to Ist opposite party.  In that letter the D.E.O informed Ist opposite party that he had submitted the GPA claim proposal with the request of the complainant.  In that letter he also requested opposite parties to give  top priority to settle the insurance claim of the complainant.   

5.  On the other hand learned counsel for opposite parties Sri.Balagopal relied  heavily  on Exts.B1 to B3 to justify their stand.  Exts.B1 dtd.4/1/2010 issued by OP.1 requesting the D.E.O for proceedings in original as per the  Govt.Order related to the matter.  Ext.B2 is the copy of the  e-mail sent  by the Deputy Manager from the office of Ist opposite party to one Damodaran.  Ext.B3 is the copy of the communication dtd.30/11/09 issued from the director of treasuries.  Ist opposite party intimating that a  D.D  for Rs. 1,43,60,500/- taken on 31/12/2007 in favour of Ist opposite party that includes the  premium recovered from the salary of Sri.Srikrishna for the month of 12/07.

6.  According to learned counsel for opposite parties , complainant delayed the production of the proceedings in original that is mandatory for the settlement of claim.  But it is seen from the documents produced, that the said demand is made for the first time in Ext.B1 dtd.4/1/2010.  In Ext.A2 what is stated by Ist opposite party is that they have not received the premium remittance  confirmation as  required U/S 64VB of the Insurance Act.  Had the  non production of  proceedings  as per the  Govt.Order was the barrier to settle the claim then the necessity for the said proceedings should have find a place in Ext.A2, the reply dtd.24/5/09 issued by Ist opposite party to complainant and the complainant could have made arrangements to make the proceedings available.  So it is clear that the opposite parties are running one after another reason  to  cover up their lethargic  approach in the matter of settlement of the complainant’s claim.  That  amounts  to  deficiency in service  and they are liable to pay the insured amount of 7,00,000/-rupees to the complainant with interest.

 7.  The Hon’ble Apex Court in the case of Secretary Irrigation Dept. Govt of Orissa Vs G.C.Roy reported in 1992(1) SCC 508 has held that a person deprived of the use of money  to which he is legitimately entitled has a  right to be compensated for the deprivation, call by any name interest, compensation or damage.  In this case it is evident that the opposite parties protracted the settlement of the claim  stating one reason or other.

8.  The Hon’ble Supreme Court in the case of United India Insurance Co.Ltd vs. MKJ Corporation reported in AIR 1997 SC 408, III1996 CPJ 8 (SC) has held that two months     would be a reasonable time to the insurer to take a decision whether claim requires to be settled or rejected in accordance with the policy.

    It is the case of the complainant that she has submitted on 7/4/08 enclosing the relevant documents.  So if two months is considered  from the date of submission of claim, it should  have been settled on or before 7/6/08.  But till date the claim is not settled the opposite parties have no case that  within 2 months from the date of submission of claim papers they demanded any  further documents for processing and settling the claim.  Hence opposite parties are liable to  pay interest for the insured amount   of 7,00,000/- rupees from 7/6/2008 onwards till payment .

    In the result, complaint is allowed and opposite parties are directed to pay 7,00,000/- rupees to the complainant together with interest @6% per annum from 7/6/08 till payment with a cost of 3000/- rupees.  Time for compliance is limited to 30 days from the date of receipt of copy of the order.  Failing which the  opposite parties shall be liable to pay interest @9%  for 7,00,000/- rupees from 7/6/08 to till date of payment.

Sd/                                             Sd/                                                                  Sd/

MEMBER                              MEMBER                                          PRESIDENT

Exts:

A1-True copy of death  certificate

A2-24/5/09- letter sent byOP.1 to complainant

A3-5/11/09-copy of application filed before the Legal Service  Authority

A4-26/3/09-copy of letter from DEO,Kasaragod to complainant

B1- 4/1/10- letter sent by OP.1 to complainant

B2-3/7/10- copy of e-mail sent  by OP.1 to one Damodaran

B3-30/11/09- copy of  letter  from Director of Treasuries to OP.1

Sd/                                             Sd/                                                       Sd/

MEMBER                              MEMBER                                       PRESIDENT

eva                                                                                 /Forwarded by Order/

                                                                       SENIOR SUPERINTENDENT