BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt.C.Preethi, Hon’ble Lady Member
Wednesday the 17th day of January, 2007
C.C. No.93/2006
M.Varalakshmi,
D/o. late Lakshmipathi,
Hindu, aged about 28 years,
Resident of Koilakuntla village,
Kurnool district. …Complainant
-Vs-
1. The Divisional Manager,
National Insurance Company Limited,
Division No.1, P.B. No.236,
Jhansi Mansions, Bank Street,
Hyderabad.
2. The Branch Manager,
Andhra Bank,
Bethamcherla Branch,
Bethamcherla Village,
Kurnool district. …Opposite parties
This complaint coming on this day for orders in the presence of Sri. P.Siva Sudarshan Advocate, Kurnool for complainant, and Sri. L.Hari Hara Natha Reddy, Advocate, Kurnool for opposite Party No.1, Sri. A. Rama Subba Reddy, Advocate, Kurnool for opposite party No.2 and stood over for consideration till this day, the Forum made the following:-
ORDER
(As per Smt C.Preethi, Hon’ble Lady member)
1. This consumer complaint of the complainant is filed under section 12 of C.P. Act 1986, seeking a direction on the opposite parties to pay Rs. 1,00,000/- with 12 interest per annum and Rs. 10,000/- towards mental agony.
2. The brief facts of the complainant case is that the complainant is the wife of one Lakshmipathi who has an account in Andhra Bank, Bethamcherla Branch bearing No. 1034 under Abaya Gold savings bank scheme. The said scheme provided an accidental insurance cover under group personal accident insurance policy. On 6.3.2003 the complainant’s husband died in an accident and the complainant informed the death of Lakshmipathi to opposite party No.1 and submitted all required documents and requested to pay the assured amount through opposite party No.2. The opposite party No.2 inturn addressed a letter dated 6.6.2003 to opposite party No.1 requesting to send prescribed claim form as one of the Abaya Gold savings back account holder expired on 6.3.2003. The opposite party No.1 stated that letter dt 6.6.2003 of opposite party No.2 reached opposite party No.1 on 9.6.2003 i.e after 90 days from the date of accident, hence they are not in a position to settle claim of the complainant, as the intimation should reach them within 90 days from the date of accident, as per agreement between opposite party No.1 and 2. But complainant submits that she submitted all papers to opposite party No.2 with a hope to settle the claim and opposite party No.1 and 2 are trying to evade payments. Hence, the above said lapsive conduct of opposite parties constrained the complainant to re-sort to the forum for redressal.
3. The complainant in substantiation of her case relied on the following documents Viz (1) certified copy of FIR in Crime No. 18/2003 of Koilkuntla P.S (2) C.C copy of PM report of late Lakshmipathi (3) C.C copy of inquest report (4) Abaya Gold Andhra Bank pass book of Laxmipathi (deceased) (5) death certificate of Laxmipathi and (6) attested Xerox copy of repudiation letter dated 11.6.2003, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex A.1 to A.6 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitablely replied to the interrogatories caused the opposite parties 1 and 2.
4. In pursuance to the notice of this Forum as to this case of the complainant the opposite parties appeared through their standing counsel and contested the case by filling separate written versions.
5. The written version of opposite party No.1 admits the deceased Lakshmipathi has opened an Abaya Gold savings bank account in Andhra bank, Bethamcherla branch with SB account No. 1034 and as per the scheme the intimation of accidents giving raise to claims in case of said scheme shall be given to opposite party No.1 through the branch of the banker within a reasonable time of 90 days from the date of accident, but in this case on 9.6.2003 the opposite party No.1 received a letter date 6.6.2003 addressed by opposite party No.2 intimating above the death of deceased Lakshmipathi. As per the agreement entered between opposite party No.1 and 2 with regard to accident or incident should be communicated to opposite party No.1 within 90 days from the date of such accident by opposite party No.2. As the opposite party No.1 received intimation after 90 days from the date of accident they could not settle the claim keeping in view the condition as per the said agreement and treated the claim as no claim and the opposite party No.1 is not liable to pay any amount to the complainant and seeks for the dismissal of complaint with costs.
6. The written version of opposite party No.2 submits that he is only agent of opposite party No.1 in making arrangements for entering into insurance agreement and therefore no liability lies against opposite party No.2 as there is no deficiency of service on part of opposite party No.2. The insurance cover is provided by opposite party No.1 is subject to terms and conditions of said policy and any claim arises out of said policy the opposite party No.1 is liable to satisfy the claim and to pay the insurance amount and opposite party No.2 has nothing to do with the claim of the complainant and seeks for the dismissal of complaint against opposite party No.2.
7. In pursuance of their case the opposite parties relied on the following documents Viz (1) letter dated 6.6.03 of opposite party No.2 to opposite party No.1 (2) Xerox copy of letter dated 6.6.2003 of complainant Varalaxmi addressed to opposite party No.2 and (3) agreement between opposite party No.1 and 2 dated 31.8.2002, besides to the sworn affidavit of the opposite party 1 and 2 in reiteration of their written version and the above documents are marked as Ex B.1 to B.3 for its appreciation in this case. The opposite parties 1 and 2 caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties:?
9. There is no dispute as to the deceased Laxmipathi covered under the Group Personal Accident Insurance Policy issued by opposite party No.1 and the complainant is nominee under the said policy. There is no dispute as to the death of deceased on 6.3.2003 in an accident and the death information was given to opposite party No.2 by the complainant vide Ex B.2 dt 6.6.2003 and the same was received by opposite party No.2 on 6.6.2003 and on the same day i.e 6.6.2003 the opposite party No.2 intimated the same to opposite party No.1 and the same was received by opposite party No.1 on 9.3.2003. The only dispute is regarding the delay in intimating the death of the deceased to opposite party No.1. The counsel for complainant submitted that all relevant documents are submitted to opposite party No.1 and being a women the complainant unaware of the fact of informing the opposite party No.1 within a stipulated time could not intimate before, but on the other hand the counsel for opposite party No.1 submitted that belatedness of the complainant in informing to opposite party No.1 about the death of deceased within 90 days from the date of accident is clear violation of condition laid down in Ex B.3 agreement between opposite parties 1 and 2 dated 31.8.2002.
10. The Ex A.1 is the certified copy of FIR, Ex B2 is the certified copy of PM report and Ex B.3 is the certified copy of inquest report, all the above exhibits in unitone says that the death of Laxmipathi is accidental one. The only attack of opposite party No.1 against the complainant is that the complainant is not entitled for any amount under the policy as she intimated the death of her husband belatedly i.e after 90 days which is clear violation. In Ex B.3 on page 7 at procedure for claims envisages the intimation of accident shall be given to the insurer through the branch of banker within a reasonable time of 90 days from the date of accident. The said procedure no where envisages forfeiture of the insured amount of the deceased on failure of the dependent/ nominee not informing the death of insured to the insurance company within stipulated time. In support of their case the complainant side 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 it was held that repudiation of claim by LIC on the ground that intimation of death was delayed, the complainant contented that he was 80 years and not able to intimation earlier and he completed all formalities, hence, held repudiation of claim unjustified and illegal.
11. In the above said case the policy holder died on 29.11.2004 and intimation of death was given by the nominee to the insurance company in June 2003. 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.
12. Following the above mentioned decision in the present case the death of policy holder occurred on 6.3.2003 on the same was intimated to opposite party No.2 on 6.3.2003 i.e on the 90th day and inturn opposite party No.2’s letter of intimation reached opposite party No.1 on 9.6.2003 i.e on 93rd day but the complainant submitted all documents and being a woman unaware of the fact of informing the opposite party No.1 within the stipulated time, as such the complainant is showing a reasonable cause of the delay in intimating the death of Laxmipathi beyond reasonable time of 90 days as per Ex B.3 and as such there appears no fraudulent suspicion on the face in violation of agreement in Ex B.3. Hence, the complainant’s approach to this Forum seeking redressal is justified. The opposite party No.1 by its doscile conduct should not have repudiated the claim of the complainant and should have condoned the delay of only 3 days after the reasonable time limited of 90 days.
12. The other decision relied by the complainant is that of Chhattisgarh State Commission reported in (III) 2006 CPJ pg 180 between Bajaj Allianz General Insurance Company Ltd Vs Manoj Agarwal, where in, it was held that intimation of death was delayed but intimation to the police was given in time, if the intimation to insurance company was delayed, but duly informed the police, hence the delay of intimation to the insurance company would not be fatal.
14. To conclude, from the above discussion and following the afore mentioned decisions the complainant except delay in intimating the opposite party No.1 and in all other accepts certainly remaining entitled to the accidental benefit under the Group Personal Accident Insurance Policy issued by opposite party No.1 covering the risk of her husband Laxmipathi and opposite party No.1 is liable to pay the same as there is deficiency of service on part of opposite party No.1 in not paying the said amount. As there is no cause of action against to opposite party No.2 case against opposite party No.2 is dismissed.
15. In the result, the complaint is allowed directing the opposite party No.1 to pay insured amount of Rs. 1,00,000/-, to the complainant with 9% interest per annum from the date of complaint i.e 30.6.2006 till realization along with Rs.5,000/- as costs within a month of receipt of this order.
Dictated to the Stenographer, transcribed by her, corrected and pronounced in the Open bench this the 17th day of January, 2007.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant: Nil For the opposite parties :Nil
List of exhibits marked for the complainant:-
Ex.A1 Certified copy of F.I.R. Cr.No.18/2003 of P.S. Koilakuntla.
Ex.A2 Certified copy of Post Mortem report of Late Lakshmipathi.
Ex.A3 Certified copy of Inquest report.
Ex.A4 Abhaya Gold Andhra Bank pass book of Lakshmipathi (deceased).
Ex.A5 Original Death Certificate of Lakshmipathi.
Ex.A6 Attested Xerox copy of repudiation letter, Dt:11-06-2003.
List of exhibits marked for the opposite parties:-
Ex.B1 Letter, Dt:06-06-2003 of O.P.2 to O.P.1.
Ex.B2 Letter, Dt:06-06-2003 of complainant Varalakshmi to O.P.2.
Ex.B3 Agreement Dt:31-08-2002 in between of O.P.1 & O.P.2.
MEMBER PRESIDENT
Copy to:-
1. Sri. P.Siva Sudarshan Advocate, Kurnool.
2. Sri L.Hari Hara Natha Reddy, Advocate, Kurnool.
3. Sri. A.Rama Subba Reddy, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
