DISTRICT FORUM :: KADAPA

PRESENT SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT

                                                                  SMT. B. DURGA KUMARI, B.A., B.L.,

                                                                    SRI S. ABDUL KHADER BASHA, B.Sc., MEMBER

Friday, 9th January 2008

CONSUMER COMPLAINT No.  112 / 2008

M. Rama Devi, W/o Late M. Venkatarama Raju,

aged about 44 years, Hindu, K. Rachapalli village,

Patur Post, Nandalur Mandal, Kadapa Dist.                                ….. Complainant.

Vs.

1)  The Divisional Manager,

     National Insurance Co. Ltd., Divisional Office No. III,

     I, Shakespera Sarani, 6th floor, Kolkatta – 700 001.

2)  The Manager, Golden Multiservices Club Ltd.,

     S.B. Mansion, 16, R.N Mukherjee Road, Kolkatta – 700 001.

3)  The Branch Manager, National Insurance Co. Ltd.,

     1st floor, #22-474/1, Sundaracharyulu road,

     Proddatur Post and Mandal, Kadapa District.                       ….. Respondents. 

This complaint coming on this day for final hearing on 07-01-2009 in the presence of Sri Md. Habibulla, Advocate and Sri D. Rajasekhar Reddy, Advocate for R1 & R3 and Sri M. Suresh Kumar, Advocate for R2 and upon perusing the material papers on record, the Forum made the following:-
O R D E R

(Per Sri P.V. Nageswara Rao, President),

1.                 Complaint filed under section 12 of the Consumer Protection Act 1986.

2.                The brief facts of the complaint is as follows:-  The complainant’s deceased husband by name M. Venkataramaraju, had a group personal accident policy bearing No. 100300/42/04/8200012, dt. 15-9-2004.   The complainant was a nominee to the policy.  The deceased paid Rs. 3,037/- on 20-8-2004 through agent No. 011377392 as the policy was in force from 15-9-2004.   The complainant’s deceased husband died in unconditional event at NIMS hospital, Punjagutta, Hyderabad on 29-7-2005 due to cardiac arrest and faced with fever and vomiting.   The death summary and death certificate were also filed.  The death was informed to the 2nd  respondent by the son of the deceased namely Rahuramaraju through EMS speed post.   The complainant addressed a letter to both the respondents on    28-10-2005 requesting to conduct an enquiry and pay the compensation mount.   The letter was sent by professional courier service and also by fax message and also by registered post.   The R2 sent a letter by registered post dt. 24-11-2005 to the complainant.  As per letter the complainant sent the required information to the respondents along with documents.  The R1 sent a letter on 9-1-2006 to the complainant.   The complainant received another letter dt. 13-6-2006 from R1 that the policy was time barred and intimation  was received after 3 months 26 days and the claim was submitted after 5 months 9 days.  The respondents 1 & 2 did not conduct any enquiry in sending necessary application forms through R3.  It was gross negligence and deficiency of service.  The son of the deceased policy holder sent the death intimation to the respondent on 27-8-2005 i.e. within 30 days of the death.  Therefore, the intimation was sent within time of 30 days.  The complainant sent another letter dt. 28-10-2005 for payment of  compensation.  The R2 sent a letter dt. 24-11-2005 along with claim form.  The complainant submitted the form to R1 along with documents on 27-12-2005 by registered post and also the same to R2.  Again the complainant received a letter from R2 dt. 9-1-2006 that the claim forms were forwarded to R1.  The R1 sent a letter dt. 25-5-2006 to the complainant received by registered post on 19-7-2006.  The respondents contended that the death intimation should be given within 30 days and claim forms should be submitted within 90 days.  The intimation was given by registered post by 27-8-2005 without any delay from the complainant.  The respondent could not take any action nor sent any claim forms.  On the request of the complainant on 28-10-2005, the claim forms were sent by the respondents on 27-12-2005 and hence, it was submitted within 90 days.  Therefore, the complaint was filed for deficiency of service and negligence on the part of the respondents directing the respondents company to pay death policy amount with interest @ 24% p.a. from the date of intimation and Rs. 50,000/- towards mental agony and costs of the complaint. 

3.                The R1 & R3 filed a counter that the complaint was not maintainable because the R2 office was at Kolkata.  The Group Personal Accident policy bearing No. 100300/42/04/8200012,  was issued for the period from dt. 15-9-2004 to 14-9-2014 with the association of R1.  The R2 received Rs. 3,037/- from the member at Kolkata and issued a receipt on 20-8-2004 at Kolkata itself.  The R2 inturn remitted the amount to R1 at Kolkata only.  There was no territorial jurisdiction to entertain the complaint.  The complainant added R3 for jurisdiction purpose only.  The complainant’s husband died at NIMS Hospital, Hyderabad due to cardiac arrest with fever and vomiting.  It was natural death, outside the purview of the policy.  It was not an accidental death.  Any breach of condition would give repudiation to the claim.  The discharge summary filed by the complainant disclosed that the deceased was suffering from fever since 10 days and vomiting since 5 to 6 days and died due to cardiac arrest.  So the cause of death was not covered under the policy.   The intimation of death should be given within 30 days and the documents should be produced within 90 days from the date of accident.  The intimation was sent after 3 months 26 days and submitted the claim after 5 months 9 days after the death.  Therefore, the complaint may be dismissed with costs. 

4.                The R2 filed a separate counter that the deceased Venkataramaraju obtained personal accident insurance coverage under a group insurance policy through Golden Multi Services Club Ltd., with the policy No. 100300/42/04/8200012, with Sl.No. 011377392/104050501438.   The period was from 15-9-2004 to 14-9-2014 and the sum assured was Rs. 5,00,000/- and the complainant was a nominee of the deceased.  As per terms of the memorandum of understanding between R1 and R2, the R1 had an exclusive right and authority to entertain and settlement of the claim.  Golden Multi services Club Ltd., Kalkota had no role or any authority in regard to claim settlement and payment of insurance claim and delayed settlement of claim and rejection of the claim.  Therefore, there was no liability to Golden Multi Services Club Ltd., for deficiency of service.  The Golden Multi Services Club Ltd, Kalkota acted as insured facilitator and was not regarded as authorized agent, Insurance Regulatory and Development Authority (IRDA) would not approve any illegal and indisciplined approach.  The R2 was not jointly and severally liable to settle the claim in favour of the nominee.   The authority was only with R1.  After the death of the insured the nominee submitted the documents including the claim form to Golden Multi Services Club Ltd, who in turn submitted to the insurance company for consideration on 9-1-2006.  The Insurance company in its letter dt. 25-5-2006 repudiated the claim on the ground of delayed intimation and submission of the documents.  The policy would cover accidental death, permanent or total disablement subject to terms and conditions stated in the policy.  The present case was not accidental.  Hence, the claim should be repudiated or should not be repudiated was a question of trial based on evidence.  It was left to the discretion of the Hon’ble forum.  There was no purpose that would be served in impleading the R2.  Hence, the complaint may be dismissed with costs. 

6.                On the basis of the above pleadings the following points are settled for determination. 

i.                   Whether there is any negligence and deficiency of service on the part of the respondents?

ii.                 Whether the complainant is entitled to the relief as prayed for?

iii.              To what relief?

7.                On behalf of the complainant Ex. A1 to A15 were marked.   On behalf of the respondents Ex. B1 to B7 were marked.   The complainant and the R1 & R3 filed written arguments also.

8.                Point No. 1 & 2  The complainant was the wife of late M. Venkataramaraju, who had a Group Personal Accident policy bearing No. 100300/42/04/8200012, dt. 15-9-2004 obtained from R2 i.e. Golden Multi Services Club Ltd., Kalkota.  The sum assured under the policy was Rs. 5,00,000/-.  It was for the period from 15-9-2004 to 14-9-2014.  The complainant as wife of the deceased was nominee to him.  Ex. A1 was Xerox copy of the policy. 

9.                The policy holder M. Venkataramaraju died on 29-7-2005 at NIMS Hospital, Hyderabad.  The Xerox copy of death summary dt. 29-7-2005 was Ex. A3.  The Xerox copy of death certificate issued by Municipal Corporation, Hyderabad was Ex. A2.   Under Ex. A3 it was noted that the deceased was admitted on 29-7-2005 in Respiratory Intensive Care Unit (RICU).  Prior to it he was suffering from fever for 10 days and vomiting for 6 days.  He was taken treatment out side the hospital.  He was referred to NIMS on 28-7-2005 but had cardiac arrest at EMD on 29-7-2005 morning and so he was shifted to RICU for further management and again he had cardiac arrest at 4.30 a.m on 29-7-2005 and revived and again had cardiac arrest at 7.50 p.m on 29-7-2005 and declared dead at 8.15 p.m on 29-7-2005.  Therefore, the deceased Venkataramaraju died due to cardiac arrest on 29-7-2005 at 8.15 p.m in NIMS, Hyderabad.  The respondent contended that the deceased was suffering from fever and vomiting and consequently he had cardiac arrest and died and so his death was not accidental but natural.   In view of Ex. A3 he had fever for 10 days and vomiting for 5 or 6 days and he was referred on 28-7-2005 to NIMS, Hyderabad but he had cardiac arrest on 29-7-2005 and died on the same day.  He had no cardiac problem prior to 29-7-2005.  Therefore, the death on 29-7-2005 due to cardiac arrest was accidental.  The complainant informed the death of the policy holder by EMS speed post to R2 on 27-8-2005 and to that effect she filed Ex. A4 the receipt issued by the postal department.  The complainant wrote a letter on       28-10-2005 to R1 and R2 to conduct enquiry and supply the claim forms for payment of compensation.  The office copy of the letter was Ex. A5 and two courier receipts were Ex. A6.  The death was occurred on 29-7-2005 and intimation was sent on 27-8-2005 within 30 days of the death and requested to supply the claim forms within 90 days i.e. on 28-10-2005.  As soon as the death intimation was sent by speed post on 27-8-2005 to R2 it was its duty to inform the same to R1.  But R2 was silent.  The complainant filed Ex. A7 telephone bill, dt. 28-10-2005 phoned to Kolkatta.  Ex. A8 was postal receipts dt. 29-10-2005 for the letter sent under Ex. A5  and acknowledgment from R1 that it received the cover on 3-11-2005.  The R2 on 24-11-2005 wrote a letter to the complainant to furnish the required documents along with claim form.  The letter was Ex. A9.  Ex. A10 was cover.  Ex. A11 was copy of letter addressed to R2 by the complainant on 27-12-2005 requesting to pay the claim amount.  Ex. A12, dt.             09-1-2006 was letter addressed by the R2 to the R1 for further processing of the claim as the documents were submitted by the nominee.  Ex. A13 was a letter dt. 25-5-2006 from R1 to the complainant that the claim could not be entertained because the intimation was sent 3 months 26 days after the accident and claim forms was submitted 5 months 9 days after the accident.  At this juncture, in view of Ex. A4 and Ex. A5, the intimation was sent within 30 days and the claim forms were not submitted within 90 days after the accident. 

10.              On perusal of Ex. A4 and A5, as discussed earlier the death intimation was intimated within 30 days of the death and request for the claim were submitted within 90 days after the death of the deceased i.e. 27-8-2005 and 28-10-2005 respectively.  In Ex. A13 there was no mention of Ex. A4 and Ex. A5.  In Ex. A9 the R2 referred Ex. A5 and the letter dt. 27-8-2005.  But stated that it was received on 11-11-2005.  On perusal of Ex. A8.  The Ex. A5 was received by R1 on 3-11-2005 itself.  There was no delay of the period mentioned by R1 in its letter Ex. A13.  The delay mentioned by R1 in Ex. A13 was only to avoid the compensation or claim amount to the nominee of the deceased i.e. the complainant. Ex. A14 and Ex. A11 were one and same.  But the complainant filed the postal receipt and Xerox copy of claim form along with Ex. A14.  Ex. A15 was Xerox copy of receipt for payment of premium of Rs. 3,037/- on 20-8-2004.   

11.              The respondent filed Ex. B1 a Xerox copy of policy issued by R2.  Ex. B1 and Ex. A1 were one and same.  Ex. B2 was Xerox copy of letter issued by R1 to R2.  Ex. B3 was Xerox copy of Notarial certificate regarding memorandum of understanding between R1 and R2.  Ex. B4 and Ex. A13 were one and same.   Ex. B5 and Ex. A12 were one and same.  Ex. B6 was Xerox copy of claim form.  Ex. B7 was terms and conditions of the policy along with Xerox copy of the policy filed by R1 and R3.  The insurance company argued that the insured should sustain any bodily injury resulting solely and directly from accident caused by external violent and visible means and then the company should pay the amount.   In the present case it was not an external violent and visible injury and was not solely and directly from the accident and hence, the company was not liable.  But the death was occurred on account of cardiac arrest at NIMS Hospital, Hyderabad and the hospital authorities had no necessity to issue death summary with the result that the patient was declared dead due to cardiac arrest at 8.15 p.m on 29-7-2005.  It was an accidental death.  The injury was bodily injury inside the body and not a visible injury.  The cardiac arrest could not be a visible injury.   But it was violent injury in side the body and so there was deficiency of service and negligence on the part of the respondents jointly and severally. 

12.              Point No. 3   In the result, the complaint is allowed.  Directing the respondents 1 to 3 jointly and severally liable to pay Rs. 5,00,000/- (Rupees Five Lakhs only) to the complainant without interest and Rs. 5,000/- (Rupees Five Thousand Only) towards mental agony and Rs. 1,000/- (Rupees one thousand only) towards costs, within 60 days from the date of receipt of this order. 

Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 9th January 2009

 
MEMBER                                        MEMBER                                    PRESIDENT

 
 
APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant    :       NIL                            For Respondent :     NIL

Exhibits marked for Complainant  : -  

Ex. A1         X/c of policy issued by R2 in favour of the deceased.

Ex. A2         X/c of death certificate issued by M.C.H., Hyderabad.

Ex. A3         X/c of discharge notes.

Ex. A4         EMS speed post receipt No. EE687262370 IN, dt. 27-8-2005.

Ex. A5         Office copy of letter from complainant to R1 and R2, dt. 28-10-2005.

Ex. A6         Two Professional courier receipts.

Ex. A7         Phone bill, dt. 28-10-2005.

Ex. A8         Two registered post slips and acknowledgement card.

Ex. A9         Letter from R2 to complainant, dt. 24-11-2005.

Ex. A10       Cover from R2 to complainant.

Ex. A11       Office copy of letter from complainant to R2, dt. 27-12-2005.

Ex. A12       Letter from R2 to R1, dt. 9-1-2006 along with cover. 

Ex. A13       Letter from R1 to complainant, dt. 25-5-2006 along with cover.

Ex. A14       X/c of letter from complainant to R2, dt. 27-12-2005.

Ex. A15       X/c of depositors copy issued by R2, dt. 20-8-2004.

Exhibits marked for Respondents: -          

Ex. B1         X/c of policy issued by R2 in favour of the deceased.

Ex. B2         X/c of letter from R1 to R2, dt. 23-8-2004.

Ex. B3         X/c of notarial certificate.

Ex. B4         X/c of letter from R1 to complainant, dt. 25-5-2006

Ex. B5         X/c of letter from R1 to complainant, dt. 9-1-2006.

Ex. B6         X/c of claim form issued by the R1.

Ex. B7         Terms and conditions of the policy along with Xerox copy of the policy

MEMBER                                         MEMBER                                   PRESIDENT
Copy to :-

1) Sri Md. Habibulla, Advocate. 

2) Sri D. Rajasekhar Reddy, Advocate.

3) Sri M. Suresh Kumar, Advocate.  

         1) Copy was made ready on     :

2) Copy was dispatched on      :

3) Copy of delivered to parties :
 
B.V.P.                                               - - -