C.C filed on:14.10.2014

 Disposed on:12.07.2016

BEFORE THE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM, TUMKUR

DATED THIS THE 12^th DAY OF JULY –  2016

C.C. No. 149 OF 2014

:PRESENT:

SMT. PRATHIBHA. R.K. BAL LLM. PRESIDENT,

SRI. D. SHIVAMAHADEVAIAH, B.A. LLB,  MEMBER

SMT. GIRIJA, B.A. LADY MEMBER

COMPLAINANT/S:

1.       Smt. Kariyamma W/o Gangaiah, 74 yrs,

2.       Smt. Venkatamma W/o Gangarangaiah, 47 years,

3.       G.Rangaswamy S/o Gangarangaiah, 28 years,

4.       G.Raju S/o Gangarangaiah, 26 years,

5.       G.Shankara S/o Gangarangaiah, 21 years,

          All are R/at Mahalakshmi Nagara, Gubbi Town,

          Gubbi Taluk, Tumkur District.

(By Sri/Smt.  H.C.Kumaraswamy (HCK) - Advocate)

-V/s-

OPPOSITE PARTY/IES

1.       The Divisional Manager,

          National Insurance Co. Ltd.,

          Bangalore Divisional Office II

          # 672, 1^st Floor, 11^th Main,

          4^th Block, Jayanagar,

          Bangalore-11.

2.       The Manager,

          Branch Office at

          National Insurance Co. Ltd.,

          Tumakur Branch Office,

          Kasturi Mansion, M.G.Road,

          Behind Krishna Talkies,

          Above Corporation Bank,

          Tumkur – 572 101.

3.       The Superintendent of  Police,

          S.P.Office, B.H.Road,

          Tumakuru.

(OP Nos. 1 & 2  - By Sri/Smt.M.Shahajabi  - Advocate)

 (OP No.3 By Sri/Smt.  S.B.Shantharajaiah - DGP)

:-O R D E R:-

SMT.PRATHIBHA R.K. - PRESIDENT

The complainant has filed this complaint Under Section 12 of the Consumer Protection Act 1986 against the OPS alleging deficiency in service on the part of OPS and prays to direct the Opposite Parties to settle the death claim of complainant No.2’s husband late Sri.Gangarangaiah for Rs.3,00,000/- with interest at 12% p.a. from the date of death of Late Gangarangaiah i.e., from 21/06/2010 to till realization and further request to direct the OPS to pay Rs.2,00,000/- towards compensation for mental agony in the ends of justice. 

The brief facts of the complaint is as under:-

2.       Late Sri. Gangarangaiah has got himself insured as a member of special group insurance policy made with the Police Department i.e. OP No.3 Department.  The OP No.3 has deposited the said group insurance premium on behalf of deceased Sri.Gangarangaiah.  Sri. Gangarangaiah died on 21/06/2010 in a Road Traffic Accident near Thilakpark Police Station and the FIR was lodged in Crime No.218/2010 dated 21/06/2010 and the death was mentioned in the FIR, complaint and P.M. report.

          The complainant submitted that after the death of Sri.Gangarangaiah, late Gangarangaiah’s wife Smt.Venkatamma the 2^nd complainant had given a requisition to Gubbi Tahasildar to give succession certificate.  The Tahasildar, Gubbi had issued an endorsement dated 04/08/2010 stating to get succession certificate from Civil Court as there was dispute regarding the successors.  Thereafter the complainants had filed a suit against the Akkayamma, Nagamma and Leelavati in O.S.No.107/2011 before the Civil Judge, Gubbi for declaring them as legal heirs of late Gangarangaiah.  After due adjudication the Hon’ble Court has passed its judgment and decree by declaring that the complainants are the legal heirs of the deceased Sri. Gangarangaiah.  In the meanwhile the Superintendent of Police had issued a notice to the PSI,  Thilakpark Police Station, Tumkur on 25/06/2010  and 16/09/2011 to submit the documents pertaining to late Sri. Gangarangaiah to settle the claim to the beneficiaries due to death of  late Sri. Gangarangaiah.  On 18/11/2010 the 2^nd complainant had given a letter to the S.P.Tumkur stating her inability to produce succession certificate well in time due to the fact that some persons by name Akkayamma, Nagamma and Neela who are strangers to the family of the complainant and also the deceased Late Sri. Gangarangaiah had filed the suit in O.S.No.8743/2011 on the file of Prl.Civil Judge and JMFC, Tumkur against the complainants Nos. 2 to 5 and S.P. Tumkur for declaration and such other relief with regard to death claim of Late.Gangarangaiah.  The suit was dismissed on 13/03/2013 for non-prosecution.

          The complainant further submitted that she has submitted all the documents to the OPS’ office through letter dated:11/09/2012, but the OPS have repudiated the claim through its letter dated 17^th September 2012 addressed to the Superintendent of Police, Tumkur District and the same letter was sent to 2^nd complainant for information. 

          The complainant further submitted that there was real delay in submitting documents as required by the OP Nos. 1 & 2 due to that litigation was pending for declaration of legal heirs of the deceased Sri.Gangarangaiah and it was a bona-fide delay in submitting the required documents.  The delay in submitting the documents was due to unavoidable circumstances and further the delay in submitting the required documents that too the very important documents regarding legal heirs of deceased Gangarangaiah was beyond the control of the complainants as there were two civil litigations pending for disposal.

          The complainant further submitted the Insurance Regulatory and Development Authority had also issued a circular in Ref:IRDA/HLTH/MISC/CIR/216/09/2011 Dated:20.09.2011 with reference to delay in claim intimation/documents submission with respect to all life insurance contracts and all non life individual and group insurance contracts, wherein it has been clearly stated guidelines to insurance companies in settling delayed genuine claims without rejecting claims on technical grounds in a mechanical fashion.

          The complainant further submitted that the OP Nos. 1 & 2 had repudiated the death claim without following the IRDA circular and further the OP Nos. 1 & 2 finally repudiated the claim of the complainant dated 27^th February 2013.  This was intimated to the complainants by the S.P.Office, Tumkur.  Hence, the complainant filed this complaint.

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3.       After service of notice,  the OPS Nos. 1 & 2 and OP No.3 appeared through counsel and filed separate version.  In the version, the OP Nos. 1 & 2 submitted that after the death of the deceased Sri.Gangarangaiah, the complainants have not informed the death of Sri.Gangarangaiah to the OP Nos. 1 & 2.   The OP Nos. 1 & 2 have no knowledge with regard to the death of Sri.Gangarangaiah.  The OP Nos. 1 & 2 further submitted that Sri.Gangarangaiah has died leaving behind the complainant as his legal heir is not known to them as the complainant did not appear before the OP Nos. 1 & 2 and the complainant has not produced any legal heir certificate. 

          The OP Nos. 1 &2 denied the averments stated in Para Nos.5, 6 and 7 of the complaint as the transaction took place between the Superintendent of Police and the complainant and this was not known to the OPS and this was only between the complainant and the OP No.3 and not with OP Nos.1 & 2.  The OP Nos. 1 & 2 further submitted that the complainants did not approach OP Nos. 1 & 2 personally nor through S.P. Office i.e., OP No.3 and that the complainant has not approached the proper court to get succession certificate as per the advice of Thasildar, Gubbi.  Hence, there is no fault of OP Nos. 1 & 2.   

          The OP Nos. 1 & 2 further submitted that as stated in Para-11 of the complaint that on 17/09/2013 and 27/02/2013 the Divisional Manager issued letters to the Superintendent of Police, Tumkur that the AGIC policy claim was repudiated as per the terms and conditions.  Hence, there was no fault on the side of OP Nos. 1 & 2 and the complainants themselves are responsible for repudiating their claim and it is the responsibility of the complainant to intimate the death of the policy holder immediately after the death of policy holder, but after lapse of two and half years, the complainant has approached the OP Nos. 1 & 2 through their officer.

          The OP Nos. 1 & 2 further submitted that the complainant did not approach the OP Nos. 1 & 2 immediately or within one month from the date of death of the deceased Sri.Gangarangaiah as stated in the policy terms and conditions as such the OP Nos. 1 & 2 are not liable to pay any compensation or the complainants are not entitled for any benefits as per the terms and conditions of the policy.  Further, the OP Nos. 1 & 2 have denied all other allegations made against them as false and thereby prays to dismiss the complaint with exemplary costs.

          The OP No.3 in his version submitted that late Sri.Gangarangaiah was an Employee of the OP No.3 Department as Head Constable in No.CHC-54 and he had died on 21.06.2010 in a road traffic accident while he was on duty.   The deceased Sri.Gangarangaiah was a member of the Group insurance policy under OP Nos . 1 & 2 and the complainants are the legal heirs and nominees of the said group insurance policy and other benefits. 

          The OP No.3 further submitted that after the death of Sri.Gangarangaiah there were many letter correspondences between the complainants and the OP No.3 Department and there was a letter correspondence between the complainants dated 25/06/2010 to submit the relevant documents to the OP No.3 Department to submit the same to OP Nos . 1 & 2 for settlement of claim, but the complainant submitted their inability to submit relevant documents. 

          The OP No.3 further submitted that again on 07/12/2010 and 16/09/2011 there were letter correspondences between OP No.3 and complainant regarding submitting of documents and the complainant on 10/05/2012 submitted their documents to the OP No.3 office and in turn the OP No.3 on 11/09/2012 submitted the said documents to the OP No.2 to settle the claim of complainants, but the OP Nos. 1 & 2 repudiated the claim of the complainants on 17^th September 2012.  Again on 19/02/2013 the OP No.3 has issued a final letter to the OP Nos. 1 & 2 to settle the claim of the complainants, but the OPS have replied on 27^th February 2013 repudiating the claim of the complainants by giving same reasons as given in letter dated 17/02/2012.

          The OP No.3 further submitted that the claim of the complainants is genuine and legal and the reasons assigned by complainants are true and correct and even though the complainants have submitted the documents to receive the death claim of Late. Gangarangaiah at belated state, the delay was not intentional one, but intentionally the OPS 1 & 2 have been dodging to settle the claim of complainants by taking baseless and illegal contentions on the ground of delay intimation of death of Sri.Gangarangaiah and delayed submission of documents.

          The OP No.3 further submitted that the OP Nos. 1 & 2 are the only persons who are liable to settle the claim of the complainants as deceased Gangarangaiah was also one of the member of Group insurance policy taken by this OP from OP Nos. 1&2 and hence the matter may kindly be adjudicated in favour of complainants.     

4.  Both parties have filed their affidavit evidence. The complainant marked the documents at Ex.C1 to C21.  The OPS have not marked the documents though produced.  Heard the arguments and then posted the case for orders.

5.       Based on the above materials, the following issues will arise for our consideration.

1. Whether there was deficiency in service on the part of the OPS as alleged by the complainant?

2. Whether the complainants are entitled for the death claim benefits of late Sri.Gangarangaiah?

3. What Order?   

6.       Our answer to the above issues are as under:-

Issue No (1)          :        In the Affirmative

Issue No (2)          :        In the Affirmative

Issue No (3)                    :        As per final order below

                          :-REASONS:-

Issue Nos. (1) & (2):-

7.       On perusal of pleadings, evidence and documents it is an admitted fact that late Sri.Gangarangaiah had died on 21/06/2010 in Road Traffic Accident while he was in duty and the FIR lodged in crime No.218/2010 dated 21/06/2010 and the death was clearly mentioned in FIR, Complaint and P.M. report.

8.       Admittedly the OP No.3/Department introduced Group Insurance Policy for all its Employees.  After the death of Sri.Gangarangaiah, their legal heirs approached OP No.3 to avail the benefits of the policy.   The OP No.3 had directed the Lrs of the complainants to obtain succession certificate.  The Lrs of the deceased/complainants were constrained to file the case before the Court to obtain succession certificate.  Accordingly, they have filed the case before the Civil Judge, Gubbi in O.S.No.107/2011.  Thereafter the Lrs of the deceased/complainants had obtained succession certificate and approached the OP No.3 for benefits of Group Insurance Scheme.  Thereafter the OP No.3 forwarded the same to the OP Nos. 1 & 2.  The OP Nos. 1 & 2 have repudiated the claim of the Lrs of the deceased/complainants on the ground that it is barred by limitation since an outer limit of 30 days has been given to approach their claim.

9.       There is a bona-fide delay for the Lrs of the deceased in submitting required documents within the period of 30 days.  Thereafter the action of OP No.1 in rejecting the claim of the complainants on the ground that it is barred by limitation and that pre requisite limitation i.e., 30 days has elapsed does not hold any water since the Lrs of deceased approached the Competent Court for enforcement of their right, this action of the OP Nos. 1 & 2 in rejecting the claim of the complainant only arbitrary and capricious. 

10.     Further, the Lrs of the deceased filed a case and awaiting orders from the Civil Court and the same does not preclude them nor barred from obtaining claim over the insurance benefits.  The delay caused for obtaining succession certificate is neither intentional nor deliberate.  The complainants were before the Civil Court to obtain the same.  The same is only a curable defect and the same does not preclude or bar the complainants from claiming the death benefits to the deceased family.  The action of the OP Nos. 1 & 2 in rejecting the claim of the complainants is wholly untenable and arbitrary.  Moreover, there is clear evidence of death on account of accident of a person covered by the insurance.  The legitimate claim of the nominee or heirs cannot be defeated on the sole ground of delay in submission of claim, more-so when the death by accident is not disputed.

11.     Further, the complainants also produced the circular issued by the Insurance Regulatory and Development Authority dated 20/09/2011/Ex.C20.   In the circular, it is clearly mentioned as under:-

“The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting vari9ous post acclaim activities like investigation, loss assessment provisioning, claim settlement etc.  However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances”.    

12.     Hence, on the above grounds and the circular issued by the Insurance Regulatory and Development Authority, the OP Nos. 1 & 2 have committed deficiency of service as the OP Nos. 1 & 2 have not released the amount towards the death claim of the deceased Sri.Gangarangaiah.  Accordingly, we answer the point No.1 in the Affirmative.

Issue No.(3):-

13.     In the result, the OP Nos. 1 & 2 are liable to pay Rs.3,00,000/- along with interest at the rate of  9% P.A. from the date of repudiation i.e., 27/02/2013 to till realization.  Further, the complainant claimed Rs.2,00,000/- towards damages.  Of-course, due to delay in releasing the death claim of  late Sri. Gangarangaiah, the complainants have suffered mental agony.  Hence, it is just and proper to direct the OP Nos. 1 & 2 to pay Rs.10,000/- towards compensation.  Further, the complainants are also entitled for the cost of  Rs.5,000/- as the complainants approached this Forum to redress their grievance purely on the deficiency of service on the part of OP Nos. 1 & 2.  Further, the case against OP No.3 is dismissed as the OP No.3 is only the Competent Authority who made the policies for their employees with OP Nos. 1 & 2 and OP No.3 has made its sincere efforts to get the benefits of death of claim to the complainants.  Hence, the case against OP No.3 is dismissed.  Accordingly, we proceed to pass the following:-     

:- ORDER:-

1. The complaint filed by the complainants is allowed in part.
2. The OP Nos. 1 & 2 are directed to pay Rs.3,00,000/- (Rs. Three Lakhs Only) to the complainants together with interest @ 9% P.A. from the date of repudiation i.e., 27/02/2013 to till realization.
3. The OP Nos. 1 & 2 are further directed to pay Rs.10,000/- (Rs.Ten Thousand only) to the complainants towards compensation/damages.
4. The OP Nos. 1 & 2 further directed to pay Rs.5,000/- (Rs.Five Thousand only) to the complainants towards litigation costs. 
5. Communicate the order to the parties.   

 (Dictated to the stenographer, transcribed and typed by him, then corrected and pronounced in the open Forum on this the 12^th Day of JULY 2016).

LADY MEMBER                    MEMBER                       PRESIDENT