Kerala

Kollam

CC/05/397

Sathyabhama,Mani Mandiram,Maruthamanpally,Other - Complainant(s)

Versus

The Divisional Manager,National Insurance Comp.,Ot - Opp.Party(s)

01 Nov 2008

ORDER


C.D.R.F. KOLLAM : CIVIL STATION - 691013
CONSUMER DISPUTES REDRESSAL FORUM ::: KOLLAM
consumer case(CC) No. CC/05/397

Sathyabhama,Mani Mandiram,Maruthamanpally,Other
M.Manoj, Mani Mandiram,Maruthamanpally,Pooyappally
...........Appellant(s)

Vs.

The Divisional Manager,National Insurance Comp.,Ot
Life India Educational and Charitable Trust,Chinnakkada
...........Respondent(s)


BEFORE:
1. K. VIJAYAKUMARAN : President 2. RAVI SUSHA : Member 3. VIJYAKUMAR. R : Member

Complainant(s)/Appellant(s):


OppositeParty/Respondent(s):


OppositeParty/Respondent(s):


OppositeParty/Respondent(s):




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ORDER

ADV. RAVI SUSHA, MEMBER. This is the complaint filed for realization of Rs.10.00.000/- with 12% interest being the Insurance claim. The averments in the complaint can be briefly summarized as follows: The first complainant is the widow and the 2nd complainant is the only son of Mr.S. Maheswaran, an Ex-serviceman who has succumbed to injuries on 28.8.2003 at Benzier Hospital, Kollam consequent to a road accident at Pooyappally on 15.8.2003.. On 25.7.2002 said Maheswaran had taken membership in the project in which the sum assured for the accidental insurance for Rs.5,00,000/- with Personal Accident Master Policy No.571000/42018110422 and Personal Accident No.NF 50919. On 30.7.2002 took another policy for Rs.3,00,000/- with personal Accident Master Policy No.571000/42018110422 and Personal Accident NO.NF-84452. He also took two other policies dated 31.7.2003 one for Rs.2,00,000/- with Personal Accident Master Policy No.571000/42018110422 and Personal Accident Serial No.84536. The 1st complainant is the nominee in all cases. The deceased had been paying all the premiums regularly as per the policy conditions till his death.As the legal heir the 1st complainant claimed the total policy amount of Rs.13,00,000/- to National Insurance Company through the 2nd opp.party. Even though at the first instance the insurance company denied to entertain the claim petition, later they agreed to pay three lakhs rupees. Since the complainants were having a rough ride in finance at that time due to expenses incurred for the treatment as well as the connected expenses incurred thereafter from the death of said Maheswaran, they were forced to give into the fake regulations made by the opp.parties and agreed to receive 3 lakhs rupees. On 2.9.2005 when the complainants approached the 1st opp.party for receiving the offered 3 lakh rupees they demanded to obtain a consent letter from the complainants, for which they had given the contents in writing to be included in it. The opp.parties have no right or authority to withheld to pay the balance 10 lakhs rupees to the complainants. As such the opp.parties are liable to pay 10 lakhs rupees to the complainants and the complainants are entitled to get such amount as per policy conditions. Hence the complaint. The first opp.party filed a version contending as follows: The complaint is not maintainable either in law or on facts. The claim of the complainants have been already settled by the 1st opp.party towards full and final settlement of the claim on the basis of the discharge voucher duly signed by the complainants. The complainants have further executed notarized consent letter expressing their willingness to accept a sum of Rs.3,00,000/- towards fill and final settlement of the sum insured eligible to them under various insurance policies obtained by the deceased S. Maheswaran from Life India Charitable Trust, Muvattupuzha, the 2nd opp.party in this case. The complainants after having received the insurance amount by way of full and final settlement is barred from raising a dispute against this opp.party attributing any kind of deficiency in service in the settlement so arrived in this matter under the provisions of the Consumer Protection Act. As per the definite and concluded contract entered in between the opp.parties 1 and 2 the maximum sum assured under one or all policies for any one accident of the certificate holder is limited to Rs.3,00,000/- in the case of death. It is submitted that the terms and conditions incorporated in the master policy agreement is the governing factor which determines the rights and liabilities of the contracting parties and as well as that of the certificate holders under the scheme. In the exemption clause in 3,2,3 and clause 9 of the master policy agreement, it has categorically made clear that the liability of the 1st opp.party under one or all certificates issued to any individual member/depositor under this master policy shall be limited to Rs.3,00,000/- only. The complainants have no manner of cause of action against this opp.party since there is no deficiency in the service performed by this opp.party in deciding the claim lodged by the complainants. Hence the opp.party prays to dismiss the complaint. The 2nd opp.party filed a separate version as follows: The 2nd opp.party admits that the 2nd opp.party insured the complainant with the company. The role played by the 2nd opp.party in this context is only insured the complainant with the company as per the terms and conditions stipulated in the application from as well as in the membership certificate. The privity of contract is only with the National Insurance Company Ltd, Divisional Office, Aluva It is conspicuously recited at the overlead of the application form as well as in the membership certificate members standard mediclaim policy and Janatha Personal Accident Policy of the company and the Trust shall not be responsible for any denial/delay on the claim settlement. The complainant has no cause of action against the 2nd opp.party. The 2nd opp.party has no way liable and responsible to compensate the complainant as the 2nd opp.party has never undertaken to indemnify the complainant and the second opp.party has never entered into any such contract or agreement with the complainant. If the complainant is found entitled for any amount as compensation that may be recovered from the first opp.party after adjudication of the matters in issue. In such a way that the 2nd opp.party has not committed any deficiency in service to the complainant. Hence the 2nd opp.party prays to dismiss the complaint. Points that would arise for consideration are: 1. Whether there is deficiency in service on the part of the opp.parties 2. Reliefs and costs For the complainant PW.1 is examined. Ext.P1 to P7 are marked. For the opp.parties DW.1 is examined. Ext. D1. to D7 are marked. Points 1 and 2 It is not disputed that the deceased had taken Ext.P5 series Policies The submission of the learned counsel for the complainant was that there was no dispute that the deceased had taken Ext.P5 series policies and the total policy value amounts to Rs.13,00,000/- to be received from the 1st opp.party. After the death of the deceased the applicants are in a steigent financial condition. Hence they forced to execute the consent letter as directed by the 1st opp.party and received Rs.3,00,000/- . According to the complainant the 1st opp.party has no right to deny to pay the balance assured sum ie.Rs. 10,00,000/-. Therefore they are entitled to this amount with interest from the 1st opp.party. On the other hand the sub mission of the learned counsel for the 1st opp.party was that since the complainants have accepted the amount to the tune of Rs.3,00,000/- in full and final settlement of theirs claim, they are not entitled to take up the matter again. It was laid down by the Hon’ble Supreme Court in a case that the complainant has to prove fraud or undue influence or misrepresentation at the time of executing the voucher by him in full and final settlement of his claim by the claimant. In this case, the fraud and mis representation are not alleged by the complainants but their submission was that they were forced to execute the consent letter as directed by the 1st opp.party. However there is no evidence to that effect. Even if the complainants were forced to execute Ext. D5, they could have accepted the payment under protest. But no such words were written by them above her signature at the time of executing Ext. D6 receipt. Therefore after accepting the full and final payment of their claim, the complainants have no right to allege any deficiency in service on the part of the 1st opp.party. Moreover in exceptions 3.23 of Ext. D1 it has made clear that the overall sum assured of any one member under all such accident policies is limited to Rs.3,00,000/- only. In clause 9 of Ext.D1 also, it is laid down that the maximum sum assured under one or all policies issued to any individual member shall be limited to Rs.3,00,000/-. Hence as per Ext.D1 the liability of the 1st opp.party is limited to Rs.3,00,000/- and the 1st opp.party paid that much amounts to the complainant and the complainant accepted that amount without any protest. So we are of the view that there is no deficiency in service on the part of the 1st opp.party. With regard to 2nd opp.party, the complainant have not sought any relief from 2nd opp.party. In the result the complaint is dismissed. No costs. Dated this the 1ST day November, 2008 List of witnesses for the complainant PW.1. - Sathyabhama List of documents for the complainant P1. – FIR P2. – Vehicle Mahazer P3. – Wound Certificate P4. – Death Certificate P5. – Copy of Policy certificate P6. – Postmortem certificate P7. – Agreement List of witnesses for the opp.parties DW.1. – Michle Antony List of documents for the opp.parties D1. – Policy agreement D2. - Application form D3. – Specimen certificate D4. – Specimen application D5. – Affidavit D6. – Original receipt D7. – Letter sent by Life India to the Divisional Manager National Insurance Co.




......................K. VIJAYAKUMARAN : President
......................RAVI SUSHA : Member
......................VIJYAKUMAR. R : Member