BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM RAICHUR.
COMPLAINT NO. (DCFR) CC.No. 49/2013.
THIS IS THE 21st DAY OF NOVEMBER 2013
PRESENTS
1. Sri. Prakash Kumar, BA.LLB PRESIDENT.
2. Sri. Gururaj, B.Com. LLB. MEMBER.
3. Smt. Pratibharani hiremath BA.LLB (Sanskrit) MEMBER.
COMPLAINANT : Anjali D/o. Yellappa Nayak, age, 16
years, by minor guardian and next friend Smt. Earamma W/o. Somanath Nayak, Major, Occ: Household R/o. H.No. 1-5-15, Eshwar Nagar, IB Raichur.
RESPONDENTS : 1. The General Manager, Life Line Care
Ltd., Corporate Office, 3rd Rainbow House Opp: Deepak Hospital, Savedi Road, Ahmednagar- 414 003 (MS).
2. The Manager, National, Insurance Company Ltd., Upstair Building, Opp: Govindrao Petrol Bunk, Raichur.
Date of Institution : 12-08-2013.
Date of Disposal : 21-11-2013.
Complainant represented by Sri. M. Mallangouda, Advocate.
Respondent No-1 In person.
Respondent No-2 represented by Sri. Vishwanath Pattansetty, Advocate.
ORDER
By Sri. Prakash Kumar, President:-
The complaint is filed by the complaint against the Respondents U/sec. 12 of Consumer Protection Act 1986.
The complaint in brief is that, the complainant’s mother Vijaylaxmi insured her life with the 2nd Respondent’s Insurance Company under Janatha Personal Accident Policy wherein the assured sum was Rs.1,00,000/- which was valid from 05-07-2011 to 04-07-2015 and the complainant is the nominee under the said policy. As per the tie up between the Respondents’ the certificate of insurance was issued by the Respondent No-1. The insured Vijaylaxmi died on 18-05-2012 due to dog bite. After her death the Respondent No-1 was intimated about the same and was asked to settle the amount assured under the policy for which Respondent No-1 did not respond. Therefore the complaint seeking reliefs as prayed for.
2. The Respondent No-1 filed the written version stating that, the Life Line Life Care Ltd., is not the insurance company. It is the service giving agency in insurance in particular, registered with the Registrar of Companies. Government of India had launched insurance products such as Janatha Personal Accident Policy, personal accident policy etc., through GIC keeping in mind the poor in Rural Areas. But they could not reach out to them and thus huge potential was available to tap. With this idea through Life Line Life Care Ltd., it is decided to obtain insurance cover to those persons. For this purpose Life Line Life Care Ltd. facility cards were launched in the market. The accident insurance cover from GIC was an add on facility. Life Line Life Care Ltd., card was of different prices. The proposer used to purchase the card of his/her choice. As per the price of the card purchased an appropriate accident policy used to be issued. In the case in point they had obtained JPA policy from National Insurance Company Ltd., Ahmednagar. As the accident policy was obtained through Life Line Life Care Ltd., the claim was routed through Life Line Life Care Ltd., to National Insurance Company Ltd., It was a working arrangement only and policy pertains to National Insurance Company Ltd., which finally settles the claim as per the terms and conditions of the policy. As per the claim procedure the claimant has to send a claim intimation to Life Line Life Care Ltd.,/insurance company. On its receipt a blank form of the National Insurance Company is sent to the claimant with a request to submit the claim along with relevant documents/information and on receipt of the same the claim is submitted for consideration/settlement to National Insurance Company Ltd., Thereafter it is their sole legal liability to settle the claim. Life Line Life Care Ltd., does not have any authority to interfere in the decision. If any communication is received from that office Life Line Life Care Ltd., sends it to the claimant to ensure compliance of remarks raised by insurance company. Late Vijayalaxmi obtained JPA policy Life Line Life Care Ltd., received the claim from insurance company on 04-08-2012 and was sent on 06-08-2012. The claim in question was received on 08-05-2013 and it was processed and submitted to National Insurance Company Ltd., Ahmednagar. Since then Life Line Life Care Ltd., has not received any communication from Insurance Company so far. Life Line Life Care Ltd., cannot explain reasons for delay. Life Line Life Care Ltd., had taken prompt action in processing the claim and never caused delay. Hence there is no deficiency in service by Life Line Life Care Ltd.,.
3. The Respondent No-2 filed the written version stating that, contents of complaint are false and incorrect and against the facts of the case and the said contents are denied. The complainant has no locus standi to file the complaint. The said complaint is premature. The allegations made in Para-1 of the complaint is specifically denied. It is denied that the complainant is the daughter of Vijayalaxmi and is a minor under the care and custody of Eramma. The complainant’s claim form discloses that deceased life assured had dog bite on 10-02-2012 and date of admission in RIMS is 17-05-2012 and date of death was 18-05-2012. As per the inpatient record she was treated for the rabies. No ARV injection and TT injection was taken by her. This shows the deceased was negligent in taking treatment after the dog bite. As such claim is not maintainable under the exclusion clause of the terms and conditions of Respondent No-1’s policy clause 2(a) which denotes that there is intentional self injury, suicide. Therefore company is not liable to pay the amount. The allegations in the complaint that the policy was issued to the deceased is in dispute. Respondents are jointly and severally are liable to answer the claim of the complainant is specifically denied. The allegations made in para- 4 to 6 of the complaint are specifically denied. The allegations made in para-7 of the complaint are denied. The complainant has not sent the documents to Respondent No-1. As such processing of claim in the absence of the documents might have been pending. No documents are sent to policy issuing office and the status of the case is not known to the Respondent No-2. Hence the complaint is premature one. Therefore the question of deficiency in service on the part of the Respondent No-2 does not arise at all. The allegations made in para 9 of the complaint are specifically denied. Therefore the complaint be dismissed in the interest of justice.
4. Complainant to prove his case filed his affidavit which is marked as PW-1 and relied on seventeen documents which are marked as Ex.P-1 to Ex.P-17. The Respondent No-2 to prove his case filed his affidavit which is marked as RW-2 one document which is marked as RW-1.
5. Arguments heard on complainant’s side.
6. Written Argument filed by Respondent No-2.
7. The points that arise for our consideration are:
1. Whether the complainant proved deficiency in service on the
Part of the Respondents against her?
2. Whether the complainant is entitled for the reliefs prayed for?
3. What order?
8. Our answer on the above points are as under:
1) In the affirmative.
2) Partly in the affirmative.
3) As per final order:
REASONS
POINT No.1
9. The issuance of Janatha personal accident policy to the deceased life assured is admitted by both the Respondents. The death of insured due to dog bite is also admitted by both the Respondents. The Respondent No-1 being only a mediator between the insured and the insurer, the liability to pay the amount assured under the policy does not fall on the Respondent No-1. It is the insurance company i.e, Respondent No-2 who has to pay the amount assured under the policy if all the conditions of the insurance policy are met. However the insurance company i.e, Respondent No-2 repudiated the claim made by the complainant on the ground that, the death of the deceased life assured occurred due to her own negligence as per the exclusion clause No. 3(a). The said clause excluded that payment of compensation in respect of death, injury or disablement of the insured from intentional self injury, suicide or attempted suicide. The contention of the Respondent No-2 is that for the dog bite as the deceased life assured had not taken treatment at Government Hospital and had taken treatment only with the local doctor she died and thus her death was due to her own negligence and therefore they are not liable to be pay the amount assured under the policy. However this contention of Respondent No-2 cannot be accepted at all because dog bite cannot be considered as death due to intentional self injury or suicide. It was accidental one. The deceased life assured cannot be said to be negligent in not taking treatment at Government Hospital because as stated by the Respondent No-2 themselves she had taken treatment with a local doctor. Then how it can be said that she was negligent in not taking treatment for dog bite, cannot be understood. It is found that just to repudiate the claim of the complainant the Respondent No-2 insurance company invented a ground and then repudiated the claim which is unsustainable in law and it is the absolute misuse of powers by the insurance company which deprived the poor claimant from the money she was entitled which amounts to deficiency in service on the part of the Respondent No-2. Accordingly this point is answered in the affirmative as against Respondent No-2.
POINT .NO:2
10. Ex.P-1 certificate of insurance clearly mentioned that the complainant is the nominee under the certificate of insurance issued by Respondents. As the complainant has proved deficiency in service on the part of Respondent No-2 and as she has proved that she is entitled for the amount assured under the policy issued in favor of her deceased mother, she is entitled for that amount assured under the policy along with interest and cost of the proceedings as well as compensation for deficiency in service which shall be as per final order. Accordingly, we answer this Point partly in the affirmative.
ORDER
The complaint filed by the complainant is partly allowed with cost against Respondent No-2.
The complainant is entitled to recover of Rs.1,00,000/- from Respondent No-2.
The complainant is also entitled to recover interest at the rate of 6% p.a. on total sum of Rs.1,00,000/- from the date of the complaint till realization of the full amount.
The ordered amount shall be given to the complainant which shall be kept in FD in any Nationalized Bank till she attaining age of majority and thereafter the complainant entitled to receive the said amount from the bank.
The complaint filed by the complainant as against the Respondent No-1 is dismissed.
Respondent No-2 is given one month time from the date of this order for making payment of the above said amount with interest.
(Dictated to the Stenographer, typed corrected and then pronounced in the open court on 21-11-2013)
Smt. Pratibha Rani HIremath, Sri. Gururaj Sr. Prakash Kumar,
Member Member President.
District consumer forum, Raichur District consumer forum, Raichur District consumer forum, Raichur
