This C.C. is coming on before us for final hearing in the presence of Sri V.Srinivas, Advocate for complainant and of Sri G.Sita Rama Rao, Advocate for opposite party No.1, Sri G.Hareender Reddy, Advocate for opposite party No.2; notice of opposite party No.3 served and called absent; upon hearing the arguments and upon perusing the material papers on record; this Forum passed the following:
ORDER
(Per Sri.R.Kiran Kumar, Member)
1. This complaint is filed u/s.12-A of Consumer Protection Act, 1986. The averments made in the complaint are that the husband of the complainant by name K.Satyanarayana during his life time has taken group personal accident policy from opposite party No.1 through opposite parties No.2 and 3 vide policy No.RCN0000131, TR.No.2812724, which is valid for 60 months from the date of enrolment i.e. from 25-8-2006, by paying Rs.3,750/- in which the complainant shown as nominee as she is being the wife of K.Satyanarayana. The husband of the complainant died on 25-3-2008. The complainant had submitted all necessary documents to opposite party No.1 through opposite party No.2 and requested for payment of insurance amount of Rs.50,000/-. The complainant made several representations to the opposite party No.1, the opposite party No.1 not paid the sum assured, the complainant had issued a legal notice on 23.7.2009 to opposite parties No.1 and 2. The opposite party No.2 got issued reply stating that they are only an intermediary who will arrange for insurance coverage and forward the documents received from the clients, as and when they raise a claim and they failed to pay the policy amount, as the opposite parties committed deficiency of service towards the complainant, as such the complainant approached the forum for redressal.
On behalf of the complainant, the following documents were filed and marked as Exs.A.1 to A.10.
Ex.A.1 - Photocopy of Membership certificate issued by opposite party
No.2, dt.25-8-06
Ex.A.2 - Photocopy of Certificate of insurance issued by opposite party
No.1 from 29-9-2007 to 28-9-2008.
Ex.A.3 - Photocopy of letter submitted by the complainant to the opposite
party No.2, dt.2-6-2008
Ex.A.4 - Photocopy of Medical certificate issued by Dr.S.Venkateswara
Rao, Rohini Nursing Home, Thallada, dt.2-4-2008
Ex.A.5 - Photocopy of Death certificate issued by Tahasildar, Kalluru,
dt.17-4-2008.
Ex.A.6 - Photocopy of Electoral identity card of the complainant
Ex.A.7 - Photocopy of Household card, issued by Dy.M.R.O., Kalluru
Ex.A.8 - office copy of Legal notice, dt.21-7-2009
Ex.A.9 - Reply given by opposite party No.2 to counsel for complainant,
dt.30-7-2009.
Ex.A.10 - Postal receipts (Nos.2), dt.24-7-2009 and acknowledgment card.
On receipt of the notice, opposite parties No.1 and 2 appeared through their counsel and filed counter. In the counter, opposite party No.1 denied the entire allegations about the transactions between the complainant and opposite party No.1. And submitted that the alleged policy number mentioned by the complainant in the complaint not tallied with the series of policies issued by opposite party No.1, as such they are no way concerned with the alleged policies, and also submitted that the husband of the complainant by suppressing the facts about his health condition, obtained the policy with malafide intention to get wrongful gain from the opposite party No.1, the opposite party No.2 without verifying the health condition of the insured and without making minimum enquiries got entered and got obtained the policies from opposite party No.1. And further submitted that as per the death certificate the insured died due to severe heart attack, clearly shows the insured was suffering from ill health by the date of obtaining policy, but did not inform the same to insurance company, the complainant wantonly did not mention about the cause of death of the insured, only with a malafide intention to get wrongful gain from the opposite party No.1, as such prayed to dismiss the complaint. And further submitted that the opposite party No.1 did not receive any claim form or intimation from the complainant, as such deficiency of service on the part of opposite party No.1 does not arise, hence prayed to dismiss the complaint.
In the counter opposite party No.2 admitted the issuance of insurance policy to the husband of the complainant, i.e. K.Satyanarayana as the member of Road safety club with certificate T.R.No.2812724 for the purpose of insurance cover and has been given a membership card for a period of 60 months and they are coordinating with the opposite party No.1 for providing policies to the members, the policy provided by opposite party No.1 for the period in which the deceased died and they are nothing to do with the claim of the complainant and also submitted that the opposite party No.2 received letter from area office and the same was forwarded to opposite party No.1 insurance company on 4-8-2008 and on 16-8-2008 along with all the documents which were furnished by the complainant and further submitted that as per the terms and conditions laid down in the membership certificate, the complainant without utilizing the arbitration clause, straight way approached the forum which is not maintainable as per the provisions of Arbitration and Conciliation Act 1996. and it is clearly manifested from the terms and conditions that any dispute in relation to this will be subject to jurisdiction of Chennai courts only, as such the Forum has no jurisdiction to entertain the complaint under Section 12 of C.P.Act, 1986. The opposite party further submitted that the complainant is not a consumer as defined under section 2(d) of Consumer Protection Act, 1986 and also specifically submitted that there is no deficiency of service on the opposite party No.2 and prayed to dismiss the complaint.
On behalf of the opposite party No.2, the following documents were filed and marked as Exs.B.1 to B.3
Ex.B.1 - Photocopy of certificate of insurance issued by
opposite party No.2,
Ex.B.2 - Photocopy of letter addressed by opposite party No.2 to
opposite party No.1, dt.4-8-2008
Ex.B.3 - Photocopy of letter addressed by opposite party No.2 to
opposite party No.1, dt.16-6-2008
On behalf of the complainant and opposite party No.1, written arguments filed.
Upon perusing the material papers on record, now the points that arose for consideration are,
1) Whether the complainant is a consumer within the meaning of Consumer Protect Act?
2) Whether the Forum has jurisdiction to entertain the case?
3) To What relief?
POINT NO.1:
In this case husband of the complainant was a member of opposite party No.2 and he has taken group insurance policy from opposite party No.1, through opposite party No.2 for the sum assured at Rs.50,000/-. The husband of the complainant No.1 died on 25-3-2008 and the complainant has submitted all the necessary documents through opposite party No.2 and made several representations to opposite party No.1 for the claim amount. On 23/7/2009 complainant got issued a legal notice.
All the above facts were admitted by opposite party No.2 and in the counter they taken objection that the complainant does not come under the meaning of the consumer and as such the complaint is not maintainable.
That as per the complainant and perusing all the documents we observe that the complainant submitted claim form along with all the necessary documents through opposite party No.2 and requested for payment of claim amount, on 23/7/2009 got issued legal notice and even after filing of the complaint before the Forum the opposite party No.1 failed to take appropriate steps to settle the claim and also taken plea that the forum has no jurisdiction to entertain the complaint, as several complicated question of law and facts are involved, it is civil court which can only adjudicate the same are only to escape from their liability and drag on the matter.
In this case, the complainant is a consumer, as the husband of the complainant was utilizing the services of opposite party No.1 to insure his life by way of group insurance through opposite party No.2. The same was observed by the Hon’ble National Commission in “M/s Harsolia Motors Vs M/s National Insurance Company Ltd. (2005) CPJ 27 (NC) wherein the National Commission made a elaborative discussion with section (2)(o) that
“‘Service’ means service of any description which is made available to potential users and includes the provision of facilities in connection with banking, financing, insurance, transport, processing, supply of electrical or other energy, board or lodging or both, housing construction, entertainment, amusement or the purveying a news or other information (but dose not include the rendering of any service free of charge or under a contract of personal service)”.
From the aforesaid definitions it can be held that:
a) a person is a consumer who buys any goods for consideration and also include user of such goods;
b) who hires any services for consideration and includes beneficiary of such services;
From the above it is observed that the husband of the complainant is a consumer as such this point is answered accordingly in favour of the complainant.
POINT NO.2:
In para No.15 of the counter of opposite party No.2, taken plea that as per the terms and conditions that “any dispute in relation to this will be subject to jurisdiction of Chennai Courts only”, as such the Forum has no jurisdiction.
For the above point, IN “Mangalchand Pawan Kumar Vs Oriental Insurance Company Ltd and others” II (2010) (CPJ)118 (NC) the Hon’ble National Commission observed that section 11 (2)(C) which reads as follows:
“ The cause of action, wholly or in part, arises”.
The brief facts of the case are that the complainant purchased 152 bags of Khandsary from M/s Hina Sugar Industry, Bareilly, U.P. valued @ Rs.1,18,000/-. It was loaded on 07-03-2004 in a truck for delivery to its destination in Siliguri, West Bengal. The said consignment did not reach its destination at Siliguri and was looted in transit. The complainant had an ‘Open Marine Policy’ issued by the R1 Oriental Insurance Company, at Bareilly, U.P.. In this the Hon’ble National Commission observed that cause of action in part arose in Siliguri. It also needs to be appreciated that as per the catena of judgments of the Supreme Court and the Commission, it has been severally held that the interpretation of clauses of C.P. Act has to be done liberally in favour of the consumer. The husband of the complainant during his life time taken group policy from the opposite parties No.1 and 2 through opposite party No.3, Sk.Saleem, r/o.Sathupalli who is their agent and also the husband of the complainant died while he was on the way to Khammam to take treatment for heart attack. The cause of action in part which is arisen within the jurisdiction of the forum. As such this point is also answered in favour of the complainant.
Point No.3:
From the above it is observed that the complainant submitted claim form through opposite party No.2 even though she is an innocent, backward and uneducated woman, who is in shock because of death of her husband, she got issued legal notice and all the steps for getting the claim amount, the opposite party No.1 which is the Multi National Company and which is expected to maintain utmost standards in settling the claim failed to perform their part of obligation or repudiating the claim with reasons, filed counter stating jurisdiction point, not submitted the claim form, several complicated questions of law and facts are involved and civil courts can only adjudicate the matter is nothing but to drag on the matter and escape from liability. Opposite party No.1 failed to come forward to settle the matter even after filing all the documents before the Forum is nothing but deficiency of service of the opposite party No.1 as such this point is answered accordingly in favour of the complainant.
7. In the result, the complaint is allowed directing the opposite party No.1 to pay an amount of Rs.50,000/- (Rupees fifty thousand only) covered under the policy to the complainant, together with interest @ 9% p.a from the date of claim i.e.2/6/2008 (as per Ex.A.3), till the date of deposit and also directed to pay Rs.2000/- (Rupees two thousand only) towards cost of the litigation. The claim against opposite parties No.2 and 3 is dismissed, as they are proforma parties to these proceedings.
Dictated to the Steno, corrected and pronounced by us in the open forum on this 14th day of December, 2010.
PRESIDENT MEMBER MEMBER
DISTRICT CONSUMERS FORUM, KHAMMAM
APPENDIX OF EVIDENCE
Witnesses examined for complainant:
None
Witnesses examined for opposite party:
None
Exhibits marked for complainant:
Ex.A.1 - Photocopy of Membership certificate issued by opposite party No.2, dt.25-8-06
Ex.A.2 - Photocopy of Certificate of insurance issued by opposite party No.1 from 29-9-2007 to
28-9-2008.
Ex.A.3 - Photocopy of letter submitted by the complainant to the opposite party No.2,
dt.2-6-2008
Ex.A.4 - Photocopy of Medical certificate issued by Dr.S.Venkateswara Rao,
Rohini Nursing Home, Thallada, dt.2-4-2008
Ex.A.5 - Photocopy of Death certificate issued by Tahasildar, Kalluru, dt.17-4-2008.
Ex.A.6 - Photocopy of Electoral identity card of the complainant
Ex.A.7 - Photocopy of Household card, issued by Dy.M.R.O., Kalluru
Ex.A.8 - office copy of Legal notice, dt.21-7-2009
Ex.A.9 - Reply given by opposite party No.2 to counsel for complainant,
dt.30-7-2009.
Ex.A.10- Postal receipts (Nos.2), dt.24-7-2009 and acknowledgment card.
Exhibits marked for opposite party:
Ex.B.1 - Photocopy of certificate of insurance issued by opposite party No.2,
Ex.B.2 - Photocopy of letter addressed by opposite party No.2 to opposite party No.1,
dt.4-8-2008
Ex.B.3 - Photocopy of letter addressed by opposite party No.2 to
opposite party No.1, dt.16-6-2008
PRESIDENT MEMBER MEMBER
DISTRICT CONSUMERS FORUM, KHAMMAM
