BEFORE THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI

Dated this the 30th day of July, 2009

Present:

SRI.LAIJU RAMAKRISHNAN PRESIDENT

SMT.SHEELA JACOB MEMBER

SMT.BINDU SOMAN MEMBER

C.C No.161/2008

Between

Complainants : 1. Kanakamma W/o Sreedharan,

Sheebhasadanam,

Nariyanpara P.O, Idukki District.

2. Shajukumar K.S. S/o K.K.Sreedharan

Sheebhasadanam,

Nariyanpara P.O, Idukki District.

3. Shibu S, S/o K.K. Sreedharan,

Sheebhasadanam,

Nariyanpara P.O, Idukki District.

4. Sheeba K.S. D/o K.K.Sreedharan,

Sheebhasadanam,

Nariyanpara P.O, Idukki District.

(Both By Adv: P.R. Muraleedharan)

And

Opposite Parties : 1. The Manager,

United India Insurance Company Ltd.,

Building Beach Road, Kollam.

(By Adv: Lakshmanan T.J.)

2. The General Manager,

Kerala Kaumudi,

Thiruvananthapuram.

3. The Unit Manager,

Kerala Kaumudi, Kottayam.

(Both By Advs: Nisar A, Beena M &

Shiji Joseph)

O R D E R

SRI.LAIJU RAMAKRISHNAN(PRESIDENT)

The petition is filed for getting the Insurance amount of the diseased husband of the 1st petitioner.

The husband of the 1st petitioner Mr.K.K.Sreedharan was expired on 26/08/2006 in a motor vehicle accident at K.K Road. The petitioners 2 to 4 are the children of the diseased. Late Mr. K.K. Sreedharan has joined in the insurance scheme on 08/08/2006 jointly conducted by the opposite parties. The policy period was from 11/08/2006 to 10/08/2007. The petitioners filed application for getting 1 lakh rupees as policy amount, to the 1st and 2nd opposite parties. But there was no response from the opposite parties. Hence the petitioners constrained to send a lawyers notice which was duly received by the opposite party. But no reply was given. Hence this petition is filed for getting the insurance amount.

2. As per written version of the 1st opposite party, they have granted an Accident Insurance coverage policy to M/s Kerala Kaumudi Private Limited and as per the said policy, the list of persons submitted by the Kerala Kaumudi were covered. The said Insurance Coverage was granted for the period from 03.10.2006 to 02.10.2007. The premium for the said insurance policy was collected by the Kerla Kaumudi directly from their members and the same was remitted before this opposite party in order to get the Insurance coverage. The Kerala Kaumudi remitted the Insurance Premium amount which is the consideration for the Insurance Coverage before the company only on 03.10.2006 and after getting the insurance premium amount from Kerala Kaumudi the insurance company granted the personal accident coverage from 03.10.2006 to 02.10.2007. This opposite party had granted the insurance coverage subject to the terms and conditions of the policy issued and it is a settled law that the parties to the insurance contract are bound by its terms and conditions. This opposite party had never granted any policy coverage to Late Mr.K.K. Sreedharan for the period from 11.08.2006 to 10.08.2007, and this opposite party had never issued any certificate No.400556 to the said Sreedharan as alleged in the complaint. This opposite party had granted the Insurance Policy in the name of Kerla Kaumudi Pvt.Ltd., and no other certificate other than the Insurance Policy was issued to the insured, hence the complaint herein is not having any cause of action against this opposite party. This opposite party had never received any amount directly from the diseased Sreedharan and the Insurance Company never issued any receipt to the diseased. In this case the Kerala Kaumudi collected the amount from their members and remitted the Insurance premium amount directly to the company only on 03.10.2006, and the coverage of the policy was commenced only from 03.10.2006. It is further submitted that this opposite party informed the Assistant Manager of Kerla Kaumudi Pvt. Ltd., regarding the non-admissible of the claim of Mr. Late. Sreedharan for the reason that the accident had taken place prior to the date of commencement of policy coverage and the insured M/s. Kerla Kaumudi is very well aware about the non-admissibility of the claim by the insurance company. Against the said non-admission of the claim, the insured (Kerla Kaumudi) had never raised any objection with the insurance company. There is no deficiency in service on their part as alleged in the complaint. The consideration (insurance premium) for the said insurance coverage was paid by the insured (Kerala Kaumudi) only on 03.10.2006 and the contract of insurance was commenced only from the said date. The claim of the 1st complaint is related to the death claim of her husband who died on 26.08.2006, in a road accident and on 26.08.2006 there was no valid insurance contract between the insured (Kerala Kaumudi) and the insurer (united India Insurance Co. Ltd) and thus the claim of the complaint clearly fall outside the scope of insurance policy.

3. The 2nd and 3rd opposite party also filed written version. It is admitted that the complaint is a subscriber of Kerala Kaumudi daily during the year 08.08.2006 to 10.08.2007. Sri.K.K. Sreedharan has joined the scheme on 08.08.2006 and as per the terms, his insurance cover will come into effect only from 11.08.2006. On the death of the applicant Sri. Sreedharan, the complaint has submitted the application and the same have been forwarded to the 1st opposite party by the 3rd and 2nd opposite parties with the relevant details. When the 2nd and 3rd opposite party receive any application for joining the scheme the same shall scrutinise by the 2nd and 3rd opposite parties and the list prepared shall sent to the 1st opposite party through online. The list of the applicant normally send to the 1st opposite party on a periodical basis. The amount of premium also send to the 1st opposite party by DD on consolidation of a lumpsum amount on periodical basis. The 1st opposite party is receiving the same accordingly. As per the agreement entered into the 1st opposite party and 2nd opposite party, the 1st opposite party agreed to accept a statement of details of the subscribers from the 2nd party and there shall not be direct transaction with the subscriber. Separate application forms on each and every subscriber shall be collected and retain by the 2nd opposite party. A completed proposal form and letter from the 2nd opposite party shall be the basis for insurance as per the norms applicable for group insurance. The amount required for effecting insurance of subscribers of the Kerala Kaumudi Daily collected by the 2nd party from their subscribers and paid to the 1st party. The amount collected from the subscribers will be remitted to the 1st opposite party by the 2nd opposite party after consolidating the amount as lumpsum and not each individual premium, the individual list will also be sent through E-mail on periodical basis. The list has been transferred through E-mail to the 1st opposite party. From the list sent from 03.08.2006 to 14.08.2006, the complainant's husband is a subscriber and his insurance period covered from 11.08.2006 to 10.08.2007. On receipt of the claim, the same has been forwarded to the 1st opposite party by the 2nd opposite party. After receipt of the same the 1st opposite party did not intimate anything to the 2nd opposite party about the denial of the claim. When the 2nd opposite party received the notice, they made an enquiry as to the claim to the 1st opposite party. But no sufficient reason has been stated by the 1st opposite party. The terms and conditions in the application form has been incorporated by the opposite parties jointly and parties are bound by the terms and conditions contained in the application form. For the consideration paid by the diseased Sreedharan these respondents had given adequate services as offered. The complainant does not disclose any deficiency in the service availed. As per the scheme, this Forum has no territorial jurisdiction to try this complaint. While joining the scheme, the complainant submitted jurisdiction at the courts at Trivandrum if any dispute arises. The Kerala Kaumudi daily and United India Insurance Company Ltd jointly declared the scheme and the insurance coverage given to the subscribers of Kerala Kaumudi daily as a welfare measure by the 2nd opposite party. The terms and conditions for the same has also been incorporated and published in the daily. The parties are bound by the terms and conditions incorporated in the application form. So there is absolutely no deficiency of service on the part of the 2nd and 3rd opposite parties.

4. The point for consideration is whether there was any deficiency in service on the part of the opposite parties, and if so, for what relief the complainant is entitled to?

5. The evidence consists of the oral testimony of PW1 and Exts.P1 to P7 marked on the side of the complainant and the oral testimony of DW1 and Exts.R1 to R10 marked on the side of the opposite parties.

6. The POINT:- The husband of the 1st petitioner was a regular subscriber of Kerala Kaumudi daily. He joined in the insurance scheme jointly conducted by opposite parties. Unfortunately the petitioner's husband died on 26.08.2006. But the claim was repudiated by the opposite party. The 3rd petitioner who is the son of the diseased K.K. Sreedharan was examined as PW1, he deposed that the diseased Sreedharan joined the insurance scheme through the agent of the 2nd opposite party named Mr. Satheesh M.S. The policy certificate was also issued by the agent as No.400556, which is marked as Ext.P1. Ext.P2 is the copy of the F.I.R from Peruvanthanam Police Station as Crime No.113/06 for the death of the father of PW1. The petitioner filed application for getting claim on 06.09.2006. Claim form also submitted, but the claim was not given. So lawyers notice was issued to the opposite parties. Ext.P3 is the copy of the same. Even though it was duly served, no reply was given. Ext.P5(series) is the AD signed by OP1 to OP3. The chief manager of the 2nd opposite party was examined as DW1. DW1 deposed that there is Memorandum of Agreement with the 1st opposite party and 2nd opposite party for conducting the insurance scheme, which is marked as Ext.R1. The OP2 and OP3 are collecting the premium from their subscriber and the list of the applicants are sending to the 1st opposite party on a periodical basis. The amount of premium also sent to the 1st opposite party by Demand Draft on consolidation of a lumpsum amount on periodical basis. As per the Memorandum of Agreement created between the 1st and 2nd opposite party, the 1st opposite party agreed to accept a statement of details of the subscribers from the 2nd opposite party and there shall not be direct transaction with the subscriber. Seperate application forms of each and every subscriber shall be collected and retain by the 2nd opposite party. A completed proposal form and letter from the 2nd opposite party shall be basis for insurance as per the norms applicable for group insurance. The individual list will also be send through mail on periodical basis. From the list send from 03.08.2006 to 14.08.2006, the complainant's husband is a subscriber and his insurance period covered from 11.08.2006 to 10.08.2007. On receipt of the claim, the same has been forwarded to the 1st opposite party by 2nd opposite party. After that the 1st opposite party did not intimate anything to the 2nd opposite party. Ext.R4 is the application form for joining the insurance policy issued jointly by OP1 and OP2 and the computer print of the DD issued to the OP1 by OP2 for an amount of Rs.7,63,326/- from 01.04.2006 to 31.03.2007 is produced as Ext.R5.

7. As per written version of 1st opposite party, the insurance coverage was granted for the period from 03.10.2006 to 02.10.2007, the OP2 remitted the insurance premium only on 03.10.2006. So the coverage of the policy is only from 03.10.2006 to 02.10.2007. No such policy was issued to diseased Sreedharan from the period 11.08.2006 to 10.08.2007 and no Certificate as 400556 is issued. Repudiation letter from OP1 is Ext.R3 and the policy issued to the Kerala Kaumudi Private Ltd., is marked as Ext.R2.

8. Considering the evidence, Ext.R4 application form clearly states the conditions of policy in "Malayalam". The application is printed with the emblem of OP1 and OP2. OP1 and OP2 jointly issued the same. The 27th Condition states that " This is the Malayalam transaction of the terms and condition of the speical insurance policy of United India Insurance Company", 28th Condition states that "All the communication regarding the claim can be done through the Unit Officer of the United Insurance Company or through the Kollam Office of the United India Insurance Company". The 22nd condition is written as "The United India Insurance Company will examine the claim forms and the cheques would be given in the name of the nominees through Kerala Kaumudi". The telephone numbers of each district also written. Ext.P1 is the Insurance Certificate issued to the complainant. In Ext.P1 also the Emblem of the 1st and 2nd opposite party is affixed, which is dated 08.08.2006. There is no dispute regarding Ext.R4 by the 1st opposite party. It means that the Insurance Scheme was introduced jointly by OP1 and OP2. OP2 have already collected the premium amount and the receipt of the same was issued jointly. If the receipt was not issued jointly, what prevented the OP1 to take legal action against OP2 for distributing Ext.P1 receipt. The Ext.R4 alone shows the joint liability of OP1 and OP2. DW1 deposed that they have made advance payment to OP1 from the beginning of the insurance scheme and the periodical payments are also making by them. Taking DD for each premium will not be technically possible always. So periodical, consolidated payment is doing by them. Ext.R5 is the computer print of the amount of the consolidated payment from 01.04.2006 to 31.03.2007 which amounts to Rs.7,63,326/-. So the repudiation of the claim by OP1, because the premium was not paid to OP1 is not proper. It is the duty of OP1 to aware of the collection of premium and all the details at once because it is a joint Insurance Policy Scheme. Collecting premium from the poor public by giving all the assurance, High advertisement, and the receipt of the same is also given, then the claim is repudiated by OP1 by shifting the whole burden to OP2. It is a gross deficiency in the part of OP1 and OP2. The OP1 had issued policy in the name of Kerala Kaumudi, then it is also the duty of the OP2 to disburse the amount to the subscriber and realise the same from OP1. DW1 also admitted in the 13 page of his deposition that the premium collection and the policy is introduced by them, so they are liable to pay the same. In the Memorandum of Agreement made between the OP1 and OP2, which is Ext.R1 were it is clearly states that the OP1 and OP2 have jointly introduced Insurance policy scheme.

Hence the petition allowed. The OP1 and OP2 are directed to disburse the Insurance amount of Rs. 1 lakh to the petitioners with 12% interest from the date of this petition and Rs.2,000/- as cost of this petition within one month of receipt of a copy of this order.

Pronounced in the Open Forum on this the 30th day of July, 2009.

Sd/- SRI.LAIJU RAMAKRISHNAN(PRESIDENT)

Sd/-

SMT.SHEELA JACOB(MEMBER)

Sd/-

SMT.BINDU SOMAN(MEMBER)

APPENDIX

Depositions :

On the side of Complainant :

PW1 - S. Shibu

On the side of Opposite Parties :

DW1 - S. Sreekumar

Exhibits:

On the side of Complainant:

Ext.P1 - Policy Certificate dated 08.08.2006

Ext.P2 - Copy of F.I.R from Peruvanthanam Police Station

Ext.P3 - Copy of Lawyers Notice dated 20.06.2007

Ext.P4 - Postal Receipt

Ext.P5 - Postal Acknowledgement Card

Ext.P6 - Copy of letter dated 06.09.2006

Ext.P7 - Copy of Claim Form

On the side of Opposite Parties :

Ext.R1 - Copy of Agreement

Ext.R2 - Policy issued to the Kerala Kaumudi

Ext.R3 - Repudiation letter from the 1st opposite party

Ext.R4 - Application form

Ext.R5 - Computer print of the consolidated payment of Rs.7,63,326/-

Ext.R6 - Computer print of the amount of Rs.1,04,420/-

Ext.R7 series (1-5) - Application details stating a letter dated 26.02.2008

Ext.R8 series (1-5) - Details of Death claim

Ext.R9 series (1-5) - Details of Accident claim

Ext.R10 series (1- 4) - Payment details