DISTRICT FORUM:: KADAPA Y.S.R DISTRICT
PRESENT SRI P.V. NAGESWARA RAO, M.A., LL.M., PRESIDENT
SRI S.A. KHADER BASHA, B.Sc., MEMBER.
SMT. K. SIREESHA, B.L., MEMBER
Tuesday, 31st August 2010
CONSUMER COMPLAINT No. 45 / 2010
R. Prabhavathi, W/o Late Ramakrishna,
aged about 32 years, H.No. 17/175, Ieeja-509127,
Mahaboobnagar district, Andhra Pradesh. ….. Complainant.
Vs.
1) Shriram DTH Pvt. Ltd., Rep. by its Manager,
O/o Shriram Chits Pvt. Ltd., Gandhi Raod,
Proddatur, Kadapa District.
2) Road Safety Club Pvt. Ltd., Rep. by its General Manager,
Administrative Office, 2A, II Floor, Prakasam Raoad,
T.Nagar, Chennai.
3) Bajaj Allianz Life Insurance Co. Ltd., Rep. by its
General manager, IV Floor, GE Plaza, Airport Road,
Yeerawada, Pune, Maharastra. ….. Respondents
This complaint coming on this day for final hearing on 25-8-2010 in the presence of Sri G. Trivikram Singh, Advocate for complainant and Sri G. S. Murthy, Advocate for R2, Sri D.V.S. Prasad, Advocate for R3 and R1 called absent and set exparte and upon perusing the material papers on record, the Forum made the following:-
O R D E R
(Per Sri P.V. Nageswara Rao, President),
1. Complaint filed under section 12 of the Consumer Protection Act 1986.
2. The brief facts of the complaint are as follows:- The husband of the complainant by name Rangu Ramakrishna had a membership with R2 through R1. As per terms and conditions of R2 one person could take 4 membership certificates at a time. At the instance of R1 the complainant’s husband obtained 4 AMS Life cards from R2 by paying Rs. 3,300/- for each membership certificate. The date of enrolment of all certificates was 10-2-2007. The certificates were 1) certificate No. 199200 and T.R. No. 2905069, 2) certificate No. 199199 and T.R. No. 2905067, 3) certificate No. 199206 and T.R. No. 3190916 and 4) certificate No. 199197 and T.R. No. 2675406. The R2 had tie-up with R3 in providing life insurance to the membership certificate holders for Rs. 50,000/-for each amount upto four certificates. The R2 had to make arrangements of getting Life Insurance and also General insurance to its members. The complainant’s husband also got life insurance coverage of Rs. 50,000/- for each certificate. He nominated his wife i.e. the complainant as his nominee / beneficiary to the policies. He did not receive life Insurance policies from R2. He was covered with Life Insurance from R3. It was acknowledged by R2. The policies might be in the custody of R2 or R3. In case of death of the holder of the certificates the R3 was liable to pay insurance amount to the nominee. On 10-7-2007 the complainant’s husband died due to ill health. Then the complainant as nominee made a claim for insurance amount with R2 and requested to settle the claim through R3. She submitted all original certificates and relevant documents to R1, who inturn submitted to R2. On 3-11-2008 the complainant received a communication from R2 that her claim was treated as closed as she failed to submit the relevant documents required by them. Even though the complainant submitted all required documents the R2 closed the matter unilaterally without any cause. It was only to avoid payment of Rs. 2,00,000/- to the complainant. It was negligent on the part of the Respondents. The complainant got issued a notice dt. 12-4-2009 to the Respondents to pay Rs. 2,00,000/- towards insurance amount. But R1 & R3 failed to give reply. The R2 sent a reply with false allegations. On 2-5-2009 that due to non – submission of relevant documents it was treated as closed. The complainant submitted death certificate and doctor certificate and other documents to R1 and R2. But without forwarding the same to R3, R1 & R2 came to conclusion that the claim was not admissible. On one hand the R2 had stated that they were only intermediary and help in settlement of claims and on the other hand the R2 concluded that the claim was not admissible. Therefore, the complaint was filed for Rs. 2,00,000/- under four policies i.e. T.R. Nos. 2905069, 2905067, 3190916 & 2675406 together with interest @ 24% p.a. from 10-7-2007 till the date of realization and Rs. 50,000/- towards mental agony and Rs. 2,000/- towards costs.
3. R1 was set exaparty on 13-7-2007.
4. R2 filed a counter that R2 was only an intermediary between the policy holder and insurance company (O.P.3). The allegation that the deceased Ramakrishna did not receive the Life Insurance policies from O.P. 2 was not correct and the O.P. 2 was not connected with the issuance of insurance policies and the policies would be issued O.P. No. 3. It was not correct that the policies might be under the custody of O.P. 2 or O.P. 3. It was not correct that the complainant made a claim with O.P. 2 and requested to settle the claim through O.P. 3 and that the complainant submitted all the original documents to O.P. 1, who inturn sent to O.P. 2. The complaint was silent on which date the claim was submitted to O.P. 2. The O.P. 2 addressed a letter dt. 01-2-2008 asking the complainant to submit the original death certificate, but she failed to submit the same. So another letter dt. 11-3-2008 was addressed to submit the certificate and as the required document was not submitted her claim was treated as closed. The O.P. 2 sent a reply dt. 2-5-2009 to the notice issued by the complainant dt. 12-5-2009. It was mentioned in reply notice that the O.P. 2 was only an intermediary and claim was not admissible as the required documentary evidence to substantiate the genuineness of the claim were not submitted and that the same was doubted and the claim was fraudulent one as many such claims were made by the same agent in the similar circumstances and that multiple policies were taken by the insured. The allegations that the complainant suspected the bonafides of O.P. 2 was not correct, because the O.P. 2 was only an intermediary and the policies had to be settled by O.P. 3. There was no necessity to avoid payment. The negligence was on the part of the complainant for not submitting required documents to settle the claim. The O.P. 2 was not a necessary party and not liable to pay the insured amount to the complainant.
5. In the terms and conditions of the Road Safety Club certificates it was mentioned that the member specifically acknowledged that the insurer would not be liable in any manner whatsoever, by virtue of any insurance coverage provided and that the company would be liable in case of any claim. The Member should not hold the insured responsible for any matter arising out of or in connection with the insurance coverage whether for or in respect of any deficiency or defect in such insurance coverage, recovery or payment of compensation, processing or settlement of claims or otherwise, however, all such matters should be addressed to and sorted out directly with the insurance company. The role of O.P. 2 was to bring awareness among the public with regard to AMS Life card and enable them to get insurance coverage from insurance company. Once the policies were issued the role of the O.P. 2 was completed and services of O.P. 2 was to the extent of arranging policies to its members.
6. The Insurance Company provided policy copy to the deceased Ramakrishna and so any dispute that arose would be sorted out by the insurance company. The dispute with regard to the settlement of claim had to be sorted out by O.P. 3. The O.P. 2 was not liable or responsible to pay any compensation. The remedy was only against the insurance company but not against O.P. 2. The O.P. 2 was not an insurance company. The insurance company issued certificates mentioning the name of each member though the O.P. 2 was “reflected as insured”. The Member acknowledged that the insurer would not be liable in any manner whatsoever, by virtue of insurance coverage provided and that the insurance company would be liable in case of any claim and that the member should not hold insurer responsible for any matter arising out of or in connection with such insurance coverage, whether for or any responsibility of any deficiency or defect in such insurance coverage, recovery or payment of compensation, to process or settlement of claims otherwise, however, all such matters should be addressed to and sorted out directly with the insurance company. The complainant had at liberty to seek reference of the dispute under Arbitration and Conciliation Act. The complainant was not a consumer under the C.P. Act. The forum had no jurisdiction and the jurisdiction was at Chennai only. There was no cause of action and there was no deficiency of service and negligence on the part of O.P. 2. Thus the complaint may be dismissed with costs.
7. R3 filed a counter that the complaint was not maintainable in view of territorial jurisdiction. The complainant belonged to Ieeja, Mahaboobnagar District. The R2 was at Chennai and R3 was at Pune. The complainant impleaded R1 to attract jurisdiction. In all the documents filed by the complainant, there was no involvement of R1 in the present complaint. The complaint was silent about the nature of transaction and relationship in between the deceased Ramakrishna and R1. The complainant had to prove that the R3 issued policies in favour of deceased husband of the complainant through R1. The complaint was silent about policy issued by R3 and in its absence the claim could not be settled. The Head Office of R3 was at Pune, which could not settle the claim without mentioning of specific policy Nos. The four T.R. Nos. mentioned in the complaint were to be connected with R2. The entire transaction took place in between the complainant and R2 only and there was no correspondence with R3 both by the complainant or R2 and without making any correspondence with R3. The R3 had unilaterally declaimed the claim of the complainant vide letter dt. 11-3-2008 on the ground that the required document was not submitted in spite of their correspondence. The complainant had not filed any documents to show that the original documents were sent to R1. Issue of notice dt. 12-4-2009 was not sufficient unless and until an acknowledgement slip was filed to show that the notice was served on the Respondent and in that notice the policy Nos. was not mentioned. But R2 sent reply to the notice mentioning that the claim was doubtful as fraudulent one, because many such claims were made by the same agent under similar circumstances and earlier there were also instances where claims preferred by the agent were proved to be fraudulent and the date of loss was close to the date of commencement of policy. The repudiation was not made by the R3. Therefore, there was no deficiency of service and the complaint may be dismissed with costs.
8. On the basis of the above pleadings the following points are settled for determination.
i. Whether there is any negligence and deficiency of service on the part of the Respondents?
ii. Whether the complainant is entitled to the relief as prayed for?
iii. To what relief?
9. On behalf of the complainant Ex. A1 to A24 were marked. The complainant filed written arguments also. No documents filed by the Respondents.
10. Point No. 1& 2. The complainant’s husband by name late Rangu Ramakrishna, took a membership with R2 through R1 and obtained four membership certificates from R2 called AMS Life cards on payment of Rs. 3,300/- for each membership certificate on 10-2-2007. All the four certificates were issued on 10-2-2007. They were 1) certificate No. 199200 and T.R No. 2905069, 2) certificate No. 199199 and T.R. No. 2905067, 3) certificate No. 199206 and T.R. No. 3190916 and 4) certificate No. 199197 and T.R. No. 2675406. The complainant filed Photostat copies of the said four certificates under Ex. A1 to A4. They were issued in the name of Rangu Ramakrishna, Ieeja village, Mahaboobnagar District. But nowhere in Ex. A1 to A4 the R1 had issued the four certificates. Ex. A1 to A4 were also silent that Shriram DTH Pvt. Ltd.,, Proddatur, Kadapa District had accepted the membership of R2 and the R2 had issued certificates through R1. In its absence and in the absence of any documentary evidence like the receipts issued by R1 for payment of Rs. 3,300/- under each certificate on 10-2-2007 it could be straight away said that the deceased Ramakrishna might have taken membership from R2 through some other branch of Shriram DTH Pvt. Ltd., and not from Proddatur branch, Kadapa District. On that ground the District forum had no jurisdiction. Ex. A1 to A4 were silent to whom the deceased Ramakrishna nominated to receive insurance amount from R2 insurance company.
11. It was alleged that the R2 had tie-up with R3 insurance company in providing Life insurance to the membership certificate holders to an extent of Rs. 50,000/- for each certificate upto four certificates. So the complainant claimed Rs. 2,00,000/- as insured amount under the said four certificates Ex. A1 to A4 from the date of death of Rama Krishna on 10-7-2007. The complainant filed Ex. A5 a Photostat copy of death certificate of Ramakrishna that he died on 10-7-2007 at Ieeja village, Mahaboobnagar District. Ex. A6 was Photostat copy of a medical certificate dt. 11-7-2007 issued by Dr. M. Ravi Kumar of Ieeja that Ramakrishna died on 10-7-2007 at his nursing home at Ieeja Village. Ex. A7 was dependent certificate issued by Tahsildar, Ieeja dt. 23-12-2009 stating that the complainant was the wife of the deceased Rangau Ramakrishna and they had two minor children. After the death of Ramakrishna the complainant made a claim to R2, who addressed a letter dt. 15-11-2007 requesting to submit the original policy, original doctor certificate attested photo identify card of the deceased and beneficiary. The letter was Ex. A8. On 26-12-2007 S.K.Y Retail Capital Limited addressed a letter to R2 claims department, Chennai that the customer sent the original bond to R2 and the policy was not received by R2 and the original physician certificate, attested ration card of the deceased and nominee were submitted to settle the claim. The Photostat copy of letter was Ex. A9. On 11-3-2008 the R2 addressed a letter to the complainant that the original documents had not been received and so the claim was treated as closed. The Photostat copy of letter was Ex. A10. Ex. A11 was copy of letter sent by the complainant to R2 sending the original death certificate of Ramakrishna and insurance policy to settle the claim. It was received by Shriram DTH Pvt. Ltd., Chennai on 27-2-2008. The complainant filed Ex. A16 house hold card issued at Ieeja Village, Mahaboobnagar District to the deceased Ramakrishna. She filed Ex. A17 transfer certificate from Z.P. High School, Ieeja Where Ramakrishna studied 10th class. Ex. A18 was bonafide certificate issued by Z.P. High School, Ieeja on 19-6-1985 to Ramakrishna. Atlast the complainant got issued a notice to R1 to R3 through advocate from Kadapa calling upon them to pay Rs. 2,00,000/-. The office copy of the notice was Ex. A12. The postal receipts were Ex. A13 and the postal acknowledgement cards from R1 & R2 were Ex. A14. Ex. A15 was letter from R2 addressed to the advocate for the complainant on 2-5-2009 stating that the claim was not admissible as there was no required documentary evidence to substantiate the genuineness of the claim. It was even doubted that the claim was fraudulent one as many such claims were made by the same agent under a similar circumstance. In all the claims preferred by the agent multiple policies were taken against same insured and the claims preferred earlier by the agent namely Mr. Pullaiah were proved to be fraudulent and the date of loss was close to the date of commencement of the policy.
12. The complainant filed Ex. A19 to A22 the insurance certificates issued by Reliance General Insurance Co. Ltd., Mumbai in favour of the deceased Rangu Ramakrishna. The R2 had tie-up with Reliance General Insurance Co. Ltd., in view of Ex. A19 and A22. On perusal of Ex. A19 to A22 the assignee was complainant as wife of the deceased. In Ex. A19 to A22 the T.R. No. / Insurance No. were shown at the bottom as Nos. 2905069, 2905067, 3190916 & 2675406 with certificate Nos. 199200, 199199, 199206 & 199197 respectively. The same Nos. were shown in the complaint as if the policies were issued by R3 Bajaj Allianz Life Insurance Co. Ltd., Pune. In fact the Reliance General Insurance Co. Ltd., Mumbai had issued the policies other than the policies referred in the complaint. The policy numbers would be different in case the policies would have been issued by R3. But in the present case the policy Nos. / T.R. Nos. shown in the complaint and the T.R. Nos. shown in Ex. A19 to A22 were one and same. Therefore, the complainant would have impleaded Reliance General Insurance Co. Ltd., Mumbai instead of Bajaj Allianz Life Insurance Co. Ltd., Pune. Even though the Ex. A19 to A22 were filed to show that the complainant was the nominee, the claim was not against Reliance General Insurance Co. Ltd., Mumbai. Ex. A23 was pamphlet issued by Sriram D.T.H. Pvt. Ltd., Chennai for AMS Life Card. Ex. A24 was another pamphlet issued by Shriram D.T.H Pvt. Ltd. Chennai. Thus in these circumstances there are no bonafidies in the complaint and the complainant failed to prove that she was the nominee of the deceased and also failed to prove that the Ex. A1 to A4 were issued by R2 through R1 from Proddatur Branch and the policies were issued by R3. The R1 was only impleaded to save the jurisdiction. In these circumstances there is no deficiency of service or negligence on the part of the Respondents. The R3 was unnecessarily impleaded and was not a necessary party in view of Ex. A19 to A22. The points are answered accordingly.
13. Point No. 3 In the result, the complaint is dismissed without costs.
Dictated to the Stenographer, transcribed by him, corrected and pronounced by us in the open forum, this the 31st August 2010
MEMBER MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses examined.
For Complainant NIL For Respondent : NIL
Exhibits marked for Complainant : -
Ex. A1 P/c of Membership certificate No. 199200 issued by R2.
Ex. A2 P/c of Membership certificate No. 199199 issued by R2.
Ex. A3 P/c of Membership certificate No. 199206 issued by R2.
Ex. A4 P/c of Membership certificate No. 199197 issued by R2.
Ex. A5 P/c of Death certificate issued by Tahsildar, Ieeja, dt. 22-8-2007.
Ex. A6 P/c of medical certificate issued by Dr. M. Ravi Kumar, Ieeja, dt. 11-7-07
Ex. A7 Dependent certificate issued by Tahsildar, Ieeja, dt. 23-12-2009.
Ex. A8 Letter from R2 to complainant, dt. 15-11-2007.
Ex. A9 Letter to R2 Claims Department, Chennai, dt. 26-12-2007.
Ex. A10 P/c of letter from R2 to complainant, dt. 11-3-2008.
Ex. A11 Letter from complainant to R2.
Ex. A12 Office copy of Legal notice from complainant’s advocate to Respondents,
dt. 12-4-2009.
Ex. A13 Three postal receipt Nos. 5724, 5169 & 5170.
Ex. A14 Two postal acknowledgment cards.
Ex. A15 Letter from R2 to complainant, dt. 2-5-2009.
Ex. A16 House hold card of the deceased Ramakrishna and family.
Ex. A17 Transfer certificate No. 237136 of R. Ramakrishna.
Ex. A18 Bonafide certificate issued by Head Master, Z.P.H.S. (B) Ieeja, dt.19-6-85.
Ex. A19 Certificate of insurance No. AF3/PB000001814 with
No. 2905067/199199.
Ex. A20 Certificate of insurance No. AF3/PB000001815 with
No. 2905069/199200.
Ex. A21 Certificate of insurance No. AF3/PB000001821 with
No. 3190916/199206.
Ex. A22 Certificate of insurance No. AF3/PB000001812 with
No. 2675406/199197.
Ex. A23 Pamphlet of Sriram DTH Pvt. Ltd.,
Ex. A24 Pamphlet of Sriram DTH Pvt. Ltd.,
Exhibits marked for Respondent: - ----- NIL ------
MEMBER MEMBER PRESIDENT
Copy to :-
1) Sri G. Trivikram Singh, Advocate for complainant
2) Sri G.S. Murthy, Advocate for R2.
3) Sri D.V.S. Prasad, Advocate for R3.
4) Shriram DTH Pvt. Ltd., Rep. by its Manager, O/o Shriram Chits
Pvt. Ltd., Gandhi Raod, Proddatur, Kadapa District.
1) Copy was made ready on :
2) Copy was dispatched on :
3) Copy of delivered to parties :
B.V.P. - - -
