BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri. S. Chinnaiah, B.A. B.L., I/C President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Thursday the 27th day of December, 2007
C.C.No. 104/07
Between:
J. Rama Krishna, S/o. J. Ch. Venkata Swamy,
Resident of Rudravaram Village, Pamulapadu Mandal, Kurnool District.
… Complainant
Versus
1. The National Insurance Company Limited, Represented by its Divisional Manager,
Division - 5, A.D.I. Avenue, Anna Nagar, Chennai - 600 040. Tamilnadu State.
2. The National Insurance Company Limited, Represented by its Branch Manager,
Kurnool.
3. Road Safety Club Private Limited,Represented by its Managing Director,
2-A, II-Floor, Prakasam Road, T.Nagar, Chennai - 600 017.
4. Road Safety Club Private Limited,Represented by its Manager, (Service Center)
C/o. Shri Ram Chits Private Limited, D.No.13/16 and 17, Vishnu Priya Complex, Near Clock Tower, Anantapur.
5. Road Safety Club Private Limited, Represented by its Manager,
C/o. Shri Ram Chits Private Limited, Branch - 2, Gayathri Estates, Kurnool.
… Opposite parties
This complaint is coming on this day for orders in the presence of Sri. M. Azmathulla, Advocate, Kurnool, for the complainant, and Sri. D.A.A. Ahammad, Advocate, Kurnool, for the opposite party No.2, and Sri.
P. Siva Sudharshan, Advocate, Kurnool for the opposite party No.3, and Sri. B. V. Ramana Reddy, Advocate, Kurnool, for the opposite party No.4 and 5 and opposite party No.1 is called absent and set exparte and upon perusing the material papers on record , the Forum made the following :
ORDER
(As per Smt. C.Preethi, Member)
C.C.No.104-07
1. This consumer complaint of the complainant is filed under section 12 of C.P.Act, 1986, seeking a direction on opposite parties to pay Rs.2,00,000/- with 18% interest P.A, Rs.1 lakh as compensation, Rs.50,000/- for deficiency of service and un fair trade practice, cost of the complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainant’s wife Jala Sarada was a member of opposite party No.5 and obtained a Janata Personal Accident Insurance Policy bearing No.500500/ 42/03/ 8200124 from opposite party No.1 for Rs.2 lakhs covering the life risk of the deceased and she nominated the complainant as her nominee. The policy commenced from 29.4.2004 till the completion of tenure membership of 72 months. On 25.1.2006 the policy holder Jala Sarada died due to accidental drowning, as nominee the complainant submitted F.I.R, inquest, post mortem certificate, death certificate and policy copy to opposite party No.3 and it was returned on 20.5.2006 stating the complainant did not submitted claim form, police inquest report and original death certificate when the claim form was not issued to the complainant question of submitting claim form does not arise, hence got issued a legal notice dated 1.9.2006 to opposite parties 1 and 3 and opposite party No.3 replied on 5.9.2006 stating that it has forwarding all the documents to opposite party No.1. On 23.9.2006 opposite party No.4 sent a claim form to the complainant and on 7.10.2006 the complainant sent the filled up claim form to opposite party No.4. Thereafter, the complainant approached opposite parties several times for settlement of the claim but there was no response. Hence, resorted to the forum for reliefs as there is deficiency of service on part of opposite parties.
3. In support of his claim the complainant relied on the following documents viz., (1) policy copy issued to the deceased, (2) death certificate of Jala Sarada, (3) F.I.R, (4) inquest report, (5) post mortem certificate, (6) letter dated 28.3.2006 issued by complainant to opposite party No.5, (7) letter dated 15.5.2006 of complainant addressed to opposite party No.3, (8) letter dated 16.5.2006 of complainant to opposite party No.3, (9) letter dated 20.5.2006 of opposite party No.3 to the complainant , (10) letter dated 2.6.2006 of complainant to opposite party No.3, (11) office copy of legal notice dated 1.9.2006 addressed to opposite parties 1 and 3, (12) letter dated 5.9.2006 of opposite party No.3 to the complainant counsel, (13) letter dated 23.9.2006 of opposite party No.4 to the complainant, (14) Xerox copy of claim form submitted by complainant and (15) xerox copy of membership certificate, besides to the sworn affidavit of the complainant in reiteration of his complaint avernments and the above documents are marked as Ex.A1 to A.15 for its appreciation in this case.
4. In pursuance to the notice of this forum as to this case of the complainant the opposite party No.1 remained absent through out the case proceedings and were made exparte. The opposite parties 2 to 5 appeared through their standing counsel. The opposite parties No.2 and 3 filed separate written versions. The opposite parties 4 and 5 adopted the written version of opposite party No.3.
5. The written version of opposite party No.2 denies the complaint as not maintainable either in law or on facts, but submits that policy was issued by National Insurance Company Limited, DO V Chennai,(opposite party No.1) and the deceased was member of Road Safety Club Limited which is situated at Chennai. As per the terms and conditions of the policy the beneficiary should lodge the claim with Road Safety Club Private Limited within the stipulated time and in turn Road Safety Club Private Limited, Chennai has to lodge with opposite party No.1 and it will be processed accordingly on merit papers submitted by the beneficiary. As per the records this opposite party do not appear to have received any claim in this regard from opposite party No.3, so there is no deficiency of service on part of opposite party No.2 and opposite party No.3 is responsible for the same and it is for the complainant to prove that he has sent the claim and the same was received by opposite party No.1 and it did not settle the claim. As per the avernments of the complaint no claim was made with opposite party No.1 and the complainant unnecessarily made opposite party No.2 as party to the proceedings and seeks for the dismissal of complaint with costs.
6. The written version of opposite party No.3 submits that the complainant has no locus- standi to file this complaint against this opposite party. As per the terms and conditions which was duly agreed by the deceased that all the disputes and differences arising shall be settled under Arbitration and Conciliation Act, 1996 and the Consumer Forum has no jurisdiction to determine the issues involved in this case. This opposite party issued a membership certificate and the tenure of the membership is for a period of 7 years and a separate certificate of Insurance was issued relating to an Insurance Company. As per the scheme the opposite party No.3 would mediate between the Insurance Company and its members and the insurance coverage was provided by opposite party No.1 in favour of the decease. The role of this opposite party No.3 is only to bring awareness among the public with regard to road safety and educate them and to enable them to get an insurance cover from an insurance company. Hence, in this case opposite party No.1 has issued a Group Personal Accident Policy No 500500/42/03/8200124 to the deceased. Hence, the role of opposite party No.3 is only confined to the processing of the claim and forwarding the same to opposite party No.1 and once the claim is forwarded to opposite party No.1 it is for opposite party No.1 to settle the same and opposite party No.3 has no role to play in the matter of settlement of the claim by opposite party No.1. In this case after receipt of claim papers from the complainant, this opposite party forwarded the same to opposite party No.1 for settlement of the claim. Hence there is no deficiency of service on part of opposite party No.3 and seeks for the dismissal of complaint with cost.
7. In support of their case the opposite parties did not file any documents. The opposite parties 2 and 3 filed sworn affidavit in reiteration
of their written avernments.
8. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service on part of opposite parties ?.
9. There is no dispute as to the deceased Jala Sarada covered under the Group Personal Accidental Policy bearing No. 500500/42/03/8200124 issued by opposite party No.1 vide Ex.A1 and nominated the complainant as his nominee. There is no dispute as to the death of the deceased Jala Sarada due to drowning on 25.1.2006. After the death, claim form vide Ex.A.14 was submitted to opposite party No.3 in turn to submit it to opposite party No.1. Thereafter, as there was no response from the opposite parties, the complainant addressed letters vide Ex.A7, A8 and A10 to opposite party No.3 for early settlement of claim, even to the said letters there was no response. Hence, got issued legal notice vide Ex.A 11 dated 1.9.2006 to opposite party No.1 & 3 there was no reply from opposite party No.1 and opposite party No.3 replied vide Ex.A 12 dated 5.9.2006 stating that it has forwarded the papers to the Insurance Company (opposite party No.1) to do the needful. Hence, the complainant resorted to Forum.
10. The Ex.A2 is the attested Xerox of death certificate issued by Village Secretary Rudravaram (V) Pamulapadu (M), the Ex.A3 is the attested Xerox of FIR issued by Pamulapadu (PS), Ex.A4 is the attested Xerox inquest report over the dead body of Jala Sarada, Ex.A5 is the Post Mortem Report on the dead body of Jala Sarada, the Ex.A6 is letter dated 28.3.2006 of complainant addressed to opposite party No.2 intimating the death of Jala Sarada.
11. The contention of the complainant is that he is nominee of the deceased Jala Sarada who died due to accidental drowning, all the above material papers filed also clearly establishes that the death of the policy holder was due to drowming only, hence, it is an accidental death, therefore he is entitled to the assured under the above said policy (Ex.A1). The opposite party No.1 who issued the said policy to the deceased, even after receipt of claim form vide Ex.A 14 and required documents from the complainant and the legal notice vide Ex.A 11 did neither settled the claim nor repudiated the claim. Being vexed the complainant approached forum for reliefs as there is deficiency of service on part of opposite parties . The opposite party No.1 even after receipt of notice of this Forum did not appear before the forum not filed any of their reply and remained exparte through out the case proceedings.
12. To, conclude, from the above discussions the complainant in all aspects of the case is certainly remaining entitled to the assured amount under Ex.A1 policy issued by opposite party No.1 covering the life risk of Jala Sarada, wife of the complainant and opposite party No.1 is liable to pay the assured amount to the complainant and there is deficiency of service on part of opposite party No.1 in not paying the said amount to the complainant. As the complainant is driven to the forum for reliefs the complainant is also remaining entitled to the costs of Rs.1,000/- also. As no cause of action is made out against opposite parties 2 to 5, case against 2 to 5 is dismissed.
13. In the result, the complaint is allowed directing the opposite party No.1 to pay to the complainant, the assured amount of Rs.2,00,000/- under policy bearing No.500500/ 42/03/ 8200124 of Jala Sarada with 9% interest from the date of filling of this case i.e. 26.6.2007 till realization along with costs of Rs.1,000/- within a month from the date of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open Forum on this the 27th day of December.
Sd/- Sd/-
MEMBER I/C PRESIDENT
Appendix of evidence
Witness examined
For Complainant: For Opposite parties:
-Nil- -Nil
Documents marked
For the Complainant:
Ex.A-1. Policy copy.
Ex.A2. Death Certificate of Jala Sarada.
Ex.A3. Attested copy of F.I. R.
Ex.A4. Attested copy of Inquest Report.
Ex.A5. Attested copy of Post – mortem Certificate.
Ex.A6. Letter dated 28-3-2006 issued by complainant
to opposite party No.5.
Ex.A7. letter dated 15-5-2006 of complainant
addressed to opposite party No.3.
Ex.A8. letter dated 16-5-2006 of complainant to opposite party No.3
Ex.A9. Letter dated 20-5-2006 of opposite party No.3
to the complainant.
Ex.A 10.. Letter dated 2-6-2006 of complainant to opposite party No.3.
Ex.A 11. office copy of legal notice dated 1.9.2006
addressed to opposite parties 1 and 3.
E.xA 12. Letter dated 5-9-2006 of opposite party No.3
to the complainant counsel.
Ex.A 13. Letter dated 23-9-.2006 of opposite party No.4
to the complainant.
Ex.A 14. Xerox copy of claim form submitted by complainant
E.xA 15. Xerox copy of membership certificate,.
For the opposite parties:
- Nil-
By the Forum:
- Nil- Sd/-
I/C PRESIDENT
Copy to :-
1. Sri.M. Azmathulla,Advocate,Kurnool for the complainant.
2. Sri.D.A.A. Ahammad, Advocate, Kurnool for the opposite
Party No.2.
3. Sri. P. Siva Sudharshan, Advocate, Kurnool for the opposite partyNo.3.
4. Sri. B..V.Ramana Reddy, Advocate, Kurnool for the opposite party
No.4 and 5.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
