::BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,
AT BIDAR::
C.C.No. 37/2015
Date of filing : 15/05/2015
Date of disposal : 10/01/2017
P R E S E N T:- (1) Shri. Jagannath Prasad Udgata,
B.A., LL.B.,
President.
(2) Shri. Shankrappa (Halipurgi),
B.A.,LL.B.,
Member.
COMPLAINANT/S: Smt. Malan Begum, w/o late Md. Bashir miyan,
Age: 26 years, Occ: household,
R/o village Baharnalli,Tq.&Dist.Bidar.
(By Shri. Rajkumar K , Advocate )
VERSUS
OPPONENT/S :- 1. The Oriental Insurance Co.Ltd.,
Branch Office, Shivram Chamber, IInd. Floor,
Opp: Zopedi Canteen, Manmad road,
Saveri, Ahmed Nagar-414003.
2. Branch Manager,
Oriental Insurance Co., Near Central Bus stand,
Bidar.
3. The Manager,
Life Line Life Care Ltd.,
No.3, Rainbow House, Saveri road,
Ahmed Nagar-414003.
( O.P.No.1- Exparte )
( O .P.No.2-By Shri. Satish.K.Advocate)
( O.P.No.3- In person )
:: J UD G M E N T : :
By Shri. Jagannath Prasad Udgata, President.
This is a complaint filed by the above said complainant U/s.12 of C.P.Act., 1986, against the O.Ps alleging deficiency in service on the part of O.Ps. The corollary of the case is as under:
2. The complainant is a native of Baharnalli village, Tq. & Dist.Bidar. The complainant’s husband by name late Md. Shabir was working as a driver with Sri.Mahmad Shad Bhikumiya Shaik. The husband of the complainant during his life time had purchased individual J.P.A. Nagarik Suraksha Policy with the O.P.no.2, policy bearing no. 163305/47/2012/60 for sum assured Rs.1,00,000/- and paid the instalments of Rs. 1,600/- . The O.P.no.3 was the agency of O.P.no.1 and 2 to sell the policy aforesaid. The policy covers the risk of the person for the period from 11-04-2011 to 10-04-2015. On 21-09-2011 complainant had gone to Ahamedabad /Naroda Market with a load of Orange in the Truck. Thereafter the husband of the complainant parked the Truck at Ekta hotel at Aslali and he had gone to attend minor call of nature. At that time one Truck bearing regd.no.AP-28Y-0565 dashed the complainant’s husband. Thereby the complainant’s husband was injured and was admitted in nearby V.S. Hospital, while under the treatment the complainant’s husband died in the hospital on 22/09/2011. Thereafter a case was registered by Police Aslali in Crime no.173/2011 for the offence punishable under Sec.279,337,338,304-A of IPC, r/w sec.177 & 184 of M.V. Act., and made the investigation and conducted inquest and spot panchanama and also Post Mortem.
3. Further complainant avers that, as the complainant being the nominee of the said policy, had intimated the O.P about the death of her husband and inspite of her approach the O.Ps have not settled her claim in spite of several requests and issuing legal notice to the O.Ps. Hence the complainant is before this Forum, claiming compensation for a sum of Rs. 1,00,000/-.
4. On receipt of the Court notice, O.P.no.1 did not appear before this Forum and was placed exparte. The O.P. no.2 had appeared through his counsel and filed his written version. O.P.no.3 had sent his written version through post. The O.P.no.2 in his written version has averred that the complaint filed by the complainant is misconceived both in law and on facts and it is not tenable. The OP.No.2 has not admitted the contention of the complainant in para no.1 of the complaint that about her residence and relationship with deceased Mohammed Bashir and the same be put to strict proof by her.
5. In reply to para no.2 of the complaint the O.P.no.2 company denied the contention of the complainant that her husband was working as driver of the Truck of one Mohammed Shad Bhikkumiyan Shaik and about the accident caused to him by driver of Truck No. AP 28 Y 0565 and his resultant death on 21-09-2011. The O.P.no.2 did not receive any such intimation of accident and death of the deceased in the accident within the period provided. As such, liability is not admitted by the respondent no.2 company. The O.P.no.2 has not disputed the contention of para no.4 and 5 of the complaint to the effect that, the deceased had purchased Personal Accident Policy for Rs.1,00,000/- But, this policy was subject to certain terms and conditions. It is mandatory on the part of the nominee to intimate the accidental death of the insured to the company within a period of 30 days, so as to enable the company to investigate the same. But in this case the complainant had not informed the respondent Company about the accidental death of her husband, which is violation of the condition of the policy. The O.P.no.2 Company has not received any claim form supported with required documents to settle the claim. Simply because the policy was issued by O.P.no.2 Company, is not a ground to hold that the complainant is entitled to claim the benefit under the policy, unless the requirements are fulfilled. The complainant had not at all made any such claim with the O.P.no.2 Company by furnishing the required documents and even she had not intimated the company about the accidental death of the her husband and the para no. 6 to 8 of the complaint are denied as false.
6. Further in reply to other paras, the O.P.no.2 avered that according to the complainant the accident took place on 21-09-2011, but the intimation was given to the O.P.no.2 Company on 01-02-2012, which is against the condition of the policy. Apart from this, the complainant has not furnished the required documents to enable the company to settle her claim. Without complying the required formalities, she has filed this complaint which is not maintainable, and fit to be dismissed and has no basis at all, and it is fit to be rejected.
7. The O.P.no.3 in his written version avered that Life Line Life Care Care Ltd. ( Hearin after referred as LLLC Ltd.) was the service giving agency and not an insurance Company and accordingly the same had been registered with the Registrar of Companies, Pune Office. O.P.no.3 averred that they never made any misleading propaganda either orally or in any their advertisements in this respect. To provide Life Insurance, in particular Life Line Life Care Ltd. had brought in market Life Care Facility Cards. These were of different prices. Issue of an Accident Policy against the Life Care Card purchased by that proposer was an add on facility. For this purpose Life Line Life Care Ltd. had business arrangement with Oriental Insurance Co. Ltd. Ahmednagar Office. As per price of the Life Care Card purchased by proposer suitable accident insurance policy was obtained from the above insurance company, and a certificate of Insurance was given to the customer. Thus the insurance policy actually pertained to the Oriental Insurance Company Ltd. Ahmednagar and they are legally bound to settle the claim. L.L.L.C. Ltd. Being a medium through which insurance policy was obtained the claim was routed though Life Line Life Care Ltd. That was a working arrangement mutually agreed between the oriental and L.L.L.C, for smooth functioning. As per claim procedure the claimant is supposed to write to Life Line Life Care Ltd. immediately after accident with details of insured person, date of accident etc. After verifying policy particulars a blank claim of the Oriental Insurance Co. Ltd. Ahmednagar was sent to the claimant with a request to submit the claim along with relevant enclosures. On receipt it was scrutinized on broad line to ensure that it was properly prepared, and if prima facie certain deficiencies were noticed. The claim was returned only once for compliance of deficiencies. On receipt it was submitted to the Oriental Insurance Company Ltd. Ahmednagar for final settlement as recieved. Therafter it was their sole legal responsibility to dispose it off as per terms and conditions of the policy. Life Line Life Care Ltd. has no scope to interfere in it. In short Life Line Life care LTd. only processed the claim. Once the claim is submitted to the insurance Company, Life Line Life Care Ltd. had no role to play. They do not interfere in the decision of the Insurance Company.
8. Further O.P.no.3 avered that Late Auradkar MD Bashir s/o Md Shabir died in road accident on 22-09-2011. As per the proposal it had obtained insurance policy from the Oriental Insurance Co.Ltd., Ahmednagar for the proposer.
Janata Personal Accident Policy
- Certificate of Insurance No. 86453/1190.
- C.S.I Rs. 1,00,000/-
- Period 11/4/2011 to 10/04/2015.
Unfortunately he met with accident. The intimation for that was received by L.L.L.C. Office on 27-09-2011 and a blank claim form in respect of the above Insurance Company was sent to the claiment on 27-09-2011 itself with a request to submit the claim early duly enclosing relevant enclosures as required by the Oriental Insurance Company Ltd. Ahmednagar. L.L.L.C. Ltd received the claim on 29-11-2012. Since there were some discrepancies, keeping interests of the card holder in mind, it returned the claim to the claimant with letter dated 29/11/2012 for compliance of deficiencies and early submission to our office. L.L.L.C. finally received the claim on 28/02/2013,my office representative visited the Oriental Insurance Co.Ltd. Ahmednagar on 06/03/2013. It’s to submit the claim. But the Oriental Insurance Co. Ahmednagar orally told that the claim is delayed as insured died on 22/09/2011 and hence they did not accept the claim. Then L.L.L.C. forwarded this claim to the Oriental Insurance Co.Ltd., Tarakpur Br. Ahmednagar and also intimated to the Divisional Mananger, Oriental Insurance Company Ahmednagar and Smt. Auradkar Malan Begum at post Manhalli, Bidar by registered Post. After submission of claim as stated above L.L.L.C has no authority or role to play in settlement, as it is sole responsibility of the Oriental Insurance Co.Ltd, Ahmednagar Office to settle the claim. The accident Insurance Policy actually pertained to the Oriental Insurance Company Ahmednagar office and O.P.no.3 has not committed any deficiency in service.
9. Both sides have led evidence is an effort justifying their contentions.
10. Considering the rival contentions of the parties, the following points arise for our consideration:-
1. Was there really any delay in conveying the death in formation
and violation of policy conditions?
- Does the complainant prove that, there has been a deficiency of service in the part of the Opponents?
- What order ?
11. Our answers to the points stated above are as follows:-
- In the negative.
- In the affirmative.
- As per the final order, for the following:
:: REASONS ::
12. Point No.1:- In the instant case, the issue is most bizarre and in human. Both sides are in agreement about the untimely accidental death of the insured on 22/09/2011 consequent the accident on 21-09-2011 at Aslali, Gujrat, while the global J.P.A. policy no. (Global) 163305/47/2012/60 ( validity 11/04/2011 to 10/04/2015) was in force. The fact of the accident death is fortified from documents produced and exhibited vide Ex.P.3 to P.7. The claim form has been submitted vide Ex.P.1 and copy of the policy as Ex.P.2 has been furnished substantiating the fact of insurance coverage. From the reply of the O.P.no.3 it is evident that, the first ever death intimation and claim was received by the O.P.no.3 on 27/09/2011. Owing to certain discrepancies in the claim, it was returned to the complainant for rectification, which was effected subsequently and the O.P.no.2 was submitted the claim in all aspects by the O.P.no.3, which it appears was not entertained on flimsy grounds by the principal O.P.no.2. It would of course would have been proper in the part of the O.P.no.3 to convey a copy of the first death intimation received on 27-09-2011. Hence for all practical purposes, we hold that, the death intimation was conveyed to the O.Ps through the O.P.no.3 at the appropriate time and we answer this point in the negative.
13. Point No.2 :- As discussed above, the complainant/nominee of the deceased policy holder had promptly informed about the accidental death of her husband to O.P.no.3 who was the marketing front/ franchisee of O.P.no.1 and 2. The intimation of death, as admitted by the O.P.no.3 was received in it’s office on 27-09-2011, well within the stipulated time of one month. As a matter of fact, at the back of Ex.P.2, the oriental Insurance Co. Ltd. ( in Hindi) has made a stipulation to that effect and the complainant/claimant has duly fulfilled her part of obligations. What had gone wrong later between O.P.no.1 and 2 in one part and O.P.no.3 of the other part is not the concern of the claimant. Inspite of raising a proper claim and further inspite of receipt of legal notice (Ex..P.13) both O.P.no.1 and 2 are shamelessly sitting over the just claim for the last more than four years, which is nothing but pinnacle of deficiency of service and unethical trade practice. At one point of time, we were contemplating to impose heavy penalty as prescribed U/s.14 (1) (hb) of the C.P.Act, 1986, but just restrain our selves taking into consideration that, the O.P.no.1 and 2 are nationalised entities created from the funds of public exchequer. But we emphasize, any repetition of deficiency of service and unethical trade practise would invite fircest ire of this Court. However, we propose to grant the maximum rate of interest permissible under the law and compensation for mental agonies in favour of the complainant. Thereby, answering this point in the affirmative, we pass the following:
:: ORDER ::
- The complaint is allowed in part.
The O.P.no.1 & 2 are jointly and severally held liable to pay te sum assured of Rs.1,00,000/- to the complaint without demur.
- The O.P.no.1 and 2 would further be liable to pay interest on the assured sum @ 18% p.a. to be calculated from the date of death of the insured i.e. 22-09-2011 till the date of realisation.
- Both the above O.Ps to pay a compensation of Rs.20,000/- to the complainant for her mental agonies and pecuniary hardships suffered together with litigation expenses of Rs.5,000/-
- Acting U/s.14 (1) (f), we direct the O.P.no.1 and 2 to discontinue the unfair trade practice as discussed supra;
- The O.P.no.3 is exonerated from any liability
f) Four weeks time granted to comply this order.
( Typed to our dictation then corrected, signed by us and then pronounced in the open Forum on this 10 th day of January-2017 )
Sd/ Sd/
Sri. Shankrappa H. Sri. Jagannath Prasad
Member. President.
Documents produced by the complainant
- Ex.P.1-Copy of Claim Form.
- Ex.P.2- Copy of Certificate of Insurance.
- Ex.P.3- Copy of FIR & complaint with English translation at the back.
- Ex.P.4 Copy of complaint with English translation at the back.
- Ex.P.5- Copy of complaint with English translation at the back.
- Ex.P.6- Charge sheet with English translation at the back.
- Ex.P.7- Copy of Post Mortem report.
- Ex.P.9-Copy of correspondence letter by L.L.L.C. Ltd., to Oriental Ins. Co., Dt.7/03/2013
- Ex.P.10 –Correspondence letter by Oriental Ins.Co. to L.L.L.C. Ltd.Dt.21/06/2012.
- Ex.P.11- Copy of letter addressed to Veerendra R Patil Adv. Dt.29/12/2014.
- Ex.P.12- Copy of cash receipt slip by L.L.L.C. Ltd.
- Ex.P.13-Copy of legal notice Dt.18/12/2014.
- Ex.P.14- Copy of reply to the legal notice Dt.24/12/2014.
- Ex.P.15 & 16 Copies of courier receipts ( 02)
Documents produced by the Opponent/s
- Ex.R.1 –Copy of policy schedule. (Global )
Sd/ Sd/
Sri. Shankrappa H., Sri. Jagannath Prasad,
Member. President.
mv.
