This complaint coming up before us for final hearing on                      04-04-11 in the presence of Sri P.Syam Kumar, Advocate for complainant and of Sri L.Vigneswara Rao, advocate for OPs 1&2, Sri K.Srinivasa Rao, Advocate for OP3,  upon perusing the material on record, hearing both sides and having stood over till this day for consideration, this Forum made the following: 

O R D E R

Per Sri M.V.L.Radha Krishna Murthy, Member:

                This complaint is filed under section 12 of the Consumer Protection Act, 1986 by the complainant praying to direct the opposite parties to pay an amount of Rs.50,000/- with interest at 24% p.a. towards the policy amount from the date of death of deceased till the date of payment, to pay Rs.10,000/- towards compensation for mental agony suffered by complainant and to pay Rs.2000/- towards legal expenses.

The averments of complaint in brief are as follows:

                The complainant’s husband Venkata Narayana was a member of opposite parties 1 and 2, who introduced a scheme with the tie-up of 3^rd opposite party, which is called Janatha Personal Accident.  The members of opposite parties 1 and 2 are eligible under the said scheme and they are covered with personal accident policy.  The complainant is nominee of her husband. The husband of complainant met with road accident on 16-10-05 and died on          17-10-05 while undergoing treatment in Amaravathi Institute of Medical Sciences, Guntur due to injuries caused to him in the accident.  Whereupon the complainant gave a report to Tadikonda Police and a crime No.106/05 was registered to that effect and postmortem was conducted on the body of deceased.  Subsequently, complainant approached opposite parties 1 and 2 and submitted all documents for settlement of claim under Janatha Personal Accident Policy.  The opposite parties 1 and 2 sent a letter to 3^rd opposite party on            16-11-07.  The complainant approached 3^rd opposite party and submitted FIR, charge sheet, PM report and other necessary documents and made a representation regarding the death claim of her husband.  But 3^rd opposite party has not settled the claim and it amounts to deficiency of service.  As the claim was not settled, the complainant suffered mental agony.  Hence, the complaint.

                The opposite parties 1 and 2 have not filed their version.

The 3^rd opposite party filed its version, which is in brief as follows:

                Most of the averments of complaint are incorrect and denied the same.  The complainant is put to strict proof of the same.  The complainant is not a consumer within the meaning of Consumer Protection Act.  The Forum has no jurisdiction as there is no cause of action to arise consumer dispute.  The liability of 3^rd opposite party is subject to terms and conditions of policy.  As per policy conditions, it is the duty of owner to act in accordance with the drivers clause shown in the policy as per the Motor Vehicles Act. The liability is out of contract of insurance between the insured and insurer.  The liability of this opposite party is a contractual but not statutory.  As per the terms and conditions of policy, it is the duty of insured to intimate immediately, if any risk occurred to any one during the period of policy.  The complainant and opposite parties 1 and 2 are bound by terms of policy to cooperate with 3^rd opposite party by sending the required documents within the specified time in order to process the claim as specified in the conditions of alleged policy.  The 3^rd opposite party is concerned, there is no deficiency of service, as alleged by the complainant.  As such this Forum has no jurisdiction to entertain the complaint.  In this particular case, there is a clause in the policy “…..persons or class of persons entitled to drive, any person including the insured provided that a person holds an effective driving license at the time of accident”.  Hence, the complainant must prove that they are not acted against the conditions of policy.  The complainant does not reveal the policy particulars or the branch office from which the alleged insurance policy was taken.  As such we are unable to trace the dealing office.  The 3^rd opposite party never gave any such policy during that period.  Hence, the case against 3^rd opposite party is not maintainable.   Hence, the complaint may be dismissed.

                The complainant and 3^rd opposite party filed their respective affidavits in support of their versions.  On behalf of complainant Ex.A1 to A10 are marked. No documents are marked on behalf of opposite parties.

Now the points for consideration are

1. Whether there is any deficiency of service on the part of opposite parties?
2. To what relief the complainant is entitled to?

POINTS 1 & 2   

                The case of complainant is that her husband is a member of Primary Agricultural Cooperative Society, Narkullapadu village of opposite parties 1 and 2, that 3^rd opposite party has got tie-up with opposite parties 1 and 2 and members of opposite parties 1 and 2 are covered with Janatha Personal Accident Policy, that she was a nominee of her husband and that her husband died on 17-10-05 in a road accident while undergoing treatment and that she made a claim for the insured amount of Rs.50,000/- to 3^rd opposite party through opposite parties 1 and 2 but 3^rd opposite party has not settlement claim inspite of submission of all the relevant documents and that therefore, there is deficiency on the part of opposite parties.  Hence, the complaint.

                        During the course of arguments, the learned counsel for opposite party stated that the policy copy or number are not furnished, that there is proof to show that opposite parties 1 and 2 submitted claim forms to 3^rd opposite party and that 3^rd opposite party did not issue any policy in favour of opposite parties 1 and 2.  As seen from Ex.A6 copy of Kisan Credit Card and passbook, the deceased insured i.e., the husband of complainant is a member of opposite parties 1 and 2.  As seen from Ex.A10 letter addressed by 1^st opposite party to 3^rd opposite party, there is a policy bearing No.431208/GPA/2006/55 valid upto 24-04-06.  A perusal of Ex.A1 and A2 shows that the deceased insured died in a motor accident on 17-10-05. The opposite parties 1 and 2 have not filed their version and affidavit stating that they have forwarded the claim of complainant.  As seen from Ex.A10 letter addressed to 3^rd opposite party by 1^st opposite party, the claim was made with 3^rd opposite party on 16-11-07 i.e., after a lapse of two years and one month from the date of death of deceased insured.   Even for Ex.A10 there is no acknowledgement or postal receipt in order to show that Ex.A10 was submitted to 3^rd opposite party. Thus there is no receipt in token of receipt of Ex.A10.  Ex.A7 is the copy of letter addressed by complainant to 2^nd opposite party requesting to settle the claim, the said Ex.A7 is dt.03-04-08.  Even for Ex.A10 also, there is no postal acknowledgement or receipt in token of receipt of same by 3^rd opposite party.  The said Ex.A7 was addressed after a long lapse of 2½ years from the date of death of husband of complainant.  Thus as already stated above, there are no acknowledgements or postal receipts for Ex.A7 and Ex.A10.  Therefore, it can be safely concluded that there is no proof of claim made either by complainant or by opposite parties 1 and 2.  As per the averments of 3^rd opposite party, if at all there is any policy the occurrence of accident shall be intimated within a period of 30 days and claim should be made with the required documents within 90 days in terms of policy.  But in this case, there is no proof that either the complainant or opposite parties 1 and 2 have intimated the occurrence within 30 days or made a claim within 90 days. As already stated above, Ex.A7 and A10 are said to have addressed to 3^rd opposite party after a long lapse of more than 2 years. The burden of proof of claim is on the complainant and opposite parties 1 and 2.  As already discussed above, there is no proof of claim made either by complainant or opposite parties 1 and 2 on record.

                During the course of arguments, the counsel for 3^rd opposite party relied on a decision reported in 2011 CJ 30 APSCDRC between Consumer Interests Protection and Research Association (CIPRA) Vs. Apollo Gleneagles Pet-CT Center and others held that

                “Mere impleading insurance company and producing insurance policy does not amount to proof of insurance company’s liability”

                In view of the foregoing discussion and in the absence of any proof showing that the complainant and opposite parties 1 and 2 made a claim with 3^rd opposite party, we cannot find any deficiency of service on the part of 3^rd opposite party.  Therefore, accordingly these issues are answered.    

                In the result, the complaint is dismissed without costs.

Typed to my dictation by the Junior Steno, corrected by us and pronounced in the open Forum, this the 19^th day of April, 2011.

              Sd/-XXX                      Sd/-XXX                              Sd/-XXX

          MEMBER                               MEMBER                            PRESIDENT

APPENDIX OF EVIDENCE

                                        DOCUMENTS MARKED

For Complainant:

For Opposite Parties:    NIL                                                                         

                                                                                                                   PRESIDENT