BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
and
Smt C.Preethi, M.A., LL.B., Member
Wednesday the 11th day of July, 2007
C.C. No.16/2007
Smt. B. Mani,
W/o. Late Kasi Viswanath Bandikollu,
H.No. 14/8, A.R.Colony, Panyam,
Kurnool District, A.P. … COMPLAINANT
Versus
1. U. Srinivasulu, S/o. Nagalakshmaiah,
Insurance Agent,
Panyam Village & Mandal,
Kurnool District.
2. Golden Multi Services Club Limited,
S.B.Monsoon, 16, R.N. Mukherjee Road,
Kolkata.
3. M/s. National Insurance Company Limited,
Division – 3, Shakespeare Sarani, 6th Floor,
Kolkata.
… OPPOSITE PARTIES
This complaint coming on this day for orders in the presence of Sri. S. Siva Rama Krishna Prasad, Advocate, kurnool for complainant, Sri. N. Narayana Reddy, Advocate, Kurnool for Opposite Party No.1 , Sri. M. Azmathulla, Advocate, Kurnool for opposite party No.2 and the opposite party No.3 is called absent set ex-parate and stood over for consideration till this day, the Forum made the following:-
ORDER
(As per Smt. C. Preethi, Member)
- The consumer complaint of the complainant is filed Under Section 12 of C.P. ct 1986 seeking a direction on opposite parties to pay Rs.2,00,000/- to the complainant with 18% interest per annum, Rs.25,000/- towards mental agony , cost of the complaint and any other relief or relief’s which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainants husband Kasi Viswanath @ Bandikolly Viswanath obtained a group personal accident policy bearing No.100300/42/04 8200012 from opposite party No.3 by paying the required premium to opposite party No.1 and joined the opposite party No.2 club and nominated the complainant as his nominee. As nominee the complainant lodged a claim with opposite party No.1 and opposite party No.1 forwarded the same to opposite parties 2 and 3 and the complainant submitted claim form along with required documents but to the dismay of the complainant, the opposite party No.3 repudiated the claim on the ground that the complainant failed to inform the death of the policy holder within one month from the date of death. But the complainant submits that the death was intimated to opposite parties 1 and 2 who have direct access to the opposite party and it is for opposite parties 1 and 2 to inform opposite party No.3 and there is no fault on part of the complainant. Therefore, the complainant approached the forum for relief as there is deficiency of service on part of opposite parties for not settling her valid claim.
3. In support of her case the complainant relied on the following documents viz., (1) attested Xerox copy of policy issued to the deceased (2) letter dated 16.7.2005 of opposite party No.3 copy marked to the complainant and (3) “No claim” letter dated 23.9.2005 of opposite party No.3 addressed to the complainant, besides to the sworn affidavit of the complainant in reiteration of her complaint averments and the above documents are marked as Ex.A1 to A3 for its appreciation in this case. The complainant caused interrogatories to the opposite parties 1 and 2 replied to the interrogatories caused by opposite parties 1 and 2.
4. In pursuance to the notice of this forum as to this case of the complainant, the opposite parties 1 and 2 appeared through their counsel and filed written version, The opposite party No.3 did not contest the case and remained absent through out the case proceedings and were made exparte.
5. The written version of opposite parties 1 and 2 admits the deceased Kasi Viswanath Bandikollu was a member of opposite party No.2 club and obtained a group personal Accident policy bearing No. 100300/42/04/ 8200012 and a certificate was issued by opposite party No.3 . After submission of claim by the complainant. The opposite party No.2 forwarded all documents by its letter dated 16.7.2005 to opposite party No.3 with a request to settle the claim. But opposite party No.3 through its letter dated 23.9.2005 stated that they are treating the claim as “No claim” on technical ground that the complainant delayed in intimating the death of policy holder. There after the complainant got issued registered legal notice dated 4.2.2006 to all opposite parties and in response the opposite party No.2 forwarded a letter dated 23.3.2006 to opposite party No.3 with a request to consider the matter, as the opposite party No. 3 in the exclusive and sole authority to settle the claim as per memorandum of understanding dated 2.4.2004 between opposite parties 2 and 3 and opposite party No.1 and 2 are in way related and concerned to settle the claim and there is no deficiency of service on part of opposite party 1 and 2 and seeks for this dismissal of complaint with cost.
6. In support of their case the opposite parties 1 and 2 relied on the following documents viz., (1) Xerox copy of notarized memorandum of understandings between opposite party No.2 and 3 , besides to the sworn affidavit of opposite parties 1 and 2 in reiteration of their written version averments and the above document is marked as Ex.B1 for its appreciation in this case. The opposite parties 1 and 2 caused interrogatories to the complainant and replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief the complainant is entitled alleging deficiency of service.
8. There is no dispute as to the deceased Kasi Viswanath covered under the group personal Accident Insurance policy issued by opposite party No.3 vide Ex.A1 and the complainant is the nominee under the said policy. There is no dispute as to the death of the deceased in a road accident and death information was given to opposite parties 1 and 2 and claim form was submitted to opposite party No.3 on 19.7.2005 . The only dispute is regarding the delay in intimating the death of the deceased to opposite parties No.3. The counsel for complainant submitted that death information was given to opposite party No.,1 and 2 within time and claim form will all documents was submitted to opposite party No.3 on 19.7.2007 by opposite party No.2 the complainant being a women un aware of the fact of informing the opposite party No.3 within stipulated time but informed opposite parties 1 and 2 within time and its is for opposite parties 1 and 2 to inform opposite party No.3 who is in direct contact. But on the other hand the counsel on opposite party No.1 and 2 submitted that belated of the complainant in informing the opposite party No.3 about the death of the policy holder within 90 days from the date accident is clear violation of policy, as per policy conditions as laid down in Ex.B1 agreement between opposite party No.2 and 3.
9. The Ex.A2 is the letter dated 16.7.2005 of opposite party No.2 addressed to opposite party No.3 it envisages submission of all relevant documents regarding the claim of the complainant with said letter to opposite party No.3, it is not disputed by opposite party No.3, that the death of deceased is not accidental. The only attack is that the complainant intimated the death of the deceased belatedly and also submitted claim form belatedly i.e., after the stipulated time which is mentioned in Ex.B1. In the said Ex.B1 at page 12 (Annexure ‘A’) at claim settlement column, it says sincere endeavour to settle claims lodged either by the insured or the GMSC limited preferably within 30 days after receipt of all requisite papers and / or information. But in this case the opposite party No.3 closed the complainant claim as “No claim” on 23.9.2005 i.e., after two months from the date of receipt of claim form and other document vide Ex.A2 dated 16.7.2005. Hence what appears is that no importance was given to the MOU (Ex. B1) entered between opposite parties 2 and 3 in the Ex.B1 on page 10 column 15 it says intimation and claim forms should be given within 30 days and 90 days from the date of accident and the claim submitted after 90 will not be entertained. When no importance was given to said MOU (Ex B1) in at the time of setting, the claims by opposite party No.3 itself, then no credence can be given to clause 15 also. Hence the said repudiation by plea of opposite party No.3 is untenable.
10. The procedure mentioned in Ex.B1 no where envisages for feature of insured amount of the deceased on failure of the dependent/nominee not informing the death of the insured to the Insurance Company (opposite party No.3) within stipulated time. In support of their case the complainants side relied on the following decision of UTTARPRADESH STATE COMMISSION BETWEEN ‘LIC’ OF INDIA VS RAJENDRA SINGH GAUR REPORTED IN (IV 2004 CPJ Pg 531). Where in it was held that repudiation of claim by LIC on the ground that intimation of death was delayed, the complainant contented that he was 80 years and not able to intimation earlier and he completed all formalities, hence, held repudiation of claim unjustified and illegal.
11. In the above said case the policy holder died on 29.11.1994 and intimation of death was given by the nominee to the insurance company in June 2003. The complainant was allowed on the ground that the policy stood intact for 10 years and the complainant was nominee under the policy and the complainant alone is entitle to the policy amount.
12. Following the above mentioned decision in the present case the death of policy holder occurred on 18.1.2005 and the same was intimated to opposite party No.2 and opposite party No.2 intimated opposite party No.3 on 16.7.2005 but the complainant submitted all documents and being a woman unaware of the fact of informing the opposite party No.3 within the stipulated time, as such the complainant is showing a reasonable cause of the delay in intimating the death of Viswanath beyond reasonable time of 90 days as per Ex.B1 and as such there appears no fraudulent suspicion on the face in violation of agreement in Ex.B1. Hence, the complainant’s approach to this forum seeking redressal is justified. The opposite party No.3 by its doscile conduct should not have repudiated the claim of the complainant and should have condoned the delay after the stipulated time limit.
13. The other decision relied by the complainant is that of Chhattisgarh State Commission reported in (III) 2006 CPJ pg 180 between Bajaj Allianz General Insurance Company Ltd Vs Manoj Agarwal, where in, it was held that intimation of death was delayed but intimation to the police was given in time, if the intimation to insurance company was delayed, but duly informed the police, hence the delay of intimation to the insurance company would not be fatal. In the present case intimation to police was given on the same day of accident and FIR was issued but there is delay in intimating insurance company. Hence basing on the above decision the delay in intimating opposite party No.3 would not be fatal.
14. To conclude, from the above discussion and following the afore mentioned decisions the complainant except delay in intimating the opposite party No.3 and in all other aspects certainly remaining entitled to the accidental benefit under the Group Personal Accident Insurance policy issued by opposite party No.3 covering the risk of her husband Viswanath and opposite party No.3 is liable to pay the same as there is deficiency of service on part of opposite party No.3 in not paying the said amount . As there is no cause of action against to opposite party No.1 and No.2 case against opposite party No.1 and 2 is dismissed.
15. In the result, the complaint is allowed directing the opposite party No.3 to pay the insured amount of Rs.2,00,000/- to the complainant with 9 % interest per annum from the date of complaint i.e., 2.1.2007 till realization along with Rs.5,000/- as costs within a month of receipt of this order.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 11th day of July, 2007
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant :Nil For the opposite parties; Nil
List of exhibits marked for the complainant:-
Ex.A1. Attested Xerox of policy.
Ex.A2. Letter dated 16.7.2005 of Opposite party No.2 and addressed
To opposite party No.3 marked copy of complainant.
Ex.A3. Repudiation letter dated 23.9.2005.
List of exhibits marked for the opposite parties:
Ex.B1. Xerox copy of notarized memorandum of understanding
Between to opposite party No.2 and No.3 (No. in 18 pages,)
Sd/- Sd/-
MEMBER PRESIDENT
Copy to:-
1. Sri. S. Siva Rama Krishna Prasad, Advocate, Kurnool.
2. Sri. N. Narayana Reddy, Advocate, Kurnool.
3. Sri M. Azmathulla, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
