DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-I, LUCKNOW
CASE No.19 of 2008
Smt. Uma Devi, aged about 50 yrs.,
W/o Late Sri Ghanshayam Kumar,
R/o 589 Kha/823, Ambedkarpuram,
Telibagh, Lucknow.
……Complainant
Versus
United India Insurance Co.,
Divisional Office, Sri Ram Tower,
33 Cantt. Road, Lucknow.
Through Regional Manager.
.......Opp. Party
Present:-
Sri Vijai Varma, President.
Smt. Anju Awasthy, Member.
JUDGMENT
This complaint is filed by the Complainant against the OP for payment of insured amount of Rs.5,00,000.00.
The case in brief of the Complainant is that on 19.06.2007 at about 5.30 am the Complainant’s husband Ghanshyam Kumar was going for a morning walk as per normal practice and when he reached near Goyal Sweet House, Telibagh, Lucknow, a motorcycle which was coming from behind, hit him from back side which resulted in severe head injuries. Mr. Mithilesh Kumar insured’s neighbour who was also taking morning walk, immediately informed about the incident at the insured’s residence. Insured’s family member came on the spot and took the insured to the Janta Clinic, Telibagh, but the doctors refused to admit the insured, hence insured was got admitted at Mayo Hospital, Gomti Nagar, Lucknow on the same day and got treatment under Dr. Sunil Agarwal but insured could not recover and ultimately died at Mayo Hospital on 22.06.2007 at 8.30 pm. The Complainant’s husband was insured by HAL Chief Resident
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Inspector with the OP under Group Janta Personal accident insurance policy and Rs.1,290.00 was paid as one time premium. The policy No.002305/47/11/61/0007/98 was w.e.f. 05.06.1996 to 04.06.2008 for a sum assured of Rs.5,00,000.00. The Complainant is the nominee in the aforesaid policy, hence she is entitled to the amount of the claim. The Complainant sent all the documents with her application for the payment of personal insurance but the payment was not made to the Complainant. A letter dated 04.07.2007 was sent by Chief Resident of HAL to the OP for payment of insured amount in response to which OP informed about their further action on 14.09.2007. The Complainant continuously sent applications to the OP for payment of claim but all in vain. The OP orally asked the Complainant if she would give written acceptance of Rs.1,00,000.00 then the OP were ready to pay this amount. The aforesaid act of OP is deficiency in service, hence this complaint.
The OP has filed the WS in the form of affidavit of Sri V.K. Saxena, Divisional Manager, United India Insurance Co. wherein the accident and the consequential death of the Complainant’s husband is admitted. It is also admitted that the JPA Policy No.082303/47/11/61/0008/98 was issued covering the risk of Rs.5,00,000.00 for the period 05.06.1998 to 04.06.2008. But it is further submitted that the answering OP informed the President of HAL Officers Association, Lucknow vide letter dated 20.07.2006 regarding policy No.0823347610071980 07.09.2008 to 04.06.2008 and cancellation of group JPA policies where CSI was more than Rs.1,00,000.00 referring their previous letters addressed to them in which it was stated that all the policies having capital sum insured over Rs.1,00,000.00 are to be cancelled and CSI is to be reduced to Rs.1,00,000.00 only it was again requested to inform all the members that CSI has been reduced to Rs.1,00,000.00 only and asked the members to collect refund
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premium. When nothing was received in response to previous letters the answering OP sent another reminder vide registered letter dated 12.08.2007 referring their previous letters once again and lastly said that all group JPA policies where CSI is over Rs.1,00,000.00 shall be treated as Rs.1,00,000.00 only and since the members did not approach the company for refund of premium, hence they felt it necessary to inform them that should any mishap occurs with their members insured with the company, then their benefit is limited upto Rs.1,00,000.00 only. After getting the matter investigated and obtaining the relevant document etc. the competent authority has been pleased to approve the claim of the insured on 07.02.2008 and answering OP informed the HAL Officers Association vide their registered letter dated 12.02.2008 and requested the document at an early date which was enclosed thereto to return the enclosed voucher of Rs.1,00,000.00 duly discharged in duplicate in full and final settlement of the claim. The Complainant is only entitled to get Rs.1,00,000.00 and she is not entitled to the relief sought for from the answering OP. There is no delay or deficiency of service on the part of the insurance Co. The Complainant has failed to provide the discharge voucher which was sent vide letter dated 12.02.2008. The complaint deserves to be dismissed with exemplary costs.
The Complainant has filed her affidavit and an affidavit of Sri Sandeep Kumar Srivastava and Sri Manish Kumar and 5 annexures with the complaint. The OP has filed the affidavit of Sri Santosh Kumar, Divisional Manager, United India Insurance Co with 4 annexures. Both the parties have filed their written arguments.
Heard Counsel for the Complainant but none appeared to argue the case from the side of the OP. Perused the entire record.
It is not disputed that the Complainant’s husband had
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taken a group janta insurance policy from the OP which was valid from 05.06.1996 to 04.06.2008 and the insured amount was Rs.5.00 lakhs. It is also not disputed that the Complainant’s husband died in an accident and the Complainant pressed claim with the OP and that the OP approved the claim of the Complainant for a sum of Rs.1.00 lakh. The disputed point according to the Complainant is that the OP offered them Rs.1.00 lakh, though the insured amount of the policy was Rs.5.00 lakh and therefore they committed deficiency in service, whereas according to the OP the insured amount of Rs.5.00 lakh was reduced to Rs.1.00 lakh and the fact was also duly informed to the Complainant through the HAL Officers Association. It is also a disputed point as to whether the information given to the HAL Officers Association about reduction of the amount of Rs.5.00 lakhs to Rs.1.00 lakh was proper information to the Complainant’s husband or not and its consequences.
It is argued by the learned Counsel for the OP that the OP had the authority to cancel this policy and that the Company shall in that case return to the insured the last premium paid less appropriate part thereof for the portions of the current insurance period which shall have expired. The OP has taken the plea that the insured amount of Rs.5.00 lakhs was reduced to Rs.1.00 lakh with regard to the aforesaid policy and therefore the OP offered to pay only Rs.1.00 lakh to the Complainant. In this regard, it is argued by the learned Counsel for the OP that there was no information given to the Complainant’s husband regarding the reduction of amount of Rs.5.00 lakhs to Rs.1.00 lakh and therefore the OP had no authority to reduce the amount of Rs.5.00 lakhs to Rs.1.00 lakh. The OP has filed the copy of the information sent to the HAL Officers Association as is evident from annexure 5 filed with the affidavit of Sri Santosh Kumar of the OP. In this letter it is clearly mentioned that all the group JPA policies where
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CSI is more than Rs.1.00 lakh has been reduced to Rs.1.00 lakh only and hence the intimation is given to inform all the members that the CSI has been reduced to Rs.1.00 lakh and asked the members to collect the refund premium. In view of this letter it is argued by the learned Counsel for the OP that there was due information to the Complainant’s husband regarding the reduction of amount from Rs.5.00 lakh to Rs.1.00 lakh. In this regard, it is argued by the learned Counsel for the Complainant that the letter was addressed to the HAL Officers Association whereas the Complainant’s husband was not the official of the HAL but of DGAQA and since the Complainant’s husband was not the member of the HAL officers and was only serving within the campus of the HAL, therefore there was no proper intimation to the Complainant’s husband regarding the change in the policy. It is clear from the policy as well as other documents that the Complainant was not an employee of HAL but he was serving in HAL as an employee of DGAQA but from the policy document it is clear that “the policy/certificate will be issued in the name of the individuals through HAOA Lucknow C/o HAL Lucknow.” From this sentence of the policy, it is clear that the Complainant’s husband Sri Ghanshyam Kumar was given an insurance policy of group janta personal accident insurance policy from the OP but the policy, certificate was to be issued in his name through HAOA Lucknow and this HAOA stands for Hindustan Aeronautics Officers Association. Therefore, there is no doubt that the policy was to be issued through HAOA i.e. HAL Officers Association. Therefore from the information given to the President of the HAL Officers Association vide letter dated 20.07.2006 it is clear that the information is given to all group janta policy individuals regarding policies having a capital sum insured over Rs.1.00 lakh being reduced to Rs.1.00 lakh only, meaning thereby the sum assured of the policy of the Complainant was also
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reduced from Rs.5.00 lakh to Rs.1.00 lakh and since the policy certificate was to be issued through the HAOA only, therefore the information was given to the President of HAL Officers Association was valid information sent regarding the cancellation of the policy and reduction of the amount from Rs.5.00 lakh to Rs.1.00 lakh. Therefore, it cannot be said that the Complainant’s husband was not informed regarding the reduction of the amount from Rs.5.00 lakh to Rs.1.00 lakh. Now only this question remains as to whether the OP had the authority to cancel the policy or reduced the amount which as per the conditions mentioned in the policy it is clear that the OP did have the power to reduce the amount or cancel the policy but only thing is required to inform this fact to the insured which appears to have been done in the instant case. From the discussions made above it is clear that the OP had reduced the amount of Rs.5.00 lakhs to Rs.1.00 lakh with regard to the policy in question and therefore they offered this amount to the Complainant which was not accepted by the Complainant, hence there does not appear to be any deficiency in service committed by the OP. The complaint therefore, is liable to be dismissed. The Complainant is entitled to only Rs.1.00 lakh which she can claim from the OP by fulfilling the formalities required for the purpose.
ORDER
The complaint is dismissed.
The parties to bear their own costs.
(Anju Awasthi) (Vijai Varma)
Member President
Dated: 26 November, 2015
