BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD.
FA.No.396/2009 AGAINST C.C.No.36/2007 DISTRICT FORUM-I, KRISHNA AT MACHILIPATNAM.
Between:
1. The Golden Multi Servies Club Ltd. of GTFS
Subhadra Arcade, Second floor
D.No.2-1-19, Bhanugudi Junction,
Kakinada.
2. The Golden Multi Services Club Ltd. of GTFS
Head Office, S.B.Mansion 16,
R.N.Mukherjee Road, Kolkata
Represented by its Manager. Appellants
Opp.parties 1 & 2
And
1. Vatapalli Venkata Ramana,
W/o.Bala Chandrudu, Hindu,
R/o.Gilikadindi
Machilipatnam. Respondent/ complainant
2. The National Insurance Company Ltd.
Rep. by its Divisional Manager,
Division-III, National Insurance Building,
Ground floor 8, India Exchange Place,
Kolkata-700 001.
3. The National Insurance Company Ltd.,
Rep. by its Divisional Manager, Eluru. Respondents/
Opp.parties 3 & 4
Counsel for the Appellant: Mr.S.Raj Kumar
Counsel for the Respondents:(Mr.G.Narasimha Rao-R1)
Mr.N.Mohan Krishna-R2 and R3
QUORUM: SMT.M.SHREESHA, MEMBER
&
SRI K.SATYANAND, MEMBER
.
TUESDAY, THE SIXTH DAY OF APRIL
TWO THOUSAND TEN
Oral order:(Per Smt.M.Shreesha, Hon’ble Member)
***
Aggrieved by the order in C.C.No.36/2007 on the file of District Forum-I, Krishna at Machilipatnam, opposite parties 1 and 2 preferred this appeal.
The brief facts as set out in the complaint are that the complainant’s husband, a fisherman, took Janata National Accident Insurance Policy bearing No.100300/47/01/9600022/03/96/30362 dated 23-1-2004 for a period of two years from 23-1-2004 to 22-1-2006 by paying the requisite premium. The complainant submitted as per the terms and conditions of the policy, in case of untoward incident, the opposite parties agreed to pay Rs.2,00,000/- to the nominee. While her husband was doing his community of fishing operations in Gilakaladindi water, he died on the intervening night of 28/29-5-2006 due to drowning. Immediately the complainant informed the death of her husband to opposite party No.1 and requested to arrange payment. Opposite party No.2 directed the complainant to submit certain documents like death certificate translated into English in Police report, charge sheet certificate copy, attested Xerox copy of voter’s, identity card and ration card of the decease and the complainant and certificate of proof of income of the deceased. The complainant submitted that she submitted those documents to opposite party No.1 which were acknowledged by letter dated 3-9-2005 but the opposite parties did not settle the claim. The complainant addressed a letter dated 25-9-2006 but there was no response and the opposite parties failed to settle the claim. Opposite party No.4 addressed a letter to the complainant seeking certain documents some of which were already submitted to opposite party No.1 but however the complainant submitted those documents to opposite party no.3 and thereafter also they failed to settle the claim. Hence the complainant approached the District Forum for a direction to the opposite parties to pay the police claim amount of Rs.2,00,000/- together with interest at 24% per annum from the date of death of the complainant’s husband till realization together with compensation of Rs.1,00,000/- and costs of Rs.5,000/-.
Opposite party No.1 filed counter which was adopted by opposite party No.2 admitted that after the death of her husband, the complainant sent a claim to opposite party No.2 through opposite party No.1. They denied allegations that the complainant submitted all the required documents and that they have not settled the claim. They submitted that he is not aware of the correspondence between opposite parties 3 and 4 and the complainant. They submitted that the policy was issued by National Insurance Company Limited i.e. opposite parties 3 and 4 in favour of it covering the Members i.e. the deceased who was a Member for the period from 23-1-2004 to 23-1-2006 for the sum assured of Rs.2,00,000/- and as per the Memorandum of Understanding among opposite parties 3 and 4 and opposite parties 1 and 2, they have extended the insurance coverage to its members under the said group. Opposite party No.3 has exclusive right and authority to entertain the process and settlement of such claim. They further submit that they have no role to play in this regard so far as the settlement of insurance claim is concerned and hence the question of deficiency of service cannot be tagged on them. They further submitted that the complainant is not a consumer so far as opposite parties 1 and 2 are concerned and pay for dismissal of the complaint.
Opposite party No.3 remained exparte.
Opposite party No.4 filed counter and additional counter contending that the complainant is not entitled to claim the sum assured of Rs.2,00,000/- with interest against opposite parties 3 and 4. It submitted that as per policy condition No.3 the policy amount shall not carry interest. As per the terms and conditions in case of risk, the insured/nominee shall forthwith give notice to the company and also written notice to the company with full particulars and the complainant failed to comply with the policy conditions. Opposite party no.3 is precluded from appointment of investigator to inspect and obtain photographs to know whether the alleged death is natural, suspicious or accidental. Liability arises only in case of accidental death of insured and not in all cases and the complainant failed to submit correct certified copies of accident and therefore they were prevented to investigate and know whether the death is suicidal, natural or accidental or suspicious or under the influence of intoxicating liquor etc., It submitted that there is flagrant violation of policy terms and conditions by the complainant and denied that the required documents were submitted and the opinion in the post mortem certificate is contrary to other documentary proof for accidental death and prayed for dismissal of the complaint.
Based on the evidence adduced i.e. Exs.A1 to A13 and B1 to B8 and the pleadings put forward, the District Forum allowed the complaint directing opposite parties 1 to 4 to jointly and severally pay Rs.2,00,000/- the policy amount with interest at 9% p.a. from the date of death of the deceased i.e. 29-5-2005 till the date of payment together with costs of Rs.2,000/-
Aggrieved by the said order, opposite parties 1 and 2 preferred this appeal.
The facts not in dispute are that the complainant’s husband took Janata National Accident Insurance Policy and paid the requisite premium amount to opposite parties 1 and 2, who in turn took the policy from opposite party No.3. The sum assured is Rs.2,00,000/- which is payable to the nominee and the period of coverage is for two years from 23-1-2004 to 22-1-2006. On the intervening night of 28/29-5-2006 the complainant’s husband died due to drowning while conducting fishing operations. The complainant informed about the death to opposite parties 1 and 2, who in turn directed the complainant to submit certain documents like death certificate, charge sheet, Voter’s, identity card and ration card of the deceased and certificate of proof of income of the deceased etc., and all these documents were sent to opposite parties 1 and 2 who acknowledged receipt of the documents vide their letter dated 3-9-2005. It is the case of the complainant that there was no response from the opposite parties and the complainant once again received a letter from opposite party No.4 seeking certain documents and the same were once again sent on 29-3-2007 to opposite party no.4. A legal notice was also issued on 25-4-2007.
It is the case of the appellants/opposite parties 1 and 2 that the policy was issued by opposite parties 3 and 4 in their favour covering the members of the club and the complainant is the wife and nominee of the deceased member of their club and that they are only facilitators.
We observe from the record that opposite party No.3 was set exparte and opposite party No.4 filed a counter stating that there is no evidence to establish that death was accidental and that the opinion in the post mortem is contrary to other documentary proof of accidental death. Ex.A7 is the F.I.R. and Ex.A8 is post mortem certificate which show that the death is due to drowning. The post mortem certificate clearly states that the cause of death is asphyxia due to drowning. It is not in dispute that opposite parties 1 and 2 had collected the documents from the complainant and forwarded the same to opposite party No.3. Ex.B7 shows that opposite party No.2 had sent these documents to opposite party No.3. The ground for repudiation by opposite parties 3 and 4 is not deficiency in service on behalf of opposite parties 1 and 2 but opposite party No.4 states that their investigator did not have an opportunity to investigate into the matter and that cause of death was not established as an accidental one.
Taking into consideration the documentary evidence, we are of the opinion that opposite parties 1 and 2 herein are only facilitators and that they have done their role by forwarding claim papers to opposite parties 3 and 4, insurance company, and it is for the insurance company to settle the claim. Therefore, we do not find any deficiency of service on behalf of opposite parties 1 and 2 and hence we allow the appeal and the order of the District Forum is set aside with respect to the liability of appellants/opposite parties 1 and 2 is concerned and the rest of the order of the District Forum is confirmed with respect to the liability of opposite parties 3 and 4.
In the result this appeal is allowed and the order of the District Forum is set aside with respect to the liability of appellants/opposite parties 1 and 2 is concerned and the rest of the order of the District Forum is confirmed with respect to the liability of opposite parties 3 and 4. There shall be no order as to costs in this appeal.
Sd/-MEMBER.
Sd-MEMBER.
JM Dt.06-4-2010
