ESTARAKULA RAMAVVA vs Oriental Insurance Company Ltd

AGGRIEVED by the order in C. D. No. 328/2002 on the file of District Forum, Nizamabad complainant preferred this appeal under Section 15 of the Consumer Protection Act.

THE brief facts as set out in the case are that the complainant''s husband died due to snake bite at 10. 00 a. m. on 29. 4. 2000 while shifting him to the hospital. The complainant''s husband was a member of opposite party No. 2 Society who had taken Group Janatha Personal Accident Policy of opposite party No. 1. Immediately after the death of complainant''s husband she informed opposite party No. 1 about the accidental death of her husband due to snake bite through opposite party No. 2 and sought for payment of insurance amount of Rs. 1,00,000. But opposite party No. 1 repudiated the claim vide letter dated 10. 5. 2000 addressed to opposite party No. 2 stating that the list of borrowers was not submitted and that the information furnished by opposite party No. 2 as to the death of the life assured was belated. Hence this complaint to direct opposite party No. 1 to pay insurance amount of Rs. 1,00,000 with interest @ 24% p. a. , from the date of claim till the date of realization and also to direct the opposite parties to pay Rs. 25,000 towards mental agony and Rs. 25,000 towards deficiency of service on their behalf. Opposite party No. 1 filed counter admitting that the Branch Office of opposite party No. 1 at Vijayawada issued a Group Janatha Personal Accident Policy to opposite party No. 3 through opposite party No. 2 for the Member loanees of opposite party No. 2 Society. Opposite No. 1 is liable to pay the claims in accordance with the terms and conditions of the policy. The period of insurance commences from 15. 4. 2000 to 14. 4. 2001. All those insured persons (borrowers) for whom the premium is paid later than 15. 4. 2000 shall be covered from the date of receipt of premium by an endorsement to the common expiry date of the group policy i. e. , 14. 4. 2001 only. In the instant case the premium has been paid by opposite party No. 3 on 8. 5. 2000 vide Challan No. 10489 covering 24 PACS to opposite party No. 1 and this opposite party issued a Memorandum dated 8. 5. 2000 forming part of policy as per which the effective period of insurance in the present case is 8. 5. 2000 to 14. 4. 2001. As the deceased Mr. Hanumanthu died on 24. 9. 2000 prior to commencement of policy no risk is covered under the policy. Therefore, no liability can be fastened on opposite party No. 1. Accordingly this opposite party repudiated the claim vide letter dated 25. 7. 2000 addressed to opposite party No. 2 and marked a copy to opposite party No. 3. There is no deficiency of service on behalf of opposite party No. 1 and the complainant is not entitled to any relief as prayed for. It is prayed to dismiss the complaint as the complaint is barred by limitation.

Opposite party No. 2 filed counter stating that an amount of Rs. 89,928 has been deposited towards insurance premium for 2498 members @ Rs. 36 each by way of credit advice into opposite party No. 3 Bank along with list of members. On receipt of death intimation a letter was addressed to opposite party No. 1 on 10. 5. 2000 to send the claim form. In spite of several letters opposite party No. 1 did not send the claim forms. There is no deficiency of service on their behalf.

IN spite of service of notice, opposite party No. 3 remained ex parte before the District Forum. Based on the evidence adduced i. e. , Exs. A1 to A6 and Exs. B1 to B4 and the pleadings put forward the District Forum dismissed the complaint.

AGGRIEVED by the said order complainant preferred this appeal. Learned Counsel for the appellant/complainant submitted that the District Forum ought to have seen that if any delay on the part of opposite party Nos. 2 and 3 in submitting the list of borrowers including the death of Hanumanthu despite receipt and payment of premium on 28. 4. 2000 issued by opposite party No. 1 is the sufficient evidence about the commencement of risk and the policy though the policy was issued subsequently putting the effective period from 8. 5. 2000 to 14. 4. 2001 simply because the premium has been paid by opposite party No. 3 on 8. 5. 2000 vide challan No. 10489 covering the members of 24 paccs to opposite party No. 1. Delay on the part of opposite party Nos. 2 and 3 does not preclude the right to claim the insurance amount when the date of death of the life assured is 29. 4. 2000 and issue of policy belatedly does not absolve the liability of opposite party No. 1. Learned Counsel further submitted that the District Forum ought to have seen that even as per counter of opposite party No. 1 the insurance commences from 15. 4. 2000 to 14. 4. 2001 and also those insured persons (borrowers) for whom the premium is paid later than 15. 4. 2000 shall be covered from the date of receipt of premium by an endorsement to the common expiry date of Group Policy i. e. , 14. 4. 2001. In the instant case the premium receipt is dated 28. 4. 2000 (Ex. A1), therefore, the policy is well covered and within the period of policy and the same is in force. The District Forum ought not to have dismissed the complaint on technicalities.

WE have gone through the material on record. The learned Counsel for the appellant/complainant argued that the list was not given by opposite party No. 1 to ascertain if the insured name is present in the list or not. Learned Counsel for the complainant further submitted that name was listed at Sl. No. 333 under A/c No. 381 which is present in the list of opposite party No. 2 Society. On 28. 4. 2000 itself the premium paid by the members was sent.

IT is an admitted fact that the life assured died of snake bite on 29. 4. 2000. We have perused para No. 6 of counter of opposite party No. 1 which states that "the period of insurance commences from 15. 4. 2000 to 14. 4. 2001. All those insured persons (borrowers) for whom the premium is paid later than 15. 4. 2000 shall be covered from the date of receipt of premium by an endorsement to the common expiry date of the group policy i. e. , 14. 4. 2001 only". Keeping in mind this clause as stated by the Insurance Company in their counter, we are of the considered opinion that the policy was in force and that the repudiation of claim by opposite party No. 1 is an act of deficiency of service. The accidental death by snake bite is not in dispute. The complainant filed Ex. A4 which is the Post Mortem Report and Ex. A5 which is the Final Report and Ex. A6 which is the death certificate, all of which state that the life assured died of snake bite. When the policy was in force and the death is not in dispute the act of opposite party No. 1 in repudiation the claim amounts to deficiency of service. Therefore, we set aside the order of the District Forum and allow this appeal directing opposite party No. 1 to pay insurance amount of Rs. 1,00,000 to the complainant with interest @ 9% p. a. , from the date of repudiation till the date of realization together with costs of Rs. 2,000. The case against opposite party Nos. 2 and 3 is dismissed.

In the result, the order of the District Forum is set aside and this appeal allowed directing opposite party No. 1 to pay insurance amount of Rs. 1,00,000 (Rupees one lakh only) to the complainant with interest @ 9% p. a. , from the date of repudiation till the date of realization together with costs of Rs. 2,000. Time for compliance six weeks. The case against opposite party Nos. 2 and 3 is dismissed. Appeal allowed.