V.LAXMIKANTHA vs BRANCH MANAGER, M/S. ANDHRA BANK LIMITED

THIS appeal has been filed by Smt. V. Lakshmi Kantha aggrieved by the order of the District Forum, Khammam in O.P. No. 246/1997 dated 11.8.1999. The only point to be considered here is whether the District Forum was right in rejecting the claim of the complainant against the opposite parties i.e., Branch Manager, Andhra Bank Limited, Khammam and Senior Divisional Manager, Oriental Insurance Company Limited, Hyderabad. The case of the complainant before the District Forum was as follows : The complainant''s husband Sri Venkataramana Naidu was an account holder under ''Abhaya Savings Scheme'' bearing Account No. 52670 with opposite party No. 1. He died in a road accident on 6.1.1996. The complainant was not aware that an account holder of ''Abhaya Savings Scheme'' of opposite party No. 1 was insured under Group Personal Accident Insurance Scheme of opposite party No. 2. On 15.4.1997 she approached the opposite party No. 1 for withdrawing the amount of Rs. 1,000/- in the account of her husband and learnt that the account also gave insurance coverage in case of accident to the account holder and for that opposite party No. 2 had to be approached. On the same day appellant/complainant sent a claim application to opposite party No. 1 and again on 5.5.1997 and requested it to send the claim forms to opposite party No. 2. On 4.6.1997 opposite party No. 2 informed opposite party No. 1 as follows : "You are aware as per the policy agreement intimation of accidents giving raise to claims should be given to us within 90 days from the date of accident. Claim intimations given beyond the stipulated time cannot be considered for settlement. We are closing the claim as No Claim and no further correspondence will be entertained in this regard."

IMMEDIATELY after receiving the above intimation from the opposite party No. 1, the complainant got issued a legal notice to opposite parties demanding Rs. 25,000/- as insurance claim after duly explaining the delay, that she was not aware of the conditions of the policy agreement and that there was no stipulation that the claim intimation had to be made within 90 days from the date of accident and that the pass book did not show such a clause and condition and that, therefore, the condition was self imposed by opposite party No. 2. As there was no reply from the opposite parties the complainant approached the District Forum for redressal on 6.8.1997. The complainant also filed xerox copy of the pass book bearing Account No. 52670 showing a balance of Rs. 1,066/-, FIR dated 6.1.1996 regarding the motor accident and death of her husband, letter dated 5.5.1997 written by opposite party No. 1 to opposite party No. 2 requesting for the claim forms, letter dated 29.5.1997 written by the complainant to opposite party No. 2 requesting opposite party No. 2 to settle the claim, letter dated 4.6.1997 sent by opposite party No. 2 to opposite party No. 1 rejecting the claim, legal notice dated 4.7.1997 issued by the complainant to opposite parties Nos. 1 and 2 and two postal acknowledgement slips. The complainant sought from the District Forum directions to opposite parties to award Rs. 25,000/- towards Group Personal Accident Insurance Scheme under Abhaya Savings Scheme alongwith interest at 24% per annum till the date of realisation and costs. Opposite party No. 1 submitted in its counter before the District Forum that there was no deficiency in service on its part and that they were not liable to pay Rs. 25,000/- as claimed by the complainant as the Group Personal Accident Insurance Coverage was by opposite party No. 2 and refused to accept the claim of the complainant against them. The claim was not accepted by opposite party No. 2 on the ground that it was made after the period of limitation of 90 days after the death of the account holder. Opposite party No. 1 also did not accept the reasons given by the complainant for delay in asking for the insurance claim.

Opposite party No. 2 however did not appear before the District Forum nor filed its version or the "Policy Agreement".

THE District Forum sympathised with the complainant but held that it was not inclined to direct the opposite parties 1 and 2 to accept the time barred claim and dismissed the complaint. The points to be considered are whether the appellant is entitled to the claim amount and if yes, how the appellant/complainant claimed Rs. 25,000/- under the Group Personal Accident Insurance Scheme when the pass book shows under Clause 29 as follows : "Depositors under the scheme are covered under the Group Personal Accident Insurance of Oriental Insurance Company to the extent of coverage as under : (a) Death due to accident Rs. 10,000/-."

Therefore, the complainant would be eligible only for Rs. 10,000/- under the scheme and not Rs. 25,000/- as claimed by her.

GOING through the record we find that the pass book did not mention anywhere that the claim had to be made within 90 days and that there was no clause stipulating 90 days for making the claim under Group Personal Accident Insurance Scheme mentioned in the pass book which she produced before the District Forum. Respondent No. 2 did not file the policy agreement showing the stipulation of 90 days nor did opposite party No. 1 produce any document in this regard. If there was such a stipulation it must be within the knowledge of opposite party No. 1 because they debited Rs. 12/- to opposite party No. 2 after opening the Abhaya Savings Scheme of the account holder. We find that there is clear deficiency of service on the part of opposite party No. 1 because they not being aware of the stipulated time, advised the complainant that she was entitled for Group Personal Accident Insurance Scheme on 15.4.1997 when she approached them for withdrawing the balance amount and not informing that it was time barred. The opposite party No. 2 also informed opposite party No. 1 that the claim was not acceptable but never bothered to inform the complainant nor did they appear in the Forum or file the rules under the policy. Assuming that there was such a stipulation, it was obligatory for opposite party No. 1 and opposite party No. 2 to see that it was printed in the pass book since that was the only document that was available with the appellant. When an insured person dies, the nominee or claimant under the policy has no means of knowing such conditions unless they are made known by printing in bold letters in the pass book or in the policy, if that was made available. In the present case, it was not stated by the respondents that a copy of the policy with its conditions were furnished to the insured so that the nominee or the claimants under the policy could know about such conditions after the insured died. We are also supported by the decision of the Supreme Court in Delhi Electric Supply Undertaking v. Basanti Devi & Anr. Opposite party No. 1 was an agent of opposite party No. 2 so far as Group Personal Accident Insurance Scheme was concerned, since the premia amount was debited from the account held with opposite party No. 1 and, therefore, opposite party No. 2 was responsible for any deficiency committed by opposite party No. 1 in not printing the said clause in the pass book or any other document furnished to the insured. On 25.11.1999 when we admitted the appeal we had noted that in the absence of any clause regarding the limitation printed on the pass book the claim could not be rejected and the benefit under the insurance scheme should not be denied as the appellant was not made aware of the procedural requirements by printing the condition in the pass book in bold letters. We further noted that the Counsel stated that he would examine the position and also indicate as to the compensation that should be awarded and we posted the matter to 28.1.2000. On 28.1.2000 the appeal was posted to 11.2.2000 for judgment and again adjourned to 28.3.2000 and it was reserved for judgment on 30.3.2000. Till 28.3.2000 the Counsel had not come forward with any such information. Therefore, we are of the view that Rs. 10,000/- should be paid to the appellant together with interest @ 12% per annum from 4.9.1997 two months after the legal notice till the date of payment. In the result, the appeal is partly allowed. The respondent No. 2 is directed to pay Rs. 10,000/- with interest @ 12% per annum from 4.9.1997 till the date of payment. The amount to be paid within 6 weeks from the date of this order. Appeal partly allowed.