State Consumer Disputes Redressal Commission
United India Insurance Co. Ltd.,40/3, ... vs The Vysya Bank Ltd.,Bvhss Extension ... on 11 April, 2011
BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI BEFORE : Honble Thiru Justice M.THANIKACHALAM PRESIDENT Thiru J. JAYARAM, M.A.,M.L., MEMBER (JUDICIAL) Thiru S. SAMBANDAM MEMBER II F.A.NO.496/2008 (Against order in CC.NO.22/2003 on the file of the DCDRF, Salem) DATED THIS THE 11th DAY OF APRIL 2011 United India Insurance Co. Ltd., K.G. Road Branch 40/3, Geetha Mansion, III Floor State Bank of Mysore Bangalore- 500 009 Appellant/ 1st opposite party Vs. 1.
The Vysya Bank Ltd., BVHSS Extension Counter Salem-
636 007 Respondent/2nd Opposite party
2. Jessie W/o. Sathiyaseelan 23/2, Thiagi Veeraiya Street Mulluvadi, Salem-1 Respondent/ Complainant The 2nd Respondent as complainant filed a complaint before the District Forum against the opposite parties praying for the direction to the opposite parties to pay Rs.3 lakhs with interest, alongwith compensation,. The District Forum allowed the complaint.
Against the said order, this appeal is preferred praying to set aside the order of the District Forum dt.19.9.2007 in OP.No.22/2003.
This petition coming before us for hearing finally on 29.3.2011. Upon hearing the arguments of the counsels on both sides, perusing the documents, lower court records, and the order passed by the District Forum, this commission made the following order:
Counsel for the Appellant/ 1st opposite party : Mr.S. Arunkumar Counsel for the 1st Respondent/2nd Opposite party : M/s. K. Sukumaran Counsel for the 2nd Respondent/ Complainant : Mr. S. Kaithaimalai Kumaran M. THANIKACHALAM J, PRESIDENT
1. The opposite party is the appellant.
2. The facts leading to the appeal.
The 1st respondent/Complainants son, by name S. Marlan Brando had premium Savings Bank Account No.10808, with the 2nd opposite party/ bank, which had a tie up with the 1st opposite party/insurance company, for Group Accident Insurance Policy, wherein the sum assured was Rs.3 lakhs. The premium for the above said policy, for the complainants son was debited from the account, and the policy commences from 10.7.2000 and terminates on 9.7.2003.
3. The complainants son, who was working in a hotel at Yercaud, was bitten by snake on 14.3.2001, for which treatment was given immediately by Dr.S. Neelamegam, who advised to take Marlan Brando, to Salem, for further treatment. Unfortunately, on the way, he died, and thereafter he was buried as per the religious custom, available in Christianity.
4. Under the Group Insurance Policy, his Legal heirs are entitled to Rs.3 lakhs as compensation, and the complainant being the only legal heir / mother, entitled to the said amount. The complainant furnishing the necessary documents available, that could be furnished, lodged a claim, not settled unjustifiably, claiming documents, which are not available, thereby the opposite parties have committed negligent act, as well as deficiency in service, for which the complainant is entitled to compensation of Rs.1 lakh also, in addition to the sum assured under the policy. Hence the claim.
5. The 1st opposite party/ appellant, exhibiting their ignorance as if they do not know about the premium Savings Bank Account, resisted the claim and the complaint interalia contending, that the complainant violated the terms and conditions of the insurance policy, which are printed in the premium, savings bank account application form itself, that when a claim was lodged, belatedly, for necessary and proper adjudication, required documents were sought for (as detailed in para 7 of the written version), not submitted, and therefore the claim was closed as no claim which cannot be termed as deficiency in service, that as per the procedure for claim, within 90 days, from the date of the accident, claim should have been lodged, but in this case, it was informed through an advocate notice, only on 4.5.2002, though the alleged accident, said to have been taken place on 4.3.2001, and in this view, for the highly belated claim, this opposite party is not answerable, since they have not committed any deficiency, and the complaint is liable to be dismissed.
6. The 2nd opposite party, admitting that the deceased Marlan Brando, was having Premium Savings Bank Account, with them, and he was covered under the Group Insurance Accident policy, covering Rs.3 lakhs, for which one time premium was collected, opposed the claim, interalia contending that the claim has to be settled, only by the insurance company, and their duty is to facilitate the arrangement of insurance cover and otherwise there is no responsibility, that they have no role except to forward the claim, that in this case, since they have not committed any deficiency, not liable to answer the claim of the complaint.
7. The District Forum, by its order dt.19.9.2007, recorded a finding, that the 1st opposite party, insisting unnecessary documents, not available, refusing to settle the claim, had committed deficiency in service, whereas the 2nd opposite party did nothing against the complainant, or adverse to the complainant. In this view, a direction was issued against the 1st opposite party alone, to pay a sum of Rs.3 lakhs, being the sum assured, with interest thereon at 9% p.a., from the date of claim, alongwith compensation of Rs.25000/-, with cost of Rs.2000/-, which is impugned by the 1st opposite party.
8. The learned counsel for the appellant, urged before us, that as demanded by them, under Ex.A3, necessary documents were not produced, and therefore they were unable to settle the claim, which cannot be described as deficiency, as incorrectly concluded by the District Forum. A further submission was made, that the claim was not made within 90 days, or within the reasonable time, and therefore as per the terms and conditions of the policy, they are not liable to pay for the alleged death of the complainants son, which are opposed.
9. The appellant/ opposite party, though attempted to deny the Group Insurance, exhibiting ignorance that defense was not taken to the destination, and in fact we would say, Group Insurance is admitted, and that is why, when a claim was lodged, or notice was issued, documents were sought for, as seen from Ex.A3.
It is also an admitted fact, as pleaded by the 2nd opposite party, the complainants son had the Premium Savings Bank Account, with their bank, and the account holder viz. the complainants son was the member of the Group Insurance Scheme, for which premium was also deducted. The period is not in dispute. Thus taking it as an admitted fact, or atleast proved fact, we have to proceed, that the complainants son was covered under the Group Insurance Accident Claim, commencing from 10.7.00 to 9.7.03, for which premium was collected, as conceded by the 2nd opposite party, who had tie-up with the 1st opposite party. Unfortunately, the complainants son died on 14.3.2001, due to snake bite, which is not seriously under challenge, as seen from the written version of both the opposite parties, though the date of death was belatedly intimated to the 1st opposite party, on 4.5.2002. The belated claim lodged, in our considered opinion, may not disentitle the legal heir of the insured, from claiming the sum assured, unless the terms and conditions of the policy, say so, or claim is barred by limitation under the Act.
10. A model form, supplied by Vysya Bank Ltd., covering this kind of policy, is exhibited as Ex.B2. Under the heading procedure for claim it is said a) Intimation of accident giving rise to claims shall be given to UIICL and the Bank within 90 days from the date of accident by the claimant.
11. This is not a condition attached to validate or invalidate, the claim or the policy, whereas it is a procedure, prescribing, within how many days, a claim should be made, and within how many days claim should be settled, thereby prescribing directions, which cannot be the terms and conditions, to be followed as mandatory, whereas it should be construed as directly. If really, neither the insurance company, nor the bank, who collected the premium, had thought, that the sum assured was not claimed within the said time, under the heading procedure for claim of the policy, they should have stated failing to claim the amount, within the said period, the insurance company is not liable to pay the sum assured, which is not available in the policy. In the model premium pass book also, we find no such condition, as seen from Ex.B1.This being the position, the procedure prescribed, not followed, cannot have the effect of extinguishing the right accrued already, unless it is barred by limitation. The period prescribed is not the period of limitation, whereas the period prescribed is only for lodging, and settling the claim, and it has nothing to do with the final settlement. Therefore, in this case, taking advantage of the delay, caused by the illiterate ignorant lady, viz. the complainant, we feel the legitimate right of the complainant, should not be deprived of. Thus rejecting the above defense, viz.
the claim was not lodged within 90 days, now we have to see, whether the 1st opposite party had committed deficiency.
12. It is not the case of the complainant, that her son met with a road accident, for which a case was registered, followed by investigation, in which postmortem involved, etc. It is the specific case of the complainant, that his won, while working at Yercaud, met with an accident viz. snake bite, for which despite initial treatment given there, then taken to Salem, died on the way, then buried, according to the religious procedure. The above facts so pleaded, are not seriously disputed. Even in the written version also, we are unable to find any specific plea, such as the complainants son, did not die, due to snake bite, or this kind of death will not cover or come, under the Group Insurance Policy, which is the subject matter. Snake bite is not a crime, and no FIR can be lodged against snake. Therefore, without understanding the nature of death insistance of the FIR, and other connected documents by the insurance company, under Ex.A3, should be held as negligent act, and deficiency in service. When there was no crime, when there was no FIR, CrPC, will not come into operation, which should follow, there cannot be a police report also.
When postmortem was not admittedly conducted, and when the complainant has repeatedly said, she buried her son, we do not understand the logic of the insurance company, insisting postmortem certificate, as well as inquest report. If at all they should have insisted the certificate from the bank, confirming the continuation of the account, payment details etc., which was not very much in dispute, as seen from the version of the 2nd opposite party.
13. The 2nd opposite party, in the written version itself, has specifically stated that the deceased Marlan Brando, possessed a Savings bank Account, which had scheme arrangement of an accident, insurance policy of 1st opposite party, to cover accident claims, to a sum of Rs.3 lakhs, and they have also collected one time premium towards insurance charges, as seen from paragraph 5 & 8 of the written version. They have further stated, it is for the 1st opposite party to settle the claim. It is also not the case of the 2nd opposite party, that the deceased had discontinued the Savings Bank account, or it was not in force, at the time of death on 14.3.2001. Therefore, the 1st opposite party, when a claim was lodged, furnishing the necessary details, which could be possibly furnished by the legal heir of the deceased, serving the purpose of the Group Insurance Scheme, would have served properly, and they should not have evaded their responsibility, insisting to do certain impossible things, for which no documents were available admittedly. This being the position, since the claim was not settled, insisting the documents, which cannot be in existence, the act of the 1st opposite party should be construed, not only as negligent, but also deficiency in service, which was correctly appreciated by the District Forum, in which finding we are unable to see any error, either on law, or on facts.
14. True, there was a delay of 14 months, from the date of death, in claiming the amount.
The District Forum, taking into account, this delay has ordered interest, only from the date of claim, not from the date of death, which ordinarily the nominee is entitled to, if the nominee had acted swiftly, which she failed. Therefore, there cannot be any grievance, regarding the grant of interest also. When the District Forum, has granted interest, it may not be proper on its part, to award compensation also, since interest is granted to compensate the deficiency in service, taking the sum assured also, and in this view, the order of the District Forum, regarding compensation alone, should be upset, for that purpose alone, the appeal required to be allowed in part, otherwise confirming the order of the District Forum.
15. In the result, the appeal is allowed in part, modifying the order of the District Forum in COP No.22/2003, dt.19.9.2007, setting aside the order of compensation alone, otherwise confirming the order of the District Forum.
There will be no order as to cost in this appeal.
S.SAMBANDAM J. JAYARAM M. THANIKACHALAM MEMBER II JUDICIALMEMBER I PRESIDENT INDEX : YES / NO Rsh/d/mtj/Bench-1/Insurance