State Consumer Disputes Redressal Commission
National Insurance Co.Ltd., vs 1. Vanama Laxmi And Others on 30 September, 2013
BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION: AT HYDERABAD. F.A.No. 139 OF 2013 AGAINST C.C.NO.9 OF 2011 DISTRICT CONSUMER FORUM NALGONDA Between National Insurance Co.Ltd., Divisional Manager (DO IV) 43, Jeevan Bhavan, Hararathganj Lucknow, UP-001 Appellants/opposite party no.2 A N D 1. Vanama Laxmi W/o alte Srinivas aged 48 yrs, Occ:Household 2. Vanama Sridevi W/o Satyanarayana aged 33 years, occ: Teacher 3. Vanama Praveen W/o late Srinivas aged 31 years, Occ: Business 4. Vanama Naveen Kumar W/o late Srinivas aged 29 years, Occ: Business All are R/o H.No.8-63, Naveen Dresses, Main Road Chityal Village and Mandal, Nalgonda Dist. Respondents/complainants 5. The Sahara India Commercial Corporation Ltd., by its Branch Manager, 1st Floor Sri Laxmi Complex Near Clock Tower Nalgonda Town and Dist. Respondent/opposite party no.1 F.A.No. 140 OF 2013 AGAINST C.C.NO.10 OF 2011 Between National Insurance Co.Ltd., Divisional Manager (DO IV) 43, Jeevan Bhavan, Hararathganj Lucknow, UP-001 Appellants/opposite party no.2 A N D 1. Vanama Laxmi W/o late Srinivas aged 48 yrs, Occ: Household 2. Vanama Sridevi W/o Satyanarayana aged 33 years, occ: Teacher 3. Vanama Praveen W/o alte Srinivas aged 31 years, Occ: Business 4. Vanama Naveen Kumar W/o late Srinivas aged 29 years, Occ:Business All are R/o H.No.8-63, Naveen Dresses, Main Road Chityal Village and Mandal, Nalgonda Dist. Respondents/complainants 5. The Sahara India Commercial Corporation Ltd., by its Branch Manager, 1st Floor Sri Laxmi Complex Near Clock Tower Nalgonda Town and Dist. Respondent/opposite party no.1 Counsel for the Appellants M/s M.Ramgopal Reddy Counsel for the Respondent M/s Vakkanti Narasimha Rao(R1toR4) Smt K.Kalpana (R5) QUORUM: SRI R.LAKSHMINARASIMHA RAO, HONBLE MEMBER
AND SRI THOTA ASHOK KUMAR, HONBLE MEMBER MONDAY THE THIRTIETH DAY OF SEPTEMBER TWO THOUSAND THIRTEEN Oral Order (As per Sri R.Lakshminarasimha Rao, Honble Member) ***
1. Both appeals are the off-shoot of two complaints filed by the complainants which involve common question of facts and law. As such they are disposed of by common order. F.A.No.139 of 2013 is taken as lead case.
2. The husband of the first respondent and father of the respondents no.2 to 4 deposited a sum of Rs.1,00,000/- with the respondent no.5 company on 2.1.2006 under Sahara Swarna Yojana in two installments, `10,000/- on 2.1.2006 and `90,000/-
on 31.5.2006 and he appointed the respondent no.1 as his nominee. The sum assured under the insurance policy is `5 lakhs. The appellant insurance company issued the personal accident insurance policy to the members of the respondent no.5 company including the husband of the respondent no.1 by virtue of an agreement with the respondent no.5.
3. The husband of the respondent no.1 met with a road accident and died on 23.11.2010. A case in Cr.No.268 of 2010 was registered by police Choutuppal for offence under 304A and 338 IPC. The respondents no.1 to 4 submitted claim on 27.8.2011 on the premise that they came to know about the subsistence of the Janata Personal Accident Policy obtained by the respondent no.5 covering the risk as to accident on the deceased husband of the respondent no.1. The respondents no.1 to 4 challenged reasonableness of repudiation of their claim by the appellant-insurance company.
4. The respondent no.5 resisted the claim on the premise that the deceased husband of the first respondent did not pay any extra amount towards premium of the insurance policy. It is contended that the respondent no.5 paid a sum of `4,15,36,631/- to the appellant insurance company to cover the risk of its employees, depositors, shareholders etc., including the husband of the respondent no.1. The husband of the respondent no.1 did not pay any amount towards premium and the respondents no.2 to 4 are not consumers. It is contended that the District Forum has no jurisdiction in view of arbitration clause incorporated in the insurance policy and that the respondents no.2 to 4 have not submitted claim within the stipulated period of 30 days from the date of death of the husband of the respondent no.1. It is contended that the husband of the first respondent opened two accounts and the respondents no.1 to 4 filed both the complaints in respect of the same cause of action i.e., the death of first respondents husband and as such the respondents no.1 to 4 being legal heirs of the deceased insured Srinivas are entitled to single insurance benefit and not for both claims. It is submitted that the respondent no.5 is a service provider insofar as the insurance claim is concerned and it is not liable to pay any amount to the respondents no.1 to 4. Further, the respondent no.5 submitted that it is ready to pay the amount relating to the accounts maintained by the deceased husband of the respondent no.1 and the respondents no.1 to 4 refusing to receive the amount, filed the complaint.
5. The appellant filed written version denying the husband of the respondent opening the accounts with the respondent no.5 and his death in an accident as also the relationship of the respondent no.1 to 4 with the deceased Srinivas. It is contended that the claim was not submitted within the stipulated period of 30 days from the date of death of incident and that the claim was lodged with a delay of 8 months and that the repudiation of claim was just and proper and prayed for dismissal of the complaint.
6. The respondent no.1 on behalf of the respondents no.2 to 4 filed her affidavit and the documents, Exs.A1 to A9. the Divisional Manager of the opposite party no.2 filed his affidavit and the documents, Exs.B1 to B12. The respondent no.5 got marked Ex.B13, attested copy of Group Personal Accident Policy issued by the appellant insurance company.
7. The District forum allowed the complaint and directed the opposite party no.2 to deposit before the Forum an amount of `5 lakhs with interest @ 9% per annum together with compensation of `5,000/- and costs of `2,000/-.
8. Feeling aggrieved by the order of the District Forum, the opposite partyno.2 filed appeals F.A.No.139 and 140 of 2013 contending that the respondent no.1 is not entitled for any benefit under the policies without there being any claim intimation to the appellant within the stipulated time that the claim intimation was received on 27.8.2011 after 9 months of the date of accident and that as per condition no.1 of the policy the death intimation is mandatory within 30 days from the date of accident and extended for 15 days for submission of claim papers is mandatory.
9. The counsels for the appellant and the respondent no.5 filed written submissions.
10. The point for consideration is whether the order of the District Forum suffers from misappreciation of facts or law?
11. The facts which are admitted and which do not require discussion are that the first respondents husband during his life time invested a sum of `1,00,000/- in two installments, a sum of `10,000/-
on 2.1.2006 and an amount of `90,000/-
on 31.05.2006 with the fifth respondent-company under Sahara Swarna Yojna. There is no dispute of the fact that the husband of the first respondent died on 23.11.2010. The appellant questioned the entitlement of the respondents no.1 to 4 to the sum assured on the premise that the claim intimation was delayed for 9 months, the death of the insured is not occurred due to an accident and double accident benefit is not applicable to the case of the respondents no.1 to 4.
12. The death of the insured in the motor vehicle accident that occurred on 23.11.2010 by the FIR, Inquest Report, Post-mortem Report and the Charge Sheet filed by the Police, Choutuppal. The deceased was proceeding on 23.11.2010 when he was proceeding in car bearing registration number AP 15 AG 3444 driven by S.Parashuramulu and when the car reached Toopranpet village of Mylram Mandal, the car dashed stationed lorry bearing number AP 20 TA 2799 as a result of which the driver of the car and he sustained injuries and died at the spot. The appellant had not rebutted the evidence as regards to the fact that the deceased died of injuries sustained in the accident. Thus, this Commission does hold that the contention of the appellant and the respondent no.5 that the deceased did not meet with accident and his death is not an accidental death does not hold water and is not sustainable.
13. The learned counsel for the appellant and the respondent no.5 have contended that the respondent no.1 to 4 had not submitted the claim within the prescribed period of one month and the delay of about ten months in claim intimation would amount to violation of terms of the insurance policy. The learned counsel for the appellant has relied upon the following decisions.
i) Delhi Assam Roadways Corporation Ltd vs United India Insurance Company Ltd in R.P.No. 3228 of 2012 decided on 03.-9. 2013.
ii) Ankit Goyaol vs The New India Assurance Company Ltd 2012 NCJ 97(NC).
iii) United India Insurance Company Ltd vs M/s Sona Spices Ltd. 2010 NCJ 896(NC).
14. In Delhi Assam Roadways Corporation Ltd (supra), the insurance company repudiated the claim on the premise that the insured vehicle was overloaded when it met with accident. The District Forum held the repudiation of the claim justified. The State Commission dismissed the appeal filed by the complainant and the Honble National Commission dismissed the revision holding that ratio laid in Amalendu Sahoo vs Oriental Insurance Company Ltd 2010(20 RCR(civil) 635 is not applicable as the overload was 80% more than permitted capacity of the vehicle. The facts of the case and the instant case are different. The decision is not applicable to the case on hand.
15. Ankit Goel(supra) is a case where the claim was repudiated on the ground that the driver of the insured vehicle which met with accident was authorized to drive LMV non-transport whereas the insured vehicle was a transport vehicle. The National Commission held that the driver of a Light Motor Transport Vehicle is required to possess distinct driving licence and not the driving licence to drive LMV non-transport. The facts of the case and the facts of the instant case are not similar and the decision has no application to the facts of the present case.
16. In Sona Spices Pvt Ltd , the complainant-company submitted claim on the premise that its insured stock was damaged and the loss was covered by two insurance policies issued by New India Assurance Company Ltd and United India Insurance Company Ltd which had appointed a joint surveyor, M/s Duggal Gupta & Associates. The surveyor assessed the loos and apportioned liability between New India Assurance Company Ltd and United India Insurance Company Ltd.
17. Being dissatisfied with the assessment of the loss to the insured stock made by the surveyor, the United India Insurance Company Ltd appointed another surveyor who opined that the claim and assessment of the loss by the earlier surveyor was exaggerated and basing on the report of the second surveyor, the United India Insurance Company Ltd repudiated the claim against which the complainant filed complaint which was allowed by the State Commission which awarded the amount as assessed by the first surveyor and was confirmed by the National Commission and the matter was carried to the Honble Supreme Court which remanded back the matter to the National Commission for non-consideration of the report submitted by the second surveyor.
18. On being remitted back, the matter was considered afresh by the National Commission which had considered both the surveyors reports and modified the order of the District Forum. Before the National Commission, the Insurance Compnay had placed reliance on the decisions of the Supreme Court in Baurao Dagdu Parker vs State of Maharashtra and others 2005 (7) SCC 605 and Oriental Insurance Company Ltd vs Sanarnallur Primary Agricultural Co-operative Bank 1999(8) SCC 543. In Bauraos decision the effect of fraud on a contract was considered and in Sanarnallur Primary Agricultural Co-operative Bank(supra), the importance of and interpretation of terms of insurance contract was considered. The National Commission observed;
Reliance was also placed upon another decision of the Supreme Court in the case of Oriental Insurnace Co. Ltd. vs. Samayanallur Primary Agricultural Coop. Bank 1999 (8) SCC 543 wherein the Supreme Court examined the question in regard to the strict nature of the terms and conditions of an insurance policy and by doing so, the State Commission held that the terms and conditions of the insurance policy has to be construed with reference only to the stipulation contained in it and no artificial meaning can be given to the words appearing in it. There cannot be possibly any quarrel with the proposition of law laid down in the above said authorities and going by the very strictly interpretation of the provisions of clause 8 of the terms and conditions of the policy, perhaps it can be said that a claimant forfeits his right of any claim under the policy, once it is found to be based on fraudulent or false declaration or fraudulent means. The question is as to how far the said legal position help the appellant-insurance company in the present case. In our view, none of these authorities to lay down that even in case where the claimant insured raised an inflated claim, which he has not been able to substantiate or which in the opinion of the insurer is exaggerated or based on some doubtful material like bills etc., in that situation, the insured should be non-suited altogether even qua the part of the claim which the company has itself found to be genuine or beyond suspicion..
19. The learned counsel for the appellant has relied upon the aforementioned decision to stress on the necessity of compliance of the terms of the insurance policy by the insured. He has also placed reliance on the decision of this Commission in The Branch Manager, Sahara India and another vs Danthaluri Gayatri Devi in F.A.No. 499 of 2011 and F.A.No. 199 of 2012 decided on 16.10.2012. In that case, the husband of the complainant deposited a sum of Rs.2,00,000/- with the respondent no.5-company herein which provided insurance coverage to its depositors by the National Insurance Company Ltd and the complainant submitted claim after 12 months of death of her husband who died in a road accident and the respondent no.5-company paid the death maturity benefit to the complainant while the Insurance Company repudiated the claim on the premise that the claim insurance was not made within the stipulated period of 30 days.
20. The National Insurance Company Ltd has relied upon the decisions, Ankit Goel(supra) and Sonal Spices Pvt Ltd(supra) and M/s Aerolex India Pvt Ltd vs New India Assurance Company Pvt Ltd 2012 NCJ 512. . This Commission allowed the appeal of the respondent no.5-company herein on the premise that M/s Sahara India Pvt Ltd proved that the copy of insurance policy was given to the depositor and as such the complainant was held to have knowledge of terms and conditions of the insurance policy.
21. There is no quarrel with the proposition that the terms of the insurance policy have to be given the meaning intended to be given and compliance of the conditions mentioned in the insurance policy have to made by the insured. In the instant case, the consistent version of the respondent no.1 to 4 is that the insured was not furnished with copy of the insurance policy and they had no knowledge of existence of the insurance policy and as such they could not submit the claim within the prescribed period of one month from the date of death of the husband of the respondent no.1. The respondent no.5-company has not pleaded nor proved that the copy of the insurance policy was handed over to the husband of the respondent no.1.
22. Even if it presumed that the deceased depositor was given copy of the insurance policy, the special terms of the insurance policy providing for extension of time for submitting the claim for a period of one year from the date of death of the insured can be pressed into service by the respondent no.1 to 4 which wipe away the effect of non-compliance of submission of claim within one month from the date of death of the insured. The only requirement for application of the special terms of the insurance policy is that the delay in submission of the claim should not cause prejudice to the appellant as to assessment of loss by the surveyor. In the instant case , the appellant has not shown any circumstances that would cause prejudice to it in being deprived of the opportunity for appointment of surveyor for the purpose of assessment of loss as there was loss of life of the insured and there was no any suspicion over his death as a result of the injuries sustained in the accident. As such repudiation of the claim is held bad. The appeal is liable to be dismissed.
F.A.No. 140 of 2013
23. The District Forum awarded the sum of Rs.5,00,000/- on the premise that the husband of the respondent no.1 deposited a sum of Rs.1,00,000/- each under two different accounts and the respondent no.5-company obtained group personal accident insurance policy from the appellant covering the accident risk on the life of its depositors and as such the respondent no.1 to 4 are held entitled to the sum assured of Rs.5,00,000/- under each account held by the first respondents husband with the respondent no.5-company.
24. The District Forum observed that the plea of the respondent no.5 that single accident benefit for the multiple accounts held by the depositor is not taken by the appellant and the District Forum held that the decision of the Chattisgarh State Commission in Branch Manager, Sahara India Parivar Vs Deepika Thakur is not applicable to the facts of the case on the premise that the first respondents husband did not choose the same option for the two accounts opened under Sahara Swarna Yojana Scheme with the respondent no.5-company.
25. As per Clause 2A of the insurance policy, the liability of the appellant-insurance company is restricted to be payable under single account of a deposit and the clause reads as under:
2. Esteemed depositors/Investors/Advance Booking Holders for Housing and various services of Sahara India Pariwar A. Depositors under various schems of Sahara India Pariwar The Sum Insured for depositors wold be as per their deposit amount in various schemes. A maximum of Five deposits of highest denomination under any one scheme would be considered. If the deposits are in more than one scheme then the maximum amount payable under any one scheme only will be considered (Maximum five deposits) Maximum Sum Insured of a deposit will be Rs.3,00,000/- only) The details of various schemes covered under the policy along with Sum Insured as per deposit amount are (mentioned in policy).
Depositors under Silver Year Labh Yojna Sahara Swarn Youjna and Sahara Rajat Yojna under Housing Scheme Where the deposits are in more than one scheme, the scheme under which the deposit is maximum would be considered.
If the deposit amount is Rs.70,000/- and above, the Sum Insured will be Rs.5,00,000/- (Rs.Five Lac only) and if the deposit amount is upto Rs.69,900/- the sum Insured will be Rs.2,00,000/- (Rs.Two Lac only).
26. Thus, the District Forum ought not to have awarded the relief of sum assured under two deposit accounts. The respondent no.1 to 4 are entitled to the sum assured under a single deposit account held by the first respondents husband with the respondent no.5-company and for not under two accounts held by him. The District Forum dismissed the complaint against the respondent no.5-company. In conclusion it can be held that of the two appeals the appeal filed against the order in C.C.No.9 of 2012 is liable to be dismissed and the other appeal F.A.No.140 of 2013 as mentioned above deserves to be allowed.
27. In the result, the appeal F.A.No. 139 of 2013 is dismissed confirming the order of the District Forum and the appeal F.A.No.140 of 2013 is allowed setting aside the order of the District Forum. There shall be no separate order as to costs.
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